Research Article

Probiotics and Prebiotics

  • Rehan Naqvi

*Corresponding Author: Rehan Naqvi. Department of Pharmacy- University of Karachi.

Citation: Rehan Naqvi. (2023), Probiotics and Prebiotics, J, Surgical Case Reports and Images 6(5); DOI:10.31579/2690-1897/162

Copyright: © 2023, Rehan Naqvi. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 25 July 2023 | Accepted: 05 August 2023 | Published: 16 August 2023

Keywords: intestinal problems; prebiotics; probiotics; symbiotic activity; ailment; purposeful food; intestinal microbiota

Abstract

Probiotics

In addition to the definition of useful ingredients, there may be a subset of meals that can be believed to be true for health, which is produced with the aid of or comprises dwelling microorganisms. We refer to these meals as probiotics. The oldest definition of probiotics is very slim and has been implemented, especially in animals. As bacterial metabolism has become more defined, greater research has pointed to the position that microorganisms play a role in human health and resistance to sickness, and there have been more microorganisms recognized that can be a part of probiotic merchandise. Therefore, there is a desire to increase the definition of probiotics has become apparent. The current WHO definition of probiotics includes the word administered word that routes of management, apart from oral, may be used as probiotics. It should be noted that discussions on probiotics are commonly confined to microorganisms, making use of and significance of years in probiotic foods has no longer acquired a lot of attention.

Criteria for Probiotics

As researchers and meal producers have begun to comprehend the capability for the inclusion of microorganisms in probiotic meals, numerous standards have been proposed for the screening of candidate microorganisms that could simultaneously satisfy the regulatory government and ensure client recognition (Table 17.2). The first three standards address the sensible aspects of choosing appropriate microorganisms for inclusion in probiotic foods, and the ultimate may be more vital in terms of patron acceptance and regulatory motion. The correct probiotic bacteria met all the criteria. But, the list Of microorganism that meets several criteria, especially those that have strong scientific proof of effectiveness and which have been incorporated into meals isn't lon [1].                                                                                                                                       

Introduction

State-of-the-art purchasers are seeking out products that incorporate stay bacteria. meantime, manufacturers are increasingly privy to the need to offer accurate information about the stages and types of bacteria of their merchandise [4]. Setting the minimal variety of feasible microorganisms in food to ensure probiotic effects is crucial. Fermented milk and the Dairy Bacteria association of Japan has set not less than 107 bifido micro organisms/g or Jr.eleven Others have suggested a lower level (105) [5,9] but, experimental proof in which exceptional tiers of the microorganism have been fed and viable counts have been counted after passing through the stomach might suggest that probiotic merchandise may additionally offer even higher (>10 [10] to 10 [11]) stages microorganisms to live on in the situations of the GI tract [12]. This conclusion is supported by in vitro exams finished on numerous ability probiotic microorganisms with the use of simulated digestive systems [13,14]. This is an extensive range of opinions that may truly replicate the differences within the potential of various bacteria that continue to exist in the gastric passage. Setting one level for all bacteria might not be viable, because the range of bacteria required to provide a selected metabolic exchange will depend on the impact to be achieved. The most effective bacteria survive passage through the stomach and may colonize the intestines to have any impact on the host. This was the maximum in reality, as reported by Pedrosa et al [15]. 

In wholesome-aged humans fed yogurt containing Lactobacillus bulgaricus and Streptococcus thermophilus, these organisms have not been found inside the intestinal contents after feeding, and there have been no changes in the three bacterial enzymes. when healthy individuals were fed a stay of Lb. gasseri (Lb.acidophilus strain MS 02), a human stress capable of adhering to intestinal cells, the organism turned detected in all topics, and β-glucuronidase, nitro reductase, and azoreductase sports were all greatly reduced. This highlights the need to measure the destiny of ingested microorganisms and their metabolic consequences to make a correct interpretation of results.                                                                                       

Diverse reports have blanketed lists of bacteria that can be taken into consideration by applicants for inclusion in probiotic products. The complete premise of useful foods is that the ingredients eaten incorporate active substances that can fight or prevent illnesses and infections. With backups in analytical strategies, new active materials are being identified every day. For probiotics, however, the identification of the active folder will not be so unambiguous, since there always exist a couple of choices. The active substance may be one or more dwelling microorganisms in food, a metabolite produced by using one of the microorganisms themselves, or a fermentation product formed by the action of microorganisms (s) on the authentic product. Depending on the probiotic in the query, each of the above arguments has been used to explain the beneficial outcomes of probiotics.

B. Probiotic products on the market

In Japan, there is an extended lifestyle of believing that fitness relies on meals, and that retaining a population of useful gut bacteria is vital for universal fitness. in 1981. The Japanese founded the Japan Bifidus basis to help bifidobacteria research, which may in part explain why fifty-three probiotic merchandise containing bifidobacteria have been sold in Japan by using 1993.11 Japan is often extolled for example of ways cooperation among industry and government fitness businesses can lead to a system of approving and labeling meals which might be top for fitness. The Meals for unique health purposes (FOSHU) system provides products to customers

with an outstanding logo, indicating that the product (or product components) was assessed as having good fitness. Eleven categories of practical additives qualify for FOSHU systems. Three of these categories, fiber, oligosaccharides, and lactic acid microorganisms, refer to gut function and management. Recent statistics display forty-three probiotics merchandise that have been granted FOSHU fame [16].

Reuter4 pointed out that, in both Germany and Switzerland, there is a powerful customer interest in probiotic merchandise. Lists 21 merchandise (made in seven European nations) on the market in Germany in 1997 in the form of yogurt or yogurt drink. Regulatory concerns have slowed the introduction of these products in North America. As of 2004, no probiotic products bought in North America have resulted in government-permitted health claims.

Table 

Possible probiotic microorganisms

Lactobacillus bacteria

Lb. acidophilus

Lb. acidophilus LC1

Lb. acidophilus NCFB 1748

Lb. plantarum

Lb. casei

Lb. casei Shirota

Lb. rhamnosus (GG strain)

Lb. brevis

Lb. delbrueckii subsp. bulgaricus

Lb. ferment

Lb. helveticus

Bifido bacterium bacteria

B. bifidum

B. longum

B. infantis

B. breve

B. adolescents

Other bacteria

Streptococcus salvarius subsp. thermophilus

Lactococcus lactis subsp. lactis

Lac. lactis subsp. cremoris

Enterococcus faecium

Leuconostoc mesenteroides subsp. dextranicum

Propionibacterium freudenreichii

Pediococcus acidilactici

Escherichia coli

Yeast

Saccharomyces boulardii

Note: The identification and classification of bacteria and yeasts vary as

More sophisticated methods were used in this study. The terminology used in this text

in the chapter is found in the cited references to avoid confusion.

Source: Lee, Y.-K. and Salminen, S., The coming of age of probiotics, Trends

Food Sci. Technol., 6: 241-244, 1995; Hui's isn't Veld, J.H.J. and Havenaar, R.,

Probiotics and human and animal health, J. Chem. Tech. Biotechnol., 51:

562–567, 1991; Hui's isn't Veld, J.H.J. and Havenaar, R., Selection criteria and

application of probiotic microorganisms in humans and animals, Microbiol. ther.,

26: 43-57, 1997

II. Prebiotics

The idea of prebiotics arose from two observations: [1] bacteria, like other living organisms have (occasionally specific) nutrient requirements [17] and [2] a few nutrients, particularly complicated carbohydrates, skip undigested into the massive gut, where they are used by resident bacteria.{18} In 1995, Gibson and Roberfroid [19] defined a prebiotic as "an indigestible meals factor that favorably

impacts the host by selectively stimulating the growth or pastime of a restricted quantity of microorganisms v colon." Rather than offering an exogenous supply of useful bacteria, the concept of a prebiotic proposes to increase the number of certain target bacteria inside the large gut. attention in particular focused on the boom of Lactobacillus and Bifidobacterium as the two main companies of "friendly microorganisms" for growth. The [20-23] variant in character response is frequently high and, as has been warned by Roberfroid{24}, the prebiotic effect may additionally depend on the initial stage of the target microorganism. A few carbohydrates of the hobbies as prebiotics are indexed in Table 17.4. The aim of growing decided on bacteria by using feeding prebiotics was regularly manufacturing various short-chain fatty acids (SCFA) because they affect the surroundings of the decreased intestines, metabolism, and ailment prevention [25-26]. SCFAs are highly absorbed and may function as a supply of power for the host, especially between foods. They make contributions to the pH of the stool and as a consequence affect the character of the big intestine and possibly the danger of most cancers [27]. The consequences of prebiotic feeding, e.g. because galactic oligo saccharides are not validated for constipation,{28,29} even though the intestinal transit time can be shortened by using feeding unique bacterial traces [30,31]

The aggregate of live microorganisms within the meals and the inclusion of vitamins (commonly sugars) that may be used by this microorganism as a bypass through the GI tract ensues in what has been termed symbiotic meals.24 The maximum famous combination thus far seems to be Bifidobacterium and fructose oligosaccharides; however, different combinations are possible if not sensible [.23,32].

Table

Some suggested prebiotics

No sugars

(GFn n = 1–4)

Inulin-like fructans (fructose oligosaccharides with a chain length of up to 60 units)

Soy oligosaccharides

Galacto-oligosaccharides

Isomalto-oligosaccharides

Genthio-oligosaccharides

Xylo-oligosaccharides

Lactulose (fructose-galactose disaccharide)

Raffinose

Stachyosis

Sorbitol

xylitol

Palatinose

Lactosucrose

Source: Tannock, G.W., Exploring the gut ecosystem using molecular

methods, in Probiotics and Health, The Intestinal Microflora, Roy, E. Ed.,

Edis Publ. Co., Saint-Hyacinthe, Canada, pp. 14–26; Macfarlane, G.T.

and Macfarlane, S., The human gut microbiota: ecology, physiology and

metabolic potential of the intestinal bacteria scan. J. Gastroenterol., 32

(Suppl. 222): 3–9, 1997.

III. Microbiology of the Gastrointestinal Tract

Human Microflora is complicated, tough to observe, and motivated using many factors. Research on microorganisms that colonize the human GI tract is hindered by the fact that sampling alternatives are limited, inter-person differences are massive, there is no fully applicable animal model, such studies are time-consuming and expensive, and advances in this subject of research are manifestly dependent on advances in microbiology. The current use of molecular biology techniques has enabled the examination of the human GI tract microbiota through the use of medium-unbiased techniques. Fluorescence in situ hybridization (FISH) and polymerase chain response (PCR) together with denaturation

Gradient gel electrophoresis (DGGE) is currently used for definitive and comparative bacterial population observations. [33,34]. Even questions such as the number and type of microorganisms that are essential in the human GI tract are not easy to reply to or find a consensus within the literature. Indeed, as a minimum, the author said that the crudeness of the methods is due to the difficulties in acquiring the proper samples used to remember distinct kinds of microorganisms and the fast length of maximum nutritional intervention studies [35]. To date, most of our understanding of human micro plates is primarily based on analyses of stool content, which can seriously limit our expertise in events in addition to the GI tract. There is a preferred settlement regarding the adjustments within the bacterial population that arise in the transition from new child to toddler to grownup. Vaginal-born toddlers are almost sterile GI tracts that can be quickly colonized, either via large amounts of Bifidobacterium and Lactobacillus within the case of breastfed babies or Bacteroides sp. and Escherichia coli inside the case of bottle-fed toddlers [36] Bifido bacterium are considered applicable and consequently, attempts had been made to add prebiotics in the infant system to support the growth of bifidobacterial [37]. At maturity, more than 400 unique species can be gifted (see Table ); however, most effectively, the most considerable microorganism was gifted properly diagnosed due to boundaries in methodology. They may find resident microorganisms beginning at the mouth and working in the GI tract. The stomach and higher small gut can have as up to 105 colony-forming gadgets (CFU/ml), ileum 107, and colon 1011 to 1012 [38]. Anaerobic. The range of bacteria exceeded the cardio by 1000 to 1. [39].

Bacteria that reside in the human intestinal tract have both useful and dangerous outcomes for the host. Production of nutrients, SCFA, a few proteins, function in digestion and absorption of vitamins, formation of protective bacteriocins, and stimulation of the immune system are all fantastic consequences of intestinal microflora. [40,41] At the same time, intestinal microorganisms produce cancer agents and mutagens at once during their metabolism, as well as the enzymes they transform digestive content material for cancer-causing agents and mutagens. Fermentation products, along with ammonia, amines, and phenols, may be dangerous, and some bacteria are pathogenic. Mitsuoka [42] and Gorbach [43] reported many enzymatic reactions of gut microorganisms and their effects on health, sickness, and infection. Because of the difficulties in identifying and counting the various microorganisms that inhabit the GI tract, several authors have cautioned that a more sensitive and perhaps more applicable method is to evaluate the metabolic sports of the bacterial vegetation because of their capability. Effects on metabolism and illness. Carman et al [44]. used Microflora-related period characteristics (MAC) and argued that adjustments in MAC caused by the weight-reduction plan (probiotic or no) interventions were actual indicators of modifications in intestinal vegetation and in an extra beneficial way of determining the consequences of such changes. Gold and Gorbach45 used essentially identical reasoning once they measured bacterial enzymes linked to the production of carcinogens in the intestine. Table 17.6 lists the MAC proposed by Carman and colleagues [45]. Unique traits can be introduced that reflect modifications inside the intestinal tract. PROBIOTIC merchandise.

A. Yogurt

Yogurt is defined as milk obtained with the aid of precise milk fermentation from Lb. bulgaricus and S. thermophilus. Extra bacteria can be introduced to boost organoleptic houses or greater these days to boom probiotic homes. Yogurt can now be marketed as containing Lactobacillus, Streptococcus, Leuconostoc, and Bifidobacterium microorganisms. Yogurt and yogurt-like merchandise can be discovered in many nations [46].

The quantity of research on yogurt over a long period exceeds that on every other probiotic product. It has been studied to determine its effects on lactase deficiency, low-density lipoprotein (LDL) cholesterol metabolism, immunity, childish diarrhea, and some cancers with various degrees of achievement.

1. loss of lactase

Yogurt is a dairy product that humans with lactase can tolerate (β-galactosidase) deficiency. It is more correct to consult lactase deficiency than

Lactose intolerance. Lactase is a digestive enzyme found in the intestinal brush lining and is responsible for the hydrolysis of milk sugar lactose into glucose and galactose. This results in lactase deficiency in the accumulation of unabsorbed lactose, which acts osmotically and retains water. A shortage is characterized by diarrhea, excessive gas, bloating, and abdominal pain after ingestion.

for milk and milk products, respectively. Measurement of enzyme activity, lactose or glucose concentration, galactose in the digestive tract, or hydrogen in the breath are ways of evaluating the dietary effects of treatment on lactase activity.

This was demonstrated in 1984 by two groups, Kolars et al [47]. and Savaiano et al. [48]. Yogurt alleviated the symptoms of lactase deficiency, and I speculated that this was due to living bacteria in yogurt. Yogurt can auto-digest lactose, resulting in 20 to 30% lower lactose levels in yogurt compared to unfermented milk when consumed. Yogurt, but not heat-treated yogurt, improves lactose digestion, suggesting that the live bacteria in the yogurt are responsible. Long-term consumption (8 d) does not seem to change this [49,50] Bacteria in yogurt survive passage through the stomach because of the increased protective (buffering) properties of yogurt compared with milk. However, the buffering capacity of yogurt can also slow hydrolysis down to the digests passing to a point in the intestinal tract where the pH favors β-galactosidase activity.49 β-galactosidase activity in commercial yogurts has been found to vary depending on the manufacturer, whether the fruit is added, the addition of additional bacteria, and whether the yogurt is frozen.

Frozen yogurt that is pasteurized before freezing has no β-galactosidase activity. To overcome this, some manufacturers add a starter culture to pasteurized yogurt before freezing; however, this does not necessarily increase enzyme activity [51].

In addition to in vivo bacterial hydrolysis, a slower stomach rate also appears to occur after yogurt load compared to milk due to differences in physical properties. This effect can contribute to improved digestion of lactose in yogurt [52,53].

The beneficial effects of yogurt on healthy individuals may not be as obvious as in those with a defined health problem. Guerin-Danan et al [54]. noted few changes in fecal bacteria and bacterial enzymatic activity of healthy infants (10 to 18 months) during a 1-month supplementation trial. However, the levels of branched and long-chain fatty acids significantly reduced during yogurt consumption.

2. Cholesterol metabolism

Research on the effects of yogurt consumption on blood cholesterol levels has been difficult to understand because of conflicting results reported over the years. It is now clear that in many cases, the results and conclusions of one experiment cannot be compared to those of others owing to differences in the experimental protocol. Sex, age, general health, initial cholesterol level, and physical activity level influence cholesterol metabolism. The diet before and during the experiment, as well as the time of day, can also affect the results, whether yogurt is consumed with other food or not, and the position in the meal (beginning or end of the meal). One of the most important details of many yogurt and cholesterol experiments, namely the type of yogurt fed (including details of levels and unambiguous identification of bacteria in test yogurt or fermented milk), is often not well described. This, coupled with the fact that proper controls for such feeding trials were often not included, reduces the scientific validity of many studies 

The observation that although the Maasai of Africa ate a diet rich in saturated fat and fermented milk, had low blood cholesterol (compared to Western standards), and had no signs of ischemic heart disease prompted Mann and Spoerry [57] to perform a much-reported study involving fermented milk. Yogurt tests conducted since then use it as a starting point, although Mann [58]. later emphasized that milk was the factor responsible for the hypocholesterolemic effect, which was enhanced by fermentation to yogurt. Taylor and Williams55 report 12 publications (13 trials) in which yogurt was served to try to lower blood cholesterol. As they pointed out, many of the study protocols can be criticized for having too few subjects, too short a feeding trial, no or incorrect control diet, and unrealistic feeding levels. Of the 13 studies, eight reported a decrease in total blood cholesterol, 1 an increase, and four reported no difference from the control. In two studies, one showed "no difference from control" [59], and one was published showing non-significant positive effects on serum cholesterol levels.{60} The addition of oligo-fructose and two probiotic bacteria to traditional yogurt (3.5

Research Method

The study aimed to research the outcomes of probiotics and prebiotics on intestine microbiota composition and their capability of health blessings. A randomized managed trial changed into a finished regarding a diverse institution of individuals. The study individuals were divided into three agencies: one institution acquired probiotics, some other business enterprises received prebiotics, and the 1/three corporation served as the manager, receiving a placebo. The intervention period lasted for 12 weeks.

through the observation, fecal samples had been gathered from all people at ordinary durations to analyze the changes in gut microbiota. additionally, members' fitness parameters, which include digestive signs and symptoms, immune markers, and regular nicely-being, have been monitored via surveys and clinical assessments.

Results

After the 12-week intervention, the study found significant changes in the gut microbiota composition of participants who received probiotics and prebiotics. The probiotic group showed an increase in beneficial bacteria species, such as Bifidobacterium and Lactobacillus, while potentially harmful bacteria like Clostridium were reduced. Similarly, the prebiotic group exhibited an increase in gut bacteria associated with improved gut health, such as Faecali bacterium prausnitzii.

Moreover, both the probiotic and prebiotic groups showed a significant reduction in digestive symptoms, such as bloating and flatulence, compared to the control group. The participants in these groups reported improved bowel movements and a higher sense of well-being.result

Discussion

The findings of this study monitor the incredible impact of probiotics and prebiotics on gut microbiota and human fitness. Probiotics are live beneficial microorganisms that, whilst fed on in good enough quantities, can confer fitness benefits to the host. The increase in Bifidobacterium and Lactobacillus in the probiotic organization indicates their capacity function in keeping intestine fitness and assisting digestion.

Prebiotics, however, are non-digestible fibers that serve as a meal supply for beneficial intestine microorganisms. The increase in Bifidobacterium prausnitzii in the prebiotic agency is promising, as this bacterium is associated with anti-inflammatory homes and balanced gut surroundings.

The widespread reduction in digestive signs and symptoms in every intervention company indicates that probiotics and prebiotics can also help alleviate gastrointestinal soreness and promote higher digestive function. this can be due to the modulation of gut microbiota, most important to greater nutrient absorption and fermentation techniques.

however, it's far crucial to endure in mind that a person's responses to probiotics and prebiotics can vary due to the correct composition of each person's intestine microbiota. moreover, the take a look At's length became restricted to 12 weeks, and lengthy-time period outcomes and capability element effects want in addition to research.

Conclusion the Future of Probiotics and Prebiotics

The market for probiotic and prebiotic merchandise will continue to grow with our expertise in intestine Microflora and its function in maintaining health and advances in sickness resistance. food producers will want a way to commercialize merchandise that maintains possible microorganisms up to shelf life and in many cases will even want to provide encapsulation or different defensive mechanisms for live microorganisms of their products to be able to transmit microorganisms to the precise website of action within the GI tract

Acknowledgements

The completion of this research project would not have been possible without thecontributions and support of many individuals and organizations. We are deeply grateful to all those who played a role in the success of this project

We would also like to thank My Mentor [. Naweed Imam Syed Prof. Department of Cell Biology at the University of Calgary and Dr. Sadaf Ahmed Psychophysiology Lab University of Karachi for their invaluable input and support throughout the research. Their insights and expertise were instrumental in shaping the direction of this project 

Declaration of Interest

I at this moment declare that:I have no pecuniary or other personal interest, direct or indirect, in any matter that raises or may raise a conflict with my duties as a manager of my office Management 

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Financial support and sponsorship

No Funding was received to assist with the preparation of this manuscript 

References

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S Munshi

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

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Tania Munoz

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

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George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

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Rui Tao

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

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Khurram Arshad

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

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Gomez Barriga Maria Dolores

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

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Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

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Maria Dolores Gomez Barriga