AUCTORES
Review Article
*Corresponding Author: P D Gupta, Former Director Grade Scientist, Centre for Cellular and Molecular Biology, Hyderabad, India.
Citation: Citation: K Pushkala and P D Gupta, (2024), Treatment of Sepsis Associated Encephalopathy by FMT, J. Women Health Care and Issues, 7(6); DOI:10.31579/2642-9756/220
Copyright: Copyright: © 2024, P D Gupta. 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: 07 August 2024 | Accepted: 15 August 2024 | Published: 27 August 2024
Keywords: Key words: neurological complication; multiple organ dysfunction; Faecal Microbiota Transplantation; bacteremia; electroencephalography
Sepsis associated encephalopathy (SAE) is a poorly understood neurological complication that occurs secondary to infection generally encountered in critically ill patients results in critical neuromyopathy. Mortality is almost certain due to multiorgan failure. Lately, Faecal Microbiota Transplantation (FMT) showed some promising results, FMT effectively improved the spatial memory and EEG abnormalities. FMT was likely mediated through the vagus nerve. Several cases of bacteremia, multiple drug resistance bacterial infection, respiratory failure, and multiple organ dysfunction showed significant improvement from FMT. Further research into the pathophysiology, management and prevention of SAE is needed.
Sepsis associated encephalopathy (SAE) is a neurological complication expressed by diffuse brain dysfunction secondary to infection elsewhere in the body without overt CNS infection. Acute systemic infection caused by various pathogenic bacteria that invade the bloodstream and rapidly proliferate and produce life-threatening toxins. Recent studies have however reported that SAE is a relatively common cause of altered mental status with diffuse disturbance in cerebral function without any lateralizing signs is characteristic of SAE [1]. SAE can develop early in the course of a sepsis or later in the course of illness as part of the multiorgan dysfunction (MODS) seen in the setting of refractory septic shock. MODS may be due to major trauma, severe illness and widespread infection. Treatment focuses on treating the initial insult and working to prevent severe injury to other organ systems. It can be scary to hear that your organs or a loved one's organs aren't working [2].
Pathophysiology of SAE
SAE is a poorly understood, common, complex and multifactorial including a number of intertwined mechanisms such as vascular damage, endothelial activation, breakdown of the blood brain barrier, altered brain signalling, brain inflammation, and apoptosis. The prevalence rate ranges from 8 to 70 depending on the inclusion and exclusion criteria in critically ill patients admitted in the ICU. The term “septic encephalopathy” might be used to define a septic state, that is, a systemic inflammatory state summoned by an infectious process of the brain or CNS instead of Sepsis associated encephalopathy [3]. The prognosis ranges from mild symptoms such as malaise and concentration deficits to deep coma. Lack of any specific investigations or biomarkers and the common use of sedation in critically ill patients pose a problem of evaluation for cognitive dysfunction.
Abnormalities in electroencephalography (EEG) and somatosensory-evoked potentials (SSEP),[4] increase in biomarkers such as neuron- specific enolase, S-100 β protein and some abnormalities on neuroimaging which are not specific could be suspected for SAE but remains a diagnosis of exclusion and can only be confirmed after other infectious, metabolic, and toxic causes have been ruled out by appropriate investigations. The activated glial cells acquire neurotoxic properties, notably by releasing nitric oxide, cytokines, reactive oxygen species, and glutamate inducing apoptosis within vulnerable areas of the brain leading to this brain signalling mechanism which is actually meant to serve as a protective and anti-inflammatory mechanism becomes the culprit in the pathogenesis of SAE [5].
The pathophysiology of SAE has not been established, though several likely mechanisms have been proposed [6], such as direct cerebral localisation of microorganisms with formation of micro abscesses in human SAE, endothelial and blood brain barrier dysfunction, cerebral microcirculation, alterations in neurotransmission, oxidative Stress, mitochondrial dysfunction, apoptosis and the alteration of calcium homeostasis impairs learning memory and cognitive function [7]. Inflammatory cytokines and complement system are the final common pathway in the pathophysiology of brain dysfunction in SAE. Presence of extracranial infection and impaired mental state are the two essential prerequisites for making a diagnosis of SAE. The primary clinical feature of SAE thus is a change in mental status especially that of awareness/consciousness and cognition is the normal clinical presentation.
Limited evidence is now available for the use of prebiotics, probiotics, fecal microbiota transplantation, and vagus nerve stimulation for the successful treatment and prevention of SAE. Management of SAE is limited in spite of high mortality rate, available drugs to treat the underlying infection and symptomatic treatment for delirium and seizures. Early detection of delirium which proves to be the first manifestation of sepsis by determination of the underlying infection and organism, accurate and prompt treatment of the infection, and providing supportive care is indispensable. Subsequent intravenous antibiotic therapy should be initiated immediately after obtaining appropriate cultures, since; early initiation of antibiotic therapy is associated with lower mortality [8].
Impact of Sepsis Treatment on the Gut Microbiota
Therapies employed for sepsis and septic shock management also pathologically alter the constitution of the gut microbiota. Antibiotics indirectly affect the gut microbiota through alteration of the host innate immune system. Antibiotic-associated depletion of gram-negative organisms reduces expression of toll-like receptors, signalling proteins and antimicrobial peptides (e.g., Reg3g) responsible for killing gram-positive organisms. Other medications commonly used in the critically ill septic patient such as corticosteroids, vasopressors, opioids, and proton pump inhibitors also promote gut dysbiosis. Antibiotics indirectly affect the gut microbiota through alteration of the host innate immune systemic responsible for depletion of gram-negative organisms that in turn reduces expression of toll-like receptors, signaling proteins and Reg3g responsible for killing gram-positive organisms. Corticosteroids though their anti-inflammatory and immunomodulatory effects are well-known, elevation in glucocorticoid concentrations may also reduce gut microbiota diversity [9].
Opioid analgesics therapy for pain management in critically ill patients with sepsis and septic shock is being recently implicated with direct mucosal injury, compromising the protective gut barrier and increasing the risk of bacterial translocation. Chronic opioid use has also been shown to alter the composition of gut microbiota and confer increased risk of infection [10]. Proton pumps inhibitors (PPI), used for stress ulcer prophylaxis in ICU patients, is found to substantially alter gut microbiota diversity and consequently increase pathogenic bacteria expression. Imhann et al., [11] examined stool sample of 211 patients with chronic PPI use demonstrated an abundance of oral microbiota but reduced healthy gut microbiota, and with an increased growth of pathogenic bacteria including Enterococcus, Streptococcus, Staphylococcus and Escherichia coli, compared to non-PPI users [11].
Faecal microbiota transplantation (FMT) as Therapeutic tool
FMT provides a new therapeutic tool to replace the entire intestinal ecosystem. FMT takes a complete intestinal ecosystem along with the necessary substrates and metabolites responsible for immunomodulation (e.g., short chain fatty acids, D-lactate) and transfers these microbes into the diseased recipient to restore the gut microbiota in its entirety [12]. Gut microbiota have been proved to induce the clonal expansion of specific B cell populations and increase production of antibodies. Toxins and other harmful antigens secreted by pathogenic bacteria or viruses can be neutralized by these antibodies and prevent the spread of infection [13]. Li et al. (14) found that FMT effectively improved the spatial memory and EEG abnormalities in an LPS-induced rat model of sepsis combined with cervical vagotomy, and the therapeutic effect of FMT was likely mediated through the vagus nerve [14]. In addition, several case reports indicate that non-Clostridium difficile infection in sepsis patients with prolonged ICU stay and complications including bacteremia, multiple drug resistance bacterial infection, respiratory failure, and organ dysfunction significantly benefitted from FMT. A total of 5 patients received FMT, of which 4 showed clinical improvement and 1 died from non-FMT-related causes [15].
Gut dysbiosis in Sepsis patients results in outgrowth of pathogenic gut-resident organisms over healthy commensal organisms. In severe cases reduced Bifidobacterium and Lactobacillus but increased colonization of pathogenic Staphylococcus and Pseudomonas spp [16]. Due to Sepsis, intestinal wall permeability is induced allowing bacterial antigens to interact with gut-resident immune cells and influence systemic immunity intensifying the progression and severity of sepsis. Endotoxin released from gut bacteria intensifies the systemic inflammation and promote organ damage in addition to promoting the development of SAE [17]. Endogenous gut microbiota such as Bifidobacterium and Lactobacillus produce gamma-aminobutyric acid (GABA), the primary inhibitory neurotransmitter in the CNS, which can pathologically alter neural signalling. Li et al., (13) hypothesized that reconstitution of microbial diversity with increased presence of commensal, beneficial bacterial species such as Bifidobacterium, Lactobacillus, and Faecalibacterium and reduction in noxious bacteria contributed to the neuroprotective benefits of FMT therapy [18]. Qin H., et al., [19] endorsed the successful management of severe scrub typhus with pneumonia, sepsis, and MOD in a pregnant woman. The patient responded very well to FMT and oral faecal microbiota capsule therapy successful management of severe scrub typhus with pneumonia, sepsis, and MOD in a pregnant woman. Despite initial challenges, the patient responded favourably to FMT and oral fecal microbiota capsule therapy [19]. Cummulative effect of the changes of this endogenous microflora observed in sepsis lead to the substantial impacts on CNS function. The reduction in SCFA production from gut microflora during sepsis increases inflammatory markers, endotoxins due to the inability to downregulate inflammation [20].
FMT offers the broader scope to correct the dysbiosis in addition to restoring the dynamic balance of bacterial species and their essential metabolites that exhibit anti-inflammatory effects to reduce the harmful neuroinflammatory mediators that contribute to SAE [21].
Rare inflammatory, infectious and procedural complications, gram-negative bacteremia and subsequent death secondary to aspiration during the procedure or due to bacterial translocation have been reported with FMT Septic Patients with underlying immunocompromised conditions or those with an acute immunocompromising illness are at a elevated risk of developing bacteremia and septic complications [12]. Besides FMT has inherent risks to critically patients. Thorough understandings of the mechanism by which an FMT can shape the host immune response is essential. Future microbiota directed therapies may focus on the restoration of bacterial metabolites such as butyrate or the delivery of specific bacterial communities capable of restoring specific microbiota functions necessary in restoring the host immune response and potential therapeutic strategies to modulate the gut microbiota to mitigate sepsis-induced brain injury.
Name of the disease | Gut biome of the patient | After FMT | REF |
Sepsis-associated encephalopathy | Associated: absence of anaerobes, including Staphylococcus species and Escherichia coli, with Clostridium difficileinfection, high relative abundance of pathogenic gram negatives, and Enterococci [15]. Increase Staphylococcus and Pseudomonas spp (pathogenic bacteria) [16] Decrease Bifidobacterium and Lactobacillus [16] | [15]. Hao M.X. et al., (2021)
[16]. Shimizu K. et al., (2006). |
Table. Microbiol (types of bacterial species) contents in Healthy, Sepsis-associated encephalopathy Patient and after FMT
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
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.
“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”.
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.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
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.
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.
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.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. 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.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.