AUCTORES
Globalize your Research
Review Article
*Corresponding Author: Fatiha Bennaoui, Neonatal intensive care unit; CHU Mohammed Vi Marrakech Research Laboratory on Childhood, Health and Development.
Citation: S Mouhdi, F Bennaoui, F Tahiri, A Lalaoui1, N Slitine Elidrissi, Fmr Maoulainine, (2024), Zellweger syndrome in a newborn: à case report, J. Pharmaceutics and Pharmacology Research, 7(6); DOI:10.31579/2688-7517/175
Copyright: © 2024, Fatiha Bennaoui. 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: 11 February 2024 | Accepted: 15 March 2024 | Published: 25 April 2024
Keywords: facial dysmorphia; hypotonia; metabolic encephalopathy; zellweger syndrome
Introduction: Zellweger syndrome, also known as Zellweger Spectrum Disorders (ZSD), is a group of rare genetic disorders affecting peroxisome metabolism. Peroxisomes play a crucial role in the catabolism of very long-chain fatty acids and the metabolism of bile acids, among other essential functions.The aim of this article is to examine the clinical features, genetic aspects, underlying pathological mechanisms and recent advances in the diagnosis and management of Zellweger Syndrome,
Observation: We report the case of a newborn admitted at his first day from a consanguineous marriage, with 3 sibling deaths at the age of 6 months, one of whom was diagnosed with zellweger syndrome. From the outset, there was massive hypotonia, poor reactivity and absence of contact. Micrognatism and large fontanelles were also noted. Generalized convulsions appeared as early as the first week of life. Électroencéphalogramme was normal and brain IRM revealed polymicrogyria. The initial fundus was without abnormality and an amino acid and organic chromatography study was performed. The evolution was marked by improvement of the sucking reflex and persistence of profound hypotonia.
Conclusion: This case reminds us of the importance of looking for a disorder of peroxisome biogenesis in hypotonic newborns with facial dysmorphia.
Zellweger syndrome, also known as cerebrohepatorenal syndrome, is a rare inherited disorder characterized by the absence or reduction of functional peroxisomes. It is an autosomal recessive disease caused by a defect in the PEX gene (1). It is a rapidly progressive disease with a high mortality rate. In the absence of curative treatment, therapeutic options are limited to supportive care aimed at improving quality of life. This activity describes the assessment and management of Zellweger syndrome, and highlights the role of the interprofessional team in caring for patients with this disease. We report the case of a newborn with Zellweger syndrome with a review of the literature after free and informed consent from the parents (2).
Observation :
We report the case of a newborn admitted to our unit at his first day of life, from a 36-year-old mother, 8 gesture, 8Parity, 5 livings children and 3 deceased children and a 6-month-old daughter for suspected zellweger syndrome due to cerebro-hepato-renal involvement.
The newborn is the result of a 1st degree consanguineous marriage in a well-monitored monofetal pregnancy estimated at 39week of amenorrhea, the infectious anamnesis is positive : greenish, tinted amniotic fluid, Caesarean delivery, imprecise APGAR and delayed cry according to the mother.
The patient was admitted to our unit for neonatal respiratory distress due to a neonatal infection with pulmonary localization. Respiratory distress exceeding 4 hours with positive infectious anamnesis and opacity on X-ray, with neonatal convulsion such as eye twitching and chewing.
Clinical examination revealed a pink newborn with facial dysmorphia, non-reactive, non-gesticulating, normochardic at 131beat/min, polypneic at 71C/ min and SaO2 at 88% in free air, weight: 3k700 (75P), height 50cm (50P), CP: 36cm (75P).
Pleuropulmonary examination: presence of signs of respiratory distress such as moderate chest indrawing, no rales on auscultation.
Neurological examination: axial and peripheral hypotonia, normotensive anterior fontanel and archaic reflex present but weak, sucking reflex present but weak.
Abdominal examination: soft abdomen and no hepatomegaly or splenomegaly
Cardiovascular examination: no murmur on auscultation and peripheral pulses are well perceived and symmetrical. Examination of the external genitalia and no abnormalities.
The initial workup showed : CBC : Hb 13.3g/dl leukocytes 8500 PNN 5770 Pq 317000 - CRP negative at 4. - ASAT/ALAT : 25/70, Staph coagulase-negative blood culture. Urea: 0.15 Creatine: 4 , Chest X-ray: opacity of the right middle lobe
Ophthalmological examination: normal, ENT examination: bilateral deafness , ETT: ostium secondum type CIA and PCA. ETF : dilatation of the 3ème and 4ème ventricle. CFM : type 1 - Carnitine dosage : arachidonic acid deficiency, carintine T : 13.09 / carnitine L : 11.4 / acylcarnitine: 1.7. - Brain IRM : polymicrogyria and bilateral bi-frontal and presylvian cortical thickening, suggesting encephalic involvement in zellweger syndrome.
The patient was initially put on oxygen goggles, Double antibiotic therapy (C3G for 10 days and gentamycin for 2 days), Gardenal loading dose, then daily maintenance dose. - Vitamin B6 - priméa baby bio artificial milk (milk with arachidonic acid)
The evolution during hospitalization was marked by the complication at D10 of hospitalization by the nosocomial infection retained before: the appearance of grayish complexion, mottles and ascencion of CRP to 95. A lumbar puncture was performed with the following results: - Leukocyte less than 3 elements - Biochemistry: results not available - Sterile culture The patient was treated for nosocomial infection for 10 days with meropenem and 5 days with amikacin.
The evolution was then marked by clinical improvement: - the patient has been weaned off oxygen - The sucking reflex was recovered with spontaneous eye opening and spontaneous gesticulation, but axial and peripheral hypotonia persisted. The patient was discharged after one month's hospitalization with a nasogastric tube and after education of the mother and hypotonia followed in our training to change the gastric tube every week then evolution was marked by improvement of sucking reflex but persistence of hypotonia.
Zellweger syndrome (ZS), also known as cerebrohepatorenal syndrome, is a rare autosomal recessive inherited disorder characterized by the absence/reduction of functional peroxisomes in cells, which are essential for the betaoxidation of very long-chain fatty acids (3).
Peroxisomes play an important role in fatty acid oxidation, particularly in the oxidation of very long-chain saturated fatty acids. Among other abnormalities, abnormally high levels of VLCFAs in bodys tissus and fluids are observed in many patients with peroxisomal disorders.
Caused either by a defect in peroxisome formation or maintenance, or by a defect in the function of a single peroxisomal enzyme, peroxisomal diseases lead to central nervous system and systemic damage. (4)
Zellweger syndrome (cerebrohepato-rena syndrome1) is the prototype of the group of disorders associated with peroxisome deficiency, also known as disorders of peroxisome biogenesis . Central nervous system malformations are characterized by a disruption of neuronal migration, resulting in microgyria/pachygyria, (5)
Zellweger syndrome is the most common peroxisomal disease of infancy, with an incidence of 1 en 50,000 live births in the United States, but with regional variations. [The incidence is higher in the Quebec region (1 en 12,000) and lower in Japan (1 en 500,000). The overall incidence of peroxisomal disorders is approximately 1 en 50,000 to 100,000 live births(6).
Zellweger syndrome is caused by mutations in various genes required for peroxisome biogenesis. Mutations in at least 13 different PEX genes have been associated, and PEX genes code for proteins called peroxins (à peroxisome assembly protein). The most common mutations are in the PEX1 or PEX6 genes, found in around 65% of patients. These genes code for ATPases, which are required to import the protein into peroxisomes from the cytosol (1).
The disease affects almost all organ systems, as peroxisomes are present in all organelles. Manifestations include severe craniofacial anomalies, hypotonia, severe neurodevelopmental delay, sensorineural hearing loss, ocular anomalies and enamel abnormalities. Hepatomegaly is present en 80% of cases, with increased liver enzymes and bilirubin levels. Renal cortical cysts are present en 70% of cases (8). Depending on the age at which they present, ZS patients are divided into three groups (2) :
1. Neonatal-infant presentation
Most of these children present with hypotonia, reduced spontaneous movements and a weak cry. They often have feeding difficulties, and seizures may occur early in neonatal life . They often present with facial dysmorphia, a high forehead, large fontanelles, wide sutures, hypoplastic supraorbital ridges and a broad nasal bridge. Ocular anomalies include glaucoma, cataracts and retinopathy, and these patients may present with varying degrees of sensorineural hearing loss.
2. Childhood presentation:
Developmental delay, growth retardation, eye and hearing abnormalities, including variable levels of liver dysfunction, adrenal insufficiency and calcium oxalate kidney stones. They may show regression of previously affected neurological milestones, secondary to demyelination (leukodystrophy).
3. presentation from teenager to adult
Developmental delay and neuroregression, cerebellar ataxia, peripheral neuropathy, adrenal insufficiency, leukodystrophy
The appropriate screening test for an infant suspected of having zellweger syndrome is to measure plasma VLCFA levels (6).
Histological diagnosis is also possible by liver biopsy using the diaminobenzidine staining procedure to study the abundance, size and structure of hepatic peroxisomes. (3) Prenatal diagnosis is also possible by direct analysis of VLCFA levels and bile acid intermediates in amniotic fluid. Another approach is cytochemical staining of peroxisomes in chorionic villus samples. Detailed DNA studies, including immunofluorescence and complementation assays, are now available to confirm and characterize the pathological mutation.
In our case, the diagnosis was not obvious at birth, despite the patient's hypotonia, as the facial dysmorphia was rather non-specific, but the notion of family history in the siblings allowed us to orient ourselves, and the diagnosis was confirmed initially by brain MRI, which revealed images of polymicrogyria, and subsequently by chromatography of amino and organic acids, which revealed a deficiency in arachidonic acid, thus supporting our diagnostic hypothesis.
The various treatment modalities tried were as follows (2) :
- Docosahexaenoic acid - This is a long-chain unsaturated fatty acid, essential for myelination and the development of the brain and eyes. Docosahexaenoic acid levels are low in the plasma of ZS patients. However, its replacement has not been associated with an improvement in neurological symptoms or visual disorders in randomized controlled trials.
- Lorenzo oil - Lorenzo oil is a mixture of glyceryl trioleate and glyceryl trierucate, and its use was initially tried in patients with X-linked adrenoleukodystrophy. It has been shown to reduce plasma VLCFA levels, but not to affect disease progression in ZS patients.
- Cholic acid - This is a 24-carbon bile acid, which contributes to the absorption of fat-soluble vitamins. Due to liver dysfunction and impaired lipoprotein synthesis in patients with ZS, there is a deficiency of fat-soluble vitamins, and the use of cholic acid has been tried in other liver function disorders. The US FDA has approved its use in shingles patients. However, there is little evidence of its efficacy.
Support measures include :
- Hearing aids or cochlear implants for hearing loss
- Referral to an ophthalmologist, cataract extraction and glasses in case of visual impairment Standard antiepileptic drugs for epileptic seizures
- Vitamin K supplementation for coagulopathy
- Vitamin supplementation for low levels of fat-soluble vitamins (A, D, E)
In our case, the patient was put on vitamin supplementation: Vitamin B6 and artificial milk with arachidonic acid with nasogastric feeding.
Zellweger syndrome is a rapidly progressive disease with a high mortality rate. In the absence of curative treatment, therapeutic options are limited to supportive care aimed at improving quality of life (3).
In our case, the evolution was marked by clinical improvement with improved sucking reflex, spontaneous eye opening and spontaneous gesticulation, but persistent axial and peripheral hypotonia.
Children who present during the neonatal period have a very poor prognosis, usually dying within the first year of life. Patients who present later in childhood may develop progressive liver disease/insufficiency and have a slightly longer survival after diagnosis compared to the neonatal form. Patients who present in adolescence have a slightly longer survival but generally develop progressive neurological symptoms, including spasticity and peripheral neuropathy, later in life.
Our study highlights the value of brain imaging for rapid confirmation of Zellweger syndrome, enabling early management.
None
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
