Assessment of C-Reactive Protein in Psoriasis Patients

Research Article | DOI: https://doi.org/10.31579/2768-0487/212

Assessment of C-Reactive Protein in Psoriasis Patients

  • Moshi Uddin Ahmed *
  • Pervin Akter
  • Mohammad Anwarul Haque
  • Md Abdul Wahab

1Assistant Professor, Department of Dermatology and Venereology, Bangladesh Medical University.

2Professor & Head, Department of Physiology, Addin Momin Medical College, South Keraniganj, Dhaka.

3Medical Officer, Department of Dermatology and Venereology, Bangladesh Medical University.

4Professor, Department of Dermatology and Venereology, Bangladesh Medical University.

*Corresponding Author: Moshi Uddin Ahmed., Assistant Professor, Department of Dermatology and Venereology, Bangladesh Medical University.

Citation: Moshi U. Ahmed, Pervin Akter, Mohammad A. Haque, Md Abdul Wahab. (2026), Assessment of C-Reactive Protein in Psoriasis Patients, Journal of Clinical and Laboratory Research, 9(3); DOI:10.31579/2768-0487/212

Copyright: © 2026, Moshi Uddin Ahmed. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: 06 July 2026 | Accepted: 21 July 2026 | Published: 28 July 2026

Keywords: C-reactive protein; psoriasis patients

Abstract

Psoriasis is a global burden of disease characterized by the presence of well circumscribed erythematous papule & plaque of various size & shape, covered by silvery scales and has an inflammatory nature demonstrated by excessive secretion of dermal, systemic, pre-inflammatory cytokines. Furthermore, liver stimulation and the production of acute phase reactants such as C-reactive Protein (CRP), which is considered an inflammatory biomarker, are believed to stem from IL-6 secretion induced by TNF-a. CRP is an acute phase reaction protein biomarker that is identifiable within 24 to 48 hours after tissue damage or infection. To assess role of CRP in psoriasis patients is the objective of the present study. It was a cross sectional observational study, conducted in department of Dermatology and Venereology, Bangladesh Medical University, Dhaka among diagnosed cases of chronic plaque psoriasis. Sample was selected by purposive sampling technique. Data were collected from the informant and recorded in structured case report form. Clinical examination and relevant investigation were done meticulously. Mean age of the patient was 39.42±8.5 years. Study shows that maximum patients (37.0%) had CRP value 3.1-6.0. The average CRP value was 4.2±1.2. On correlation between severity of psoriasis with CRP value revealed that, out of 24 patients of severe disease, 13(54.1%) cases was ≥9.1 and 8(33.3%) cases was 6.1-9.0 CRP. On the other hand maximum patients [34 (44.7)] of mild cases had CRP 3.1-6.0. CRP was significantly elevated (>6 mg/L) in severe psoriatic patients with severe disease than those with mild disease. The mean CRP values in mid disease (PASI<10) was 0.9±0.2 and in severe cases (PASI>10) was 7.5±2.1. There was a significant difference in CRP values with PASI score. So, CRP shows a significant association with severity of psoriasis. From this study, we suggest that CRP value is a good predictor in the diagnosis and disease severity of psoriasis. Patients with moderate to severe psoriasis had active systemic inflammation, which was demonstrated by increased levels of C-reactive Protein.

Introduction

Psoriasis is an immune-mediated genetic skin disease. The underlying pathomechanisms involve complex interaction between the innate and adaptive immune system. T cells interact with dendritic cells, macrophages, and keratinocytes, which can be mediated by their secreted cytokines. In the past decade, biologics targeting tumor necrosis factor-a, interleukin (IL)-23, and IL-17 have been developed and approved for the treatment of psoriasis.1 These biologics have dramatically changed the treatment and management of psoriasis. In contrast, various triggering factors can elicit the disease in genetically predisposed individuals. Recent studies suggest that the exacerbation of psoriasis can lead to systemic inflammation and cardiovascular comorbidity. In addition, psoriasis may be associated with other auto-inflammatory and auto-immune diseases. Despite its systemic nature, the quantification of the burden of systemic inflammation in psoriatic disease is challenging. Hence, the levels of C-reactive protein (CRP), which is commonly used to quantify systemic inflammation, are increased in psoriatic disease.2-3 Psoriasis is a chronic, recurrent inflammatory cutaneous disease. Psoriasis patients alternate between periods of remission and periods of exacerbation of the disease. Usually, psoriasis severity is clinically evaluated using tools like Psoriasis Area and Severity Index (PASI) that present some limitations and subjectivity. Clinicians select the therapy according to psoriasis severity, aiming that patients achieve longer remission periods and improve their quality of life. Biological markers for diagnosis and prognosis of psoriasis help to establish its severity and to monitor the therapeutic response; moreover, collaboration of Psoriasis Area and Severity Index (PASI) score with biomarkers of psoriasis assists clinician's precise evaluation, therapeutic decision to treat psoriasis and to choose earlier and more adequate therapeutic strategies, avoiding or minimising worsening of psoriasis. C-reactive protein (CRP) has special importance for psoriasis due to its relation with cytokines which are responsible for skin inflammation. CRP is cheap, available and common biomarkers. The plasma half-life of CRP is constant under all conditions of health and disease, so that the sole determinant of circulating levels of CRP is the synthesis rate, which thus directly reflects the intensity of pathological process stimulating CRP production. With this marker, it would be able to monitor therapeutics, avoiding unnecessary therapeutic surcharge or changes to a more aggressive therapy.

Methods

Study design: Cross sectional observational study

Place of study: Outpatient Department of Dermatology and Venereology, Bangladesh Medical University, Dhaka

Study period: This study was conducted over a period of six months from February 2021 to August 2021.

Study Population: The study population were patients diagnosed chronic plaque psoriasis, above the age of 18 years & both sexes, attended for further management after giving informed written consent

Sample size: The following standard formula is widely used in determining sample size:

n = the desired sample size

Standard normal deviate usually set at 1.96 

p = Proportion in the population. Psoriasis affects about 2%-3% of the World population 23. We considered 3%, so 'p' value will be 0.03. q = 1 - p Or 0.97 d = Acceptable error or precision (which is considered as 2%). So acceptable error is 0.02

According to this formula the targeted sample will be 279.3; therefore 100 samples were taken in this study.

Sampling: Purposive sampling was applied for sample selection.

Inclusion criteria

Diagnosed cases of chronic plaque psoriasis, above the age of 18 years & both sexes

Not receiving any systemic treatment for psoriasis for at least one month prior to enrolment

Exclusion criteria

Concomitant other skin infection

Psoriatic arthritis and other inflammatory disorders

Pregnant and lactating females

Patients having acute illness such as fever of unknown origin, diagnosed case of RA or other known arthropathies, malignancy, history of MI, deep fungal or disseminated localized gonococcal infection Data collection procedure: This study was conducted in the Department of Dermatology of BMU, Dhaka. It is a hospital-based, cross sectional study. The study group included 100 patients of chronic plaque psoriasis. All consecutive clinically diagnosed cases of chronic plaque psoriasis (excluding psoriatic arthritis and other inflammatory disorders) above the age of 18 years not receiving any systemic treatment for psoriasis for at least one month prior to enrolment were included in the study. Relevant data included age, gender, weight, height, body mass index, blood pressure, age of onset, and duration of psoriasis. Severity of psoriasis was assessed according to Psoriasis Area and Severity Index (PASI) score, determined by the same investigator in all 100 cases. PASI<10 considered mild and PASI >10 considered severe disease. Investigations carried out included all routine test, and C-reactive protein (immunoturbidimetry) evaluated. Result of CRP correlates with PASI score. Statistical analysis of the data was done using statistical processing software (SPSS) and Microsoft. Quantitative data expressed as mean and standard deviation and qualitative data as frequency and percentage. Comparison was done by tabulation and graphical presentation in the form of tables, pie chart, graphs, bar diagrams, histogram & charts etc. Variables: Main outcome variables: An interview-based questionnaire was used to collect information from the patients or relatives, regarding age, sex, socio-demographic characteristics, educational level, clinical presentation, Severity of disease PASI score, CRP level. The data were analysed by statistical (SPSS) method and presented in the form of tables, figures, graphs, diagrams & charts etc. Data analysis: Data for socio- demographic and clinical variables were obtained from all participants by the use of a pre- designed and easily understandable questionnaire. After collection of all information, these data were checked, verified for consistency and edited for finalized result. After editing and coding, the coded data directly entered into the computer by using SPSS version 22. Data cleaning validation and analysis was performed using the SPSS/PC software and graph and chart by MS excel. The result was presented in tables in proportion. p value <0.05 is considered as significant. Quality assurance strategy: It is extremely important that the data collection procedure, method becomes good in quality, for that purpose at first work manual was made. Then a sample size was selected. A standard questionnaire was made. Then the questionnaire was pretested. The pre-test ensures that the respondents are able to understand the questionnaire and answer accordingly. 

Results

Results

AgeFrequencyTotal
 malefemale 
12-209(10.84%)09
21-3048(57.83%)9(52.94%)57
31-4019(22.89%)7(41.17%)26
41-507(8.43%)1(5.88%)8
Mean ± SD39.42 8.5
M:F4.88:1

Table 1: Age & Sex distribution of the patients (n=100).

In the study, the maximum incidence was seen in the 3rd decade (57.0%), next to it was the 4th decade (26.0%). Mean age of the patient was 39.42 plus/minus 8.5 years. Out of 100 cases 83?ses were male and 17% were female. Male and female ratio was 4.88:1.

Figure 1: Line chart showing the frequency of disease with age variation (n=100).

Figure-l shows that frequency of disease was predominant at middle age in both sexes, but more female are affected at elder age. Highest incidence of male and female patients were in age group between 21-30 years, 57.83% and 52.94% respectively.

Income classesNumber of patientPercentage
Low-income class66.0
Lower middle class1818.0
Upper middle class4747.0
High income class2929.0

Table 2: Socioeconomic status (SES) of study population.

Socioeconomically patients were grouped into three classes. Among the patients the upper middle class (47%) comprising the major percentage of the patients, followed by high income class (29%) and remaining were lower middle class (18%), and low income class (6%).

PASI scoreIndicatorNumber of PatientsPercentage
<10Mild7626.0
>10Severe2431.0

Table 3: Evaluation the severity of the psoriasis according to Psoriasis Area Severity Index (PASI).

Table 3 demonstrated the psoriasis Area Severity Index (PASI). Score revealed that maximum cases (76.0%) were score <10, 24.0% of patients were score >10.

Figure 2: Clinical impression at presentation.

On clinical evaluation, 24.0% of patients considered as severe psoriasis and remaining 76.0% patients revealed that mild psoriasis.

CRP valueNumber of patientsPercentage
<0.500.0
0.6-3.01616.0
3.1-6.03737.0
6.1-9.02828.0
⋝9.11919.0
Mean ± SD4.2±1.2

Table 4: Assessment of C-reactive protein (CRP) in psoriasis patients.

Table 5 shows the assessment of C-reactive protein (CRP) in psoriasis patients. The CRP was assessed in all patients. Study shows that maximum patients (37.0%) had CRP value 3.1-6.0. The mean CRP value was 4.2±1.2.

CRP valueSeverity of disease according to PASI score
 Mild disease, n = 76Severe disease, n = 24p-value
<0.500

 

 

 

 

 

0.001

0.6-3.016 (21.0)0
3.1-6.034 (44.7)3 (12.5)
6.1-9.020 (26.3)8 (33.3)
>= 9.16 (7.89)13 (54.1)
Mean ± SD0.9± 0.27.5 ± 2.1

Table 5: Evaluation of validity of CRP to predict the severity of psoriasis (n=100).

In this series correlation was done in between severity of psoriasis with CRP value. Out of 24 patients of severe disease, 13(54.1%) cases were >= 9.1 and 8(33.3%) cases was 6.1-9.0 CRP. On the other hand maximum patients [34 (44.7)] of mild cases had CRP 3.1-6.0. The p-value is <0.05. The difference was significant.

Figure 3: Comparison of CRP value with PASI score.

Figure shows the comparison of CRP value with PASI score. CRP was significantly elevated (>6mg/L) in severe psoriatic patients with severe disease (PASI>10) than those with mild disease (PASI<10) The mean CRP values in mid disease (PASI<10) was 0.9 plus/minus 0.2 and in severe cases (PASI>10) was 7.5 plus/minus 2.1 There was a significant difference in CRP values with PASI score. So, CRP shows a significant association with severity of psoriasis.

CRP ValuePASI score
Severe disease (n=24)Mild disease (n=76)
Significant (n=47)21(87.5%)26 (34.2%)
Non-significant (n = 53)3(12.5%)50(65.7%)

Table 6: Distribution of adults’ behavioral characteristics.

True positive (TP) = 21

False positive (FP) = 26

False negative (FN) = 3

True negative (TN) = 50

Among the 24 cases of severe disease, 21(87.5%) has correlates with significant CRP value, but 3(12.5%) cases proven non-significant in CRP findings. Maximum cases 50(65.7%) of mild disease had non-significant CRP. So effectiveness of CRP finding is valuable in diagnosis of psoriasis.

Figure 4: Determination of sensitivity, specificity of CRP.

StatisticValue95% CI
Sensitivity87.50%67.64% to 97.34%
Specificity65.79%54.01% to 76.29%
Positive Predictive Value44.68%36.35% to 53.32%
Negative Predictive Value94.34%85.10% to 97.99%
Accuracy71.00%61.07% to 79.64%

Table 7: Distribution of adults’ behavioral characteristics.

Discussion

This cross sectional observational study was conducted in Department of Dermatology and Venereology, Bangladesh Medical University, Dhaka, for assessment of C reactive protein in psoriasis patients. In this study maximum incidence was seen in the 3rd decade (57.0%), mean age of the patient was 39.42±8.5 years. Out of 100 cases 83% cases were male and 17%were female. Male and female ratio was 4.88:1. Findings consistent with result of previous study. In a study total of hundred patients with chronic plaque psoriasis and an equal number  of age and gender-matched healthy controls were enrolled. The mean age of the patients with psoriasis was 44.71±10.84. Maximum number of patients was in the age group 41-50 years". In another study, out of 25 patients, there were 18 males (72%) and seven females (28%). They were treated by NB-UVB therapy. The ages of these patients ranged from 21 to 67 years, with a mean age of 41.08±14.60 years. In this study Psoriasis Area Severity Index (PASI) score revealed that maximum cases (76.0%) were score <10, 24.0% of patients were score.6 CRP was assessed in all patients. Study shows that maximum patients (37.0%) had CRP value 3.1-6.0. The mean CRP value was 4.2±1.2. On correlation between severity of psoriasis with CRP value revealed that, out of 24 patients of severe disease, 13(54.1%) cases  was 29.1 and 8(33.3% ) cases were 6.1-9.0 CRP. On the other hand maximum patients [34 (44.7)] of mild cases had CRP 3.1-6.0. The p-value is <0.05. The difference was significant. It is evident that psoriasis is associated with the metabolic syndrome or its components such as obesity, insulin resistance, hypertension, and atherogenic dyslipidemia. The association of psoriasis with enhanced atherosclerosis and risk of cardiovascular disease (CVD) may account for higher morbidity and mortality rates in psoriatic patients. The intensity of inflammation and skin changes in psoriasis may not only indicate the severity of psoriasis but also that of other systemic pathologies.7-8. Previous study demonstrated that psoriasis, metabolic syndrome, systemic arterial hypertension and age share the increase in C-reactive protein Another study reported that patients with moderate to severe plaque-type psoriasis had active systemic inflammation, which was demonstrated by increased levels of C-reactive protein. Furthermore, skin disease severity was correlated with C-reactive protein levels. Elevated C-reactive protein levels result from the interaction between pro-inflammatory cytokines, namely IL-6, TNF-alpha and IL-1. The increased magnitude of CRP seems to be related to the extent of tissue injury and inflammation severity in active stage of psoriasis.2-3 Unlike the earlier rejection of CRP as an empirical test because of its perceived lack of specificity, the current stress over CRP is widely characterized by failure to recognize appropriately the nonspecific nature of the acute phase response". The plasma half-life of CRP is constant under all conditions of health and disease, so that the sole determinant of circulating levels of CRP is the synthesis rate, which thus directly reflects the intensity of pathological process stimulating CRP production.20-21 Several studies have investigated the role of CRP in psoriasis. Two studies by Vanizor et al. have shown that patients with psoriasis have significantly high baseline levels of CRP compared with healthy controls (p<0.004 and p<0.001).22 Malbris et al. noted that patients with psoriasis had higher levels of CRP compared with controls, with a positive correlation between CRP and total plasma cholesterol.23 In this study CRP was significantly elevated (>6 mg/L) in severe psoriatic patients with severe disease (PASI>10) than those with mild disease (PASI<10). The mean CRP values in mid disease (PASI <10) was 0.9±0.2 and in severe cases (PASI >10) was 7.5±2.1. There was a significant difference in CRP values with PASI score. So, CRP shows a significant association with severity of psoriasis. C-reactive protein is an inflammatory biomarker and its level increases in the serum of psoriatic patients. Its level is also associated with Psoriasis Area and Severity Index score². In another study, CRP was elevated (>5 mg/L) in 52% of psoriatic patients when compared with 14%  of control population and the difference was statistically highly significant (p value 0.001).1 Similar results were observed by Rocha-Periera et al.24 In a study by Kimbell et al25 CRP levels correlated with the presence and severity of disease, with the lowest levels seen in the control group and progressively higher CRP levels observed in patients with increasing disease severity. Compared with controls, patients with mild and severe psoriasis had significantly higher levels of CRP (mean ± standard deviation; 0.31±0.02 mg/dL vs 0.90±0.27 mg/dL; p<0.001). Further comparison indicated that patients with severe psoriasis had significantly higher levels of CRP than those with only mild disease (mean±standard deviation; 0.63±0.03 mg/dL vs 1.16±0.07 mg/dL; p<0.001). In another study, it was found a significant association between disease severity and elevated CRP levels. Psoriatic patients with severe disease (PASI>10) had significantly higher levels of CRP than those with mild disease (PASI<10) (44% vs 25%) (p value=0.003)11. Thus, these results are consistent with the characterization of psoriasis as an inflammatory response that worsens with increasing disease severity. Several other studies have also reported a correlation between increased levels of CRP and PASI.26-28 Thus, CRP can be considered as a useful marker of disease severity that could be used to monitor the disease course and its treatment.

Conclusion

C-reactive protein (CRP) is an important bio marker of inflammation. Present study concluded that CRP values are known to be elevated in a proportion of patients with psoriasis and are associated with disease severity. CRP estimation is inexpensive, widely available, and can be easily carried out in an outpatient clinical setting. CRP along with PASI could be used as a powerful and sensitive blood marker to evaluate psoriasis disease severity, as it is not based on visual evaluation of the lesions. It can be used to monitor the disease course and treatment.

References

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Dr Chiara Giuseppina Beccaluva

Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.

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Dr Aline Tollet

Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.

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Dr Ravi Shrivastava

Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora

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Dariusz Ziora

Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.

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Dr Jelle Lettinga

Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.

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Dr Walter F Riesen

Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.

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Dr Rakhi Mishra

Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.

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Hala Al Shaikh

Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD

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Dr Eric S Nussbaum

Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.

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Dr Susan Anne Smith

Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.

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Dr Victor Olagundoye

Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.

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Dr Farahnaz Fallahian

Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.

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Dr Susan Anne Smith

Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.

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Dr Oleg Golyanovski

To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina

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Dr Elvira Farina

My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.

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Gertraud Teuchert-Noodt

We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.

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Dr David Vinyes

Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.

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Dr Anyuta Ivanova

I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.

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Dr Farooq Wandroo

"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".

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Dr Shweta Tiwari

To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.

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Dr Tewodros Kassahun Tarekegn

I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.

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Cristina Berriozabal

Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."

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Thomas Urban

I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.

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Zhao Jia

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.

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Luiz Sellmann

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.

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Sonila Qirko

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.

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Lin-Show Chin

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

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Dr Susan Weiner

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!”

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Zsuzsanna Bene

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¨.

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Dr Maria Regina Penchyna Nieto

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.

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Dr Maria Dolores Gomez Barriga

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

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, 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

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

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

“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

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

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.

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S Munshi

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.

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Husain Taha Radhi

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.

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Dr Tong Ming Liu

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.

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Dr Griffith

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.

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Douglas Miyazaki

"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".

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Jesus Simal-Gandara

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!

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Baheci Selen

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.

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Bruno Chauffert

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.

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Dr Suramya Dhamija

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.

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Andreas Filippaios

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.

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Raed Mualem

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.

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Dr Shiming Tang

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.

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Hao Jiang

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.

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Prof Sherif W Mansour

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.

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Bernard Terkimbi Utoo

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.

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Pedro Marques Gomes

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.

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Anthony Kodzo-Grey Venyo

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.

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Katarzyna Byczkowska

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.

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Orlando Villarreal

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.

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Sing-yung Wu

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.

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Layla Shojaie

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.

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Mina Sherif Soliman Georgy

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.

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Ziemlé Clément Méda

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.

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Delcio G Silva Junior

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.

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Virginia E. Koenig