AUCTORES
Globalize your Research
Review Article | DOI: https://doi.org/10.31579/2688-7517/200
Department of Advanced Science and Technology, National Institute of Medical Science and Research, NIMS University Rajasthan, Jaipur, Rajasthan 303121, India; Former Department of College Education, Government of Rajasthan, Jaipur. Rajasthan 302015, India.
*Corresponding Author: Shanti Lal Choubisa, Deprtment of Advanced Science and Technology, National Institute of Medical Science and Research, NIMS University Rajasthan, Jaipur, Rajasthan 303121, India.
Citation: Shanti L. Choubisa, (2024), A brief review of fluoride-induced bone disease skeletal fluorosis in humans and its prevention, J. Pharmaceutics and Pharmacology Research, 7(8); DOI:10.31579/2688-7517/200
Copyright: © 2024, Shanti Lal Choubisa. 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: 12 June 2024 | Accepted: 26 June 2024 | Published: 18 July 2024
Keywords: airborne fluoride; bio-accumulation; bone deformities; denat fluorosis; drinking water; fluoride; industrial fluoride pollution, fluorosis; skeletal fluorosis; prevention
Fluorosis disease is common in areas where people drink water containing fluoride (>1.0 ppm or 1.5 ppm) and/or are exposed to airborne fluoride or other sources of fluoride over a long period of time. In this disease, primarily the teeth and bones are affected to varying degrees depending on the level of fluoride and the duration and frequency of exposure. In general, fluorosis appears mainly in two forms, dental and skeletal fluorosis. The latter is extremely painful and irreversible. Actually, skeletal fluorosis is a bone disease caused by excessive accumulation of fluoride which weakens the bones. In advanced state, skeletal fluorosis causes varying degree of damage to the bones and joints depending on the fluoride concentration and its duration of exposure. In fact, in this disease the bones become harder and less flexible, resulting in increased frequency of fractures. Thickening of the bone structure and accumulation of bone tissue, both of which contribute to decreased joint mobility. Ligaments and cartilage can also be ossified in this disease. Skeletal fluorosis is extremely important as it reduces mobility at a very young age due to progressive changes in bones such as periosteal exostosis, osteosclerosis, osteoporosis and osteophytosis. These changes manifest clinically as vague pains in the body and joints. Excessive accumulation of fluoride in muscles also reduces mobility and this condition leads to disability or disfigurement. In severe cases, neurological complications (paraplegia and quadriplegia) and deformities of the limbs, such as bowing of legs at the knee outward (genu-varum) and inward (genu-valgum), also occur. Once skeletal fluorosis develops in humans it persists for life. In the present brief review, the focus is on the origin of skeletal fluorosis and ways to prevent it in humans. The aim of this review is to create awareness about this disease among people living in fluoride-affected areas.
It is well known that fluoride is universally present in water, soil, air, and food at varying levels. This may be due to geological processes and/or anthropogenic or industrial activities. Fluoride intake has both beneficial and negative effects on humans depending on the concentration of fluoride. Intake of fluoridated water in the range of 0.5 to 1.0 ppm is beneficial and reduces the incidence and possibility of dental caries [1,2], but excessive intake through drinking water containing fluoride beyond the recommended or standard value of 1.0 ppm or 1.5 ppm leads to the dangerous and extremely painful fluorosis disease [3-5]. Globally, water-borne fluorosis also known as “hydrofluorosis” is the most common and widespread disease in humans [3]. But “industrial fluorosis” is limited to specific areas or regions due to exposure to fluoride emitted from various industrial activities, such as such as power generating stations and the manufacturing of steel, iron, aluminum, zinc, phosphorus, chemical fertilizers, bricks, cement, hydrofluoric acid, etc. These are generally discharging fluoride into their surrounding areas which create industrial fluoride pollution. [6,7]. An industrially emitted fluoride not only contaminates the surrounding environment including soil, air, and fresh water reservoirs, but also contaminates vegetation, agricultural crops and many other biological communities on which man and animals generally survive. Fluoride-induced fluorosis disease occurs not only in humans [8–22] but also in herbivorous wild [23–29] and domestic animals [30–56] if they are exposed regularly to fluoride for long periods of time.
Once fluoride enters the body it is absorbed by the digestive and/or respiratory tract and then eventually reaches all parts of the body through the blood. More than 50% of the absorbed fluoride is excreted through feces, urine, and sweat, while the rest is retained in the body where it is deposited in various organs. However, its maximum accumulation is occurred in calcified organs, bones and teeth compared to non-calcified organs. This bio-accumulation of fluoride causes diverse toxic effects or pathological changes in all kinds of hard and soft tissues and also interference with various physiological and metabolic processes and ultimately triggers the occurrence of adverse reversible and non-reversible health effects in people of all age groups. These fluoride-induced pathological or health changes are collectively called fluorosis [3-5]. Various fluoride- induced anomalies or deformities in teeth and bones are permanent, irreversible and not curable and can be easily observed. However, other fluoride-induced changes in soft tissues or organs are mostly reversible and disappear when the source of fluoride exposure is removed.
Chronic fluoride exposure through ingestion of drinking water containing high fluoride levels (>1.0 or 1.5 ppm) can lead to three forms of fluorosis namely dental fluorosis (dental mottling), skeletal fluorosis (bone deformities), and non-skeletal fluorosis [57,58]. But it is not necessary that all these three forms exist in the same person. However, among the various forms of fluorosis, skeletal fluorosis is a relatively more dangerous and highly painful bone disease in both man and animals [57,58].
Skeletal fluorosis
Excessive fluoride intake or fluoride bio-accumulation alters the balance between bone formation and resorption. This physiological process is accomplished with the participation of certain regulatory determinants and signaling pathways, leading to various bone malformations (lesions) known as skeletal fluorosis. This disease is also known as fluoride-induced bone disease in both humans and animals. The severity of skeletal fluorosis and the different clinical stages depend on the amount of fluoride accumulation in bones (mg F/kg). At bone ash fluoride concentrations of 500 to 1,000 mg F/kg, there will be no bone changes. The different clinical stages of skeletal fluorosis and the development of various symptoms and signs in different ranges of bone ash fluoride concentrations are shown in Table 1
| Osteosclerotic phase | Bone ash fluoride concentration (mgF/kg) | Symptoms and signs |
| Normal Bone | 500 to 1,000 | Normal |
| Preclinical Phase | 3,500 to 5,500 | Asymptomatic; slight radiographically-detectable increases in bone mass |
| Clinical Phase I | 6,000 to 7,000 | Sporadic pain; stiffness of joints; osteosclerosis of pelvis and vertebral column |
| Clinical Phase Il | 7,500 to 9,000 | Chronic joint pain; arthritic symptoms; slight calcification of ligaments; increased osteosclerosis and cancellous bones; with/without osteoporosis of long bones |
Clinical Phase Ill |
8,400 | Limitation of joint movement; calcification of ligaments of neck vertebral column; crippling deformities of the spine and major joints; muscle wasting; neurological defects/compression of spinal cord |
Table 1. Various clinical phases and symptoms and signs of skeletal fluorosis at different range of bone ash fluoride concentration. Source: [59]
[59]. This entity of chronic fluoride intoxication or skeletal fluorosis is very painful and more dangerous than other forms of fluorosis (dental and non-skeletal fluorosis) and is extremely important as it reduces mobility at a very young age. The most common fluoride-induced changes that develop slowly in bones are periosteal exostosis, osteoporosis, osteoporosis and osteophytosis. These bony changes can be seen in radiographs of various bones (Figure 1)
Figure 1. Radiographs of different bones of subjects, afflicted with skeletal fluorosis. Cervical and dorsal spines showing extreme osteosclerosis, lipping and osteophytosis (a, e); osteosclerosis of the pelvis with calcification of ligaments (e); contrast of the osteosclerosis in bony cage with radiolucent lungs and clavicular involvement (b); calcification of interosseous membrane (arrow) between radius and ulna bones of forearm (c); bony exostosis in tibia (d). The calcification of interosseous membrane (arrow) is the most ideal and confirmative indication of skeletal fluorosis.
[60-62]. Skeletal fluorosis can be diagnosed and confirmed based on radiographs. The severity of skeletal fluorosis can also be interpreted or determined based on radiological findings. These bone changes manifest clinically as vague pain in the body and joints. Excessive accumulation of fluoride in muscles also reduces mobility and this condition causes disability or disfigurement (Figure 2).
Figure 2. Subjects afflicted with severe skeletal fluorosis characterised with invalidism, kyphosis, genu-varum (a, b, d, e) and genu-valgum (c)syndromes, crippling with paraplegia and quadriplegia (a, d), and crossing or scissor-shaped legs (e).
In its advanced stages, neurological complications like paraplegia and quadriplegia and genu-varum (outward bending of legs at the knee) and genu-valgum (inward bending of legs at the knee) syndromes also result from long term fluoride exposure and is the worst form of skeletal fluorosis.
These bone changes or skeletal fluorosis caused by fluoride can occur in people of any age. However, children are more susceptible to the changes in various bones of the skeleton. Interestingly, all these bone deformities or changes in humans persist throughout their lifetime and cannot be cured by any treatment. The most negative aspect of skeletal fluorosis is that many people suffering from skeletal fluorosis in rural areas are unable to perform daily tasks and have a high rate of bone fractures. Women may also face problems in delivery due to skeletal fluorosis. However, the severity of skeletal fluorosis depends not only on the fluoride concentration and the duration and frequency of exposure but also on age, sex, food, nutrients, chemicals in water, physical function, individual fluoride sensitivity or tolerance and genetics, environmental factors, etc. [63-73].
How to prevent skeletal fluorosis
It is well documented that all types of fluoride-induced bone deformities, such as disability, neurological complications (paraplegia and quadriplegia), limb deformities (genu-varum and genu-valgum syndromes), etc. are irreversible and cannot be cured. But their further progression or severity in people can be prevented or controlled by adopting and implementing the following potentially effective and feasible methods: (a) regular supply or provision of fluoride-free treated drinking water, (b) control of fluoride entry into the body from various potential sources such as fluoridated water, air-borne fluoride (industrial fluoride emission), and various food items such as alcohol, tea, rock salt, tobacco, and betel nut which naturally contain high amount of fluoride, (c) provide nutritious foods containing adequate amount of calcium, vitamin C, vitamin E nutrients and antioxidants, and (d) disseminate current knowledge about various causes and severity of the dreaded skeletal fluorosis disease and create general awareness among people living in fluoride endemic areas regarding preventive measures of fluoride poisoning with the help of well-trained volunteers, students, and teachers [3].
It is well known fact that expectant and lactating mothers are most vulnerable groups for chronic fluoride poisoning. Therefore, these mothers should only consume fluoride- free water. It is well known that fluoride is also potential to cross the placenta barrier and enter in fetus where it can affect the developing fetus. To avoid fluorosis, as far as possible, only fluoride-free water should be used for drinking and cooking. If this is not possible, then water from such a source should be used in which the fluoride content is less than 1.0 ppm or 1.5 ppm. But the water in which the fluoride content is more than 1.0 ppm or 1.5 ppm should neither be used for drinking nor for cooking. Otherwise, there is a high possibility of getting fluorosis. For regular supply of fluoride- free drinking water in the community or population inhabiting fluoride endemic areas defluoridation technology can be used or adopted. However, several defluoridation techniques have been developed that are readily available [74,75]. Nevertheless, among these techniques, “Nalgonda Defluoridation Technique” is an ideal technique as it is simple, effective, and low cost which can be used at both household and community levels [76,77].
In fluoride-affected India, where hydrofluorosis is most common and hyperendemic in almost all rural areas, this Nalgonda technique is the most successful and potential in the prevention and control of chronic fluoride poisoning or hydrofluorosis. Although this technique is inexpensive and gives good results but its success rate at the community level is poor due to lack of public participation, lack of responsibility for its supervision and lack of proper monitoring and maintenance [77]. Instead of adopting any defluoridation technique, harvesting and conservation of rainwater is a better option to get low fluoride or fluoride free water on regular basis. Perennial freshwater sources like ponds, rivers, lakes, dams, reservoirs etc. also allow regular supply of fluoride free water to the community as their water contains only small amount of fluoride [3]. But use of groundwater for drinking and cooking in India should be avoided as it is most likely to contain fluoride [44]. However, controlling skeletal fluorosis requires a holistic approach, collective efforts and people’s participation; while monitoring and evaluation of fluorosis control projects also need to be done with sincerity.
Long-term exposure to fluoride or excessive intake of fluoride through drinking water and industrial fluoride emissions causes severe fluorosis disease which can develop in all age groups, children, adolescents, adults and the elderly. Even low levels of fluoride can develop fluorosis in humans. The disease is endemic in many countries, especially in their rural areas. Among the various forms of fluorosis, skeletal fluorosis is the most dangerous and highly painful. Excessive bio-accumulation of fluoride in various bones of the skeleton leads to the development of various deformities or changes in the bone, such as disability, neurological complications, and lower and upper limbs deformities, and these persist for a lifetime and are irreversible or even incurable. This condition is the worst form of skeletal fluorosis. Therefore, the only cure or solution to this dreaded disease in human population is prevention which is possible by regular supply or availability of fluoride-free drinking water, checking the entry of fluoride into the body, providing nutritious food and spreading current knowledge about fluorosis and creating awareness among people about preventive measures. However, controlling fluorosis requires a holistic approach, collective efforts and people’s participation.
Funding sources
There is no funding source for this work.
The author declares no conflict of interest.
The author thanks to Prof. Darshana Choubisa, Department Prosthodontics and Crown & Bridge, Geetanjali Dental and Research Institute, Udaipur, Rajasthan 313002, India and Dr. Pallavi Choubisa, Senior Resident, Department of Gynaecology and Obstetrics, RNT Medical College and Pannadhay Janana Hospital, Udaipur, Rajasthan 313001, India for their cooperation.
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.
