Research Article | DOI: https://doi.org/10.31579/2690-4861/1136
1Teaching Hospital, Kurunegala, North-Western Province, Sri Lanka. ORCID ID-0009-0007-9934-0353
2Faculty of Medicine, University of Colombo, Sri Lanka. ORCID ID-0009-0005-7272-7625
3Teaching Hospital, Kurunegala, North-Western Province, Sri Lanka.
4Undergraduate, RMIT Royal Melbourne University of Technology.
*Corresponding Author: Kulathunga. K. M. C. N, Teaching Hospital, Kurunegala, North-Western Province, Sri Lanka. Email: chandananishantha.kulathunga@yahoo.com
Citation: Kulathunga. K. M. C. N, Mapalagama Y.A, D. G. N.I. Karunarathna, K.M.T.K. Kulathunga, (2026), A Cross-sectional Study of Silicosis and assessment of spirometry among workers of a Silica processing factory in Kurunegala, Sri Lanka, International Journal of Clinical Case Reports and Reviews, 36(3); DOI:10.31579/2690-4861/1136.
Copyright: © 2026, Kulathunga. K. M. C. N. 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: 12 June 2026 | Accepted: 19 June 2026 | Published: 26 June 2026
Keywords: silicosis: spirometry; progressive massive fibrosis; pneumoconiosis; silica; surveillance; small airway disease
Objectives: A cross-sectional epidemiological study was carried out in February 2025 in a silica processing factory in Kurunegala to study silica dust related lung complications.
Method: All 18 factory workers were studied. An examiner-introduced questionnaire was used. Chest X-rays and Spirometry was assessed.
Results: 5 were diagnosed with silicosis; among them, 3 presented with the accelerated form, 2 with the chronic form of the disease. 66% of the workers with accelerated form of silicosis had a history of two years of exposure. Three workers without silicosis showed probable spirometry evidence of small airway dysfunction.
Conclusions: Exposure to excessive levels of silica dust can result accelerated silicosis after short periods of time. Chest X-rays are essential during the screening of silica related industrial workers. Respiratory function testing should be conducted in accordingly to detect pneumoconiosis early.
Learning Outcomes
1.To screen the workers for silicosis.
2.Assessment of spirometry.
3.Screen for respiratory symptoms.
4.Assess for small airway dysfunction.
Occupational lung diseases or work-related lung conditions are caused or aggravated by the inhalation of irritants in the workplace [1]. There are surveillance gaps and diagnostic limitations to Occupational lung diseases in resource poor countries. Workplace based and systematic studies on occupational lung diseases including silicosis are scarce in Sri Lanka.
Silicosis is an occupational lung disease, a type of pneumoconiosis due to inhalation of crystalline silica dust [1,2]. Silicosis is of three common types: acute, accelerated and chronic. The usual form, chronic Silicosis is characteristically demonstrated after high level of chronic exposure to crystalline silica, usually over a decade. Chronic Silicosis is asymptomatic and radiography should be demonstrated for diagnosis. Chest radiographs should characteristically reveal nodular lesions located at the upper lobes [2]. Patients with Complicated silicosis are symptomatic and they commonly present with chronic cough and difficulty in breathing. Complicated silicosis is a variant of chronic silicosis [1,2]. Exposure to silica dust over a shorter period could potentially result in the development of accelerated silicosis, a complicated form of silicosis, which develops 5 to 10 years after significant exposure to crystalline silica dust [1,2]. These patients are symptomatic.
Work related interstitial lung disease is an important issue concerning public health, that can potentially be prevented by implementing specific measures. The periodic surveillance of workers exposed to potentially hazardous agents is required to detect adverse respiratory conditions at their early stages.
The present Sri Lankan supply of silica constitutes mostly of crushed and pulverized silica products. The process of production of silica from quartz requires washing, crushing and sieving, a high dust generating mechanical procedure, consequently increasing exposure risk.
In addition, non- occupational exposure to silica dust can occur around industrial sites (quartz crushing, agate grinding, ceramics, use of slate pencils, mining and milling of sand stones, silica flour milling) or from naturally occurring sources such as desert dust or sand. Common occupations which result in silica exposure in Sri Lanka include quartz processing factories, quarrying, tile industry and sandblasting.
Recent evidence shows that the exposure to particulate matter of size less than or equal to 2.5 µm (PM 2.5) is a risk factor for small airway dysfunction (SAD) and the development of chronic obstructive pulmonary disease (COPD). Early changes caused by inhalation of particulate matter and ultra fine particles initiates inflammation in distal and small airways. The interest to utilize spirometry for the assessment and treatment of small airway dysfunction (SAD) and pre-clinical obstructive airway disease, has therefore surged in recent years [4,5].
The objective of this study was to evaluate silicosis and respiratory impairment using radiological and spirometry assessment among workers in a silica processing factory in Kurunegala, Sri Lanka.
Study design and study site
A cross-sectional study was carried out in February 2025 in a silica processing factory in Kurunegala, Sri Lanka
Study population
The entire workforce employed at the time of the study were enrolled. Three main exposure categories were identified based on job tasks. Individuals who worked in the kitchen had mild exposure. The workers involved in grinding of quartz and sieving were identified as having severe exposure due to dust generating activity. No quantitative air sampling was performed and the above levels were identified according to the job task, proximity to the dust generating process and nature of tasks. The workers who had moderate exposure, engaged in washing of quartz.
Sample size
The study population consisted of all workers employed. The total workforce comprised of 18 workers and no sampling was undertaken. Therefore, no formal sample size calculation was performed.
Inclusion and exclusion criteria
All workers employed at the silica processing factory at the time of the study were and occupationally exposed to silica dust were eligible for inclusion. All workers provided voluntary informed consent and were enrolled in the study. Workers with acute respiratory infection and at the time of the assessment or unable to perform acceptable reproducible spirometry despite repeat attempts were planned to be excluded the spirometry analysis. No workers were to be excluded based on smoking or presence of respiratory symptoms. No workers met these exclusion criteria, so all workers were enrolled in the study.
Ethical clearance was taken from Ethics Review Committee - Department of Health Services, Provincial Council of the North western Province, Sri Lanka.
Data was collected at the workplace using a structured interviewer administered questionnaire. Demographic characteristics, occupational history, job tasks type of exposure, duration of occupational exposure to silica dust respiratory symptoms and smoking status were assessed. Exposure categories were assigned to the workers based on the job roles and nature of work performed. Occupational exposure to silica dust was qualitatively categorized as mild, moderate, or severe based on job task, proximity to dust-generating processes, and duration of time spent in each task. Exposure classification was performed by the study investigators following workplace walkthrough observation and review of job descriptions. Workers involved in crushing, sieving, and belt operations were categorized as having severe exposure; workers engaged in washing of quartz were categorized as having moderate exposure; and workers performing kitchen or administrative tasks were categorized as having mild exposure. Quantitative environmental dust measurements, personal air sampling, and crystalline silica concentration analysis were not performed. Use of personal protective equipment and ventilation characteristics were recorded but not objectively measured.
All participants underwent standardized clinical assessment followed by spirometry and chest radiography as a part of the study protocol. Silicosis was diagnosed based on two key factors, history of the participant being exposed to occupational silica dust and having radiological digital chest X-ray findings or HRCT findings consistent with silicosis. Spirometry was performed in all participants using a calibrated spirometer MIR SPIROLAB-iii, according to the standardized guidelines of the American Thoracic Society (ATS). Measurements included forced vital capacity (FVC), forced expiratory volume in one second (FEV1), the FEV1/FVC ratio, and forced expiratory flow between 25% and 75% of vital capacity (FEF25–75). Participants performed a minimum of three acceptable forced expiratory maneuvers, and the best values were selected according to ATS acceptability and repeatability criteria. Tests that did not meet quality criteria were repeated until acceptable and reproducible results were obtained.
Participants who failed to perform the initial spirometry test or could not produce reliable results, were re-scheduled for other examinations in one-week intervals until reliable results were obtained to achieve the acceptability and repeatability criteria for spirometry [6].
Chest Radiography was performed in all participants and radiological changes were graded using International Labour Organization (ILO) Classification of Radiographs and pneumoconiosis. Participants suspected of accelerated silicosis based on chest radiography underwent further evaluation with high resolution computer tomography (HRCT). Participants who had radiological evidence of silicosis underwent bronchoscopy to exclude infections, including Pulmonary Tuberculosis. All Radiographs were reviewed by a trained Respiratory Physician with experience in occupational lung disease, independent of spirometry findings and clinical symptom status based on Standardized ILO Criteria. SAD was defined as maximum mid-expiratory flow (MMEF) < 65>
Data collected from the questionnaire were entered into Microsoft Excel and cross checked for accuracy. Analysis was performed using Statistical Package for Social Sciences (SPSS) software version 31.0.2.0. Descriptive statistics were used to summarize participant characteristics, exposure categories, radiological findings, and spirometry patterns. Categorical variables were presented as frequencies and percentages.
The study population in the silica factory comprised of 18 participants with median age of 49 years and 44.4% of them were between the age of 50-60years.Twelve participants (66.7%) were male.
Demographics of the study population.
Tablie1.
Past history of respiratory diseases.
Table 2.
15 participants (83.3%) reported no prior respiratory diseases and three workers (16.7%) were diagnosed of Asthma by physicians prior to starting employment at this workplace. No participants reported chronic obstructive pulmonary disease, Bronchiectasis, interstitial lung disease, or lung malignancy.
Table 3 Smoking status of the Sample.
Nine workers (50%) were current smokers; all were male and exclusively cigarette smokers. Among smokers, 77.8%) reported smoking one cigarette per day and two (22.2%) reported smoking three cigarettes per day.
Exposure to indoor air pollutants.
Fifteen workers, 83.3%, used a cook stove or hearth for domestic cooking and used firewood as the main source of fuel. Among them eleven workers (73.3%) had installed their cooking stove or hearth inside the house. Additional fuels were kerosene oil (11.1%, n=2) and plastic (5.6%, n=1).
Table 4 Exposure to indoor air pollutants.
Table 5 Type of occupational category.
Half of the workers (n=9,50%) had severe exposure, 33.33% (n=6) moderate and 16.67% (n=3) had low exposure.
Workers were categorized into three exposure levels based on job tasks and proximity to dust-generating processes. Severe exposure was identified in nine workers (50.0%) who were involved in crushing, sieving, and belt operations. Moderate exposure was identified in six workers (33.3%) engaged in quartz washing. Mild exposure was identified in three workers (16.7%) performing administrative or driving duties. All workers diagnosed with silicosis belonged to moderate or severe exposure categories.
Prevalence of Respiratory symptoms in silica factory workers.
Table5 Respiratory symptoms among employees.
Most workers were asymptomatic at the time of assessment (77.7%, n=14). Respiratory symptoms were reported in two workers. Cough and shortness of breath were reported by two workers (11.1%), itchy eyes by one worker (5.6%), and headache by one worker (5.6%).
Spirometry findings.
Spirometry was successfully performed in all participants. Restrictive ventilatory defects were identified in five workers (27.8%), and all of these workers had radiological evidence consistent with silicosis. Small airway dysfunction was identified in three workers (16.7%) without radiological evidence of silicosis.
Table 6- Spirometry readings.
Table 7 Small air way dysfunction.
Radiological Findings.
Table- 8. International Labour Organization- ILO Classification of chest x-ray.
Five workers (27.8%) had chest radiographic findings consistent with pneumoconiosis based on the International Labour Organization classification. Among these workers, three (16.7%) were consistent with accelerated silicosis, two (11.1%) with chronic silicosis, and one (5.6%) had progressive massive fibrosis. Radiological patterns included nodular opacities in two workers, fibrotic nodular disease in two workers, and progressive massive fibrosis in one worker.
Figure 8, HRCT-chest abnormality.
2 (11.11%) workers had nodular opacities, 2 (11.11%) symptomatic patients had nodules and fibrosis and one (5.56%) patient had radiological evidence of progressive massive fibrosis.
Type of Silicosis according to the working area.
Exposure duration among workers with silicosis.
Duration of occupational exposure among workers diagnosed with silicosis ranged from 1 to 12 years. Three workers developed silicosis within two years of occupational exposure. One worker developed progressive massive fibrosis after two years of exposure. All affected workers were employed in moderate to severe-exposure job roles.
| Variable | Number of workers | Percentage % |
| Age Category | ||
| 30-40 | 5 | 27.8 |
| 40-50 | 5 | 27.8 |
| 50-60 | 8 | 44.4 |
| Gender | ||
| Female | 6 | 33.33 |
| Male | 12 | 66.67 |
Table 1: Distribution of socio-demographic characteristics.
| Variable | Number of workers | Percentage % |
| None | 15 | 83.3 |
| Asthma | 3 | 16.7 |
| COPD | 0 | 0 |
| Bronchiectasis | 0 | 0 |
| ILD | 0 | 0 |
| Lung Cancer | 0 | 0 |
Table 2: Past history of respiratory diseases.
| Variable | Number of workers | Percentage % |
| Smoking status | ||
| No | 9 | 50 |
| Yes | 9 | 50 |
| No. of Cigarette / Day | ||
| 1 | 7 | 77.8 |
| 3 | 2 | 22.2 |
Table 3: Smoking status of the Sample.
| Variable | Number of workers | Percentage % |
| Usage of Cook stoves or hearth for cooking | ||
| No | 3 | 16.7 |
| Yes | 15 | 83.3 |
| Location of Cook stoves or hearth | ||
| Inside the house | 11 | 73.33 |
| Outside the house | 4 | 26.67 |
| Energy source used for the cook stoves/hearth | ||
| Firewood | 15 | 83.33 |
| Kerosene oils | 2 | 11.11 |
| Dung | 0 | 0.00 |
| Wood dust | 0 | 0.00 |
| Plastic | 1 | 5.56 |
| Other indoor exposures | ||
| Mosquito coils | 6 | 33.33 |
| Incense Sticks | 11 | 61.11 |
| Fragrance smoke | 0 | 0.00 |
Table 4: Exposure to indoor air pollutants.
| Task | Number | Percentage |
| Driver | 1 | 5.6% |
| Supervisor | 2 | 11.1% |
| Crushing | 7 | 38.9% |
| washing | 6 | 33.3% |
| Sieving and belt | 2 | 11.1% |
Table 5: Type of occupational category.
| Respiratory symptoms | Number of workers | Percentage % |
| Itchy Eyes | 1 | 5.6 |
| Cough and Shortness of breath | 2 | 11.1 |
| Headache | 1 | 5.6 |
| Wheezing | 0 | 5.6 |
| None | 14 | 72.2 |
Table 6: Respiratory symptoms among employees.
Table 7: Spirometry readings
| Small air way disfunction | Number of workers | Percentage % |
| Present | 3 | 16.66 |
| Absent | 15 | 83.33 |
Table 8: Small air way dysfunction.
Table 9: International Labour Organisation- ILO Classification of chest x-ray3.
| Abnormality detected | Number of workers | Percentage % |
| Nodular opacities only | 2 | 11.11 |
| Fibrosis with nodules | 2 | 11.11 |
| Progressive massive fibrosis | 1 | 5.56 |
| Total | 5 | 27.78 |
Table 10: HRCT -chest findings.
| ID | Type of Silicosis | Type of Exposure | Duration of exposure-Years |
| 1 | Progressive massive fibrosis | Belt | 2 |
| 2 | Fibrosis with nodules | Crushing | 2 |
| 3 | Fibrosis with nodules | Crushing | 12 |
| 4 | Nodular opacities only | Supervisor | 7 |
| 5 | Nodular opacities only | Crushing | 1 |
Table 11: Type of Silicosis according to the working area.
This study identified a high prevalence of silicosis (27.8%) among workers in a silica processing factory in Sri Lanka. Notably, several workers developed silicosis after relatively short exposure durations of less than two years, and one worker developed progressive massive fibrosis. Most affected workers were asymptomatic at the time of assessment, and all demonstrated restrictive ventilatory defects on spirometry. These findings indicate substantial occupational exposure and early disease development in this workforce.
The prevalence observed in this study is consistent with findings reported in other silica-exposed occupational settings globally, where silicosis prevalence varies depending on exposure intensity, industrial processes, and workplace protective measures. Accelerated silicosis has increasingly been reported in workers exposed to high concentrations of respirable crystalline silica, particularly in industries involving crushing and processing of quartz. The early onset of disease observed in this study supports existing evidence that high-intensity exposure may lead to rapid disease progression.
All workers diagnosed with silicosis were employed in tasks that involve significant generation of respirable silica dust, increasing the risk of inhalation. Personal protective equipment use was limited and primarily consisted of surgical masks, which provide inadequate protection against respirable crystalline silica. These workplace factors may have contributed to the development of silicosis and the occurrence of accelerated forms of the disease in this population.
Most workers diagnosed with silicosis were asymptomatic, highlighting the importance of radiological screening for early detection. Silicosis may remain clinically silent in its early stages, and reliance on symptom-based detection alone may result in underdiagnosis. The restrictive ventilatory defects observed in affected workers are consistent with fibrotic lung disease and reflect physiological impairment associated with silica exposure.
Small airway dysfunction was identified in three asymptomatic workers without radiological evidence of silicosis, suggesting early physiological effects of occupational exposure. Occupational exposure to respirable particulate matter, including crystalline silica, has been associated with early airway dysfunction and may precede overt radiological abnormalities. These findings highlight the importance of periodic lung function monitoring in silica-exposed workers to detect early functional changes.
Smoking and exposure to biomass fuel were assessed as potential confounding factors. Although half of the workers were current smokers, smoking intensity was low, and most workers had no prior respiratory disease. These factors suggest that occupational silica exposure was the primary contributor to the observed radiological and spirometry abnormalities.
A previous Sri Lankan study conducted among 250 silica-exposed workers reported a prevalence of silicosis of 5.6%, with most cases demonstrating features of accelerated silicosis and one case of progressive massive fibrosis10. In contrast, the prevalence observed in the present study was substantially higher at 27.8%. This difference may be partly explained by methodological differences, as the previous study screened only symptomatic workers, potentially underestimating the true burden of disease. In the current study, all workers underwent radiological assessment irrespective of symptom status, enabling detection of asymptomatic cases.
Notably, both studies demonstrate a predominance of accelerated silicosis, suggesting high levels of occupational exposure in silica processing industries in Sri Lanka. However, the present study identified cases of silicosis, including progressive massive fibrosis, occurring after relatively short exposure durations of two years or less, which is shorter than that reported in the earlier study. This finding raises concern regarding the intensity of exposure and possible inadequacies in workplace control measures in the studied setting.
In contrast to findings from large-scale studies in other occupational settings, a study conducted among over 14,000 gold miners in South Africa reported a silicosis prevalence of 3.8%, with the majority of affected workers having more than 15 years of exposure11. Although this population differs from silica processing workers in terms of work environment and exposure characteristics, the findings highlight the typical long latency of silicosis in settings with regulated occupational exposure.
Compared to this, the present study demonstrated a markedly higher prevalence of silicosis and a significantly shorter duration of exposure among affected workers, with cases identified within two years of employment. This suggests that workers in silica processing industries may be exposed to higher concentrations of respirable crystalline silica, particularly in the absence of adequate dust control measures. The occurrence of silicosis over such short exposure durations in the present study contrasts with the predominantly long-latency disease observed in gold mining cohorts, emphasizing the potential role of exposure intensity in accelerating disease onset.
This study has several strengths. All workers employed at the factory were included, minimizing selection bias within the workplace. Comprehensive assessment using radiography and spirometry enabled detection of both structural and functional abnormalities. Exposure classification was based on direct workplace assessment and job tasks, allowing appropriate identification of high-risk exposure groups.
This study also has limitations. The small sample size limits generalizability of the findings. Quantitative environmental dust measurements were not performed, preventing precise exposure quantification. The cross-sectional design limits assessment of temporal relationships and disease progression. Additionally, the study was conducted at a single workplace and may not represent all silica processing environments. These findings highlight the importance of occupational health surveillance in silica-exposed workers. Early detection through radiological and spirometry screening may facilitate identification of disease before symptom onset. Effective workplace exposure control measures and appropriate respiratory protective equipment are essential to reduce disease risk.
1. All sources of support relevant to publication- None.
2. Specific Author Contributions of every Author.
KMCNK- Conception and design, Interpretation of Spirometry and imaging, Analysis and interpretation of results, Manuscript writing, study supervision, critical manuscript review.
YAM-Analysis and interpretation, Manuscript writing, critical revision of manuscript.
DGNIK- Data acquisition and collection, data management, manuscript review.
MAIP-Data acquisition and collection, data management, manuscript review.
KMTKK- Data management, spirometry and equipment calibration, manuscript review.
3. Data Availability
The data that support the findings of this study are not publicly available due to confidentiality and ethical restrictions but are available from the corresponding author upon reasonable request.
4. EQUATOR Network checklist- Not applicable.
5. Author(s) thesis information -Not applicable.
6. AI detailed, manuscript preparation etc.
Artificial intelligence tools (ChatGPT, OpenAI, Grammarly) were used to assist with language refinement and editing of the manuscript. The authors reviewed and verified all content and take full responsibility for the accuracy and integrity of the work. No AI was utilized at any stage during research development & design, data collection, clinical or radiographical interpretation, data analysis or result interpretation.
7.Ethical Considerations & Disclosure(s) (e.g. IRB Information, consent process, if applicable).
Ethical approval was obtained from the Ethical Review Committee of the Department of Health Services, Provincial Council of North Western Province, Sri Lanka on the 25th March 2025, valid through 25th March 2026 under application number ERC/NWP/2024/24. Informed voluntary consent was obtained from all participants. The study did not deviate from the protocol permitted by the Ethical Review committee.
Funding Sources for All Authors -Non-Declared.
Conflict of Interest for All Authors - Non-Declared.
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Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
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.
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.
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
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
"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".
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.
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.
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."
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.
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.
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 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.
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
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!”
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, 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.
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.
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, 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.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
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.
“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”.
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.
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.
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 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.
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 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 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 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!
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.
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.
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.
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 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.
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.
