AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2834-5142/013
1 Lecturer – Nephrology - Faculty of Medical Sciences - UNIFACISA – PhD Student - Federal University of Pernambuco – Recife, Pernambuco, Brazil.
2 MD, PhD - Scientific Director – UNIFACISA - Campina Grande - Paraíba - Brazil.
3 Medical Student – UNIFACISA - Campina Grande - Paraíba - Brazil.
4 Nutricionist – Paraíba Endoscopic and Obesity Surgery Institution – ICOEP - Campina Grande - Paraíba - Brazil.
*Corresponding Author: Juliana Amaro Borborema Bezerra, Lecturer – Nephrology - Faculty of Medical Sciences - UNIFACISA. – PhD Student - Federal University of Pernambuco – Recife, Pernambuco, Brazil.
Citation: Borborema Bezerra JA, Carlos T. Brandt., Bezerra Borborema DM, Guilherme de Brito Lira Dal Monte and Florêncio Maciel FAM (2021). Does Bariatric Surgery Improve Kidney Function in obese Patients? A Cohort Study. International Journal of Clinical Nephrology. 3(1); DOI:10.31579/2834-5142/013
Copyright: © 2021 Juliana Amaro Borborema Bezerra. 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: 25 October 2021 | Accepted: 16 November 2021 | Published: 22 November 2021
Keywords: obesity; bariatric surgery; renal function; glomerular filtration rate; cystatin
Introduction: Obesity is a global epidemic that may cause renal dysfunction. Weight loss in the postoperative follow-up of bariatric surgery may improve renal function in these patients. Thus, the purpose of this study was to give insight on the subject using a sensible biomarker: cystatin C.
Materials and methods: This cohort was performed in the Obesity Department from Campina Grande – Paraiba, Brazil. It was recruited 35 obese (25 women and 10 men) who underwent bariatric surgery with follow-up of at least one year. The ages ranged from 24 and 57 years. Those with thyroid disease and with microalbuminuria ≥ 30mg/g were excluded. Serum levels of creatinine and cystatin C were measured, and the glomerular filtration rate (GFR) was estimated using the CKD Epi (Chronic Kidney Disease Epidemiology Collaboration) equation creatinine- cystatin C. The investigation was approved by the Ethics Committee. The sample was of convenience. Quantitative variables were expressed by the mean and standard deviation. Paired tests were used for assessing difference between means. Chi square test and exact Fisher were used for difference among frequencies. p ≤ 0.05 was used for rejecting the null hypothesis.
Results:The most frequent associated morbidities were: sexual dysfunction (n = 17 – 48.5%); hypertension (n =15 – 42.8%); type II diabetes (n =13 – 37.1%); anxiety (n = 14 – 40.0%); and depression (n = 12 – 34.2%). Twenty-three (65.7%) patients underwent sleeve technique and 12 (34.2%) bypass surgery. It was observed a significant reduction in the mean of body mass index (BMI) in the post-operative follow-up – p < 0.0001. The mean concentrations of cystatin C were similar, regarding to pre- and post-operative periods – p = 0.1614. There was a significant improvement of glomerular filtration rates - p= 0.0091. The improvement of renal function was more significant among those who underwent sleeve surgery as compared to bypass - p = 0.0008.
Conclusion: It was observed improvement of the majority of morbidities after bariatric surgery, as well as renal function, in obese individuals. Despite these results, larger and longer-term outcome cohorts are required for better answer of the main purpose of this health issue.
Obesity is an abnormal or excessive fat accumulation that may impair
health. It is most commonly assessed using body mass index (BMI), a simple and quick anthropometric tool that has a low cost. BMI ≥30 kg/m2 is considered obesity [1].
Obesity is a global epidemic, affecting all age, race and ethnic groups. Nowadays, overweight and obesity represent over one third of the planet population [2]. It increases the risk for many chronic diseases, such as diabetes mellitus, cardiovascular diseases, cancers and chronic kidney disease (CKD), which may impair renal function [3-9].
Inflammations, oxidative stress and hyper activation of renin/angiotensin/aldosterone system, besides leptin and adipocin may play an important role in the physiopathology of renal dysfunction in obese patients [10-12]. One can observe increase renal sodium reabsorption, besides the recruitment of functional reserve with glomerular hyper filtration. Obesity can also promote hypo filtration, increasing the risk for CKD [13-17].
Aiming to reduce the risk of obesity and its morbidities, as well as improving life quality of these individuals several clinical and surgical approach have been used including change in life style, drugs and surgical interventions [18]. Bariatric surgery has become the main operative way of controlling the associated morbidities, and an effective method for achieving sustained weight loss, improves blood pressure, reducing hyperglycemia, and even inducing diabetes remission [19-22].
The effect of bariatric surgery regarding the renal function is a subject of intensive research. In some papers [23-27] one can observe, after this operative procedure, improvement of glomerular filtration rate (GFR), reduction of hyper filtration and decrease in the micro albuminuria, preventing the onset of CKD and its progression. But in others, the improvement of kidney function is not well clear [28,29].
The purpose of this study was to evaluate the impact of bariatric surgery on renal function of the patients using a more sensitive biological marker such as cystatin C.
An observational, longitudinal and analytical study (cohort) was performed, in the Obesity Department from Campina Grande – Paraiba, Brazil. The investigation was approved by the Ethics Committee of the Faculty of Medical Sciences - UNIFACISA - Campina Grande – Paraíba, Brazil. All patients who participated in the study signed the informed consent form.
The criteria for performing bariatric surgery followed the recommendation of the National Consensus of Health Institutes with body mass index (BMI) ≥ 40kg/m2 without comorbidities or ≥ 35kg/m2 associated with comorbidities [30]. BMI was obtained by weight, in kilograms, divided by height, by squared meter, and classified according to the protocol established by the World Health Organization (WHO) [31].
The sample was of convenience, being recruited 35 patients who underwent bariatric surgery (12 bypass and 23 sleeve) with follow-up of at least one year, with ages from 24 to 57 years of age. Those with thyroid disease and with microalbuminuria ≥ 30mg/g were excluded to avoid patients with the possibility of already having diabetes mellitus nephropathy and/or systemic arterial hypertension.
The weight was measured using a calibrated digital body scale Tanita BC533®, because it is more resistant, with the patient standing in barefoot, with light clothes, without props. Height was measured by a stadiometer, with the subject standing, barefoot, with heels together, back straight and arms extended at the side of the body.
Blood samples were collected in the morning after a fasting period of at least 12 hours.
The creatinine dosage was performed from the isotope dilution mass spectrometry (IDMS) methodology, according with organizations involved with laboratory quality management programs, for monitoring of total analytical error linked to the method, with a result expressed in mg/dL [32].
The cystatin C was measured by nephelometry and later calibrated to recent cystatin C standardization, with a result expressed in mg/L [33].
The estimated glomerular filtration rate (GFR) was calculated using Nefrocalc 2.0 through the CKD-EPi creatinine- cystatin C equation. After the calculation of the GFR, a correction was made for the corresponding body surface [34]. It was defined normal GFR between 90 and 120 mL/min/1.73 m2, hypo filtration was defined by GFR < 90> 120mL/min/1.73 m2 [23].
The adjustment for body surface was made as follows: [23]
The samples were gathered from the obesity out patient department when they were coming for the preoperative period and at least one-year post-operative follow-up.
The sample was of convenience. Quantitative variables were expressed by the mean and standard deviation. Paired tests were used for assessing difference between means. Chi square test and exact Fisher were used for difference among frequencies. p ≤ 0.05 was used for rejecting the null hypothesis.
Twenty-five women (71.4%) and 10 man (28.5%) were randomly recruited for the research. Among them, 27 (77.1%) were white, four black (11. 4%) and four brown (11.4%). The mean age of them was 41.4 ± 9.7 years ranging from 24.0 to 57.0 years; the median was 42.0 years.
The more frequent associated morbidities were: sexual dysfunction (n = 17 – 48.5%); hypertension (n =15 – 42.8%): type II diabetes (n =13 – 37.1%); anxiety (n = 14 – 40.0%); and depression (n = 12 – 34.2%). Twenty-three (65.7%) patients underwent sleeve technique and 12 (34.2%) to bypass surgery. Table 1.
The mean time of follow-up was 16.2 ± 2.6 months ranging from 12 to 22 months; median 18 months.
It was observed a significant reduction of BMI in the post-operative follow-up (pre-operative: mean 40.3 ± 5.7 versus post-operative: mean 29.5 ± 4.5 – p < 0 xss=removed>
Among the patients with hypertension the majority (12 out of 15 – 80.0%) obtained control without medication and three (20%) required medication for controlling their blood pressure.
Among the diabetic patients, 10 (76.9%) obtained control of this morbidity. However, three (23.1%) remained with the need of medication for control of this morbidity.
Regarding sexual dysfunction, 14 (82.3%) patients obtained improvement of this construct and three (17.6%) remained the same status. Furthermore, eight out of 12 (66.6%) informed better control of depression and five (35.7%) out of 14 decrease their anxiety.
It was observed a significant improvement of glomerular filtration rates of obese patients who underwent bariatric surgery (preoperative 91.9 ± 17.8mL/min/1.73m2 ranging from 50.9 to 132.3 mL/min/1.73 m2- median of 90.8 mL/min/1.73 m2 versus - follow up - 100.5 ± 14.3 mL/min/1.73 m2, ranging from 62.7 to 129.8 mL/min/1.73 m2 - with a median of 100.6 mL/min/1.73 m2 – p = 0.0091). Out of 35 recruited patients, 26 (74.2%) improved GFR, four (11.4%) did not change GFR and five (14.2%) worsened GFR. Figure 1.
The improvement of renal function was more significant among those who underwent sleeve surgery as compared to bypass (22 out of 23 – 95.6% versus 5 out of 12 – 41.6% - p = 0.0008).
Obesity, as human being earth problem, has been continually increasing its prevalence, as well as its associated comorbidities and health care costs. Effective management of obesity and early intervention measures are necessary to overcome this global issue. The responsibility for preventing and managing this global epidemic does not lie solely on an individual, but also on the entire society and the health care systems [2,4].
Multidisciplinary approaches for obesity management and the collaboration among clinical physicians, endocrinologists, nutritional professionals, physiotherapists, psychiatrists, surgeons and nurses need to be improved across the whole globe to tackle this huge health issue, which great affect the life quality [1].
Bariatric surgery remains the best strategy for the management of obesity regarding to effective and sustained weight loss. One can observe, in this study, a significant weight lost after at least one year follow-up of these patients, as indicated in several studies [18-22, 35].
As regard to comorbidities (hypertension and diabetes) one can observe significantly decrease of the prevalence of these diseases after bariatric surgery, similar to most studies [18-22,36]. Similarly, there was improvement of sexual dysfunction, especially among those who could control anxiety and depression [37].
Cystatin C has been used as biological marker for renal function due to its high sensitivity and specificity and it is not influenced by weight loss [23, 38-40], reasoning because it was used for assessing renal function after bariatric surgery in obese patients in the present study. Hyperthyroidism has been shown to increase and hypothyroidism to decrease cystatin C serum concentrations, reasoning because thyroid disease was excluded [41].
Cystatin C has been used, successfully, for assessing renal function in child and adolescents obese. However, there was no difference between this metabolic parameter, when compared obese and non-obese individuals [42].
Studies have pointed the improvement of renal function after bariatric surgery, either with increased glomerular filtration rate in patients with chronic kidney disease, or reduction of hyper filtration in patients with no evidence of kidney disease. In this regard, the present results give support to this evidence, which can be summarized in improvement of renal function after bariatric surgery [27, 34, 43-46]
There are also renal risks in bariatric surgery, namely, acute kidney injury, nephrolithiasis, and, in rare cases, oxalate nephropathy, particularly in types of surgery involving higher degrees of malabsorption. Although bariatric surgery may improve long-term kidney outcomes, this potential benefit remains unproved and must be balanced with potential adverse events [47]
Renal function improvement was more evident among the patients who underwent sleeve technique. However, whether any kind of bariatric surgery delays the deterioration progression of this crucial biological function is still debatable subject. Large randomized prospective studies with a longer follow-up are needed [27].
Recent data, in obese adolescents, indicate that patients who require bariatric surgery may need a more personal technique as part of medicine precision for protecting kidney function, especially when long term outcome is anticipated. Furthermore, future non-surgical interventions therapies may mitigate the morbidities associated with obesity [25].
First, the sample size is too small for definitive evidence on this important question. Second, the follow-up time could not be sufficient for assessing renal function after bariatric surgery in obese patients. On the other hand, cystatin C has been used for assessing renal function in children and adolescents, but not in adults as it is in this investigation. Even though, the study has made a contribution for this challenging and unsolved question–Does bariatric surgery improve kidney function?
Significant improvement of glomerular filtration rate was observed, when compared the pre- and post-bariatric surgery periods, corroborating other studies that came to the same results. Furthermore, this outcome is more evident among patients who underwent sleeve technique. Further larger and longer post-operative follow-up cohorts are required for better answer of the main purpose of this health issue.
BMI: body mass index; GFR: glomerular filtration rate; CKD: chronic kidney disease; CKD-EPi: Chronic Kidney Disease Epidemiology collaboration; WHO: World Health Organization; IDMS: isotope dilution mass spectrometry; BSA: body superficial area; mGFR: measured glomerular filtration rate; eGFR: estimated glomerular filtration rate.
Ethics approval and consent to participate
The Institutional Ethical Committee of Faculty of Medicine –Campina Grande – Paraiba, Brazil approved the research under the number- 79501417.0.0000.5175.
Consent for publication
Not applicable.
Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Competing interests
The authors declare that they have no competing interests
Funding
The first author funded the research.
Authors' contributions
Bezerra JAB: collected the data, contributed in interpretation of data and prepared the manuscript.
Brandt CT: contributed in interpretation of data and made the final revision.
Borborema DMB: collected the data.
Dal Monte GBL: collected the data.
Maciel FAMF: contributed in interpretation of data.
Acknowledgements
Not applicable.
Authors' information
This manuscript is part of an ongoing thesis for obtained the PhD in surgery, from the Federal University of Pernambuco.
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.
