AUCTORES
Globalize your Research
Chat with us
Research Article | DOI: https://doi.org/10.31579/2693-4779/169
1 Department of Internal Medicine, Sudan Medical Specialization Board, Khartoum, Sudan.
2 Department of Obstetrics &Gynecology, Alneelain University, Khartoum, Sudan
3 Department of Obstetrics &Gynecology, Prince Sattam bin Abdulaziz University Saudia Arabia.
4 General Practitioner, Christchurch Medical Centre, Ardington Rd, Northampton NN1 5LT, Abington Park Surgery, United Kingdom.
5 General Practitioner, St Helens and Knowsley Teaching Hospital Lead Employer, United Kingdom.
*Corresponding Author: Awadalla Abdelwahid Suliman, Obstetrician &Gynaecologist Consultant, Head of Department of Obstetrics and Gynecology, Faculty of Medicine, Al Neelain University, Khartoum, Sudan.
Citation: Ahmed Abdelgadir, Awadalla Abdelwahid, Omer Mandar, Khalid Basheer, Abdelgader Suliman, et al, (2023), Frequency and Risk Factors of Persistent Hyperparathyroidism Post Kidney Transplant in Sudanese, Clinical Research and Clinical Trials, 8(1); DOI:10.31579/2693-4779/169
Copyright: © 2023, Awadalla Abdelwahid Suliman. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 03 November 2023 | Accepted: 14 November 2023 | Published: 28 November 2023
Keywords: frequency; risk; factors; persistent; Hyperparathyroidism; post-kidney; transplant
Background: Persistent secondary hyperparathyroidism after renal transplantation is common, and risk factors for post-transplant secondary hyperparathyroidism are pre-transplant levels of PTH and calcium, time spent on dialysis before transplantation, and nodular hyperplasia of the parathyroid glands.
Purpose: This study aimed to determine the frequency and risk factors of persistent hyperparathyroidism one-year post-kidney transplant.
Methodology: Cross-Sectional Hospital-based study was conducted in a period from September 2018 to March 2019 in Ibn Sina Hospital and Ahmed Gasim Hospital and covered 81 study participants.
Results: Pre-kidney transplantation PTH level, (58%) reported mild increase in PTH level, (37.1%) reported moderate increase while only (4.9%) had a severe increase. Post-kidney transplant PTH, (60.5%) reported normal levels of PTH, (34.6%) a mild increase while (4.9%) reported a moderate decrease in PHT.
After three months of PKT, serum calcium was high in (38.3%) and low phosphate (2.5%). After one year of PKT, serum calcium was high in (8.6%) and low phosphate (2.5%). a significant reduction in the PTH after KT compared with PTH levels before KT (p-value < 0.001) and the association between PKT level of PTH with age, gender and duration of dialysis before KT (P value < 0.05).
Conclusion: Obtaining a level of PTH adequate to the graft function and to normalize levels of calcium, and phosphorus as a primary clinical objective for patients with secondary HPT after renal transplantation in Sudan.
Risk factors such as age, duration of dialysis, and pre-transplantation level of PTH should be taken into account in the management policy after renal transplantation.
One of the most common complications in cases with chronic renal failure is secondary hyperparathyroidism (HPT). Several pathways have been linked as the means by which HPT is initiated and sustained in renal failure, notwithstanding the gaps in our current understanding.
The disturbance of the endocrine parathyroid hormone – vitamin D axis has been linked to abnormalities in both calcium/ phosphate and vitamin D metabolism. 3Furthermore, secondary hyperparathyroidism is a nearly universal finding in cases with end- stage renal complaint. undressed secondary hyperparathyroidism causes osteoporosis, pathological fractures, and order monuments [1].
These symptoms and the necessity of dialysis have serious counteraccusations on case’s quality of life. order transplantation remains the treatment of choice in renal failure and is reported to resolve numerous of the endocrine and metabolic imbalances of hyperparathyroidism [2]
In the transplant community, it's presently standard procedure to stay a full-time following transplant before considering parathyroidectomy.
This is grounded on earlier exploration showing that, following a successful order transplant, post-transplant hypercalcemia generally goes down in time. Consequently, a vigilant waiting approach is generally employed for asymptomatic cases with elevated parathyroid hormone situations in the time following transplantation. [3] Successful order transplantation corrects the endocrine and metabolic imbalances and the main abnormalities responsible for secondary HPT in the first months. however, parathyroid hormone (PTH) affair doesn't always return to normal after the original positive events. In cases with satisfactory renal function, elevated complete PTH (iPTH) situations have been seen in further than 25 of cases one-time following transplantation. [ 2]
Only many data are available in the literature on the long- term natural history of HPT after successful renal transplantation. This can be explained by the lack of a dependable and precise iPTH assay until the late 1980s. Prior to this, estimates of physiologically active PTH were squishy, inconsistent, and non-uniform due to the use of colourful PTH fractions in radioimmunoassay for iPTH. [ 3] The preface of an immunoradiometric assay (IRMA) to measure complete PTH in the late 1980s redounded in an important enhancement in the study of HPT in both non-uraemic and uraemic individualities.[3]
It's well honoured that cases with end stage renal conditions (ESRD) have altered bone mineral metabolism and hyperplastic parathyroid glands. phosphorus, and calcitriol a drop in serum parathyroid hormone (PTH)
occurs by about 1 time after successful renal transplantation. [ 3] still, some renal transplant donors with indeed good renal function indeed by one time may continue to have elevated position of PTH and patient hypercalcemia [3]. In some studies, deficient resolution of hyperparathyroidism is reported in further than 50 of cases despite excellent allograft function. This may be due to deficient normalization of renal function and/ or to a deficient resolution of there-transplant parathyroid hyperplasia. Although some enhancement has passed, threat factors for this morbidity remain inadequately understood. [3].
When treating a patient with chronic kidney disease (CKD) the clinician is handling one of the most challenging tasks in clinical practice. Few failing organs have such a widespread impact on the organism as the kidney. Patients with end stage renal disease (ESRD) have a mortality risk 10-20 times higher than patients with normal renal function, and the major cause of death is cardiovascular disease. [4] Patients with ESRD also develop bone disease and have a higher risk of fractures compared to the general population. The complex relation between the kidney, the bones and vascular calcifications led to the definition in 2005 of chronic kidney disease – Mineral and Bone Disorder (CKD-MBD) by Kidney Disease International Improving Global Outcome (KDIGO). [4] Secondary hyperparathyroidism (sHPT), with increased volume of the parathyroid glands and increasing levels of parathyroid hormone (PTH), is a major element of CKD-MBD and it develops over time in the vast majority of patients with CKD. Vascular and bone-related outcomes as well as increased mortality are a direct effect of sHPT. [5] After renal transplantation, renal function increases and the mineral metabolism dramatically improves. Renal function increases and mineral metabolism significantly improves following renal transplantation. The understanding of sHPT following renal transplantation has grown in the last several years. Nevertheless, there are currently no target PTH levels for recipients of renal transplants, and treatment recommendations are still ambiguous. [4] In addition, there is disagreement over whether PTX should be done prior to or following renal transplantation. Research has indicated that performing PTX following transplantation results in a decline in renal function. The benefits of PTX on mortality rates observed in dialysis patients have not been demonstrated in patients receiving a kidney transplant. [4, 5] First Point. The endocrine system comprises four small glands called parathyroid glands, which are typically located behind the thyroid's left and right lobes. Supernumerary glands are occasionally present and are typically located in the thymus tissue, though they can also be found in other places. [6] Chief cells and oxyphil cells are the two cell types that make up the parathyroid gland. Parathyroid hormone is produced and released by chief cells. Although oxyphil cells proliferate in CKD and express a large number of genes found in chief cells, their exact role is still unknown. [6] The preservation of a healthy calcium homeostasis is the parathyroid gland's primary duty. When calcium is present, calcium-sensing receptors (CaSR)16 on the surface of chief cells cause PTH to be produced and released. The preservation of normal calcium homeostasis is the parathyroid gland's primary job. When calcium levels fall below a specific threshold, calcium-sensing receptors (CaSR)16 on the surface of chief cells trigger the synthesis and release of PTH. PTH release is inhibited by high calcium levels. Three mechanisms exist for parathyroid hormone to mobilize calcium. The first method involves triggering
osteoblasts, which then trigger osteoclasts, causing the skeleton to release calcium into the net. [7]. The second method involves boosting calcium reabsorption in the kidney's distal tubuli. The activation of vitamin D, which in turn acts to increase calcium absorption in the intestine, is the third way PTH increases calcium. PTH release is also stimulated by elevated phosphate levels, though the exact mechanism is unknown. [7]. So, throughout this context, this study aimed to measure the frequency and risk factors of persistent hyperparathyroidism post-kidney transplant in Sudanese patients.
Material and Methods: This was a descriptive, cross-sectional hospital-based study conducted at Ibn Sina Hospital and Ahmed Gasim Teaching Hospital, during the period from September 2018 to March 2019. Ibn Sina Hospital is a tertiary hospital, located in the Khartoum capital of Sudan in Mohamed Najeeb Street and Ahmed Gasim Hospital in Khartoum North. These are the two hospitals in Sudan where kidney transplantation operations are done. In Ibn Sina Hospital there is a separate kidney transplant refer clinic per week with an average of 60 patients in each clinic, while in Ahmed Gasim Hospital there are two refer clinics.
The study populations were patients who underwent kidney transplants attending Ibn Sina
and Amed Gasim hospitals and had measured parathyroid hormone levels before kidney transplantation. Inclusion criteria, recipients of first renal transplant, no history of parathyroidectomy before transplant, and availability of pre-transplant parathyroid hormone measurement in the 2 months preceding transplantation the study excluded suboptimal renal function post-transplantation (creatinine more than 1.3 mg/dl.
The participants were interviewed about age, gender, time of transplantation duration of hemodialysis before kidney transplantation, baseline creatinine Parathyroid hormone level before and one year after transplantation, Calcium, phosphorus, and alkaline phosphatase levels 3month and one year after transplantation.
Sampling techniques via simple random sampling, it was included all patients with available elevated parathyroid hormone levels before transplantation, statistical analysis was performed using SPSS 25 software (SPSS, Chicago, IL, USA), and variables were compared using Student's t-test (for paired data) or post hoc test, Mann–Whitney U test for non-parametric data. For categorical data, comparisons were performed using the chi-square test (X2) or Fisher's exact test, as appropriate. Statistical significance was set at P <0>
Ethical clearance was obtained from the ethical committee of the Sudan Medical Specialization Board, Council of Internal Medicine. An official agreement from the general managers of Ibn Sina &Ahmed Gasim Teaching Hospital preceded the study. Ethical considerations were taken, presented to the ethics review committee, and approved, data was handled with a high degree of confidentiality throughout the study, and written informed consent was obtained from all participants in the study.
During the study period, a total of 81 study participants were included. Two-thirds of them (66.7%) were less than 40 years in age and more than half of them (55.6%) were males with a male: female ratio of about 1: 1.3. Table (1)
| Demographic | Frequency | Percent |
| Age – years | ||
| 20_29 | 17 | 21.0 |
| 30_39 | 37 | 45.7 |
| 40_49 | 15 | 18.5 |
| 50_60 | 12 | 14.8 |
| Gender | ||
| Male | 45 | 55.6 |
| Female | 36 | 44.4 |
| Total | 81 | 100.0 |
Table 1: Sociodemographic characteristics of the study participants (n = 81)
Concerning the post-kidney transplant OTH, our study found that more than half of them (60.5%) reported normal levels of PTH, (34.6%) a mild increase while (4.9%) reported a moderate decrease in PHT. After three months of PKT, serum calcium was high among only (38.3%) and low phosphate was reported among (2.5%). After one year of PKT, serum calcium was high among only (8.6%) and low phosphate was reported among (2.5%) as detailed in Table (2).
| Investigation | Frequency | Percent | ||
| Parathyroid hormone | Normal (≤ 65 pg/ml) | 49 | 60.5 | |
| Mild increase (66_ 200 pg/ml) | 28 | 34.6 | ||
| Moderate increase (201_400 pg/ml) | 4 | 4.9 | ||
| Calcium | Three months PKT | Low (< 8> | 0 | 0.0 |
| Normal (8.5 – 10.2 mg/dL) | 50 | 61.7 | ||
| High (> 10.2 mg/dL) | 31 | 38.3 | ||
| One-year PKT | Low (< 8> | 0 | 0.0 | |
| Normal (8.5 – 10.2 mg/dL) | 74 | 91.4 | ||
| High (> 10.2 mg/dL) | 7 | 8.6 | ||
| Phosphate | Three months PKT | Low (< 2> | 2 | 2.5 |
| Normal (2.5 – 4.5 mg/dL) | 79 | 97.5 | ||
| High (>4.5 mg/dL) | 0 | 0.0 | ||
| One-year PKT | Low (< 2> | 2 | 2.5 | |
| Normal (2.5 – 4.5 mg/dL) | 79 | 97.5 | ||
| High (>4.5 mg/dL) | 0 | 0.0 | ||
Table 2: the distribution of the study participants according to their post-transplant investigation results (n = 81)
The study reported a significant reduction in the PTH after KT compared with PTH levels before KT (p-value < 0>
| Parathyroid hormone level | Before | After | ||
| Freq. | Percent | Freq. | Percent | |
| Normal (≤ 65 pg/ml) | 0 | 0.0 | 49 | 60.5 |
| Mild increase (66_ 200 pg/ml) | 47 | 58.0 | 28 | 34.6 |
| Moderate increase (201_400 pg/ml) | 30 | 37.0 | 4 | 4.9 |
| Severe increase (> 401_ pg/ml) | 4 | 4.9 | 0 | 0.0 |
| Total | 81 | 100.0 | 81 | 100.0 |
Table 3: comparison between the parathyroid level before and after kidney transplant (n = 81)
P - value < 0>Our study found that there is a significant association between PKT level of PTH with age, gender, and duration of dialysis before KT (P value < 0> Table 4: The relation between the post-kidney transplant parathyroid hormone level with demographical characteristics (n = 81 Table (4) The relation between the post-kidney transplant parathyroid hormone level with demographical characteristics (n = 81) Moreover, the levels of calcium and phosphate were also related to the level of parathyroid hormone after KT (p-value < 0> Our study showed that nearly two-thirds of the (64.2%) had been transplanted within the period 2015 – 2017 and the majority Table (5) The relation between the post-kidney transplant parathyroid hormone level with demographical characteristics (n = 81) Table 7: the relation between the post-kidney transplant parathyroid hormone level with Phosphate level (n = 81) (89%) was on hemodialysis for less than four years before the transplantation Figure (1) and (2). Figure 1: the distribution of the study participants according to their time of transplantation (n = 81) Figure 2: Distribution of the study participants according to their duration of hemodialysis before transplantation (n = 81) Study participants reported normal levels of serum creatinine on the baseline. Regarding the pre-kidney transplantation PTH level, more than half of them (58%) reported a mild increase in PTH level, (37.1%) reported a moderate increase while only (4.9%) had a severe increase Figure (3). Figure 3: Distribution of the study participants according to their pre-transplant Parathyroid hormone (n = 81)
This study aimed to know the frequency and risk factors of persistent hyperparathyroidism one-year post-kidney transplant and covered 81 study participants. Two-thirds of them (66.7%) were less than 40 years in age and more than half of them (55.6%) were males with male: female ratio of about 1: 1.3. In the context of this issue. In Taiwan, Cheng sp etal stated that female gender is associated with an increased risk of parathyroid nodular hyperplasia and parathyroidectomy rate in dialysis patients Women with secondary hyperparathyroidism had worse bone mineral metabolism before parathyroidectomyand they stated that additional research regarding target organ susceptibility to hyperparathyroidism in different genders is warranted. [8] in United States, Lou I. etal claimed that many parameters have been studied as possible risk factors for predicting persistent post-transplant hyperparathyroidism, including female gender, elevated pre-transplant parathyroid hormone (PTH) and hypercalcemia, but none have been prospectively validated. [9]
Our study reported that the majority (89%) was on hemodialysis for less than four years before the transplantation. Correspondingly, In UK, Alireza H.
etal reported that patients were on dialysis for an average period of 17.4 months prior to transplantation. [10]
Regarding the pre kidney transplantation PTH level, more than half of them (58%) reported mild increase in PTH level, (37.1%) reported moderate increase while only (4.9%) had severe increase. Similar findings were reported in Norway, by Gøransson LG et al who found that one hundred and three patients (80%) had an elevated level of PTH prior to kidney transplantation. [11]
Concerning the Post-kidneytransplant PTH, our study found that more than half of them (60.5%) reported normal level of PTH, (34.6%) mild increase while (4.9%) reported moderate decrease in PHT. Likewise, In UK, Alireza H. etal found tha hyperparathyroidism was in 12 (9.9%) and 7 (5.7%) patients three months and one year after transplantation respectively. [10] In more depth, in Belgium, Evenepoel P etal add that post-transplant iPTH levels correlated significantly with transplant kidney function. [12] Furthermore in United States, Wolf M etal found THAT The results did not differ across the low and high PTH strata, and rates of persistent hyperparathyroidism remained higher than 40% when defined using a higher PTH threshold greater than 130 pg/mL and confirmed that persistent hyperparathyroidism is common after kidney transplantation. [13] Further studies should determine if persistent hyperparathyroidism or its treatment influences long-term post transplantation clinical outcomes.[13]
After three months PKT, serum calcium was high among only (38.3%) while after one-year PKT, serum calcium was high among only (8.6%). A higher proportion was reported in Norway, by Gøransson LG etal (23%) had hypercalcaemia. [9] Moreover, in UK, Alireza H. etal, confirmed that an increase in the serum Ca and a decrease in serum P and iPTH level was seen in the patients after transplantation (P< 0>
Our study reported that low phosphate was reported among (2.5%) after three months and also after one-year PKT. A differ findings, reported in US by Wolf M, who stated that in its most severe form, disordered mineral metabolism after kidney transplant is characterized by hyperphosphatemia, and markedly elevated levels of parathyroid hormone (PTH) .[16]Moreover, hypophosphatemia present clinicians with management challenges because they may jeopardize graft function and bone health and exacerbate fracture and cardiovascular risk. [13]
The study reported a significant reduction in the PTH after KT compared with PTH levels before KT (p value < 0>
Moreover, similar results were reported in Norway, by Gøransson LG etal who concluded that patients transplanted pre-emptively had a statistically significantly lower iPTH level compared with patients who had received dialysis. [9] Furthermore, In United States, Jahromi AH, etal found that (26.6%) attained normal PTH between 1 and 2 years, with the remaining (43.1%) categorized as having HPT. [15] likewise, In France, Bonarek H etal found that the basal PTH decreased from 195 +/- 54 pg/ml before KT to 70 +/- 12 pg/ml six months later (P < 0>
Our study found that there was a significant association between PKT level of PTH with age, gender and duration of dialysis before KT (P value < 0 P = 0.006)>
Our study had some limitations. The relatively limited number of study participant (81 study participants from limited number of study areas - Ibn Sina hospital and Ahmed Gasim hospita) may affect negatively the probability of finding significant relationships between different factors and characteristics with HPTH among Sudanese patients who had been renal transplanted.
The study reported a significant reduction in the PTH after KT compared with PTH levels before KT and there was a significant association between PKT level of PTH with age, gender, and duration of dialysis before KT and with levels of calcium and phosphate were also related with the level of parathyroid hormone after KT.
This study concluded that the age of presentation is less than 40 -years, with males more than females, and there is a
mild and moderate increase of parathyroid hormone in pre-kidney transplantation PTH level.
our study found that post-kidney transplant OTH more than half reported normal levels of PTH, with a one-third mild increase while small reported a moderate decrease in PHT.
After three months of PKT, serum calcium was high among only two-fifths, and low phosphate was reported in lower cases.
I would like to express my sincere gratitude and thankfulness to my supervisor; Dr. Mohammed Ibrahim for his guidance, meticulous supervision, revising, and discussing all aspects of this study. His valuable advice and comments are highly appreciated.
Consent: All participants provided informed consent.
Approval: Ethical clearance and supportive letters were obtained from the Sudan Medical Specialization Board (SMSB) and& the Educational Development Centre (EDC). Written permission was obtained from Ibn Sina and Ahmed Gasim hospitals.
All authors contributed to the manuscript writing of the manuscript.
Disclosure statement
No potential conflicts of interest were reported by the authors.
Not funded
ORCID: https://orcid.org/my-orcid?orcid=0009-0008-3102-2786
Data Sharing
The authors agreed on the date-sharing policy of this journal.
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
