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Research Article | DOI: https://doi.org/10.31579/2640-1053/187
1 Department of Biostatistics, Virginia Commonwealth University, USA.
2 Department of Information Technology Science, University of the Cumberlands.
3 Professor of Statistics [Retired], Jahangirnagar University, Bangladesh.
*Corresponding Author: Atika Farzana Urmi, Department of Biostatistics, Virginia Commonwealth University, USA.
Citation: Atika F. Urmi, Mohammad A. Rahman, K.C. Bhuiyan, (2024), Identification of Symptoms and Factors Influencing Lung Cancer in Bangladeshi Adults, J Cancer Research and Cellular Therapeutics, 8(2); DOI:10.31579/2640-1053/187
Copyright: ©2024, Atika Farzana Urmi. 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: 24 February 2024 | Accepted: 04 March 2024 | Published: 11 March 2024
Keywords: lung cancer; symptoms of lung cancer; factors associated with lung cancer; logistic regression; association of lung cancer with some factors and symptoms; risk ratio
The study was performed using the secondary data of 309 adults of Bangladesh, out of them 87.4% were reported as lung cancer patients during survey period. Among the respondents 52.4% were males, 95.1% were of ages 50 years and above, 56.3% were smokers, 55.7% were alcoholic, 67.3% were fatigue, 55.7% were suffering from allergy, 50.5% were suffering from chronic diseases, 57.0% had yellow finger, 55.7% felt chest pain, 55.7% had wheezing problem, 46.9% had swallowing difficulty, and 50.2% were under peer pressure. These were some symptoms and factors related to lung cancer and some of these factors had significant impact on prevalence of lung cancer as was observed from the study of association and in fitting logistic regression model using prevalence of cancer as dependent variable. The previous research report indicated that there were 7 symptoms of lung cancer. This analysis indicated that the symptoms coughing, swallowing, and becoming fatigue had significant impact on prevalence of lung cancer. Beside these, adult people having yellow finger had 15% more risk of suffering from lung cancer. The factors chronic disease, allergy, smoking habit were also enhancing the risk of lung cancer.
Lung cancer is a wide spread disease worldwide creating public health hazard in both men and women and it continuous to be the leading cause of death everywhere and it has been the most common cancer. It kills over 1 million people throughout the world every year [1, 2, 3]. There has been a large relative increase of lung cancer patients in developing countries including Bangladesh [4, 5]. The percentage of prevalence of cancer patients in developing countries was approximately 49.9% in developing countries, on the other hand 69 percent cases were reported in developed countries in 1980. The increased cases of cancer was 51% since 1985 [3].
Lung cancer was the most commonly diagnosed disease and it was the leading cause of cancer death in men in 2008 and the fourth most commonly diagnosed cancer and the second leading cause of cancer death in female [6]. In 2008 cancer accounted for 13% of all cancer cases and 18 percent cancer related deaths worldwide. In 2020, deaths due to cancer accounted for nearly 10 million, out of these 2.21 million cases of lung cancer [6-9]. It was reported that in 2013 1.3 to 1.5 million cancer patients were reported in Bangladesh with 0.2 million newly diagnosed cancer cases each year [10]. One of the top cancer disease was lung cancer in males [10] and the rate of increase of cancer patient was in increasing trend. The reason is that there exists the problem of facilities for early detection and treatment, where treatment and diagnosis is very costly. Higher rate of increase of the disease is due to increase in obesity, increasing rate of physical inactivity, bacterial infection, papilloma virus in human beings, rate of increase in hepatitis B virus, hepatitis C virus, Epstein –Barr virus, helicobacter pylori infection, etc. Thus, one needs to identify the significant symptoms of lung cancer and to identify the responsible social factors for lung cancer. In this paper, an attempt was made to do so.
The analytical results presented here was based on data collected from the website online lung cancer prediction system. The data were recorded from 309 adults, recorded information of each adult were on gender, age, smoking habit, yellow finger, anxiety, peer pressure, allergy, fatigue, chronic disease, wheezing, habit of alcohol consumption, coughing, shortness of breath, swallowing difficulty, chest pain, and prevalence of lung cancer. Among these variables some are symptoms of lung cancer; these symptoms are coughing, feeling chest pain, suffering from chronic disease, fatigue, swallowing difficulty, shortness of breath, and weight loss. The other variables like age, gender, smoking habit, peer pressure, alcohol consumption are not the symptoms of lung cancer but are associated with prevalence of lung cancer. Except age, all the variables were recorded in nominal score and presence of any variable was noted by numerical figure 2 for ease of analysis. The numerical figure 1 was assigned if the variable was not observed in any respondent. Out of 309 respondents lung cancer prevailed in 270 adults and 39 adults did not report the prevalence of lung cancer in them during investigation. Thus, we have two groups of adults. Among the lung cancer patients 145 were males and 125 were females. In other group 17 were males and 22 were females. The respondents were classified into 4 groups according to their age; in the first group there were 15 adults of ages less than 50 years, in the second group there were 95 respondents of ages 50 - less than 60 years, third group was of 129 adults of ages 60 - less than 70years, the remaining 70 adults were of ages 70 years and above. According to the objective of the study association of each of the recorded variables with prevalence of lung cancer was studied. Significance of association of a variable with prevalence of lung cancer was decided if the p-value of an observed Chi-square statistic is less than or equal to 0.05. The risk ratio along with its confidence interval was calculated for any level of a variable when the prevalence rate of lung cancer was found higher for the level of the variable. Finally, logistic regression model was fitted to identify the responsible symptom and variable for the prevalence of lung cancer. All the calculations were done using SPSS Version 25.
There were 52.4% male respondents in the sample; out of them 89.5% were suffering from lung cancer. This prevalence rate was slightly higher compared to the rate observed in females (85.0%). These two prevalence rates were not significantly different as was observed by Chi-square test [
= 1.398, -value=0.237]. The risks of prevalence of lung cancer for males and for females were almost similar [R.R.=1.05; C.I. (0.96, 1.21]. There were 22.7% respondents of ages 70 years and above; 95.7% of them were cancer patients. The lowest (80.0%) prevalence rate was noted in adults of ages less than 50 years (4.9%). The percentage of cancer patients among 64.4% respondents of ages 60 years and above was 88.4. Though insignificant, there was an increasing trend of prevalence of lung cancer [=6.220, p-value=0.111] with the increase in ages of adults. Highest prevalence rate (95.7%) was noted in 22.7 percent adults of ages 70 years and above, but for them the risk of prevalence was only 13% more compared to the risk of other adults [R.R.=1.13; C.I. (1.05, 1.21)]. There were 56.3% smokers in the sample; among them 89.1% were cancer patients. Among non-smoker adults the rate of prevalence of lung cancer was 85.2%. However, these two rates were not significantly different [
= 1.046, p-value=0.306]. Though highest prevalence rate was observed in smoker adults, but for them the risk of prevalence was only 5% more compared to the risk of non-smokers [R.R.=1.05; C.I. (0.96, 1.15)]. The percentage of adults habituated in drinking alcohol was 55.7; among them 95.9% were cancer patients. This prevalence rate was too high compared to the prevalence rate (76.6%) in non-alcoholic adults. These two rates were significantly different [= 25.725, p-value=0.000]. Alcoholic persons had 25% more risk of affecting by lung cancer.
[R.R.=1.25; C.I. (1.3, 1.38)]. The percentage of adults who were in anxiety was 49.8; lung cancer prevailed in 92.2% of them. The corresponding percentage in adults who were not anxious was 82.6. This rate was significantly lower compared to that prevailed in anxious adults [= 6.492, p-value=0.011]. Anxiety created a higher risk of suffering from lung cancer by 12% [R.R.=1.12; C.I. (1.03, 1.22)]. Peer pressure was felt by 50.2% respondents; among them 93.5% were suffering from lung cancer. Significantly lower prevalence rate (81.2%) was noted in adults for whom there were no peer pressure [=10.735, p-value=0.001]. Peer pressure created a higher risk of lung cancer by 25% [R.R.=1.25; C.I. (1.15, 1.36)].
There were 50.5% patients of chronic diseases; among them 91.0% were suffering from lung cancer. This percentage was almost significantly different than the corresponding percentage (83.7%) observed in adults free of chronic diseases [=3.800, p-value= 0.051]. Patients of chronic diseases had 9% more risk of affecting by lung cancer [R.R.=1.09; C.I. (1.00, 1.19)]. The percentage of allergic adults in the sample was 55.7; 97.1% of them were suffering from lung cancer. The percentage of non-allergic lung cancer patients was 75.2. Proportion of allergic lung cancer patients was significantly too high than that in non-allergic adults [= 33.196, p-value=0.000]. The risk of the discussed disease was 29% more in allergic adults [R.R.= 1.29; C.I. (1.17, 1.42)]. There were 67.3 percent adults of ages 70 years and above, but for them the risk of prevalence was only 13% more compared to the risk of other adults [R.R.=1.13; C.I. (1.05, 1.21)]. There were 56.3% smokers in the sample; among them 89.1% were cancer patients. Among non-smoker adults the rate of prevalence of lung cancer was 85.2%. However, these two rates were not significantly different [ = 1.046, p-value=0.306]. Though highest prevalence rate was observed in smoker adults, but for them the risk of prevalence was only 5% more compared to the risk of non-smokers [R.R.=1.05; C.I. (0.96, 1.15)]. The percentage of adults habituated in drinking alcohol was 55.7; among them 95.9% were cancer patients. This prevalence rate was too high compared to the prevalence rate (76.6%) in non-alcoholic adults. These two rates were significantly different [ = 25.725, p-value=0.000]. Alcoholic persons had 25% more risk of affecting by lung cancer.
[R.R.=1.25; C.I. (1.3, 1.38)]. The percentage of adults who were in anxiety was 49.8; lung cancer prevailed in 92.2% of them. The corresponding percentage in adults who were not anxious was 82.6. This rate was significantly lower compared to that prevailed in anxious adults [ = 6.492, p-value=0.011]. Anxiety created a higher risk of suffering from lung cancer by 12% [R.R.=1.12; C.I. (1.03, 1.22)]. Peer pressure was felt by 50.2% respondents; among them 93.5% were suffering from lung cancer. Significantly lower prevalence rate (81.2%) was noted in adults for whom there were no peer pressure [ =10.735, p-value=0.001]. Peer pressure created a higher risk of lung cancer by 25% [R.R.=1.25; C.I. (1.15, 1.36)].
There were 50.5% patients of chronic diseases; among them 91.0% were suffering from lung cancer. This percentage was almost significantly different than the corresponding percentage (83.7%) observed in adults free of chronic diseases [ =3.800, p-value= 0.051]. Patients of chronic diseases had 9% more risk of affecting by lung cancer [R.R.=1.09; C.I. (1.00, 1.19)]. The percentage of allergic adults in the sample was 55.7; 97.1% of them were suffering from lung cancer. The percentage of non-allergic lung cancer patients was 75.2. Proportion of allergic lung cancer patients was significantly too high than that in non-allergic adults [ = 33.196, p-value=0.000]. The risk of the discussed disease was 29% more in allergic adults [R.R.= 1.29; C.I. (1.17, 1.42)]. There were 67.3 percent fatigue respondents; the prevalence rate of lung cancer in them was 90.9%. This percentage was significantly higher than that prevailed (80.2%) in non-fatigue adults [= 7.015, p-value=0.008]. Fatigue adults had 13% more risk of suffering from lung cancer [R.R.=1.13; C.I. (1.02, 1.26)]. Chest pain was felt by 55.7% respondents; among them 93.0% were lung cancer patients. The percentage of lung cancer patients in adults who had no chest pain was 80.3%. This proportion was significantly lower compared to the proportion of lung cancer patients in adults who had chest pain [= 11.208, p-value=00.1]. The risk of lung cancer in adults feeling chest pain was 16% more compared to the risk of other group [R. R=1.16; C.I(1.06, 1.27)]. Yellow finger was noted in 57.0 percent adults; among them 92.6% were suffering from lung cancer. Significantly lower rate of the disease (81.2%) was recorded in respondents who had no yellow finger [=10.161, p-value=0.001]. The risk of lung cancer was 15 percent more in adults who had yellow finger [R.R.=1.15; C.I. (1.05,1.26)]. Coughing was noted in 57.9 percent adults; the prevalence rate of lung cancer in this group was 94.4 percent. Rate of prevalence of lung cancer was 77.7 percent in adults who had coughing problem. These two prevalence rates were significantly different [=19.092, p-value=0.000]. The risk of lung cancer was 22 percent more in patients suffering from cough [R.R.=1.22; C.I. (1.09, 1.36)]. The percentage of adults feeling shortness of breathing was 64.1 percent; 88.9 percent of them were lung cancer patients. Prevalence rate of lung cancer was found 84.7 percent in adults who had no breathing problem. These two prevalence rates were not significantly different [=1.140, p-value=0.286]. The risk of the diseases was only 5 percent more for the adults suffering from shortness of breathing [R.R.=1.05; C.I. (0.96, 1.16)]. Shortness of breathing is a problem due to which a person may feel suffocation when he/she breathes. Wheezing is another type of breathing problem which occurs due to airway obstruction if any other symptom of disease is diagnosed. In this study it was diagnosed that 55.7 percent adults had wheezing problem and 94.8 percent of them were suffering from lung cancer. The corresponding percentage among adults without wheezing symptom was only 78.1. This percentage was significantly very low compared to that prevailed in adults experienced of wheezing problem [= 19.204, p-value=0.000]. Those who were suffering from wheezing for them the risk of prevalence of lung cancer was 21 percent more [R.R.=1.21; C.I. (1.10,1.33)]. Swallowing difficulty or dysphagia includes coughing or choking when eating or drinking. The problem prevailed in only 46.9 percent respondents, but 96.6 percent of them were facing the problem of lung cancer. Lung cancer also prevailed in adults free of swallowing difficulty; prevalence rate in them was 79.3 percent. This rate was significantly low [=20.845, p-value= 0.000]. Former group had 24% more risk of affecting by lung cancer [R.R.=1.24; C.I. (1.15,1.40)].
Table 1: Distribution of respondents according to prevalence of lung cancer and other responsible factors and symptoms.
| Symptoms and factors | Levels/ prevalence | Prevalence of lung cancer | Total | ||||
| Yes | No | ||||||
| Number | % | Number | % | Number | % | ||
| Gender | Male | 145 | 89.5 | 17 | 10.5 | 162 | 52.4 |
| Female | 125 | 85.0 | 22 | 15.0 | 147 | 47.6 | |
| Total | 270 | 87.4 | 39 | 12.6 | 309 | 100.0 | |
| Age (in years) | < 50> | 12 | 80.0 | 3 | 20.0 | 15 | 4.9 |
| 50 – 60 | 82 | 86.3 | 13 | 13.7 | 95 | 30.7 | |
| 60 – 70 | 109 | 84.5 | 20 | 15.5 | 129 | 41.7 | |
| 70+ | 67 | 95.7 | 3 | 4.3 | 70 | 22.7 | |
| Smoking | Yes | 155 | 89.1 | 19 | 10.9 | 174 | 56.3 |
| No | 115 | 85.2 | 20 | 14.8 | 135 | 43.7 | |
| Alcohol consumption | Yes | 165 | 95.9 | 7 | 4.1 | 172 | 55.7 |
| No | 105 | 76.6 | 32 | 23.4 | 137 | 44.3 | |
| Chronic disease | Yes | 142 | 91.0 | 14 | 9.0 | 156 | 50.5 |
| No | 128 | 83.7 | 25 | 16.3 | 253 | 49.5 | |
| Allergy | Yes | 167 | 97.1 | 5 | 2.9 | 172 | 55.7 |
| No | 103 | 75.2 | 34 | 24.8 | 137 | 44.3 | |
| Anxiety | Yes | 142 | 92.2 | 12 | 7.8 | 154 | 49.8 |
| No | 128 | 82.6 | 27 | 17.4 | 155 | 50.2 | |
| Chest pain | Yes | 160 | 93.0 | 12 | 7.0 | 172 | 55.7 |
| No | 110 | 80.3 | 27 | 19.7 | 137 | 44.3 | |
| Coughing | Yes | 169 | 94.4 | 10 | 5.6 | 179 | 57.9 |
| No | 101 | 77.7 | 29 | 22.3 | 130 | 42.1 | |
| Wheezing | Yes | 163 | 94.8 | 9 | 5.2 | 172 | 55.7 |
| No | 107 | 78.1 | 30 | 21.9 | 137 | 44.3 | |
| Shortness of breath | Yes | 176 | 88.9 | 22 | 11.1 | 198 | 64.1 |
| No | 94 | 84.7 | 17 | 15.3 | 111 | 35.9 | |
| Swallowing difficulty | Yes | 140 | 96.6 | 5 | 3.4 | 145 | 46.9 |
| No | 130 | 79.3 | 34 | 20.7 | 164 | 53.1 | |
| Yellow finger | Yes | 163 | 92.6 | 13 | 7.4 | 176 | 57.0 |
| No | 107 | 80.5 | 26 | 19.5 | 133 | 43.0 | |
| Peer pressure | Yes | 145 | 93.5 | 10 | 6.5 | 155 | 50.2 |
| No | 125 | 81.2 | 29 | 18.8 | 154 | 49.8 | |
| Fatigue | Yes | 189 | 90.9 | 19 | 9.1 | 208 | 67.3 |
| No | 81 | 80.2 | 20 | 19.8 | 101 | 32.7 | |
| Total | 270 | 87.4 | 39 | 12.6 | 309 | 100.0 | |
Results of Logistic Regression Analysis
The analytical results presented above showed that some of the symptoms of lung cancer were significantly associated with prevalence of lung cancer. The risk of lung cancer was more for the prevalence of some symptoms. None of social factors was significantly associated with prevalence of lung cancer. Thus, further attempt was made to identify the significant impact of any symptom on lung cancer. It was done by fitting binary logistic regression model using prevalence of lung cancer as dependent variable and social factors and symptoms as explanatory variables. The included explanatory variables were gender, age, smoking habit, allergy, anxiety, habit of consumption of alcohol, feeling fatigue, coughing, feeling chest pain, shortness of breath, swallowing difficulty, wheezing, prevalence of chronic disease, yellow finger, and peer pressure. The fitted model was significant as was observed from the results
– 2 log likelihood= 91.909 and Nagelkerkee R2= 0.695. The results were presented in Table 2.
Table 2: Results of logistic regression analysis.
| Variable | B | S.E. | Wald statistic | p-value | Exp (B ) |
| Gender | -0.526 | 0.709 | 0.551 | 0.458 | 0.591 |
| Age | 0.022 | 0.034 | 0.413 | 0.520 | 1.022 |
| Smoking | 1.776 | 0.702 | 6.402 | 0.011 | 5.906 |
| Alcohol consumption | 1.410 | 0.799 | 3.114 | 0.078 | 4.095 |
| Chronic disease | 3.192 | 0.888 | 12.909 | 0.000 | 24.326 |
| Allergy | 1.646 | 0.769 | 4.583 | 0.032 | 5.187 |
| Anxiety | 0.888 | 0.813 | 1.193 | 0.275 | 2.430 |
| Chest pain | 0.559 | 0.689 | 0.658 | 0.417 | 1.749 |
| Coughing | 3.311 | 1.072 | 9.547 | 0.002 | 27.420 |
| Yellow finger | 1.376 | 0.743 | 3.436 | 0.064 | 3.961 |
| Fatigue | 3.070 | 0.825 | 13.844 | 0.000 | 21.551 |
| Wheezing | 0.966 | 0.834 | 1.342 | 0.247 | 2.628 |
| Shortness of breath | -0.729 | 0.760 | 0.920 | 0.338 | 0.482 |
| Swallowing difficulty | 3.122 | 1.130 | 7.636 | 0.006 | 22.644 |
| Peer pressure | 1.731 | 0.660 | 6.875 | 0.009 | 5.648 |
| Constant | -30.657 | 5.483 | 31.267 | 0.000 | - |
It was found that the fitted model gave satisfactory results. Each of the variables smoking habit, prevalence of chronic disease, peer pressure, and allergy had significant influence in enhancing the disease lung cancer. The probability of prevalence of lung cancer was significantly increasing with the increase in level of each of the above mentioned variable. This was noted from the values of Exp(B) > 1. Coughing, swallowing difficulty, and fatigue were the 3 significant symptoms in detecting lung cancer. The increasing level of incidence of each of these 3 symptoms increased the probability of suffering from lung cancer. The probability of lung cancer was in increasing trend, though not significant, with the increase in severity of wheezing, feeling more chest pain, and yellow finger indicated that these 3 symptoms were the risk factors for lung cancer. Anxiety was also a risk factor in enhancing lung cancer. It was also noted that if all variables and all the symptoms prevailed in a male of age 70 years and above, he would be affected by lung cancer with probability 0.978.
Worldwide lung cancer kills more than one million people per year and it is established in earlier studies that the major cause of the disease is smoking. Long back the disease was prevalent in developed countries. Now, it is one of the health hazards in developing countries also [1-4]. It was evident from earlier studies that the disease prevailed in people of ages less than 50 years [11-13]. Current evidence is that the disease prevails in non-smokers also [14] and is associated with age, and smoking and more prevalent in females [15,16]. The other responsible factors are demographic differentials and one or more co-morbidity, poverty, and lack of facilities for treatment [17-21]; obesity, physical inactivity, cancer causing virus and bacterial infection, human papilloma virus, hepatitis B virus, hepatitis C virus, helicobacter pylori infection, Epstein –Barr virus, etc. In this paper an attempt was made to identify some responsible factors influencing lung cancer and to identify the symptoms those were significantly created higher risk for prevalence of lung cancer.
To identify the responsible factors and the higher risk generating symptoms for lung cancer analysis was done on the basis of data collected from 309 adults. Out of them 270 were lung cancer patients of both sex in the ratio 53.7: 46.3. Among the patients, only 12 were of ages less than 50 years; 95.6% were of ages 50 years and above. The analysis showed that age and gender were not associated with prevalence of lung cancer. However, older people of ages 70 years and above had 13% more risk of prevalence of the disease. The study also indicated that smoking and chronic disease were not significantly associated with prevalence of lung cancer and these two factors were not the risk creating factors, though higher proportion (56.3%) of adults were smokers and higher proportion of respondents (50.5%) were patients of chronic diseases. Each of the variables anxiety, alcohol consumption and peer pressure were significantly associated with prevalence of lung cancer. Each of both allergic and alcoholic respondents was 55.7%. Allergic patients had 29% more risk of affecting by the disease. For alcoholic respondents the risk was 25% more. There were 50.2 percent adults who were under peer pressure; for this group the risk of the disease was 25% more.
The data on symptoms of lung cancer recorded from the respondents were coughing, chest pain, shortness of breath, swallowing difficulty, wheezing, yellow finger and fatigue. The percentages of adults who had these symptoms were 57.9, 55.7, 64.1, 46.9, 55.7, 57.0 and 67.3, respectively. All these symptoms, except shortness of breath, were significantly associated with the prevalence of lung cancer. For each group the risk of prevalence of the disease was found out separately. These risks were 22%, 16%, 24%, 21%, 15%, and 13% more, respectively.
Logistic regression analysis indicated that coughing, swallowing difficulty, and fatigue were the most influencing symptoms for prevalence of lung cancer. Increasing rate of prevalence of these symptoms increased more risk of prevalence of the disease. The risk of the disease was also in increasing trend with the increase in prevalence rates of the factors peer pressure, chronic disease, and allergy.
The study was planned to identify the responsible symptoms and factors for prevalence of lung cancer among mostly adults. There were 309 investigated units; among them 52.4% were males, 95.1% were of ages 50 years and above, 56.3% were smokers, and 50.5% had chronic disease. None of these 4 variables was associated with prevalence of lung cancer. There were 55.7% allergic adults, 49.8% were feeling anxiety, 55.7% alcoholic adults, and 50.2% were facing peer pressure. These 4 variables were significantly associated with the prevalence of the disease. Out of these 4 variables the incidence of the disease was in increasing trend with the increase in level of peer pressure and allergy. Peer pressure and allergy had significant influence on prevalence of lung cancer. Increased peer pressure and increased prevalence of allergy increased the probability of incidence of lung cancer. Though smoking and chronic disease were independent of lung cancer, the probability of occurrence of the disease was more among smokers and among patients of chronic disease.
The symptoms, except shortness of breath, of lung cancer were the risk factors for prevalence of the disease. The probability of the disease was significantly more in fatigue patients. Coughing, and swallowing difficulty also enhanced the probability of occurrence of lung cancer. These were observed in fitting logistic regression model.
Finally, it might be concluded that to get rid of lung cancer people should (i) avoid tobacco consumption, (ii) take healthy food, and diet, (iii) maintain healthy body weight, (iv) do physical work of any type, (v) avoid alcohol consumption, (vi) avoid ultra violet radiation exposure, (vii) avoid indoor and outdoor air pollution, (viii) getting vaccinated against HPV and hepatitis B, (ix) avoid can and processed food, (x) arrange treatment of allergy and chronic disease.
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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.
