Unprovoked Vaginal Bleeding in the Second Trimester and Preterm Birth: A systematic Review and Metanalysis

Research Article | DOI: https://doi.org/10.31579/2578-8965/307

Unprovoked Vaginal Bleeding in the Second Trimester and Preterm Birth: A systematic Review and Metanalysis

  • Ilianna Armata 1*
  • icole Armata 2
  • Alexandra Argyrou 3
  • Asma Eshag 4

1Steroids and Metabolism, MRC Laboratory of Medical Sciences, Imperial College London, UK.

2Gynaecology Department, Metaxa Hospital, Greece.

3Hepatology Department, Laiko Hospital, Greece.

4Obstetrics & Gynaecology Department, Royal Free London Hospital NHS Foundation Trust, UK.

*Corresponding Author: Ilianna Armata., Steroids and Metabolism, MRC Laboratory of Medical Sciences, Imperial College London, UK.

Citation: Ilianna Armata, Nicole Armata, Alexandra Argyrou, Asma Eshag, (2026), Unprovoked Vaginal Bleeding in the Second Trimester and Preterm Birth: A systematic Review and Metanalysis, J. Obstetrics Gynecology and Reproductive Sciences, 10(3) DOI:10.31579/2578-8965/307

Copyright: © 2026, Ilianna Armata. 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: 15 April 2026 | Accepted: 27 April 2026 | Published: 06 May 2026

Keywords: laparoscopic sacropexy, genital prolapse, pelvic organ prolapse, mesh shape, POP Q, minimally invasive surgery

Abstract

Bleeding in the second trimester is a common and distressing presentation in pregnancy, yet its clinical implications remain poorly defined and there are no universally accepted guidelines. This systematic review and meta-analysis aims to evaluate the association of unprovoked vaginal bleeding (UVB) in the second trimester and preterm birth (PTB), and to synthesise the available evidence to inform clinical practice. Across included studies, second trimester UVB was found to be significantly associated with PTB (OR: 6.72, 95%CI 3.36-17.47), highlighting its role as an important marker of adverse pregnancy outcomes. We showcase our findings as proof of a higher risk pathology that can lead to significant pregnancy outcomes. Greater awareness of this association between UVB and PTB is needed to support risk stratification, closer surveillance, as well as timely investigations and management.

1.Introduction

Antepartum bleeding is a common complication of pregnancy which, although not always associated with adverse outcomes, remains a well-recognised risk factor for maternal and perinatal morbidity and mortality. Beyond its clinical implications, it is frequently a source of emotional distress for many patients, making timely assessment, clear communication and emotional support a central component of care. Existing literature has predominantly focused on the effects of bleeding in the first and third trimesters, where clearer diagnostic pathways and management strategies have evolved. However, bleeding in the second trimester remains comparatively underexplored, despite its clinical uncertainty and significant psychological burden for pregnant people.

Second trimester bleeding (13-24+6 weeks) affects up to 1.1% of all pregnancies [1]. It is typically medically assessed to distinguish between provoked or unprovoked causes, with no clear aetiology identified in over half of cases. Provoked bleeding would be attributed to identifiable factors such as vaginal infections, cervical ectropion or inflammation, presence of fibroids or polyps, placental abnormalities including low lying placentas or subchorionic haematomas. In these cases, reassurance can often be provided. In contrast, unprovoked vaginal bleeding (UVB) refers to bleeding without an identifiable cause following clinical assessment, where both reassurance and accurate risk stratification for the future remain challenging.

Moreover, the management of UVB in the second trimester is limited and inconsistent. Patients commonly attend maternity triage units for review where assessment may include history taking, laboratory investigations, confirmation of fetal viability and speculum examination. However, there are no specific national guidelines directing management. Care is largely expectant, with decisions regarding admission or surveillance varying between clinicians and institutions. Ultrasound follow up for UVB is not justified under the NHS during the second trimester. Fetal surveillance is not feasible until the third trimester, and fetal movements do not have an established pattern until 28 weeks. Obstetric assessment alone may not always provide adequate explanation. Thus, it can be frustrating to patients and challenging to healthcare professionals to provide support. 

Despite these limitations, second trimester UVB has been associated with adverse pregnancy outcomes including miscarriage, preterm pre-labour rupture of membranes (PPROM) and preterm birth (PTB) [1-3]. Among these, PTB represents the most clinically significant outcome, given its strong association with neonatal morbidity, risks associated with prematurity and the increased rates of neonatal intensive care unit (NICU) admission and lower birth weight [2, 4, 5]. Furthermore, recurrent bleeding episodes appear to confer an even greater risk of adverse outcomes, particularly PTB and PPROM [6].

However, the existing literature is limited by heterogeneity in definitions regarding the timing of bleeding, and the inconsistent characterisation between provoked and unprovoked bleeding. As a result, there is a lack of robust evidence addressing unprovoked second trimester bleeding and its clinical implications. Given emerging evidence suggesting that UVB is most strongly associated in a third of patients with PTB compared to other adverse outcomes(7); this study aims to characterize the risk of PTB following 2nd trimester UVB and to better define its clinical significance for patient counselling and management.

2. Materials and methods

2.1 Search strategy

The present systematic review and meta-analysis aimed to comprehensively synthesize the available evidence regarding the association between second trimester per vaginal bleeding (PVB) and the risk of preterm birth (PTB), in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [8]. Adherence to PRISMA standards was intended to promote transparency, methodological rigor, and reproducibility, thereby strengthening the validity of the findings. A systematic literature search was conducted across multiple electronic databases, including PubMed and MEDLINE including articles published up to December 2025, in English. The search strategy combined the following terms: (“per vaginal bleeding” OR “vaginal bleeding” OR “antepartum hemorrhage” OR “antepartum haemorrhage” OR PVB OR “unprovoked vaginal bleeding” OR “idiopathic bleeding in pregnancy”) AND (“second trimester” OR “mid-pregnancy”) AND (“preterm birth” OR “preterm delivery” OR “PTB” OR “prematurity”) AND (“outcomes” OR “risk factors” OR “association”). No geographical restrictions were applied. Additionally, the reference lists of all included studies were manually screened to identify any further relevant publications not captured in the initial search. Two independent reviewers screened titles and abstracts, followed by full-text evaluation of potentially eligible studies. Any disagreements were resolved through discussion and consensus. The study protocol was registered in the PROSPERO international prospective register of systematic reviews (protocol number: CRD420261367031). As this meta-analysis was based exclusively on previously published data, ethical approval and patient consent were not required.

2.2 Eligibility criteria

Studies were deemed eligible if they were original research articles (prospective or retrospective cohort or case-control studies) involving pregnant women with documented unprovoked second-trimester per vaginal bleeding and reported outcomes related to preterm birth, or provided sufficient quantitative data (e.g., odds ratios, relative risks, or extractable raw data) to assess this association. Unprovoked bleeding was defined as no known cause being associated with it, being a placenta pathology such as placenta previa, vasa previa, placenta accreta, or a cervical or vaginal bleeding point. Studies were excluded if they were non-primary research articles (including reviews, meta-analyses, editorials, letters, or case reports), did not specifically address second-trimester bleeding, lacked adequate quantitative data for analysis, involved non-human subjects or were not published in English, or represented duplicate publications or overlapping study populations.

2.3 Data Extraction & Quality Assessment

Data was independently extracted by two reviewers using a standardized form. Extracted variables included study characteristics, baseline population data, and details of exposure and outcomes. Effect estimates were recorded where available; otherwise, raw data was extracted for calculations. Discrepancies were resolved by consensus. Study quality was parallelly assessed by two reviewers using the Newcastle–Ottawa Scale (NOS) as per standard procedure [9]. Discrepancies were also resolved through consensus. As per sensitivity analysis and risk of bias evaluation, studies scoring below 7 were considered of lower methodological quality and were excluded. Detailed assessments are included in Table 1.

2.4 Statistical Analysis

All analyses were conducted using IBM SPSS Statistics version 31.0. The genetic inverse variance method was used with odds ratios (ORs) converted to log scale (lnOR) and standard errors were calculated. Where not reported, ORs and confidence intervals (CI) were derived from raw data. Heterogeneity was assessed by Cochran’s Q-test and the I² statistic (p < 0>

In addition, a retrospective analysis was completed with aim to include our results and contribute to the assessment of the significance of bleeding in the second trimester. Patient electronic records of all women attending the Rosie Hospital in Cambridge, UK with antepartum vaginal bleeding between January 2019 and December 2021 were accessed. This period was chosen because of accessibility linking patients to preterm birth outcomes following the above inclusion and exclusion criteria. Records were reviewed and only women with UVB in the second trimester, from 13+0 weeks until 24+6 weeks presenting, were included. These results have not been published before. 

Study, yearSelection 
(max 4 stars)
Comparability (max 2 stars)Exposure/outcome (max 3 stars)Overall quality score(max 9 stars)Design
   Armata, 2026**** ***7cohort
Özdemirci, 2016*** **5case-control
Ramaeker, 2012*********9cohort
Smits, 2012*********9cohort
Harlev, 2008********8cohort
Koifman, 2008*******7cohort
McCormack, 2008*******7cohort
Towers, 2008*******8cohort
Arafa, 2000********8cohort
Signore, 1998********8case-control
Karim 1998**** **6case-control
Sipila, 1992*********9cohort
Lipitz, 1991*** ***6cohort
Batzofin, 1984**** ***7case-control

Table 1: The Newcastle-Ottawa scale for assessing the risk of bias of the included studies.

3. Results

The search strategy yielded a total of 1858 articles, out of those 126 passed the initial article selection and under more detailed assessment only 13 satisfied the inclusion criteria and were included in the final analysis (Figure. 1). The characteristics of the included studies are summarized, including study design, sample size, and key findings (table 2). The results of the meta-analysis, including the overall effect size and confidence intervals, are presented. Subgroup analyses and sensitivity analyses are also reported to explore potential sources of heterogeneity.

Figure 1: Flowchart of the study selection procedure

First Author (Year)Type of Study, Setting

Population & selection

(characteristics)

Examined/ RF

 

Outcomes

(stats and details)

Armata
2026
Retrospective cohort, 
UK
2nd T UVB: 57
Controls: 15184
UVB 2nd TThe incidence of PTB in 2nd T UVB is 33% vs 6% in controls with no UVB 
Özdemirci, 2016

Retrospective case-control,

Turkey

Total: 544

Cases: 219 PVB 

Control: 325 no PVB

PVB 14-22wk

 

PVB increased risk of PTB and PPROM (OR: 10.8, 95% CI: 4.5-26.1]; OR: 12.0, 95% CI: 3.5-40.6]

Mean GA overall was earlier (37.9 ± 2.8 versus 38.9 ± 1.4, p<0.001)  

BW was lower 3071 ± 710 vs 3349 ± 446, p< 0.001). 

 

GDM and polyhydramnios were commoner (4.1% vs 1.2%, p = 0.031; 1.9% vs 0%, p = 0.025).

Ramaeker, 2012CohortTotal PVB: 2988
2nd Trimester: 274
1st, 2nd, both trimester PVBAdjusting  for cervical length and interaction of length with PVB, the OR for PVB and PTB was 4.8 (95% CI:1.89-12.4; P .001)
Smits, 2012

Retrospective cohort,

multinational

780 PVB up to 20wkRisk of pre-eclampsia was not associated with the presence or absence of bleeding
Harlev, 2008

Retrospective cohort 1988-2005, Israel

 

Total 173,621

PVB: 2077

UVB: 67

PVB in 2nd half of pregnancy

PVB increased risk of PTB (56.7% vs. 7.3%; mean GA of 33.6+/-5.7 vs. 39.2+/-2.1 wk; p < 0.001) 

Higher Caesarean rates (35.8% vs. 12.1%) 4.0; 95% CI 2.4-6.6; p< 0.001

Lower APGARs were noted in UVB OR:10.3; 95% CI: 5.9-17.8; p < 0.001- 1min OR:17.8; 95% CI: 7.1-44.5; p < 0.001- 5min

Koifman, 2008Retrospective cohort 1988-2005, Israel

Total 175,093

PVB on admission: 2010 

PVB in 2nd half of pregnancy requiring hospital admission

Delivery by Caesarean was higher (72.9 vs. 12.1%, OR = 19.5; 95% CI 17.6-19.9; 14.9 vs. 1.1%; P < 0.001). 

Perinatal mortality was significantly higher, p <0.001

McCormack, 2008Retrospective cohort, Australia26,583 deliveriesUVB 20wk until deliveryPVB significantly increased rates of IOL (2.00, 95% CI: 1.72-2.32, p < 0>< 0 xss=removed xss=removed xss=removed xss=removed>
Towers, 2008Retrospective cohort, 12 year, 

128
30: light PVB previa+ nonprevia

36: heavy PVB previa
62: heavy UVB

PVB 16-24wk; light vs heavy PVB

UVB: 51 (82%) PTB, 31 (50%) pregnancies lost, 9 (15%) with major morbidity outcomes 

The prognosis is worse for heavy UVB than heavy bleeding with previa

Arafa, 2000Retrospective cohort, Egypt

No Bleeding: 1344

2nd T PVB: 58

1st and 2nd T

PVB in 2nd trimester increased risk of adverse pregnancy outcomes: LBW deliveries adj OR: 3.9 (1.7-8.9), IUGR adj OR: 1.4 (0.46-4.5), PTB adj OR: 7.3 (3.1-17.1), perinatal death adj OR: 8.2 (3.8-18.5)

 

Signore, 1998Case-control, USA

Total: 334

Cases: 167 

Controls: 167

2nd T PVB 2nd trim. PVB was associated with increased risk of PTB RR: 1.9 (1.4-2.8), fetal death RR: 6.3 (1.9-2.1), and perinatal death RR: 5.4 (2.1-13.7).
Karim 1998Case-controls, Iraq

2nd T PVB: 24

Controls: 173

1st and 2nd trim PVB

Increased risk of PTB with 2nd T PVB OR: 6.5 (1.7-23, p<0>

Identified 25% incidence of miscarriage with 2nd T bleeding, but no association between PVB and LBW p=0.8

Sipila, 1992Prospective cohort

Total: 8718

PVB 2nd T: 206
Controls: 7911

1st and 2nd trim UVB2nd T UVB was associated with increased incidence of PTB OR: 2.9 (1.9-4.6), SGA OR: 2.5 (1.3-4.9), LBW OR: 4.1 (2.6-6.4), perinatal mortality <7days OR: 1.3 (0.3-5.4)
Lipitz, 1991

Prospective cohort

 

Total: 6964

UVB: 65

UVB 14-26wk2nd T UVB was associated with: 25 cases PTB (40%)
Batzofin, 1984Case controls

Total: 7486

PVB: 523- 20 had placental pathology

PVB <20wk

 

PVB increased risk for PTB rate ratio: 2.07 (p=3.1 x 10-9) 

Non-statistical significance between PVB and stillbirth

Table 2: Characteristics of included studies.

3.1 Main findings 

All included studies provided data regarding the exact number and mean age of patients. In total, 420,307 patients were included in the present study and the mean age ranged from 27 to 31 years. A total of 14 studies, including our results, were included in the quantitative synthesis, encompassing 5,601 cases of second trimester per vaginal bleeding associated with preterm birth and 414,706 controls across diverse ethnic populations.

Due to substantial heterogeneity observed among the studies included (I2 = 99%, Cochrane Q test = 559.04, p-value < 0.001), the random effects model was employed. The overall odds ratio (OR) for PTB due to 2nd trimester PVB compared to PTB non-relevant to PVB was 6.72 (95% CI 3.35-13.47, p-value<0.001). All the included studies exhibited statistical significance, despite one that showed marginal significance (10) (Figure. 2).

Figure 2: Forest plot demonstrating the summary odds ratio for PTB due to 2nd trimester PVB compared to non-related to bleeding PTB. Studies are listed in chronological order.

.2 Subgroup analysis

3.2.1 By age: Subgroup analysis based on maternal age demonstrated that the association between second-trimester PVB and PTB remained statistically significant within each examined age category. The overall pooled OR estimate of 11.56 (95% CI 2.28–58.55, p < 0.001), suggesting that maternal age may influence the strength of the association between PVB and PTB. (Figure.3)

Figure 3: Forest plot of the subgroup analysis stratified by maternal age, examining the association between second-trimester per vaginal bleeding (PVB) and preterm birth (PTB).

3.2.2 By smoking status, hypertension during pregnancy and parity: The meta-regression analysis based on data only from three studies, was performed to assess the effect of smoking prevalence, hypertension and parity on the association between second-trimester PVB and PTB. Only three studies provided patient characteristics for the above information. Smoking and hypertension showed a positive correlation but this was not statistically significant. Multiparity demonstrated a significant positive correlation. These findings, contradicting current knowledge, can only be explained because of the small size of studies and participants, as many papers did not provide this information. 

3.3 Sensitivity analysis

Through a sensitivity analysis that considered the weight of each study, three studies conducted by by Ӧzdemirci et al., Karim et al., and Lipitz et al. were removed as they carried the lowest weight in the meta-analysis results Following this exclusion, the pooled odds ratio (OR) was 4.64 (95% CI 2.78–7.75, p<0.001), indicating a significant association between second-trimester PVB and PTB. High heterogeneity persisted (I² = 98%, Cochrane Q = 535.59, p < 0.001), suggesting that these studies did not substantially influence the overall effect estimate or heterogeneity. (Figure. 7)

Notably, a sensitivity analysis restricted to high-quality studies (NOS score ≥ 7) resulted in the exclusion of the same studies, yielding consistent findings and further confirming the stability and robustness of the observed association. (Figure. 4).

Figure 4: Forest plot demonstrating the summary odds ratio for PTB due to 2nd trimester UVB compared to non-related to bleeding PTB, after excluding the studies with the lowest weight.  Studies are listed in chronological order.

3.4 Publication bias

Upon inspection, the funnel plot of studies included in the primary analysis showed evidence of asymmetry suggestive of publication bias, which was confirmed statistically (Egger P=0.008).  (Fig. 5). After 3 studies that appeared to be the cause of the asymmetry [Karim, Ozdemirci, LIpitz] were removed, little to no evidence of underlying bias could be found. Visual inspection of the updated funnel plot demonstrated improved symmetry, with a more balanced distribution of studies around the pooled effect estimate, suggesting a reduced likelihood of small-study effects. This observation was further supported by Egger’s regression test, which no longer indicated statistically significant asymmetry (p = 0.032). (Figure 6) These findings suggest that, after removal of the influential studies, the risk of publication bias is attenuated, thereby increasing confidence in the stability and reliability of the meta-analysis results.

Conversely, when visually assessing the funnel plots of studies encompassed within the majority of subgroup analyses, no significant asymmetry indicative of publication bias was evident.

Figure 7: Funnel plot of the 8 studies included in the meta-analysis

Discussion

Second trimester unprovoked vaginal bleeding represents a clinically significant, yet incompletely characterised obstetric event. In this systematic review and meta-analysis, we demonstrate a strong and consistent association between second trimester bleeding and preterm birth (PTB), with a pooled odds ratio of approximately 6.72. This magnitude of effect indicates that women experiencing second trimester bleeding are at substantially increased risk of PTB compared to those without bleeding.

The physiology of this association strengthens the clinical relevance of our findings. Vaginal bleeding during pregnancy may reflect underlying decidual instability, subclinical inflammation or early cervical remodelling. It is well recognised clinically that blood is a uterine irritant [11]. Mechanistically, thrombin generation following intrauterine bleeding has been shown to promote uterine contractility and weaken fetal membranes, contributing to both preterm labour and preterm pre-labour rupture of membranes (PPROM) [12, 13].

Unprovoked second-trimester vaginal bleeding is increasingly recognised as a clinical manifestation of underlying placental and decidual dysfunction, different to placenta previa. Specifically, it can represent signs of occult placental abruption, defective trophoblast invasion, or decidual vascular fragility. Occult placental abruption is a recognised mechanism of UVB in late pregnancy. Chronic abruption can present with periodic small amounts of bleeding, but it is often concealed, with a suspected prevalence up to 18%; thus the timing and severity cannot always be determined by visible loss [14]. Defective trophoblast invasion, particularly in early pregnancy, is implicated in early bleeding presentations and later placental complications. Pregnancies with threatened miscarriage presentations have increased risk of placenta previa (OR 1.62), UVB in the third trimester (OR 2.47) and placental abruption (OR 5.6)[15]. And these are the considered high-risk causes of UVB that require extra attention. 

In addition, second trimester bleeding may represent an early manifestation of pathological processes such as uterine or intra-amniotic infection or inflammation, or cervical pathology. Subclinical intra-amniotic inflammation, which may not be readily detectable, has been associated with both vaginal bleeding and adverse pregnancy outcomes. Supporting this, Musilova et al. recently demonstrated that the attenuation of intra-amniotic fluid inflammation following antibiotic therapy is achievable following antibiotics in the second trimester in patients experiencing UVB. This could support a possible mechanistic pathway linking UVB to PTB as patients with inflammation had a mean delivery of 28 vs 37 weeks in the no inflammation group [16]. 

Cervical factors may also play a key role. Conditions such as cervical ectropion, polyps, local infection, and early dilatation can present with bleeding. Studies have shown that local infections can induce pro-inflammatory cytokines IL-6, IL-8, TNF-a and prostaglandins that promote cervical ripening and membrane remodelling[17]. Furthermore, pathogens such as Gardnerella vaginalis have been shown to stimulate cervical metalloproteinase activity, that contributes to collage degradation and disruption of the epithelial integrity, which overall can result in premature cervical changes and ripening [18]. And in some cases as well, cervical remodelling, can occur in conjunction with placental pathologies and intrauterine inflammation. 

Therefore, second trimester UVB is not a benign symptom but rather a clinical marker of underlying biological processes that can predispose patients to preterm birth. Thus, bleeding should be considered as a clinical sign to prompt for targeted investigations to evaluate for infection- inflammation, placental problems, such as small detachments and haematomas, as well as other cervical pathologies. We believe that this systematic approach will improve the management and outcomes of patients with second trimester bleeding to differentiate high and low risk placental, cervical or inflammatory causes and when these transition to higher complication risk. 

Our findings align with previous studies demonstrating an association between vaginal bleeding and adverse pregnancy outcomes, including PTB and PPROM. Prior literature has often grouped bleeding across all trimesters or failed to distinguish between provoked and unprovoked bleeding. By focusing specifically on unprovoked second trimester bleeding, our study provides a more clinically relevant estimate of risk during a gestational window where prognostic uncertainty is high and management strategies are limited. However, our study does not show the expected association with smoking, hypertension and parity. Vascular factors pertaining to smoking and hypertension have been well established due to the risk of abruption in the third trimester, where they appear to almost double and quadruple that risk respectively [19]. 

Notably, our local cohort further supports this relationship, demonstrating that second trimester bleeding was more strongly associated with PTB than with other adverse outcomes. This reinforces the significance of PTB as the primary clinical endpoint in unprovoked second trimester bleeding and supports the rationale for focusing risk stratification efforts and preventative interventions on preterm delivery.

Despite the strength of the observed association, several limitations should be considered. First, heterogeneity across studies was substantial, reflecting variation in study deign, population characteristics, timing and definition of the bleeding presentation. Moreover, a few of the included studies examined patients with bleeding in the 1st or 3 trimester, along with 2nd trimester findings. We ensured that these studies had clear descriptive information regarding the bleeding presentation; however certain gestational outcomes were often combined, which may have introduced some misclassification bias. Lastly, evidence of potential publication bias was observed, with an Egger’s test p=0.039, suggesting that smaller studies with null findings may be underrepresented, potentially inflating the observed effect size.

From a clinical standpoint, these findings have important implications despite the above limitations. Second trimester bleeding should not be considered a benign or self-limiting symptom but rather a important clinical sign of increased risk for preterm birth. It is a clinical challenge to distinguish high-risk bleeding causes vs low-risk, and in cases of low-risk causes with recurrent presentations, be able to adapt management strategies when low-risk causes have resulted in chronic, more severe pathologies and transform to higher risk presentations. Recognition of this association should prompt careful evaluation, enhanced surveillance and patient counselling. However, the absence of standardized management pathways highlights another important gap in current clinical practices.

Conclusion

In conclusion, our study is clearly demonstrating that unprovoked vaginal bleeding during the second trimester is strongly associated with an increased risk of preterm birth and should be recognised as a clinically significant risk marker rather than a benign finding. Our analysis demonstrates a consistent and substantial association across study designs, supporting both the robustness and clinical relevance of this relationship.

These findings emphasise the importance of prompt evaluation and targeted investigation in women presenting with second-trimester bleeding, including assessment for infection, cervical pathology, and placental abnormalities. Improved recognition of this association may facilitate earlier risk stratification, enhanced surveillance, and the development of preventative strategies aimed at reducing preterm birth. Further prospective research is required to better characterise the underlying mechanisms, refine risk prediction, and establish evidence-based management pathways for this high-risk population.

References

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Dr SABITA SINHA

Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.

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Dr Ted Christopher

International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.

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Joel Yat Seng Wong

Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.

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Dr Mamoun Magzoub

Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.

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Baciulescu Laura

Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal

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Christoph Maurer

Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.

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Dr Elena Salvatore

Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed

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Mahmoud Kamal Moustafa Ahmed

Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.

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Dr Meng-JouLe

Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell

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Dr Andriy Sinelnyk

I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.

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Edouard Kujawski

Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.

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Dr Matteo Bonori

Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti

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Dr Claudio Ligresti

Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.

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Dr Chiara Giuseppina Beccaluva

Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.

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Dr Aline Tollet

Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.

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Dr Ravi Shrivastava

Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora

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Dariusz Ziora

Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.

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Dr Jelle Lettinga

Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.

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Dr Walter F Riesen

Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.

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Dr Rakhi Mishra

Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.

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Hala Al Shaikh

Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD

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Dr Eric S Nussbaum

Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.

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Dr Susan Anne Smith

Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.

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Dr Victor Olagundoye

Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.

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Dr Farahnaz Fallahian

Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.

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Dr Susan Anne Smith

Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.

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Dr Oleg Golyanovski

To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina

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Dr Elvira Farina

My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.

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Gertraud Teuchert-Noodt

We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.

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Dr David Vinyes

Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.

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Dr Anyuta Ivanova

I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.

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Dr Farooq Wandroo

"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".

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Dr Shweta Tiwari

To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.

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Dr Tewodros Kassahun Tarekegn

I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.

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Cristina Berriozabal

Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."

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Thomas Urban

I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.

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Zhao Jia

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.

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Luiz Sellmann

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.

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Sonila Qirko

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.

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Lin-Show Chin

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

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Dr Susan Weiner

Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”

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Zsuzsanna Bene

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¨.

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Dr Maria Regina Penchyna Nieto

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.

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Dr Maria Dolores Gomez Barriga

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.

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Maria Dolores Gomez Barriga

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.

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Lin Shaw Chin

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.

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Gomez Barriga Maria Dolores

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

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Khurram Arshad

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.

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Rui Tao

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

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George Varvatsoulias

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.

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Tania Munoz

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.

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S Munshi

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.

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Husain Taha Radhi

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.

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Dr Tong Ming Liu

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.

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Dr Griffith

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.

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Douglas Miyazaki

"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".

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Jesus Simal-Gandara

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!

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Baheci Selen

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.

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Bruno Chauffert

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.

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Dr Suramya Dhamija

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.

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Andreas Filippaios

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.

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Raed Mualem

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.

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Dr Shiming Tang

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.

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Hao Jiang

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.

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Prof Sherif W Mansour

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.

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Bernard Terkimbi Utoo

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.

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Pedro Marques Gomes

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.

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Anthony Kodzo-Grey Venyo

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.

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Katarzyna Byczkowska

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.

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Orlando Villarreal

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.

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Sing-yung Wu

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.

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Layla Shojaie

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.

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Mina Sherif Soliman Georgy

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.

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Ziemlé Clément Méda

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.

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Delcio G Silva Junior

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.

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Virginia E. Koenig