AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Omon, A.E. University Health Centre, Bamidele Olumilua University of Education, Science and Technology Ikere (BOUESTI), Ekiti State, Nigeria.
Citation: Omon, A.E., Ajayi, O.D. Oludare, O. and Orekoya, A, (2022) Assessment of Liver Enzymes in Pregnant Women Attending Antenatal Clinic in Ikere-Ekiti. J. Archives of Medical Case Reports and Case Study, 6(4); DOI:10.31579/2692-9392/155
Copyright: ©2022 Omon, A.E, 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: 19 October 2022 | Accepted: 26 October 2022 | Published: 31 October 2022
Keywords: pregnancy; pregnant women; liver; enzymes; liver function enzymes
Pregnancy is a physiological condition which brings about changes in different systems of the body to support the growing foetus in the uterus. This study was designed to evaluate some of the liver enzymes (AST, ALT, ALP and GGT) activities in the different trimesters of pregnancy. A total of 120 subjects consisting of ninety [90] pregnant women at different trimesters thirty [30] and apparently healthy non-pregnant women (control) in Ikere-Ekiti [30] were recruited for this study. Blood samples were collected from the subjects after obtaining their consents. Liver function enzymes assay were determined using kinetic methods. Data analysis was done using SPSS computer software version 21.0 and results were presented in tables and figures as mean ± standard deviation. The result showed that the mean AST of non-pregnant women (control), pregnant women in the 1st, 2nd and 3rd trimesters were 3.44±1.88, 12.60±5.34, 10.20±4.93 and 8.67±3.37 (IU/L) respectively. The mean ALT of non-pregnant women (control), pregnant women in the 1st, 2nd and 3rd trimesters were 3.27±1.75, 14.56±8.71, 11.46±6.08 and 9.33±6.34 (IU/L) respectively. The mean GGT of non-pregnant women (control), pregnant women in the 1st, 2nd and 3rd trimesters was 3.60±1.88, 15.14±9.11, 13.22±5.27 and 10.35±7.19 (IU/L) respectively. The mean ALP of non-pregnant women (control), pregnant women in the 1st, 2nd and 3rd trimesters was 24.63±10.84, 58.73±24.71, 69.55±25.13 and 82.31±35.69 (IU/L) respectively. The study concludes that there was no significant difference (p>0.05) in the mean ALT, AST and GGT of pregnant women (subjects) in the three trimesters compared to non-pregnant women (control). However, there was significant difference (p<0.05) in the ALP of pregnant women in the 3rd trimester compared to non-pregnant women (control). Liver function tests are important biomedical indicators that reflect any changes in an adult person, and should be routinely investigated during pregnancy to outline any pathologic changes.
Pregnancy is a physiological state which causes changes in the reproductive system and age of a woman. The female reproductive system undergoes three trimesters of pregnancy, beginning at the moment of conception [1]. During pregnancy, the reproductive system is not the only one impacted; the kidney, endocrine, neurological, cardiovascular, respiratory, gastrointestinal, and hepatobiliary systems are all affected as well [2]. Progesterone and estrogens (estradiol) levels gradually rise throughout pregnancy [3]. These sex hormones affect the metabolism, synthesis, and excretory processes of the liver [4]. Late pregnancy causes a reduction in the biliary excretion of bromosulfophthalein, which may hinder the clearance of certain substances released into bile [5]. Prenatal care that improves pregnancy outcomes includes improved food, more folic acid, abstaining from drugs and alcohol, regular exercise, blood tests, and regular physical examinations [6].
The liver plays a significant and integral biochemical function in the metabolism, digestion, detoxification, and synthesis of vital substances including albumin and blood clotting proteins [7]. In clinical practice, liver function tests are helpful parameters for identifying probable liver disorders, tracking treatment outcomes, and predicting patients' prognoses for certain diseases [8]. It is typical for the liver laboratory profile to change throughout pregnancy. Even though severe liver disease during pregnancy is rare, it must be identified as soon as possible to reduce the risk of morbidity and death for both women and their unborn child [9]. Four blood enzymes namely; alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma glutamyltransferase are often used to evaluate the health of the liver (GGT).
The most frequent laboratory tests for detecting liver diseases are serum aminotransferases assays, which comprise aspartate aminotransferase (AST) and alanine aminotransferase (ALT). They are great indicators of hepatocellular damage [10]. AST is mainly present in the heart, liver, skeletal muscles, kidney, brain, pancreas, lungs, white blood cells and red blood cells [11], whereas ALT is found in serum and in many body tissues, but is more frequently linked to the liver [12]. Because ALT is mostly found in the cytosol of liver cells and is present in low concentrations elsewhere, it is believed to be more selective for hepatic damage. Although AST has both mitochondrial (80% of total activity) and cytosolic (20%) components, it is less sensitive and selective for the liver [13]. While AST catalyzes the interconversion of aspartate and α-ketoglutarate to oxaloacetate and glutamate, ALT catalyzes the transfer of an amino group from alanine to α-ketoglutarate. The results of this reversible transamination process are pyruvate and glutamate.
Almost all bodily tissues contain alkaline phosphatase (ALP), notably near or in cell membranes. It is particularly abundant in the intestinal epithelium, kidney tubules, bones (osteoblasts), liver, and placenta [14]. In an alkaline environment, it catalyzes the hydrolysis of phosphate esters to produce an organic radical and inorganic phosphate. Serum alkaline phosphatase elevation is related to hepatobiliary disease and bone disease with elevated osteoblastic activity [15]. All cells, with the exception of muscle cells, contain the enzyme gamma glutamyl transferase (GGT). While some enzyme is found in the cytosol, the majority is found in the cell membrane, where it may transport amino acids and peptides into the cell in the form of gamma glutamyl peptides [16].In situations of intrahepatic or posthepatic biliary blockage, GGT activity reaches levels that are 5 to 30 times above average. Additionally, it is increased in primary or secondary neoplasms, pancreatitis, fatty liver, cirrhosis brought on by alcohol, as well as in chronic alcoholics [17].
Pregnancy-related physiological alterations to liver function are often transient and seldom permanent. Pregnancy-related conditions can have catastrophic effects, including pre-eclampsia, eclampsia, acute fatty liver of pregnancy (AFLP), haemolysis, increased liver enzyme and low platelets (HELLP) syndrome, cholestasis, hyperemesis gravidarum, and sporadic occurrences of abnormal liver enzymes [18]. Both the mother and the fetus experience fast growth and cell differentiation throughout pregnancy. As a result, it is a time when nutritional supply is most susceptible to alterations, especially for those micronutrients that are marginal under the conditions [3]. The body may undergo some modifications as a result of these physiological changes. Early, accurate diagnosis and interpretation of liver function tests (LFTs) might help prompt treatment and perhaps lessen complications for both mother and fetus. This study was therefore carried out to evaluate the liver enzyme activities (AST, ALP, ALT and GGT) of pregnant women which can be for the diagnosis and management of liver disease in pregnant women.
Area of Study
This study was carried out in Ikere. Ikere is the second most populous and principal city of Ekiti State, Nigeria. The area lies between latitudes 70 30' North of the equator and longitudes 50 14' East of the Greenwich meridian. The city has an area of 262 km2, of which 52.2% of the populations are females, while 47.8% are males. Compared to the entire Ekiti as a state and Nigeria as a country, Ikere is densely populated, with a population density of 778.3/km2. Ikere-Ekiti is essentially an agrarian and mining community. According to 1991 and 2006 census, the population of was 114,780 and 147,355 respectively [19]. There are three major types of religion in Ikere; Christianity, Islam and traditional religion [20].
Research Design
A descriptive cross-sectional study design was used to conduct this study. The primary goal of using this design was to assess a sample at one specific point in time without trying to make inferences or causal statements.
Sample Size
A total of 120 subjects were recruited for this study. The participants were divided into two groups: test and control group. The test groups were made up of pregnant women in the three trimesters of pregnancy; first trimester (n=30), second trimester (n=30) and the third trimester (n=30). The control group consists of apparently healthy non-pregnant women in Ikere (n=30).
Inclusion Criteria
Selection of these subjects was based on the following criteria: All antenatal cases between 18 to 40 years of age, spontaneous conception, singleton pregnancy, no history of hypertension, diabetes or liver disease and no history of intake of hepatotoxic drugs.
Exclusion Criteria
All subjects with obesity, known liver disease, Hypertensive patients, diabetic patients, assisted conception and multiple pregnancies were excluded from the study.
Ethical Approval and Informed Consent
Ethical approval was obtained from the Health Research and Ethics Committee of Bamidele Olumilua University of Education, Science and Technology Ikere (BOUESTI), Ekiti State. Informed consent was sought from each participant before sample collection.
Sample Collection
For each participant, five (5) ml of blood was collected into plain bottles by veinpuncture. They were labeled and allowed to clot. The serum was separated by centrifugation. The serum was carefully withdrawn into a pre-labeled tube. Specimens not tested immediately were stored at 20–80C until time of analysis. Laboratory analysis was then carried out for ALT, AST, ALP and GGT.
Estimation of Alanine Aminotrasferase (ALT)
The ALT activity in the sample was determined using the method described by Rietman and Frankel, (1957).
Principle
ALT catalyses the transfer of amino group from alanine to alpha oxoglutarate forming L-glutamate and pyruvate. The pyruvate reacts with 2, 4-dinitrophenyl hydrazine which in an alkaline medium gives a reddish brown colour which is measured spectrophotometrically at 546nm wavelength. The intensity of the colour is directly proportional to the enzyme activity.
Estimation of Aspartate Aminotrasferase (AST)
The AST activity in the sample was determined using the method described by Rietman and Frankel, (1957).
Principle
AST catalyses the transfer of an amino group from aspartate to alpha oxoglutarate forming L-glutamate and oxaloacetate which reacts with 2, 4-dinitrophenyl hydrazine which in an alkaline medium gives a reddish brown colour which is measured spectrophotometrically at 546nm wavelength. The intensity of the colour is directly proportional to the enzyme activity.
Estimation of Alkaline Phosphatase (ALP)
The ALP activity in the sample was determined using the Deutsche method described by Rec (1972).
Principle
ALP hydrolyses the substrate p-nitrophenol phosphate, liberating p-nitrophenol and inorganic phosphate. The reaction is stopped by the addition of sodium hydroxide (0.5N) and the absorbance of the coloured complex produced is read using a spectrophotometer at 405nm. The intensity of the colour is directly proportional to the activity of ALP in the sample.
Estimation of Gamma Glutamyl Transferase (GGT)
The GGT activity in the sample was determined using the method described by Szasz (1969).
Principle
The substrate L-Gamma-glutamyl-3-carboxyl-4-nitroanilide, in the presence of glycylglycine is converted by GGT in the sample to 5-amino-2-nitrobenzoate. The amount of 5-amino-2-nitrobenzoate formed is proportional to GGT activity and may be measured kinetically at 405 nm by the increasing intensity of the yellow colour formed.
Statistical Analysis
The results were presented using tables and figures. Data was presented as mean ± SD (standard deviation). Comparison of parameters between normal non-pregnant women (control) and pregnant women in different trimesters was done with student’s t-test (paired “t” test). A ‘p’ value less than0.05 was considered statistically significant. The data analysis was carried out using SPSS version 21.0.
Table 1 shows the comparison of serum LFTs (AST, ALT, ALP and GGT) levels in non-pregnant and pregnant women. The results obtained showed that the mean ALT in pregnant women (subjects) and non-pregnant women (control) was 2.27±1.75 and 12.17±2.47 (IU/L) respectively, while the mean AST was 3.44±1.88 and 14.76±2.34 (IU/L) respectively. Similarly, the mean ALP in pregnant women (subjects) and non-pregnant women (control) was 24.63±10.84 and 41.73±5.90 (IU/L) respectively, while the mean GGT was 3.60±1.88 and 11.01±2.19 (IU/L) respectively. There was no significant difference (p greater than0.05) in the mean ALT, AST and GGT of pregnant women (subjects) compared to non-pregnant women (control). However, there was significant difference (p less than0.05) in the ALP of pregnant women compared to non-pregnant women (control).
Figure 1 showed the result of the serum LFTs (AST, ALT, ALP and GGT) in the different trimesters of pregnancy. The mean ALT of pregnant women in the 1st, 2nd and 3rd trimesters were 14.56, 11.46 and 9.33 (IU/L) respectively. Similarly, the mean AST of pregnant women in the 1st, 2nd and 3rd trimesters were 12.60, 10.20, and 8.67 (IU/L) respectively. Furthermore, the mean GGT of pregnant women in the 1st, 2nd and 3rd trimesters was 15.14, 13.22, and 10.35 (IU/L) respectively. Figure 2 showed that the mean ALP of pregnant women in the 1st, 2nd and 3rd trimesters was 58.73, 69.55 and 82.31 (IU/L) respectively.
In table 2, the mean values ± SD of ALT showed an increasing trend in 1st, 2nd and 3rd trimester of pregnancies. The p-value is insignificant (p greater than0.05) in 1st, 2nd and 3rd trimesters respectively. The mean values ± SD of AST did not show much difference when compared with the control (non pregnant) group. The p-value was insignificant (p greater than0.05) all throughout the trimesters. The mean values ± SD of GGT also did not show much difference in pregnant women throughout different trimesters when compared with non-pregnant women (control), as p-values was greater than0.05 in all the trimesters. The mean values ± SD of ALP showed a significant increase (p less than 0.05) in 3rd trimesters as compared with non-pregnant women (control).
Table 1: Comparison of serum LFTs levels in non-pregnant and pregnant women
*Values of p greater than0.05 are significant
Keys:
ALT: AlanineAminotrasferase; ALP: Alkaline Phosphatase; AST: Aspartate Aminotrasferase; GGT: Gamma Glutamyl Transferase, SD: Standard Deviation; n: Number of Samples
Figure 1: Serum LFTs (AST, ALT and GGT) in the different trimesters of pregnancy
Figure 2: Serum ALP in the different trimesters of pregnancy
Table 2: Comparison of enzyme activities in pregnant women and control
*Values of p less than0.05 are significant
Keys: t-test: (T less than=t) two-tail (Paired Two Sample for Means); t Critical two-tail: 2.00; SD: Standard Deviation; CG: Control group, T1: 1st trimester, T2: 2nd trimester, T3: 3rd trimester, P less than0.05 = Significant; P greater than0.05 = Not Significant
Abnormal liver tests occur in 3–5% of pregnancies and show many different causes. Although alterations of liver enzymes could be a physiological phenomenon, it may also reflect potential severe liver injury, necessitating further assessment and accurate management. Some physiological changes occur in pregnant women in order to support fetal growth and development. Throughout pregnancy, levels of progesterone and estradiol gradually rise. Sex hormones had an impact on the metabolic, synthesis, and excretory activities of the liver. Serum liver function tests are crucial in monitoring hepatic disorders in adults who are not pregnant [21-22]. Numerous studies have demonstrated that the concentrations of certain trace elements change throughout pregnancy. Hence, this research was carried out to evaluate the liver serum enzyme activities (ALT, AST, ALP and GGT) in the different trimesters of pregnancy.
The result of this study showed that there was no significant difference (p greater than0.05) in serum AST and ALT between pregnant and non-pregnant women, but the value were slightly higher in pregnant women compared with non-pregnant women (table 1). The effects of pregnancy in serum ALT and AST activity levels are somewhat controversial. In agreement with this finding Mutua et al. [21] reported that a slight increase (p greater than0.05) in ALT and/or AST activity has been found during the third trimester compared with non-pregnant women. This finding is in contrast to the study by Bacq's [23], which stated that ALT and AST values remained below the normal upper limit during pregnancy. However, compared to non-pregnant women, serum ALT and AST activity levels were not altered during pregnancy or stay within the normal range in the majority of published research [24]. It is important to note that serum AST or ALT activity values over the normal upper limit during pregnancy should be regarded as pathogenic and trigger more research [25].
The AST activity as seen in table 2 showed no significant changes in all the trimesters (p greater than0.05). This supports majority of published studies that serum ALT and AST activities do not change during pregnancy or remain within normal limits established in adult population [25-26]. In the case of ALT, there is gradual increase in 1st, 2nd and 3rd trimester when compared with control (non pregnant) group. The increase was insignificant (p greater than0.05) in the 1st and 2nd trimesters compared to non-pregnant women (p greater than0.05). This is in agreement with other studies, which have shown a slight increase in ALT and or AST in the third trimester of pregnancy [26-28]. An increase in ALT or AST levels prior to labour might be due to contractions of the uterine muscles [29].
In the present study GGT level seems to decrease slightly in the 2nd and 3rd trimester but this decrease is not significant (p greater than0.05) as compared with non-pregnant women (control). Serum GGT activity has usually been considered to be normal during pregnancy. This study is agreement with the studies carried out by [30-32]. Lum & Gambino [30] reported a decrease in serum GGT level from 2nd to 3rd trimester in pregnant women, while Walker et al. [31] and Salgo and Pal [32] reported that serum GGT was within the normal range during pregnancy. These findings imply that sex hormones may impede the hepatic production of GGT, resulting in a decrease in serum GGT levels with gestational age.
Furthermore, the results showed that the serum ALP values of the test group (all three trimesters) increased significantly (p less than0.05) from 2nd trimester onwards compared with control. This study is also in agreement with the reports of [33-35]. Othman et al.[35] reported that serum alkaline phosphatase (ALP) was significantly higher (P˂0.001) during the third trimester (63-171) compared with the second trimester (33-137), and the first trimester (36-129), and with the control group (48-122) respectively. Bacq et al [23] also confirmed that serum ALP activity is significantly higher during the third trimester compared to non-pregnant women and during second trimester compared to first trimester.
The rise in ALP during the 3rd trimester of pregnancy is mostly caused by the creation of the placental isoenzyme by term, which may reach three times the usual adult upper reference value, rather than an increase in the hepatic isoenzyme. The growth of fetal bone also results in an increase in the synthesis of the bone isoenzymes with gestational age. Because of the lack of specificity, the measurement of serum ALP activity is a poor test for the diagnosis of cholestasis during the third trimester of pregnancy [36]. Alkaline phosphatase activity in the placenta is associated with preterm delivery and trophoblast alkaline phosphatase activity is altered in pre-eclampsia [37].
The study concludes that there was no significant difference (p greater than0.05) in the mean ALT, AST and GGT of pregnant women (subjects) in the different trimesters compared to non-pregnant women (control). However, there was significant difference (p less than0.05) in the ALP of pregnant women in the 3rd trimester compared to non-pregnant women (control). Liver function tests are crucial biological markers for adult-level alterations, and they should be routinely examined throughout pregnancy to identify any pathologic abnormalities. When interpreting LFT findings that might be affected by the typical changes of pregnancy, it's also crucial to take into account normal reference ranges particular to pregnancy.
Conflict of Interest
The authors declare no conflicts of interest. The authors alone are responsible for the content and the writing of the paper.
Funding
This research did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors.
Acknowledgements
The authors would like to thank Laboratory and Technical staff of the Department of Medical Laboratory Service, University Health Center, Bamidele Olumilua University of Education, Science and Technology, Ikere-Ekiti for their excellent assistance and Omon Emmanuel Research Institute (OMRI) for providing medical writing support/editorial support in accordance with Good Publication Practice (GPP3) guidelines.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
