AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Aisha A Muhammed, Omar Al-Mukhtar University, Department of Physiology, Faculty of Medicine, Libya.
Citation: Riad M Abughali, Milad A. Arzeni, Karima R. Zarug Edawib, Aisha A Muhammed. 2021 Evaluation of Thyroid Hormones Levels in Libyan Patients with Chronic Renal Failure Before and after Maintenance Hemodialysis. Biomedical Research and Clinical Reviews. 3(2); DOI: 10.31579/2692-9406/036
Copyright: © 2021 Aisha A Muhammed, 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: 23 November 2020 | Accepted: 05 February 2021 | Published: 08 February 2021
Keywords: chronic renal failure (CRF); hemodialysis (HD); triiodothyronine (T3); andthyroxine (T4)
Data from recent studies revealed that kidney diseases might affect the thyroid function in various ways. A variety of alterations in thyroid hormone levels and metabolism have also been reported in patients with chronic renal failure (CRF) in some studied population. In addition, it was reported that serum levels of both T3 and T4 might altered immediately after a hemodialysis (HD) treatment than before. Therefore, this study was aimed to investigate the level of triiodothyronine (T3) and thyroxine (T4) in CRF Libyan patients before and after HD.
This study was carried out on 46 CRF patients (30 male and 16 female) with a mean age of 47.46 ±15.75 years. These patients were treated at the hemodialysis unit of Educational Central Zelitin Hospital, Zelitin, Libya. None of these patients apparently have any thyroid problems and no history of drug intake that may affect thyroid function. Blood samples were taken from each patient to measure serum levels of T3 and T4, before and after HD. In addition, the effect of several variables include age, gender, body mass index (BMI), presence of both hypertension and, diabetes mellitus and duration of kidney dialysis on serum levels of T3and T4 before and after HD were also studied.
After HD, there was a statistically significant increase in the serum levels of T3, T4. The age, gender, BMI, duration of kidney dialysis and the presence of hypertension and diabetes mellitus did not have any significant effect on the serum level of T3 and T4 before and after HD. However, the serum levels of T3 and T4 were still in the normal range in these examined patients either before or after HD.
From these findings, it can be concluded that these CRF patients may be in a euthyroid state, because the serum levels of T3 and T4 were in the normal range. In addition, HD was seem to improve the T3 and T4 thyroid hormone concentrations, suggesting that HD might activate the secretion of thyroid glandand catabolism. The other variables did not play any role in thyroid hormone levels in these patients either before or after HD. It is highly recommended that large scale evaluation of thyroid hormone levels in Libyan CRF patients is performed more patients, especially elderly patients.
The interaction between thyroid gland and the kidney in each other's functions is known for many years (1). Thyroid dysfunction affects renal physiology and development, whereas kidney disease could result in thyroid dysfunction. The kidney normally plays an important role in the metabolism, degradation and excretion of several thyroid hormones. (2). Thyroid gland is the largest endocrine gland in vertebrates which located in the front of the neck, and just below the larynx. Thyroid glands can synthesize three important hormones, known as thyroxine (T4), triiodothyronine (T3) and calcitonin (3). T4 and T3 are necessary for the normal growth, development, differentiation, and stimulate the rate of metabolism in most body tissue (4);(5). Calcitonin was found to decreases calcium level in the blood via inhibiting bone breakdown by osteoclasts (6).
Kidney function might be influenced or impaired by various factors, including infections, poisoning, tumors, stone formation and others (7);(8). These factors might can cause a decline in kidney function, and/or lead to kidney diseases or renal failure.
Renal failure is one of the most serious consequences of kidney diseases. Renal failure is a situation when the kidneys fail to function effectively and unable to maintain homeostasis of the blood. It can be divided into two forms: acute and chronic renal failure (9). Whereas, there are other factors which may help to differentiate acute and chronic kidney disease include; the presence of anemia and the kidney size on ultrasound. Chronic kidney disease generally leads to anemia and small kidney size (10). Patients with chronic renal failure (CRF) often have signs and symptoms indicative of thyroid dysfunction. These discovers include dry skin, sallow complexion, low temperature, cold intolerance, decreased basal metabolic rate, sleep and tiredness. Various studies of thyroid functions in uremic patients have been carried out which have shown conflicting results (11).However, CRF disease affects thyroid function in multiple ways, including low levels of circulating thyroid hormone concentration, altered peripheral hormone metabolism, disturbed binding to carrier proteins, possible reduction in tissue thyroid hormone content and increased iodine stores in the thyroid gland (12). Thus, patients with renal failure may have various abnormalities of thyroid function nevertheless; they are typically clinically euthyroid (13).The aim of the present study was to evaluate the serum levels of thyroid hormones T3and T4 levels in Zeletin city patients with chronic renal failure, before and after haemodialysis (HD).
Objective of research:
Several factors have been shown to influence the results of thyroid function tests. These include the type of kidney diseases, the degree and duration of renal failure, the extent of malnutrition, diabetes mellitus, dietary factors, HD with heparin or CAPD, and renal transplantation (14), (15), (16). Taken together, it appears from these previous studies, there is an evidence of relationship between the level of thyroid hormones and CRF. However, the issue of thyroid function in patients with CRF is still inconclusive due to the complexity of the system studied. Therefore, the goal of this research will be to examine the status of thyroid function in Zeletin city patients with CRF before and after the HD. According to our knowledge this study is the first study conducted on the Zeletin city populations.
Materials and methods
Study sample: Forty six Libyan CRF patients from Zeletin City were invited to participate in this study. The subjects were invited by using multistage, stratified cluster sampling by the gender (male and female) and age groups (≤40, 41-65, and >65and years). Totally 46 patients (30 males and 16 females) where, apparently don’t have any thyroid problems and no history of drug intake that affects thyroid function (e.g. beta blockers, thyroid hormone replacement therapy, thiouracil, neomercazole) were recruited to participate in the study. The verbal consents were obtained from each individual after explaining the aims and methods of this study.
Data collection:
Personal and socio-demographic data from the volunteers were collected in structured questionnaires consist of a series of questions. Gender, age, height, body weight, history of health problems were including in questionnaires (diabetes, blood pressure, and other diseases). Furthermore, the subjects were asked about the period of using HD treatment.
Blood collection:
Blood were collected from the volunteers of Libyan in Zelitin city. Five milliliter of venous blood was withdrawn before and after HD treatment from each recruited patient. The blood samples was taken in Serum-Separating Tubes (SSTs). That tube was used to provide the serum for measuring T3 and T4 hormones. However, the Libyan blood samples were collected in the hemodialysis unit of Educational Central Zelitin Hospital, and then kept at 4 ˚C before transferred to their diagnostic lab.
Biochemical Analysis:
The serum was separated from the blood samples. The samples were centrifuged at 3000 rpm for 5 min at 4˚C. Serum total T3 and T4 hormone concentrations were assayed by Microparticle Enzyme Immunoassay (MEIA) using Abbott AxSYM system (AxSYM, Abbott Diagnostics, Abbott Park, IL), fully automated immunoassay analyzer and commercially available kits from Abbott, USA at Educational Central Zelitin Hospital lab in Libya
Dependant and independent variables:
Dependant variable: The level of T3 (ng/ml) in the blood was measured and divided into three main groups; under normal (<0.45), Normal (0.45-1.37), andAbove normal (>1.37). The serum T4 (µg/dl) level was measured and divided into three main groups: Under normal (<4.5), Normal (4.5-12.0) and above normal (>12.0).
Independent variables: The following variables are identified to be predictors for thyroid functional hormone among the study patients:
Age: It was divided into three groups as the following: (≤40, 41-65, and >65and years).
Gender: Male or female.
Body mass index (BMI): After measuring the height (meter) and body weight (Kg) of each patient, BMI was calculated for each subject by using the following formula (BMI = weight/Kg / (height/m)2) then it was divided into four categories as the following; (<19:Under weight, 19-25:Normal, >25-29.9:Overweight, ≥30:Obese )
Diabetes: No or Yes.
Blood pressure: No or Yes.
Duration of kidney dialysis (Years): It was divided into three groups as the following: (≤4, 5-9 and ≥10).
Data processing and statistical analysis:
Data were entered and analyzed by the Statistical Package for Social Sciences (SPSS) software version 11.0 (SPSS®: Inc., Chicago, IL, USA). Normality test was done to check the data. Percentages, cross tabulation, means and standard deviations were produced and calculated. In addition, McNemar-test was used for comparisons among paired dichotomous groups and Paired t test used for paired continuous parametric variables. Chi square test also was used to do comparison between before and after HD for Zelitin patients regarding to the levels of T3 and T4 hormones. The level of significance was set at (P ≤0.05).
RESULTS:
Introduction:
The patients included in this study are 46 CRF patients from Zelitin city in Libya and their age, sex, duration of HD, BMI, presence or absence of both high blood pressure and diabetes mellitus were investigated. Thyroid hormones (T3 and T4) were measured for all of these patients before and after of hemodalysis (HD).
Characteristic of studied patients:
The samples consist of 30 males forming 65.2% and 16 females forming 34.8%. Their ages ranged from 20 to 90 years. The samples divided to three groups as shown in the (Table 4.1).
Medical history of sample:
In current study, CRF patients of Zelitinwere suffered of additional diseases. Whereas, 10 persons (12.7%) were suffered of diabetes mellitus and 34 persons (73.9%) were had hypertension. The duration of kidney dialysis among the studied patients is different and was divided to three groups; 1 to 4 years, 5 to 9 years, and more than 10 years. The mean and SD value of duration of kidney dialysis was 6.76 and 4.18 years, respectively (Table 4.2).
3.4. The hormonal status at times before and after HD samples:
Table 3-3 shows the mean serum levels of T3 and T4 hormones for the 46 patients with CRF, before and after HD. The mean serum levels of T3 were 110 ng/ml and 121 ng/dl before and after HD, respectively. This study also revealed that 34 patients were had normal serum level of T3 (45-137 ng/dl) before HD, but their number decreased to become 29 patients after HD. In addition, before HD, the serum level of T3 in 2 cases were lower than the normal range and 10 cases were higher than the normal range. After HD, only 1 cases had serum level of T3 lower than the normal range and 16 cases had serum level of T3 above the normal range. Statistically, the mean values of serum level of T3 in patients with CRF showed significant change after HD (P < 0.05).
Furthermore, of the 46 HD patients with CRF entered in the study, the mean values of serum level of T4 were 4.5 µg/dl before HD and 5.9 µg/dl after HD. The number of the patients before HD who had normal serum level of T4 (4.5-12.0 µg/dl) were 19 (41%) patients and this number had increased to 41 (89%) patients after HD. whereas, the number of the patients who had under normal serum level of T4 before HD were decreased from 27 (58.7%) to 5 (10.9%) (Table 3-3). Statistical analysis revealed that there was a significant difference on the mean serum levels of T4 in CRF Libyan patients before and after HD (P <0.001).
Data are shown as N (%). Patients are divided into two subgroups on the basis of T3 and T4 level: under normal, normal, above normal. Significant differences were observed on serum level of T3 and T4 before and after HD.
Discussion:
The serum thyroid hormone was used as indicator to determine the level of the hormones both before and after the kidney dialysis. The thyroid hormones level; T3 and T4 were analyzed and measured for all recruited patients in the study from Zelitin city in Libya. large number of hormonal systems are affected by CRF, until now CRF disease remains unclear to what extent these changes are responsible for aspects of uraemic syndrome. Patients with CRF often have signs and symptoms suggestive of thyroid dysfunction. Therefore, the diagnoses of thyroid disease in these patients have obvious prognostic implications (11).
In this study, 29 (63%) out of 46cases of patients were had normal serum levels of T3 after HD and 41 (89%) out of 46 cases had normal serum levels of T4 after HD. The mean value before and after HD for T3 level in patients were 110 ± 32ng/dl and 121 ± 37 ng/dl, respectively. Similarly, the mean values of serum level of T4 were 4.5 µg/dl before HD and 5.9 µg/dl after HD. There was a significant change in serum levels of T3 and T4 before and after HD. Taken together, our data revealed that the HD treatment increase the serum levels of both T3 and T4 hormones. Based on these data, it is possible to suggest that HD might activate the secretion of thyroid glandand catabolism.This can be explained by the normal negative feedback regulation of the pituitary thyroid axis or the thyroid hormones and thyrotropes form a negative feedback loop. This mean when the serum level of T3 and T4 increase, the production of TSH must decreased, because no need to stimulate thyroid gland to secret more T3 and T4 hormone.
Taken together, HD seem to contribute to positively to the thyroid function, because the serum levels of T3 and T4 in most of patients included in this study were in the normal range after HD. Uremia has been reported to cause a reduction in peripheral conversion of T4 to T3, producing a functionally hypothyroid state (17). On other hand, a previous study done by El-Reshaid and colleagues showed that, after iron depletion, thyroid abnormalities improved in 8 cases out of 9 cases in patients with iron overload (18). Based on these data, it possible to suggest that regular HD treatment may also lower morbidity and mortality among Zeletin city patients with CRF.
The opposite of our finding was illustrated by Hershman et al.. They reported a decreased in serum T4 hormone level after HD (19). Similarly, two later studies done byKayima et al. and by Hardy et al. reported that patients with CRF had low serum levels of T4 in adults after HD (20); (21). In addition, Xess and coworkers also reported that patients with CRF had significant decrease in total T3 level (22). These reports indicated that the CRF patients were in a subclinical hypothyroid state. It has been suggested that the low serum T3 levels is due to presence of dialyzable toxins in uremic plasma that might impair T3 transcriptional activity or extra-thyroidal T4 to T3 conversion (23).While the low level of T4 is due to the presence of circulating inhibitors.
In agreement with our study, it had been demonstrated that TSH level on CRF Japanese patients were not significantly changed before and after HD (24).Shamsadiniand colleagues demonstrated that there was a significant changed in serum levels of T3 and T4 before and after HD in 57 Iranian patients with CRF (25). Similarly, Alsaran et al. also reported that there was a significant difference in free-T3 and free-T4 hormone levels before and after HD and no significant difference between before and after HD for TSH level in 40 Saudi Arabia patients with end stage renal disease (26).
This study provide an evidence that the presence of diabetes mellitus and hypertension showed no effect on serum levels of T3 and T4 in CRF patients before and after HD. Similarly, the duration of HD exhibited no effect on serum levels of T3 and T4 in CRF patients before and after HD. By contrast, In addition, a study conducted by Zoccali et al. concluded that low FT3 is frequently shown in inflammatory illnesses, and the similar association also observed in chronic kidney disease patients as well as in patients with end stage renal disease (27). Thus, these findings suggested that these variable factors such as presence diabetes mellitus, hypertension or duration of HD did not contribute to changed that observed in levels of thyroid hormones.
Conclusion:
The results of this study has demonstrated that, some of Libyan CRF patients had serum levels of T3 and T4 lower than the serum normal range before HD, then after HD, they had normal serum levels of T3 and T4 hormones. For this cause we conclude that, there is a novel interactions of kidney with thyroid hormones in patients with CRF. Moreover, HD might participate in the regulation of thyroid hormone synthesis (T3 and T4). On the other hand, thyroid gland levels seem to be dependent on renal function.
However, the consequences of the present study highlighted that the most CRF patients have lower than the normal range of T3 and T4 hormones before kidney dialysis, then after kidney dialysis patients have normal levels of T3 and T4 hormones.
Finally, kidney dialysis may have a positive feedback effect on thyroid gland secretions. The thyroid gland hormones increase catabolic activities resulting an increase in T3 and T4 hormone levels, which in turn deactivate the secretion of thyroid hormones by a feedback mechanism.
ACKNOWLEDGEMENT
Above all we are grateful to Allah who granted us the strength and patience throughout our research until the completion of this work. we wish to thank all those who helped us to complete our thesis. Special thanks to the Educational Central Zelitin Hospital administration in Libya for helping us to make this study in the hospital lab. Our gratitude also goes to the Robia Company for helping us to provide the reagents to do this research.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
