AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Rahaf Abdulhai King Abdulaziz Medical City. Saudi Arabia.
Citation: Rahaf A. Ghazzawi, Fadwa H. Taher, Raed A. Sayed, Raghad A. Ghazzawi, Hawazen M. Alsulaimani, Waad I. Barnawi, et al, (2024), Prevalence of Polycystic Ovarian Syndrome and its Relation to Urinary Tract Symptoms among Female Medical Students of Umm Al-Qura University, J. Obstetrics Gynecology and Reproductive Sciences, 8(8) DOI:10.31579/2578-8965/231
Copyright: © 2024, Rahaf Abdulhai Ghazzawi. 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 July 2024 | Accepted: 29 July 2024 | Published: 18 November 2024
Keywords: pcos; androgens; obesity; menstrual irregularity; urinary symptoms
Background / Aim:
Polycystic ovarian syndrome (PCOS) affects women of reproductive age. Lower urinary tract symptoms (LUTS) are characterized by urgency, frequency, and dysuria. Limited information is available regarding the possible association between PCOS and LUTS. This study aimed to determine the prevalence of PCOS among female medical students and the association between PCOS and LUTS.
Materials and Method: This cross-sectional study was carried out in the Umm Al-Qura University, Makkah, Saudi Arabia. The study was conducted from August to December 2022. An online, self-administered, and validated Arabic-based survey was conducted using Google Forms.
Results: The prevalence of PCOS among the female medical students was 21.6% (n=42). The participants reported urinary tract symptoms; the most reported symptom was pelvic pain (61.9%), followed by urinary frequency (35.7%). A total of 72% of females with an intermenstrual (IM) period of < 21 days had PCOS versus 12.2% of those with variable IM periods, displaying statistically significant differences (P=.001). In addition, 71% of females with dark coarse hair on the belly had PCOS, compared to those with hair on other body parts (P=.001). PCOS was diagnosed in 57.1% of obese/overweight females and 9.7% of females with normal body mass index (P=.001). Similarly, 57.1% of currently obese females were diagnosed with PCOS, whereas 12.5% of those with normal body weight had PCOS (P=.001). Approximately 90.9% of females with milky nipple discharge had PCOS (P=.001).
Conclusions: The prevalence of PCOS among female medical students is surpassing the global average; hence, awareness campaigns and educational programs must be conducted in schools and colleges to spread awareness among young girls.
LUTS is a multifactorial diagnosis with no direct link to PCOS. The sample size of this study was small. Therefore, a cross-sectional study with a larger sample size is needed to investigate the association between PCOS and LUTS.
Polycystic ovarian syndrome (PCOS) is a metabolic and endocrine disorder [1]. Moreover, PCOS is a disease that affects 4–21% of females of reproductive age worldwide [2]. It is characterized by numerous symptoms such as hirsutism, amenorrhea, oligomenorrhea, obesity, acne vulgaris, infertility, alopecia, insulin resistance, and hyperandrogenism [3, 4]. Furthermore, PCOS can lead to complications, such as infertility, dysfunctional uterine bleeding, and several metabolic disorders, including insulin resistance, diabetes mellitus, hypertension, dyslipidemia, and cardiovascular disease [5].
Lower urinary tract symptoms (LUTS) are characterized by three main symptoms: storage symptoms such as urgency, frequency, nocturia, and urge incontinence; voiding symptoms such as poor and/or intermittent stream; and post-voiding symptoms such as the feeling of incomplete emptying [5]. In cases where LUTS exceed the critical threshold, the quality of life is impaired, the level of physical activity is decreased, and psychological condition is negatively affected [6]. Large-scale epidemiological studies have reported that, on average, 84% of females experience at least one LUTS during their lifetime [6].
A study conducted in 2021 in Iraq demonstrated that a significant number of females with PCOS suffer from LUTS, such as the urge to urinate, polyurea, and cloudy urine [7]. Moreover, another study conducted in 2023 discovered that PCOS and LUTS are closely associated, emphasizing the importance of a detailed urinary system evaluation in females with PCOS. (6) However, limited information is available on the possible association between PCOS and urinary tract symptoms. This study aimed to determine the prevalence of PCOS among female medical students and the prevalence of urinary tract symptoms in patients with PCOS.
Study design, setting, time, and study participants: This is a cross-sectional study performed at Umm Al-Qura University (UQU) in Makkah, Saudi Arabia. The study was conducted between August and December 2022.
Inclusion criteria included all female medical students at UQU who agreed to participate from the second year (batch 43) until the internship year (batch 38).
Exclusion criteria included pregnancy, females using contraceptive pills or injections, females who had undergone bilateral oophorectomy or hysterectomy, and individuals with diabetes requiring hypoglycemic drugs.
Sample size: The required sample size for this study was 194 participants, with a 95% confidence level and a margin of error of 5%. The calculations were performed using the Rasoft sample size calculator based on the number of female medical students at UQU, which was 194.
Data collection: A self-administered online questionnaire via Google Forms consisted of 11 questions divided into three main sections. The first section aimed to obtain participants’ consent to participate in the study while clarifying the exclusion criteria, followed by a section on each individual's medical history regarding menstruation and PCOS symptoms, and finally, a section to confirm the presence of a relationship between the individual's medical history and urinary tract infection symptoms. The questionnaire is provided in the Appendix.
Ethical approval and confidentiality: Ethical approval for this study was obtained from the Institutional Research Board (IRB) approval no. (HAPO-02-K-012-2023-08-1699).
Data management and statical analysis: The data were collected, reviewed, and fed into the Statistical Package for Social Sciences version 21 (SPSS: An IBM Company). All statistical methods used were two-tailed with an alpha level of 0.05 considering significance if the P-value was ≤ 0.05. Descriptive analysis was performed by providing the frequency distribution and percentage of the study variables, including female demographic data and income. In addition, the PCOS-related symptoms experienced by females, their history of being diagnosed with PCOS, and the effect of PCOS on their daily lives were tabulated. Moreover, the prevalence of PCOS and associated urinary symptoms were depicted graphically. Crosstabulation was used to assess the factors associated with PCOS among female medical students, based on the chi-square test and exact probability test for small-frequency distributions. Furthermore, multiple regression analysis was performed to assess the predictors of PCOS among the study participants by assessing the adjusted odds ratio (OR) with a confidence interval (CI) of 95%.
In total 194 female medical students were included in this study. Among them, 73 (37.6%) reported an average annual income of < 100000 SR, 79 (40.7%) reported approximately 100000 SR, and 42 (21.6%) reported> 100000 SR. Regarding menstrual cycle days, 25 (12.9%) reported < 21 days and 27 (13.9%) reported 21–35 days, but most of the females (71.6%; 139) reported them to be variable (Table 1).
| Demographics | No | % |
| Average income per year | ||
| < 100000 days | 73 | 37.6% |
| Approximately bout 100000 SR | 79 | 40.7% |
| > 100000 SR | 42 | 21.6% |
| Intermenstrual cycle days | ||
| <21 days | 25 | 12.9% |
| 21-35 days | 27 | 13.9% |
| > 35 days | 3 | 1.5% |
| Variable | 139 | 71.6% |
Table 1: Biodemographic data of female medical students at Umm Al-Qura University
Table 2 displays the symptoms of PCOS in female medical students at UQU. The most common sites of dark coarse hair were the legs (39.2%), arms (37.6%), face (23.2%), upper lips (19.6%), and belly (16%). The least reported sites were the back (6.7%) and chest (5.7%). A total of 49 (25.3%)
patients were obese or overweight from the age of 16 years, 40 (20.6%) were underweight from the age of 16 years. Regarding current body mass index (BMI), 136 (70.1%) had normal weight, 36 (18.6%) were overweight, 7 (3.6%) were obese, and 15 (7.7%) were underweight. Eleven (5.7%) patients noticed a milky discharge from their nipples, and 39 (20.1%) reported that these symptoms affected their daily lives.
The prevalence of PCOS among female medical students at UQU is demonstrated in Figure 1. A total of 42 (21.6%) participants were diagnosed with PCOS or experienced some of the previously described symptoms of PCOS while 152 (78.4%) did not.
Figure 2 displays the urinary tract symptoms among medical female students with PCOS at UQU. The most common urinary symptoms were pelvic pain (61.9%), frequent urination (35.7%), urgency (16.7%), nocturia (16.7%), incontinence (9.5%) and dysuria (2.4%).
Figure 1: Prevalence of PCOS among female medical students of Umm Al-Qura University
Figure 2: Urinary tract symptoms among female medical students with PCOS at Umm Al-Qura University
Factors associated with PCOS among female medical students at UQU are depicted in Table 3. A total of 72% of females with an intermenstrual (IM) period of <21 days had PCOS versus 12.2% of others with variable IM periods, displaying statistically significant differences (P=.001). In addition, 71% of females with dark coarse hair on the belly had PCOS, compared to 69.2% with hair on the back, 68.4% with hair on the upper lip, and 3.5% without dark coarse hair (P=.001). PCOS was diagnosed in 57.1% of obese/overweight females and 9.7% of females with normal body mass index (P=.001)”). Similarly, 57.1% of currently obese females were diagnosed with PCOS, whereas 12.5% of those with normal body weight had PCOS (P=.001). Approximately 90.9% of females with milky nipple discharge had PCOS, in contrast to 17.5% of those without milky nipple discharge (P=.001).
A multiple logistic regression model was used to assess predictors of PCOS among female medical students (Table 4). Among all included factors, the IM period demonstrated an elevated risk of PCOS for all periods compared to the risk observed in < 21 days (OR range from 25 for 21–35 days to 6.7 for> 35 days). In addition, females who were overweight or obese from the age of 16 years were 11 times more likely (OR=11.6) to have PCOS than those with normal body weight. Moreover, those with dark coarse hair also demonstrated an 11 times higher likelihood of having PCOS (OR=11.3) than those without dark coarse hair.
| PCOS symptoms | No | % |
| During your menstruating years (not including during pregnancy), did you tend to grow dark, coarse hair on | ||
| Legs | 76 | 39.2% |
| Arms | 73 | 37.6% |
| Face | 45 | 23.2% |
| Upper lip | 38 | 19.6% |
| Belly | 31 | 16.0% |
| Back | 13 | 6.7% |
| Chest | 11 | 5.7% |
| None of the above | 113 | 58.2% |
| Were you ever obese or overweight from the age of 16 till now? | ||
| Yes | 49 | 25.3% |
| No | 145 | 74.7% |
| Were you ever underweight since the age of 16 till now? | ||
| Yes | 40 | 20.6% |
| No | 154 | 79.4% |
| Body mass index | ||
| <18.5 (Underweight) | 15 | 7.7% |
| 18.5–24.9 (Normal) | 136 | 70.1% |
| 25–29.9 (Overweight) | 36 | 18.6% |
| 30–39.9 (Obese) | 7 | 3.6% |
| Since the age of 16 till now, have you ever noticed a milky discharge from your nipples? | ||
| Yes | 11 | 5.7% |
| No | 183 | 94.3% |
| Are these symptoms affecting your daily life? | ||
| Yes | 39 | 20.1% |
| No | 155 | 79.9% |
Table 2: Symptoms of PCOS as reported among female medical students, at Umm Al-Qura University
| Factors | PCOS | p-value | |||
| Yes | No | ||||
| No | % | No | % | ||
| Average income per year | .422 | ||||
| < 100000 SR | 17 | 23.3% | 56 | 76.7% | |
| About 100000 SR | 19 | 24.1% | 60 | 75.9% | |
| >100000 SR | 6 | 14.3% | 36 | 85.7% | |
| Intermenstrual cycle days | .001*^ | ||||
| < 21 days | 18 | 72.0% | 7 | 28.0% | |
| 21–-35 days | 5 | 18.5% | 22 | 81.5% | |
| > 35 days | 2 | 66.7% | 1 | 33.3% | |
| Variable | 17 | 12.2% | 122 | 87.8% | |
| During your menstruating years (not including during pregnancy), did you tend to grow dark, coarse hair on | .001* | ||||
| Face | 27 | 60.0% | 18 | 40.0% | |
| Upper lip | 26 | 68.4% | 12 | 31.6% | |
| Arms | 35 | 47.9% | 38 | 52.1% | |
| Chest | 7 | 63.6% | 4 | 36.4% | |
| Back | 9 | 69.2% | 4 | 30.8% | |
| Belly | 22 | 71.0% | 9 | 29.0% | |
| Legs | 37 | 48.7% | 39 | 51.3% | |
| None of the above | 4 | 3.5% | 109 | 96.5% | |
| Were you ever obese or overweight from the age of 16 till now? | .001* | ||||
| Yes | 28 | 57.1% | 21 | 42.9% | |
| No | 14 | 9.7% | 131 | 90.3% | |
| Were you ever underweight since the age of 16 till now? | .061 | ||||
| Yes | 13 | 32.5% | 27 | 67.5% | |
| No | 29 | 18.8% | 125 | 81.2% | |
| Body mass index | .001*^ | ||||
| <18.5 (Underweight) | 3 | 20.0% | 12 | 80.0% | |
| 18.5 - 24.9 (Normal) | 17 | 12.5% | 119 | 87.5% | |
| 25 - 29.9 (Overweight) | 18 | 50.0% | 18 | 50.0% | |
| 30 - 39.9 (obese) | 4 | 57.1% | 3 | 42.9% | |
| Since the age of 16 till now, have you ever noticed a milky discharge from your nipples? | .001*^ | ||||
| Yes | 10 | 90.9% | 1 | 9.1% | |
| No | 32 | 17.5% | 151 | 82.5% | |
P: Pearson X2 test ^: Exact probability test
* P< 0.05 (significant)
Table 3: Factors associated with PCOS among female medical students of Umm Al-Qura University
| Factors | P-value | AOR | 95% CI of OR | |
| Lower | Upper | |||
| Intermenstrual cycle days | ||||
| 21–35 vs. < 21 days | 0.001* | 25.0 | 3.5 | 178.6 |
| > 35 vs. < 21 days | 0.229 | 6.7 | 0.3 | 150.6 |
| Variable vs.< 21 days | 0.002* | 9.4 | 2.2 | 39.1 |
| Were overweight/obese since the age of 16 till now | 0.003* | 11.6 | 2.3 | 58.7 |
| Were underweight from the age of 16 till now | 0.094 | 2.8 | 0.8 | 9.4 |
| Body mass index | 0.415 | 1.6 | 0.5 | 5.3 |
| Milky discharge from nipples | 0.141 | 7.2 | 0.5 | 100.7 |
| Have dark coarse hair | 0.001* | 11.3 | 3.4 | 38.0 |
AOR: adjusted odds ratio CI: confidence interval* P < 0.05 (significant)
Table 4: Multiple logistic regression model to assess predictors of PCOS among female medical students
In the United States, PCOS is the most common endocrine disorder affecting women of reproductive age [8].
The worldwide prevalence of PCOS is estimated to be 6–7% [9]. The prevalence of PCOS in our study was 21.6%, which is higher than the prevalence. This high prevalence may indicate a lack of information and awareness about PCOS among medical students. This lack of knowledge can lead to inappropriate lifestyle behaviors, which further exacerbate the risk of PCOS.
One meta-analytic study investigated the prevalence and health consequences of PCOS medical students. A complete search of seven recent studies (2019–2022) was conducted, and relevant data were retrieved and summarized. The pooled prevalence of PCOS was 24.7% among 2498 female medical students included in this meta-analysis and systematic review [10]. The results of the aforementioned study were comparable to our findings.
Another study among students at a tertiary care teaching hospital had a significant prevalence of PCOS (32.11%) [11]. The annual cost of diagnosing and treating PCOS in the American healthcare system is estimated to be $4 billion [8].
Thus, obesity may play a significant role in the development of PCOS. Weight gain can exacerbate insulin resistance, which not only increases testosterone production but also disrupts ovulation. Therefore, motivating females upon diagnosis to follow a diet and exercise plan that will assist in weight loss, menstrual cycle regulation, emotional well-being, and the reduction of insulin resistance is imperative [12].
In our study, 49 (25.3%) patients were obese or overweight from the age of 16 years, while 40 (20.6%) were underweight from the age of 16. Regarding current BMI, 136 participants (70.1%) had normal weight, 36 (18.6%) were overweight, 7 (3.6%) were obese, and 15 (7.7%) were underweight. These findings are consistent with the results of previous studies. Other studies have confirmed the association between obesity and PCOS in medical and dental students.
In a study conducted in Nepal, 20.73% of the participants reported being obese or overweight, either currently or at some point in the past [12]. In another study conducted in India, 62.5% of the students with PCOS were overweight or obese [13]. In a study conducted in Pakistan, 36.3% of the students with PCOS who participated were obese [14].
Menstrual irregularities are known to increase among medical students who undergo dietary, lifestyle, and stress-related changes. Overactivation of the hypothalamic-pituitary (HP) axis psychological stress increases plasma cortisol levels, which in turn can cause menstrual disturbances [15]. In our study we identified menstrual irregularities among medical students. For instance, 25 (12.9%) participants reported a menstrual cycle of < 21>
Therefore, medical and dentistry students should be encouraged to pay attention to the early symptoms of irregular menstrual cycles and obesity and receive medical assistance to facilitate early diagnosis and treatment, as well as to prevent comorbidities associated with PCOS. Patients with PCOS may exhibit hirsutism on various body parts. The presence of excess male gender hormones such as testosterone, dihydrotestosterone, dehydroepiandrosterone sulfate, and androstenedione is the reason behind the development of such hair. The degree of hirsutism varies in individuals affected with PCOS, owing to variations in the sensitivity of hair follicles to excess androgens [18].
In our study, we found that 71% of females with dark coarse hair on the belly had PCOS, compared to 69.2% with hair on the back, 68.4% with hair on the upper lip, and 3.5% without dark coarse hair (P=.001). In clinical practice, the Ferriman-Gallwey scoring system is frequently used to visually examine body hair patterns and rate excessive terminal hair [19–20]. In our study, dark coarse hair was distributed as follows: legs (39.2%), arms (37.6%), face (23.2%), upper lips (19.6%), and bellies (16%). The back and chest were the least frequently affected (6.7% and 5.7%, respectively).
Anatomical and neuroendocrine factors are required for voiding physiology. Furthermore, LUTS occur when this dynamic is disrupted. The lower urinary system is affected by the inflammatory and metabolic effects of PCOS. Patients with PCOS experience a significantly diminished quality of life when urinary symptoms are present [6].
Many changes occur in bladder dynamics in patients with PCOS. For instance, the effects of changes in androgen levels on the urinary bladder have been emphasized in many studies. In a study that investigated rats undergoing oophorectomy, low levels of androgen and estrogen reduced bladder capacity and compliance; however, function was restored after hormone therapy [21]. Another study evaluating the effect of testosterone on rat bladders demonstrated an increase in bladder capacity and smooth muscle/collagen content [22]. Moreover, a study noted no statistically significant differences in pelvic floor muscle strength between females with PCOS and controls. However, the control group had a higher incidence of urinary incontinence (UI) than the PCOS group [23]. Another study reported similar results and identified a correlation between bladder symptoms, such as nocturia, dyspareunia, urgency, and testosterone levels in females with PCOS. However, no statistically significant relationship was observed between ultrasonographic results such as bladder capacity, post-void residual volume (PVR), and testosterone levels [24].
Similarly, a previous study observed an increased incidence of LUTS with high testosterone levels; however, there were no significant differences in maximum flow rate, PVR, bladder capacity, or bladder wall thickness [6]. Numerous studies have examined the association between LUTS and obesity. This can be explained by the lowering collagen levels, induction of oxidative stress in the urethral mucosa, and decreased urethral elasticity. Additionally, the lower urinary system is linked to increased intra-abdominal pressure [25]. In a large study, Lai et al. identified a correlation between obesity and hyperactive bladder frequency, urinary incontinence, and stress incontinence [26]. Another study indicated that in patients with PCOS, a direct association was observed between high waist circumference, BMI, and urinary symptoms [6].
Bladder dynamics are significantly impacted by metabolic diseases [27]. A large meta-analysis revealed that patients had a 3.35-fold higher prevalence of metabolic syndrome [26]. A study performed on experimental animals indicated bladder dysfunction with increasing leukocytes in interstitial tissue, severe neutrophil infiltration surrounding the endothelium, and damage to the mitochondria of the smooth muscle of the bladder [27]. Another study revealed that 62.5% of rats exhibited detrusor hyperactivity after the development of metabolic syndrome [28].
This study had some limitations. The study population was limited to female medical students at UQU and may not be representative of the general population. The use of self-reported questionnaires may have introduced recall bias and subjectivity. Future research could expand on this study to include a large and diverse population to enhance the generalizability of the findings. Longitudinal studies should also be conducted to assess the long-term impact of PCOS on urinary tract symptoms and to explore the potential mechanisms underlying this association.
From this study, we can conclude that the prevalence of PCOS among female medical students is surpassing that of the global average; therefore, awareness campaigns and educational programs must be conducted in schools and colleges to spread awareness among young girls to help them identify the symptoms of PCOS and seek medical assistance to prevent further consequences and metabolic disorders. PCOS can develop regardless of body weight and socioeconomic status but is strongly influenced by lifestyle and obesity.
LUTS is a multifactorial diagnosis with no direct link to PCOS. The sample size of this study was insufficient to identify the prevalence of LUTS in patients diagnosed with PCOS. Therefore, a cross-sectional study with a larger sample size is needed to examine the relationship between PCOS and LUTS.
UQU: Umm Al-Qura University
PCOS: polycystic ovarian syndrome
LUTS: lower urinary tract symptoms
Ethics approval and consent to participate: Ethical approval for this study was obtained from the Institutional Research Board (IRB) (approval no. (HAPO-02-K-012-2023-08-1699).
Consent for publication: Not applicable
Availability of data and material: Not applicable
Competing interests:
The authors declare that they have no competing interests
Funding: Not applicable
RG wrote the paper; RA performed the analysis; FT contributed with analytical tools; WB approved the abstract; AS collected the data; HA designed the analysis.
The authors are grateful to the medical students who participated in this study.
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.
