The effect of wet-cupping therapy on menopause specific quality of life: A randomized-controlled trial

Research Article

The effect of wet-cupping therapy on menopause specific quality of life: A randomized-controlled trial

  • Nurcan Gokgoz 1
  • Gul Pinar 1*

*Corresponding Author: Gul Pinar, Department of Nursing, Faculty of Health Sciences, Yıldırım Beyazıt University, Ankara, Turkey

Citation: Gul Pinar. (2021) The effect of wet-cupping therapy on menopause specific quality of life:A randomized-controlled trial. J. Women Health Care and Issues, 4(5); DOI:10.31579/2642-9756/061

Copyright: © 2021 Gul Pinar, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Received: 23 April 2021 | Accepted: 03 May 2021 | Published: 31 May 2021

Keywords: wet-cupping therapy; menopause; life quality; post-menopausal women

Abstract

Purpose: The purpose of the study was to evaluate the effectiveness of wet-cupping therapy (CT) on menopause specific quality of life (MENQOL). 
Methods: This study was conducted with randomized controlled pretest, and posttest method between July 2015 and July 2016 at a Gynecology Outpatient Clinic of University Hospital in Ankara, Turkey. Intervention group (n=30) received wet CT while control group (n=30) did not receive any therapy. Both groups were measured quality of life using MENQOL scale before and two weeks after wet CT.
Results: The women’s age ranged from 45 to 60 years. Baseline characteristics were similar in the both groups. Women treated with wet CT showed significant improvements in their vasomotor, physical and sexual symptoms (p<0.001). No significant effect was found for pshysco-social area (p>0.05). No adverse effects were recorded after treatment.
Conclusion: Wet CT can be considered as an effective method for reducing of menopausal symptoms. In conclusion, this study provides preliminary data on the effectiveness of various symptoms in postmenopausal period. However, further with larger sample size evidence-based trials are needed in order to confirm these results for improving MENQOL.

Introduction:

Menopause is a natural biological process, not a disease, but it is a long challenging period of life for many women (about 85%) over the age of 50 due to suffer from various short time or long time physical, psychological, and social symptoms during the menopausal transition, including hot flushes, night sweats, sleep disturbances, sexual dysfunction, mood disorders, vaginal dryness, dyspareunia, back pain, change in skin, weight gain, and cognitive declines, which impacts their quality of life negatively for longer than 10 or 15 years [1,2]. Hormone Replacement Therapy (HRT) is often prescribed to alleviate MS. However, despite the effectiveness of HRT, many women refuse hormonal drugs because of some side effects such as vaginal bleeding, bloating, or other HRT-linked conditions. Eventually, the Women’s Health Initiative (WHI) report, it has associated HRT with an increased risk for breast cancer and thromboembolism [3, 4]. Consequently, through menopause non-hormonal several interventions as complementary- alternative medicine (CAM) such as yoga, acupuncture, massage, Tai chi, physical exercise, phyto-therapy, homeopathy, and vitamins are relatively have emerged. The positive results on welfare obtained regarding wide range of CAM have been confirmed by many evidence-based studies and preferred to relieve menopausal complaints (MS) by many women (22%-95%) [5, 16].
Cupping therapy (CT) is not as well-known as other CAM (. In fact, CT has been used since antiquity for health promotion, preventive and therapeutic purpose in various diseases for millennia through the world, including Turkey such as herpes zoster [17], facial paralysis [18], stroke and fatigue [19], arthritis and osteoporosis [20], anemia and heart disease [21], insomnia, and emotional problems [22], cellulite, acne, psoriasis and other skin problems [23], hypertension [24,25], diabetes mellitus [26], metabolic syndrome [27], fibromyalgia [28], headache, back and neck pains [29,33], carpal tunnel syndrome [34], and even menopausal symptoms (MS) [35]. In spite of its common use by folk healers and practitioners, the evidence for effectiveness of CT is not always well established due to some methodological limitations. However, CT has re-emerged and become a popular formal treatment in the clinical area recently as a cost-effective and simple method and has transformed into a better version over the years [36]. The mean purpose of this CT with various mechanisms is; to open meridians so that Qi (invisible life force circulates through the blood vessels and nourishes the body tissue) can flow freely; to increase oxygenation and capillary blood flow, to activate lymphatic system, to regulate the function of organs by assisting in the elimination of waste products/excess heavy metals or toxins/oxidative stress from the body and to promote endothelial cell repair by boosting immunity [37]. CT also provides information on 1) where the problem is, 2) the kind of problem, and 3) the severity of the problem. In this regard, CT is diagnostic as well as therapeutic and its effects are immediate [15, 33]. Similar to acupuncture, CT follows the lines of the meridians at different points on the body. In essence, CT provides one of the best deep tissue massages by creating a vacuum effect within cups (plastic-PVC, silicone, glass or bamboo), which is called as dry-CT. In wet CT with combination of vacuum, the skin is lacerated by superficial incisions so that blood is drawn into the cup using a vacuum, which is also known as “hijama” and it is seen to be more effective than dry-CT. Wet-CT is generally considered safe and painless when performed by trained and competent professionals [9,29]. However, wet CT can cause rarely infections on the cupping region. The cupping point’s appearance (red marks due to local suction on blood vessels) generally returns to normal in a few days. Like many CAM, CT includes the potential to improved many different clinical conditions and enhance the quality of life [9, 38, 40]. More studies have been proposed to elucidate the health benefits of CT in clinical situations and to encourage its practice in the clinical setting by World Health Organization [41].
Evaluation of life quality is quite remarkable in terms of measuring well-being, which is one of the health indicators in postmenopausal women. Initiatives to increase postmenopausal women’s life quality are also valuable in reducing the burden on public health costs. Indeed, the effectiveness of wet CT to treat MS is well unknown across the world [16]. At present, there is not any study about therapeutic effect of CT for MS in the literature. Therefore, the present study was designed to objectively evaluate the effectiveness of the wet CT on menopause specific quality of life (MENQOL).

Methods:

Sample Size, Study Design, and Participants
We rigorously implemented a randomized controlled pre and post treatment trial to evaluate the effectiveness of wet CT on MENQOL between July 2015 and July 2016 at a Gynecology Outpatient Clinic of University Hospital in Ankara, Turkey. Sample size was calculated on the basis of the assumptions that the minimum clinical improvement, that resulted in 30 women in each group with 80% power and a=0.05. In totally, sixty eligible women with menopause at least 3 months (based on the patient record) were selected through purposive sampling during their routine gynecologic visit. Then, they were randomly assigned into control (routine self-care) (n=30) group and interventional (wet CT group) (n=30) group using the table of random numbers. At the and of study; the intervention group received wet CT, whereas the control group received no treatment.
For the both groups, inclusion criteria included: 1) diagnosed with natural menopause (last menstrual ≥12 moths) at least 3 months, 2) open to communication and cooperation, 3) volunteering women were included in the study, 4) women without an auditory or mental disability, 5) aged between 40-65 years, and 6) not receiving specific treatments for MS such as HRT or other medical therapies (within previous six months and also during study period). Exclusion criteria included: 1) possible spinal pathology, malignancies, 2) being currently surgery and severe or progressive heath condition, 3) bleeding disorders, 4) having side effects related to the wet-CT during study period, and 5) having a special drug (anticoagulants or others) or dietary regimen.
The instruments used include 1) Questionnaire Form and 2) MENQOL scale.

Instruments:

Questionnaire Form:
This form consists of total 24 questions in two sections; related with socio-demographic characteristic (n=9), and general health and menopause specific characteristics (n=15), which was developed by researchers benefiting from the literature[5, 16].

MENQOL:
The scale was introduced in 1996 as a tool to assess health-related quality-of-life in the menopausal period by Hilditch et al [42].It was adapted to Turkish society by Kharbouch and Sahin (2007) and its validity and reliability study was carried out.The scale is a self-administered questionnaire and consists of a total of 29 items in four domains: vasomotor (items 1-3), psychosocial (items 4-10), physical (items 11-26), and sexual (items 27-29). For each item, participants were asked to rate whether or not they had experienced each symptom in the past month from 0 (not all bothered) to 6 (extremely bothered). As the score increases, the severity of the complaint increases and the quality of life decreases. The total scale score is not calculated. The Cronbach's alpha value of the scale is 0.73-0.88 [2].

Procedures:
The data were obtained through face-to-face interview method by the researchers during the routine gynecologic visits at the study hospital. Filling up the Questionnaire form and MENQOL scale lasted about 20 minutes. Five points of the posterior neck, bilateral perispinal areas the neck and thoracic spine were located for wet CT according to the WHO criteria [41]. Same points were used for all women in the intervention group.
All women in the intervention group underwent a physical and neurological examination and, then Wet CT was performed to women by a single physician who was trained in CT and regularly performed CT in the study hospital. For the CT, participants were asked to lay topless on the massage strecher. This protocol for application of wet CT involved the following steps; first, the selected site was cleaned with antiseptic solutions; sterile disposable plastic cups (5 cm) were placed on selected region bilaterally. Then, negative pressure was applied by cupping pump. After about 5 minutes of wait, cups were gently removed and twelve superficial incisions was made on each chosen area in 2 mm-depth using a sterile auto-lancet; the cups were replaced again over the incision area; suctioning was made by manuel pumping and blood was drained; after 10–15 minutes’ till filling with blood the valve of cup were opened and removed the cups. Finally, the area was disinfected by betadine and dressed.For the possibility of any negative reaction, a phsician and a nurse with emergency response kit were kept ready in the room during the CT procedure. 
Women were advised to avoid water contact on the cupping areas within the next 24 hours and limited tobacco/alcohol intake to prevent delays in wounding healing. No advice for stretching or strengthening exercises was given after the intervention. All other medications, CAM therapies, and physical therapies were prohibited for two weeks. After some minutes of rest, patients were free to leave. No adverse events were reported throughout the study and this procedure was very well tolerated (cupping point assessment was made by using the CONSORT criteria [43]. Meanwhile, the control group received routine self-care. After 2 weeks, women in the both groups again filled out the MENQOL scale. At the end of the study, the women in the control group were counseled the CT and then also offered to specialist in case of severe MS. No women were dropped out from study following randomization.

Ethical Approval
The study protocol was approved by the Institutional Review Board of Research Department of Gynecology Outpatient Clinic. (approval number: 06-4358) All women who suffer from menopause syndorme for at least three months signed written informed-consent about study purpose, benefits, the right to refuse and withdraw at any time, as weel as obtain confidentiality before the beginning of the study. Rules specified in the Helsinki Declaration were observed in the data collection phase.

Data Analysis
The descriptive statistical analyzes the number of percentage, mean, standard deviation were used. Data were evaluated with the Statistical Package for the Social Sciences (SPSS, version 20.0, Chicago, USA). After the Kolmogorov-Smirnov test was performed to evaluate normality Differences between groups were assessed using the Chi-square test or the Fisher exact test (if the expected count was <5>

Results

As shown in Table 1, baseline characteristics were not significantly different for both groups (p>0.05). In the intervention group; it was established that the mean age of women was 54.1±4.9  (min=42, max=63), the average BMI was 28.2±3.8. It was found that 90% of the women were married, 70% of women’s income level was good, 66.7% graduated from primary school, 63.3% were housewife and the average number of delivery was 3.1±4.6 (all women had social security).
It was investigated that hot flashes (100.0%), sleeping problems (96.6%) and joint and muscle pain (96.6%) were the most frequently experienced MS. Also, it was determinded that 93.3% of the women had emotoional problems, 90% ot he women had sexual problems, 77% of the women had aches in back of neck or head, respectively (Table 1).

 

* x2 test, Mann Whitney U test, and student’s t test
** Other symptoms in totally; change in the appearance of skin (68.5%), headache (67.1%), feeling memory fading (53.5%), energy decrease feeling (51.6%), weight gain (68%) and hair problems (48.4%).

Table 1; Baseline characteristics of women

The mean pre-test MENQOL subscale of intervention group; vasomotor area was 4.34 ± 1.12, psychosocial area was 2.77 ± 1.24,  physical area was 3.45 ± 1.06, and sexual area was 3.90 ± 1.55. The mean post-test MENQOL subscale; vasomotor area was 3.95 ± 0.92, psychosocial area was 2.66 ± 1.23, physical area was 3.16 ± 1.00, and sexual area was 3.65 ± 1.49 (Table 2).

 

aStudent t test , Paired t test, SD; standart deviation

Table 2: The distribution of the mean pretest posttest MENQOL scores of women for both groups

At the beginning of the study, before the wet CT intervention there was no significant differences between in two groups in terms of scores in MENQOL subscales (p>0.05). In table 2, in the intervention group; there were significant changes of the MENQOL score before and after wet-CT in the vasomotor, physical area and sexual area (p<0> 0.05). In the control group; there was no statistically significant difference between the pretest and postest in all MENQOL subscales except the vasomotor area (p> 0.05).
In different time, the vasomotor (p=0.002) and physical area (p<0 xss=removed>

 

It was found that the change in the psychosocial between the two groups was not different (p>0.05) (Table 3).

 

bRepeated Measure ANOVA
Table 3: Comparison of the mean pretest-postest MENQOL scores of women in both groups

It was determined that the change between the two groups was different from each other for sexual area. The increase in this area was found to be significant in favor of the intervention group (p<0>

 

In the intervention group showed a significant improve after the wet CT within two weeks compared to the control group in all MENQOL subscales area (p<0>

 

 

Discussion

In the present study, it was determined that the most common symptoms in women with menopause experiencing hot flashes, night sweats, difficulty sleeping, sexual problems and back or neck pain (Table 1). Many women seek solutions for their problems and they show interest in non-pharmacological methods. As a matter of fact, there are also many good news from previous studies regarding the clinical effect of CAM methods on MS such as acupuncture, aromatherapy, hypnosis, biofeedback, homeopathy, herbal medicine, reflexology, yoga, natural products (herbal, dietary, vitamin and mineral supplements), reiki, and cognitive behavioral therapies 5-16). However, the lack of evidence-based studies about applicability or effectiveness of CT as a part of CAM in order to reduce MS in the literature limits the discussion of our study.
Our study confirmed that wet CT has apparently beneficial effect on MS-related life quality only within two weeks (p<0>
Michalsen et al (2009) concluded that CT was effective therapy in reducing the pain of carpal tunnel syndrome [34]. In different study Al-Bedah et al (2016) it has been showed that CT is highly effective for reduction in law back pain in women [29]. According to the Yuefeng et al (2010), dry CT was more effective than analgesic drug treatment in women with painful condition and strain [22]. In a randomized controlled studies conducted by Refaat et al (2014), it was found a significant reduction in serum lipid profile as well as increasing HDL-C serum level as a preventive effect against atherosclerosis in the cupping group. In the same study, it was found that Wet CT has positive effect to blood glucose level by enhancing insulin sensitivity on subject who has diabetes mellitus [44].
Furthermore, CT is also reported to be effective in cellulitis, asthma, and headache, and migraine, genital or oral ulceration [30]. CT appears to be positive effective for enfection control by filtering out pathogen, increasing the white blood cell counts, producing disease-fighting lymhocytes and enhancing the body’s resistance [26]. A different study examined the benefit effects of CT on cardiac problems [21]. It has been also stated that dry CT is effective in more than half of the women (56%) on MS in particular emotional problems, insomnia, poor memory, and pain in the low back or knee [35].
In the light of all this information, it is thought that all these positive changes are impresive. The women’s experiences with wet CT support the assumption that wet CT might be a prophylactic or protective effect for MS. Several ways of action; might explain the significant effects of wet CT on MS such as anti-nociceptive (analgesic), immune, neural, haematological, and physhological effects [26]. Wet CT leads to improve the blood flow tissue perfusion, and oxygen supply, removal of toxins and other degenerative conditions from the body, regulated neuroendocrine and immune system balance, and provided relaxation of muscle with vasodilation, relaxation thus allowing a deep relaxation to move through the entire body and contributing to increased rate of healing disease [36].
As a matter of fact, CT can be also applied in combination with other treatment methods to increase the effectiveness of treatment creating synergetic effect [18, 22]. It is thought that the positive change in the women’s quality of life may be also due to the functioning of wet CT similar to the effect of acupuncture. In the studies of Dodin et al (2013), Jonhson et al (2019), and MacPherson et al (2010) it has been proposed that acupuncture may have potential to relieve vasomotor symptoms frequency and severity by increasing the activity of hypotalamic beta-endorphin and improve quality of life of postmenopausal women. Even if acupuncture therapy is offered as an alternative to HRT, acupuncture appeared to be less effective than HRT [11, 14, 43]. Although it has some negative health effects many studies reported that HRT is the most effective therapy for MS. There are many studies in the literature regarding the effect of acupuncture on vasomotor symptoms. For instance, a randomized controlled study was determined that integrating CT with acupuncture decreased the severity and intensity pain or psychological changes [7, 10, 22]. Thus, they proved CT to be a good analgesic and anti-inflammatory with efficacy better than acetaminophen for treatment of various conditions.
CT may also reduce anxiety through a process called homeostatic regulation, buffering hormonal disturbance and stimulating feel good endorphins. Researchers also beleive that CT can reduce pain and inflammation throughout the body and it can promete mental and physical relaxtion. There was moderate evidence for the short-term effects of yoga, mindfulness and meditation on psychological symptoms in menopause [8, 13, 14]. Interstingly, Gartoulla et al (2015) tested CT for emotional problems that compared to medications alone, CT combined with plus medications was significantly better on tension and depression remission [12]. Significant reduced on anxiety and sleeping difficulties complaints was found in the CT group only [28, 38]. In the present study, we tested wet CT on psyschosocial symptoms to postmenopausal women who were not receiving any treatment. On the contrary, results of the wet CT showed a little improvement in the women’s quality of physchosocial area, therefore, it is not considered trully effective within two weeks (p>0.05) (Table 3).

Conclusion

In conclusion, wet CT directly decreased women’s vasomotor, physical and sexual problems and increased their quality of life within two weeks. In this regard, relatively evidence emerged only a single intervention that wet CT might be effective in the treatment of MS. These results important source of variation to other trials to improve postmenopausal women’s quality of life as it is the first time in the literature. Further comprehensive randomized controlled trials aiming at the mechanism of repeated interventions in different intervals and body points with a broader sample size are required to clarify the effect of wet-CT and better understand to expand the therapeutic spectrum of wet CT on MENOQL in long term following.

Limitation:
This study is limited by its short duration. These reults of this study may not be generalized due to the small sample size. Although we had positive affect in relieving MS after wet CT, further studies with larger sample size may planned to determine the long –term results of wet CT in different symptoms related to menopause. The other limitation of the study was that the research could not be blinded due to the nature of intervention and the women aware of the mechanism and reason of the CT. On the other hand, there are no suitable sham devices for placebo effect. Because there is lack of clinical trials on this topic, we tried to run a randomized controlled trials with the best possible methodological approach, even though we are aware of its some limitations.

Acknowledgements:
The authors would like to express gratitude to the hospital staff for allowing them to conduct this study using their patients and facilities. They also thank the women for taking interest in the study.

Conflicts of interest:
There is no conflict of interest to declare.

Authors’ Contributions:
GP and NG participated in the design of this clinical trial. They drafted this manuscript, conducted the clinical trial and participated the statistical analyses. All authors read and approved the final manuscript.

Source of funding:
The authors have received no funding for this study.

References

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.

img

Virginia E. Koenig

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.

img

Delcio G Silva Junior

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.

img

Ziemlé Clément Méda

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.

img

Mina Sherif Soliman Georgy

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.

img

Layla Shojaie

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.

img

Sing-yung Wu

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.

img

Orlando Villarreal

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.

img

Katarzyna Byczkowska

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.

img

Anthony Kodzo-Grey Venyo

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.

img

Pedro Marques Gomes

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.

img

Bernard Terkimbi Utoo

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.

img

Prof Sherif W Mansour

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.

img

Hao Jiang

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.

img

Dr Shiming Tang

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.

img

Raed Mualem

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.

img

Andreas Filippaios

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.

img

Dr Suramya Dhamija

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.

img

Bruno Chauffert

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!

img

Baheci Selen

"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".

img

Jesus Simal-Gandara

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.

img

Douglas Miyazaki

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.

img

Dr Griffith

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.

img

Dr Tong Ming Liu

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.

img

Husain Taha Radhi

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.

img

S Munshi

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.

img

Tania Munoz

“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”.

img

George Varvatsoulias

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.

img

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.

img

Khurram Arshad

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.

img

Gomez Barriga Maria Dolores

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.

img

Lin Shaw Chin

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.

img

Maria Dolores Gomez Barriga

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.

img

Dr Maria Dolores Gomez Barriga

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¨.

img

Dr Maria Regina Penchyna Nieto

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.

img

Dr Marcelo Flavio Gomes Jardim Filho

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!”

img

Zsuzsanna Bene

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

img

Dr 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.

img

Lin-Show Chin

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.

img

Sonila Qirko

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.

img

Luiz Sellmann