AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2690-4861/061
*Corresponding Author: Sorush Niknamian, CEO and Executive Manager of Violet Cancer Institute, Federal Health Professionals and Department of Defense (DoD). VA, USA.
Citation: Sorush Niknamian. (2020) Effects of high iodine containing low osmolar contrast agent (visipaque) on thyroid function tests. International Journal of Clinical Case Reports and Reviews. 4(5); DOI: 10.31579/2690-4861/061
Copyright: © 2020 Sorush Niknamian, 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: 18 September 2020 | Accepted: 18 December 2020 | Published: 24 December 2020
Keywords: thyroid disease; hyperthyroidism; thyroid function test
Objective: Investigating high iodine containing low osmolar contrast agent (visipaque) effects on thyroid function tests and thyroid sonography characteristics.
Methods: 65 euthyroid cases and 92 controls composed the samples in baseline. Thyroid function tests, Urine Iodine Concentration (UIC) and thyroid sonography were conducted for both groups before and 1 and 3 months after angiography. Serum levels of T4, T3, T3RU, TSH, TPO-Ab and UIC were measured, and hypo/heyperthyroidism prevalence was compared between groups.
Results: Mean T3,T4 and TSH changes 1 month after angiography were insignificant in both groups (P:0.61,P:0.4 and P:0.14, P:0.23 in cases and controls for T3 and T4). Medians among cases and controls were 12.8 and 16.75 µg/dl, respectively, at baseline. These values varied to 28.45 and 15.2µg/dl, and 12.95 and 14.2µg/dl 1 month and 3 months after angiography in case and control groups, respectively. UIC increase one month after angiography was significant among cases (P=0.002). TPO-Ab+ were same 3 months after angiography. Thyroid volume changes were significant among cases (P<0.001) and insignificant among controls (P=0.680). No significant difference was seen between cases and controls in overt hypothyroidism, however, a considerable change was seen in thyroid volume and UIC one month after angiography among cases. The hypothyroidism rate among cases was insignificant which may be either related to few cases or short half-life of visipaque (2.1 hour) so that 97% of injected dose was excreted in urine within 24 hours.
Conclusion: Thyroid function test is not recommended before angiography in patients without previous thyroid records.
Thyroid diseases are the second most common cause of endocrine disorders following diabetes [1, 2]. Coronary angiography and angioplasty are important diagnostic and therapeutic procedures for the coronary artery diseases. Iodine containing contrasts which is used in angiography may lead to thyroid dysfunction due to high contents of iodine. Thyroid dysfunction can increase symptomatic coronary artery diseases and cardiovascular mortality [3]. Although, another study showed that administration of iodine containing contrast agents which is usually used for coronary angiography on following thyroid hormone concentrations is not companied with hyperthyroidism in patients with normal results of thyroid analysis [4]. Medications containing iodine mostly induce thyroid dysfunction. Usual sources of iodine such as antiarrhythmic drugs (amiodarone), eye drops and eye ointments, topical ointments, tooth pastes and multivitamins are disinfectants [5, 6] . Although, a case study demonstrated that consumption of high-dose drugs containing iodine can be considered as a predisposed to thyroid dysfunction [7]. Iodine containing radio-contrast is the most conventional compounds used in medicine [8]. For example, increased ischemic heart diseases, need to cardiac catheterization and CT scans lead to increase in consumption of iodine containing contrasts [9]. A single-dose injection for CT-scan releases 7000µg iodine which composes almost 45 folds of needed daily iodine [2]. Iodine overload condition can lead to decrease the hormone synthesis in thyroid gland by down regulation of Na/I co-transporters [10]. However, high amount of iodine intake can impair thyroid regulation and induce thyroid dysfunction[11]. Iodine containing contrasts includes low-osmolar agents, isosmolar agents and high -osmolar agents. The iso-osmolar and hypo-osmolar agents are suitable for patients with chronic kidney diseases, although they have higher iodine levels than high-osmolar agents[12].
One study has reported that after radio contrast intake, iodine thyroid pool in normal thyroid remains high up to 4-8 weeks and urinary iodine increases up to 300% and returns to normal level after 43 days [12]. On average, each patient receives about 50-100cc and 30cc iodine containing contrast in CT-scan and angiography, respectively [13]. In angiographic centers, 50cc and 30cc of visipaque (Iodixanol) is typically used for CT-angiography and angiography, respectively, [1] as iso-osmolar contrast agent with iodine content of 320 mg/ml.
We investigated the thyroid function tests, thyroid autoimmunity marker (TPOAb), thyroid ultrasonography and urinary iodine in patients undertaking coronary angiography, CT-angiography in Iran, an iodine sufficient area according to WHO reports [12]
Patients
This study was performed at angiographic center of Isfahan Endocrine and Metabolism Research Center in 2016-2017. Patients were selected from candidates for coronary angiographic or coronary CT angiography based on continuous enrollment. Inclusion criteria were age over 18 years old, candidate for elective angiography or CT angiography, euthyroid subjects and patient’s consent for study. Our study was approved by ethics committee of Isfahan University of Medical Sciences. The medical records include history of previous thyroid diseases or malignancy or taking any medications. Accordingly, history of other disorders such as diabetes, hypertension and dyslipidemia was evaluated. Then, thyroid examination and baseline laboratory tests- including blood and urine samples- were conducted. Next, the thyroid sonography was carried out to evaluate the thyroid and neck soft tissue. The next day, angiography or CT-angiography was done for the case group. The patients were explained by the symptoms of hyperthyroidism or hypothyroidism and they were asked to report any symptoms of hyper/hypothyroidism. The same physical examinations, laboratory tests and thyroid sonography were repeated at 1 and 3 months after angiography or CT-angiography in case and control groups. Data of people enrollment is shown in consort diagram. (Figure 1).
The Fasting Plasma Glucose (FPG), lipid profile include (TG, Cholesterol, LDL-c, HDL-c), Blood Urea Nitrogen (BUN), creatinine (Cr) TSH, T4, T3, T3RU, thyroid peroxidase antibody (TPO-Ab), were determined before coronary angiography.
Analytic Approach:
Statistical analysis was performed using SPSS version 24. Descriptive data was presented based on mean, Standard Deviation (SD), frequency, percentage and qualitative data using Chi-square, independent sample T-test and one way-ANOVA for comparing quantitative data between the two groups. ANOVA test was repeated for comparing changes in variables over time within each group or between groups. Median (range) was used for the variables without normal distribution such as UIC. Also, for evaluation of some parameters such as TSH and TPO-Ab that have no normal distribution, we used log-transformation.
100 patients under the angiography or CT coronary angiography and 100 non-cardiovascular patients were enrolled. During the three month period of follow up, 35 patients in the case group were excluded (Figure 1) and data analysis was done on 65 patients and 92 controls who completed the study. The mean age of case and control groups members was 60.1 and 59.6 years, respectively (p=0.81); 38(58.5%) of cases and 48(52.2%) of controls were male (p=0.44). Demographic characteristics are presented in Table 1.
T3: three iodothyronin, T4: thyroxin, TSH: thyroid stimulating hormone, T3RU:T3 resin uptake, UIC: urinary iodine concentration *P value <0.05 TPOAb thyroid peroxidase antibody, as considered positive when level >37 IU/Ml
T3 mean at baseline was 1.65(0.63)nmol/l and 1.7(0.31)nmol/l in case and control groups, respectively; it was 1.82(0.48)nmol/l and 1.78(0.33) nmol/l in case and control groups, respectively, one month after angiography; and it was 1.65(0.5)nmol/l and 1.81(0.13)nmol/l for case and controls groups three months after angiography; as a result, T3 changes were statistically insignificant in both groups (p:0.61 and p:0.4 in case and control groups). Furthermore, T4 at baseline was 9.11(2.26)µg/dl and 8.78(1.58)µg/dl in case and control groups; it varied to 9.15 (2.16)µg/dl and 8.62(1.48)µg/dl 1 month after angiography and also 8.76( 1.89)µg/dl and 8.83 (6.15)µg/dl three months after angiography in case and control groups respectively, indicating no significant change (P:0.07 and P:0.8 for case and control groups). Baseline TSH among cases and controls was 2.84(2.1)µu/ml and 3.15(2.95)µu/ml, respectively; it varied to 2.98(1.06)µu/ml and 3.22(2.39)µu/ml 1 month later and 4.14(1.5)µu/ml and 3.49(2.58)µu/ml 3 months later in case and control groups, respectively, indicating no significant TSH changes (P:0.14 and P:0.23 among cases controls). (Table 2).
*mean ± SD;**median (percentile25-75); T3: threeiodothyronin, T4: 1thyroxin, TSH: thyroid stimulating hormone; *P value <0.05
The mean of serum TSH, T4, T3 and TPOAb concentrations in different thyroid functions are presented in (Tables 3a and 3b). Mean of serum TSH level was statistically increased in one month after study in both groups but other functional thyroid hormones (T3 and T4) were not different among exposed and non-exposed groups. Moreover, 14 cases and 28 controls were become hypothyroid (mild and overt hypothyroidism) and no statistically significant difference was seen between the two groups (p=0.07). Also the mean level of TSH was not different between the case and control groups in 1 and 3 months after intervention. Distribution of TSH level (including range, median and 25-75 percentile) in 1 and 3 months after intervention are shown in Figure 2.
T3: three iodothyronin, T4: thyroxin, TSH: thyroid stimulating hormone, TPOAb thyroid peroxidase antibody, as considered positive when level >37 IU/Ml, T3RU:T3 resin uptake, *P value <0.05 UIC: urinary iodine concentration
T3: threeiodothyronin, T4: thyroxin, TSH: thyroid stimulating hormone, TPO-Ab thyroid peroxidase antibody, as considered positive when level >37 IU/Ml, T3RU:T3 resin uptake, *P value <0.05, UIC: urinary iodine concentration\
In addition, frequency of TPO-Ab+ in case and control group was 14 and 29 (21.5% VS 31.5), respectively, and no statistically difference was found between the two groups (P=0.17).
Median of urinary iodine was not different between exposed and non-exposed groups at baseline (P=0.93) as well as 1 and 3 months after intervention (Figure 2). Median of urinary iodine before exposure was 12.8µg/dl and 16.75µg/dl among cases and controls, respectively, indicating no statistically significant difference between two groups (p=0.059). Median of urinary iodine one month after exposure was 28.45µg/dl and 15.2µg/dl among cases and controls, respectively, indicating a statistically significant difference between the two groups (p=0.002); while it was 12.95µg/dl and 14.2µg/dl among cases and controls, respectively, 3 months after exposure, indicating no statistically significant difference between the two group (p=0.13) (Figure 3). Mean value of thyroid volume in case group at baseline was 5.908(1.36-8.8)cc which increased to 6.244.7(1.039.6)cc one month later and decreased to 5.630(1.323)cc three months later. Thyroid volume changes in case group were statistically significant (P<0.001) but they were insignificant among the controls (P=0.680)cc. Similarly, mean thyroid volume at baseline was 5.611.9(1.477.6)cc and it was 5.662(1.394)cc and 5.639(1.403)cc one and three months later, respectively, respectively (Tables 4 and 5).
The patients with cardiovascular diseases usually considerably need angiography and angioplasty for management of coronary disease, which lead to exposure to iodine containing contrast media and cause some problems for such patients such as congestive heart failure and cardiac arrhythmia [2]. It is also reported that contrast agents increase thyroid dysfunction such as hyperthyroidism and hypothyroidism[14], and cardiopulmonary arrest after radio-contrasts injection [15]. The result from a large epidemiological study in Iran showed this country as an endemic iodine deficient area [16].
Our results showed the mean urine iodine as 20/3mg and 20/1mg/d for Euthyroid and hypothyroid subjects, respectively, [16] and in a study conducted in Isfahan, the UIC median for iodine sufficiency is reported 18 µg/dl [20]. It is also shown that contrast medias are independent risk factors for mortality and cardiovascular events [17]. Also, in a prospective cohort conducted on 101 euthyroid patients, hyperthyroidism was arisen among such these patients [18]. Additionally, evaluation of thyroid function tests 1,3,6,12 months after angiography indicate several new cases of hyperthyroidism where severity of baseline thyroid dysfunction is increased [19]. Some studies found no finding about any effect or significant change in thyroid function tests[20]. Due to different results of studies and lack of similar study in Iran, we decided to evaluate effect of contrast agents on thyroid function tests as our main goal. Previous studies have not investigated thyroid sonographic features and UIC and their association with thyroid dysfunction. In our study, no significant difference was found in terms of mean changes of T4 (P=0.47), total T3(P=0.7) and TSH(P=0.95) between the two groups. Median of UIC was12.8µg/dl and 16.75µg/dl among cases and controls, respectively, at baseline; and it increased to 28.45µg/dl and 15.2µg/dl and also 12.95 µg/dl and 14.2µg/dl one and three months after intervention, respectively, among cases in controls, indicating a statistically significant change after one month (P=0.002). Mean values of TPO-Ab+ three months after angiography were same as the baseline. Thyroid volume changes in case group were statistically significant (P<0.001) while they were insignificant among controls (P=0.680). There was no significant difference between case and control group in overt hypothyroidism while a significant difference was seen in terms of thyroid volume and size and UIC one month after angiography in both groups. Consequently, the use of iodine containing contrast media in angiography in cardiovascular diseases may be associated with thyroid dysfunction and cardiac dysfunctions such as cardiac arrhythmia among such patients, this is why we were motivated for this study. Among the patients, we found some insignificant changes in thyroid volume and mean TSH level among members of exposed group, therefore, follow up of thyroid function tests among euthyroid patients is not recommended.
In conclusion, thyroid volume changes were significant among cases (P<0.001) and insignificant among controls (P=0.680). No significant difference was seen between cases and controls in overt hypothyroidism, however, a considerable change was seen in thyroid volume and UIC one month after angiography among cases. The hypothyroidism rate among cases was insignificant which may be either related to few cases or short half-life of visipaque (2.1 hour).
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.
