1. Home
  2. Journals
  3. Biomedical Research and Clinical Advancements
  4. Articles In Press
  Submit Manuscript

Research Article | DOI: https://doi.org/BRCA-MRW-25-32

Excess Fat Tissue May Be the Most Significant Atherosclerotic Risk Factor in The Bod

Mehmet Rami Helvaci 1*, Elif Helvaci 2, Irem Sultan Kamalak 2, Yusuf Aydin 1, Leyla Yilmaz Aydin 3, Alper Sevinc 1, Celaletdin Camci 1, Abdulrazak Abyad 4, Lesley Pocock 5

1 Specialist of Internal Medicine, MD, Turkey

2 Manager of Writing and Statistics, Turkey

3 Specialist of Pulmonary Medicine, MD, Turkey

4 Middle-East Academy for Medicine of Aging, MD, Lebanon

5 Medi-WORLD International, Australia

*Corresponding Author: Mehmet Rami Helvaci, Specialist of Internal Medicine, MD, Turkey.

Citation: Mehmet Rami Helvaci, Elif Helvaci , Irem Sultan Kamalak, Yusuf Aydin, Leyla Yilmaz Aydin et al (2025). Excess Fat Tissue May Be the Most Significant Atherosclerotic Risk Factor in The Bod, J Biomedical Research and Clinical Advancements; 2(5) 32, DOI: BRCA-MRW-25-32

Copyright: Mehmet Rami Helvaci, et al © (2025). 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: 02 September 2025 | Accepted: 09 September 2025 | Published: 19 September 2025

Keywords: sickle cell diseases; excess fat tissue; capillary endothelial inflammation; atherosclerotic endpoints; diabetes mellitus; acarbose; metformin

Abstract

Background: Atherosclerosis may be the main cause of aging and shortened survival in human being.

Methods: All patients with sickle cell diseases (SCD) were included.

Results: We studied 222 males and 212 females with similar mean ages (30.8 vs 30.3 years, p>0.05, respectively). Smoking (23.8% vs 6.1%, p<0.001), alcohol (4.9% vs 0.4%, p<0.001), transfused red blood cells (RBC) in their lives (48.1 vs 28.5 units, p=0.000), disseminated teeth losses (5.4% vs 1.4%, p<0.001), ileus (7.2% vs 1.4%, p<0.001), stroke (12.1% vs 7.5%, p<0.05), chronic renal disease (9.9% vs 6.1%, p<0.05), cirrhosis (8.1% vs 1.8%, p<0.001), chronic obstructive pulmonary disease (25.2% vs 7.0%, p<0.001), coronary heart disease (18.0% vs 13.2%, p<0.05), leg ulcers (19.8% vs 7.0%, p<0.001), and clubbing (14.8% vs 6.6%, p<0.001) were all higher in males.

Conclusion: As an accelerated atherosclerotic process, hardened RBC-induced capillary endothelial damage initiated at birth terminates with multiorgan insufficiencies in early decades in the SCD. Diabetes mellitus (DM) may actually be one of the atherosclerotic endpoints of the pancreas. Although all of the above atherosclerotic consequences are frequent in SCD, we have not detected any case of DM probably due to the significantly lower body mass indexes of them. Similarly, just 20% of elderly have DM, but 55% of patients with DM are obese. So excess fat tissue may be much more significant than smoking, alcohol, or other chronic inflammatory or infectious processes for systemic atherosclerosis. Acarbose and metformin are safe, cheap, oral, long-term used, and effective drugs for loss of excess fat tissue.

References

  1. Widlansky ME, Gokce N, Keaney JF Jr, Vita JA. The clinical implications of endothelial dysfunction. J Am Coll Cardiol 2003; 42(7): 1149-60.
    View at Publisher | View at Google Scholar
  2. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005; 365(9468): 1415-28.
    View at Publisher | View at Google Scholar
  3. Franklin SS, Barboza MG, Pio JR, Wong ND. Blood pressure categories, hypertensive subtypes, and the metabolic syndrome. J Hypertens 2006; 24(10): 2009-16.
    View at Publisher | View at Google Scholar
  4. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106(25): 3143-421.
    View at Publisher | View at Google Scholar
  5. Helvaci MR, Aydin LY, Aydin Y. Digital clubbing may be an indicator of systemic atherosclerosis even at microvascular level. HealthMED 2012; 6(12): 3977-81.
    View at Publisher | View at Google Scholar
  6. Anderson RN, Smith BL. Deaths: leading causes for 2001. Natl Vital Stat Rep 2003; 52(9): 1-85.
    View at Publisher | View at Google Scholar
  7. Helvaci MR, Gokce C, Davran R, Akkucuk S, Ugur M, Oruc C. Mortal quintet of sickle cell diseases. Int J Clin Exp Med 2015; 8(7): 11442-8.
    View at Publisher | View at Google Scholar
  8. Platt OS, Brambilla DJ, Rosse WF, Milner PF, Castro O, Steinberg MH, et al. Mortality in sickle cell disease. Life expectancy and risk factors for early death. N Engl J Med 1994; 330(23): 1639-44.
    View at Publisher | View at Google Scholar
  9. Helvaci MR, Yaprak M, Abyad A, Pocock L. Atherosclerotic background of hepatosteatosis in sickle cell diseases. World Family Med 2018; 16(3): 12-8.
    View at Publisher | View at Google Scholar
  10. Helvaci MR, Kaya H. Effect of sickle cell diseases on height and weight. Pak J Med Sci 2011; 27(2): 361-4.
    View at Publisher | View at Google Scholar
  11. Helvaci MR, Aydin Y, Ayyildiz O. Hydroxyurea may prolong survival of sickle cell patients by decreasing frequency of painful crises. HealthMED 2013; 7(8): 2327-32.
    View at Publisher | View at Google Scholar
  12. Mankad VN, Williams JP, Harpen MD, Manci E, Longenecker G, Moore RB, et al. Magnetic resonance imaging of bone marrow in sickle cell disease: clinical, hematologic, and pathologic correlations. Blood 1990; 75(1): 274-83.
    View at Publisher | View at Google Scholar
  13. Helvaci MR, Aydin Y, Ayyildiz O. Clinical severity of sickle cell anemia alone and sickle cell diseases with thalassemias. HealthMED 2013; 7(7): 2028-33.
    View at Publisher | View at Google Scholar
  14. Fisher MR, Forfia PR, Chamera E, Housten-Harris T, Champion HC, Girgis RE, et al. Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension. Am J Respir Crit Care Med 2009; 179(7): 615-21.
    View at Publisher | View at Google Scholar
  15. Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013; 187(4): 347-65.
    View at Publisher | View at Google Scholar
  16. Davies SC, Luce PJ, Win AA, Riordan JF, Brozovic M. Acute chest syndrome in sickle-cell disease. Lancet 1984; 1(8367): 36-8.
    View at Publisher | View at Google Scholar
  17. Vandemergel X, Renneboog B. Prevalence, aetiologies and significance of clubbing in a department of general internal medicine. Eur J Intern Med 2008; 19(5): 325-9.
    View at Publisher | View at Google Scholar
  18. Schamroth L. Personal experience. S Afr Med J 1976; 50(9): 297-300.
    View at Publisher | View at Google Scholar
  19. Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 1999; 341(15): 1097-105.
    View at Publisher | View at Google Scholar
  20. Helvaci MR, Aydin Y, Gundogdu M. Smoking induced atherosclerosis in cancers. HealthMED 2012; 6(11): 3744-9.
    View at Publisher | View at Google Scholar
  21. Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med 1999; 340(2): 115-26.
    View at Publisher | View at Google Scholar
  22. Ridker PM. High-sensitivity C-reactive protein: Potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. Circulation 2001; 103(13): 1813-8.
    View at Publisher | View at Google Scholar
  23. Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA 1998; 279(18): 1477-82.
    View at Publisher | View at Google Scholar
  24. Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB. Elevated C-reactive protein levels in overweight and obese adults. JAMA 1999; 282(22): 2131-5.
    View at Publisher | View at Google Scholar
  25. Zhou B, Wu Y, Yang J, Li Y, Zhang H, Zhao L. Overweight is an independent risk factor for cardiovascular disease in Chinese populations. Obes Rev 2002; 3(3): 147-56.
    View at Publisher | View at Google Scholar
  26. Zhou BF. Effect of body mass index on all-cause mortality and incidence of cardiovascular diseases--report for meta-analysis of prospective studies open optimal cut-off points of body mass index in Chinese adults. Biomed Environ Sci 2002; 15(3): 245-52.
    View at Publisher | View at Google Scholar
  27. Helvaci MR, Kaya H, Yalcin A, Kuvandik G. Prevalence of white coat hypertension in underweight and overweight subjects. Int Heart J 2007; 48(5): 605-13.
    View at Publisher | View at Google Scholar
  28. Heilbronn LK, Ravussin E. Calorie restriction and aging: review of the literature and implications for studies in humans. Am J Clin Nutr 2003; 78(3): 361-9.
    View at Publisher | View at Google Scholar
  29. Fodor JG, Tzerovska R, Dorner T, Rieder A. Do we diagnose and treat coronary heart disease differently in men and women? Wien Med Wochenschr 2004; 154(17-18): 423-5.
    View at Publisher | View at Google Scholar
  30. Helvaci MR, Aydin LY, Aydin Y. Chronic obstructive pulmonary disease may be one of the terminal end points of metabolic syndrome. Pak J Med Sci 2012; 28(3): 376-9.
    View at Publisher | View at Google Scholar
  31. Helvaci MR, Kayabasi Y, Celik O, Sencan H, Abyad A, Pocock L. Smoking causes a moderate or severe inflammatory process in human body. Am J Biomed Sci & Res 2023; 7(6): 694-702.
    View at Publisher | View at Google Scholar
  32. Grunberg NE, Greenwood MR, Collins F, Epstein LH, Hatsukami D, Niaura R, et al. National working conference on smoking and body weight. Task Force 1: Mechanisms relevant to the relations between cigarette smoking and body weight. Health Psychol 1992; 11: 4-9.
    View at Publisher | View at Google Scholar
  33. Helvaci MR, Camci C, Nisa EK, Ersahin T, Atabay A, Alrawii I, Ture Y, Abyad A, Pocock L. Severity of sickle cell diseases restricts smoking. Ann Med Medical Res 2024; 7: 1074.
    View at Publisher | View at Google Scholar
  34. Walker JF, Collins LC, Rowell PP, Goldsmith LJ, Moffatt RJ, Stamford BA. The effect of smoking on energy expenditure and plasma catecholamine and nicotine levels during light physical activity. Nicotine Tob Res 1999; 1(4): 365-70.
    View at Publisher | View at Google Scholar
  35. Hughes JR, Hatsukami DK. Effects of three doses of transdermal nicotine on post-cessation eating, hunger and weight. J Subst Abuse 1997; 9: 151-9.
    View at Publisher | View at Google Scholar
  36. Miyata G, Meguid MM, Varma M, Fetissov SO, Kim HJ. Nicotine alters the usual reciprocity between meal size and meal number in female rat. Physiol Behav 2001; 74(1-2): 169-76.
    View at Publisher | View at Google Scholar
  37. Froom P, Melamed S, Benbassat J. Smoking cessation and weight gain. J Fam Pract 1998; 46(6): 460-4.
    View at Publisher | View at Google Scholar
  38. Helvaci MR, Kaya H, Gundogdu M. Gender differences in coronary heart disease in Turkey. Pak J Med Sci 2012; 28(1): 40-4.
    View at Publisher | View at Google Scholar
  39. Prescott E, Hippe M, Schnohr P, Hein HO, Vestbo J. Smoking and risk of myocardial infarction in women and men: longitudinal population study. BMJ 1998; 316(7137): 1043-7.
    View at Publisher | View at Google Scholar
  40. Helvaci MR, Kabay S, Gulcan E. A physiologic events’ cascade, irritable bowel syndrome, may even terminate with urolithiasis. J Health Sci 2006; 52(4): 478-81.
    View at Publisher | View at Google Scholar
  41. Helvaci MR, Dede G, Yildirim Y, Salaz S, Abyad A, Pocock L. Smoking may even cause irritable bowel syndrome. World Family Med 2019; 17(3): 28-33.
    View at Publisher | View at Google Scholar
  42. Helvaci MR, Algin MC, Kaya H. Irritable bowel syndrome and chronic gastritis, hemorrhoid, urolithiasis. Eurasian J Med 2009; 41(3): 158-61.
    View at Publisher | View at Google Scholar
  43. Kamimura D, Loprinzi PD, Wang W, Suzuki T, Butler KR, Mosley TH, et al. Physical activity is associated with reduced left ventricular mass in obese and hypertensive African Americans. Am J Hypertens 2017; 30(6): 617-23.
    View at Publisher | View at Google Scholar
  44. Sun Z, Lazar MA. Dissociating fatty liver and diabetes. Trends Endocrinol Metab 2013; 24(1): 4-12.
    View at Publisher | View at Google Scholar
  45. Rastogi A, Sakhuja P, Kumar A, Hissar S, Jain A, Gondal R, et al. Steatosis in chronic hepatitis B: prevalence and correlation with biochemical, histologic, viral, and metabolic parameters. Indian J Pathol Microbiol 2011; 54(3): 454-9.
    View at Publisher | View at Google Scholar
  46. Köse D, Erol C, Kaya F, Koplay M, Köksal Y. Development of fatty liver in children with non-Hodgkin lymphoma. Turk J Pediatr 2014; 56(4): 399-403.
    View at Publisher | View at Google Scholar
  47. Aktas E, Uzman M, Yildirim O, Sahin B, Buyukcam F, Aktas B, et al. Assessment of hepatic steatosis on contrast enhanced computed tomography in patients with colorectal cancer. Int J Clin Exp Med 2014; 7(11): 4342-6.
    View at Publisher | View at Google Scholar
  48. Balcik OS, Akdeniz D, Cipil H, Ikizek M, Uysal S, Kosar A, et al. Serum thrombopoietin levels in patients with non-alcoholic fatty liver disease. Saudi Med J 2012; 33(1): 30-3.
    View at Publisher | View at Google Scholar
  49. Çiftci A, Yilmaz B, Köklü S, Yüksel O, Özsoy M, Erden G, et al. Serum levels of nitrate, nitrite and advanced oxidation protein products (AOPP) in patients with nonalcoholic fatty liver disease. Acta Gastroenterol Belg 2015; 78(2): 201-5.
    View at Publisher | View at Google Scholar
  50. Kucukazman M, Ata N, Yavuz B, Dal K, Sen O, Deveci OS, et al. Evaluation of early atherosclerosis markers in patients with nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol 2013; 25(2): 147-51.
    View at Publisher | View at Google Scholar
  51. Agaç MT, Korkmaz L, Cavusoglu G, Karadeniz AG, Agaç S, Bektas H, et al. Association between nonalcoholic fatty liver disease and coronary artery disease complexity in patients with acute coronary syndrome: a pilot study. Angiology 2013; 64(8): 604-8.
    View at Publisher | View at Google Scholar
  52. Inci MF, Özkan F, Ark B, Vurdem ÜE, Ege MR, Sincer I, et al. Sonographic evaluation for predicting the presence and severity of coronary artery disease. Ultrasound Q 2013; 29(2): 125-30.
    View at Publisher | View at Google Scholar
  53. Öztürk H, Gümrükçüoğlu HA, Yaman M, Akyol A, Öztürk Ş, Akdağ S, et al. Hepatosteatosis and carotid intima-media thickness in patients with myocardial infarction. J Med Ultrason (2001) 2016; 43(1): 77-82.
    View at Publisher | View at Google Scholar
  54. Karasin M, Tokgoz O, Serifoglu I, Oz I, Erdem O. The Doppler ultrasonographic evaluation of hemodynamic changes in hepatic vascular structures in patients with hepatosteatosis. Pol J Radiol 2014; 79: 299-304.
    View at Publisher | View at Google Scholar
  55. Ozbulbul NI, Yurdakul M, Tola M. Does the visceral fat tissue show better correlation with the fatty replacement of the pancreas than with BMI? Eurasian J Med 2010; 42(1): 24-7.
    View at Publisher | View at Google Scholar
  56. Van Geenen EJ, Smits MM, Schreuder TC, van der Peet DL, Bloemena E, Mulder CJ. Nonalcoholic fatty liver disease is related to nonalcoholic fatty pancreas disease. Pancreas 2010; 39(8): 1185-90.
    View at Publisher | View at Google Scholar
  57. Stamm BH. Incidence and diagnostic significance of minor pathologic changes in the adult pancreas at autopsy: a systematic study of 112 autopsies in patients without known pancreatic disease. Hum Pathol 1984; 15(7): 677-83.
    View at Publisher | View at Google Scholar
  58. Lameloise N, Muzzin P, Prentki M, Assimacopoulos-Jeannet F. Uncoupling protein 2: a possible link between fatty acid excess and impaired glucose-induced insulin secretion? Diabetes 2001; 50(4): 803-9.
    View at Publisher | View at Google Scholar
  59. Aubert A, Garnet JM, Hammel P, Levy P, O'Toole D, Ruszniewski P, et al. Diffuse primary fat replacement of the pancreas: an unusual cause of steatorrhea. Gastroenterol Clin Biol 2007; 31(3): 303-6.
    View at Publisher | View at Google Scholar
  60. Chai J, Liu P, Jin E, Su T, Zhang J, Shi K, et al. MRI chemical shift imaging of the fat content of the pancreas and liver of patients with type 2 diabetes mellitus. Exp Ther Med 2016; 11(2): 476-80.
    View at Publisher | View at Google Scholar
  61. Quintero JHR, Grosser R, Velez GR, Ramos-Santillan VO, Pereira X, Flores FM, et al. Safety and efficacy of roux-en-y gastric bypass in older aged patients. Rev Col Bras Cir 2022; 49: e20223332.
    View at Publisher | View at Google Scholar
  62. Kim MK, Chun HJ, Park JH, Yea DM, Baek KH, Song KH, et al. The association between ectopic fat in the pancreas and subclinical atherosclerosis in type 2 diabetes. Diabetes Res Clin Pract 2014; 106(3): 590-6.
    View at Publisher | View at Google Scholar
  63. Selim Kul, Ayşegül Karadeniz, İhsan Dursun, Sinan Şahin, Ömer Faruk Çırakoğlu, Muhammet Raşit Sayın, et al. Non-Alcoholic Fatty Pancreas Disease is associated with Increased Epicardial Adipose Tissue and Aortic Intima-Media Thickness. Acta Cardiol Sin 2019; 35(2): 118-25.
    View at Publisher | View at Google Scholar
  64. Pezzilli R, Calculli L. Pancreatic steatosis: Is it related to either obesity or diabetes mellitus? World J Diabetes 2014; 5(4): 415-9.
    View at Publisher | View at Google Scholar
  65. Parfrey NA, Moore W, Hutchins GM. Is pain crisis a cause of death in sickle cell disease? Am J Clin Pathol 1985; 84(2): 209-12.
    View at Publisher | View at Google Scholar
  66. Helvaci MR, Ayyildiz O, Gundogdu M. Hydroxyurea therapy and parameters of health in sickle cell patients. HealthMED 2014; 8(4): 451-6.
    View at Publisher | View at Google Scholar
  67. Helvaci MR, Tonyali O, Yaprak M, Abyad A, Pocock L. Increased sexual performance of sickle cell patients with hydroxyurea. World Family Med 2019; 17(4): 28-33.
    View at Publisher | View at Google Scholar
  68. Helvaci MR, Aydin Y, Aydin LY, Sevinc A, Camci C, Abyad A, Pocock L. Red blood cell transfusions should be preserved just for emergencies in sickle cell diseases. World Family Med 2025; 23(4): 40-53.
    View at Publisher | View at Google Scholar
  69. Helvaci MR, Atci N, Ayyildiz O, Muftuoglu OE, Pocock L. Red blood cell supports in severe clinical conditions in sickle cell diseases. World Family Med 2016; 14(5): 11-8.
    View at Publisher | View at Google Scholar
  70. Helvaci MR, Ayyildiz O, Gundogdu M. Red blood cell transfusions and survival of sickle cell patients. HealthMED 2013; 7(11): 2907-12.
    View at Publisher | View at Google Scholar
  71. Helvaci MR, Cayir S, Halici H, Sevinc A, Camci C, Abyad A, Pocock L. Red blood cell transfusions may have the strongest analgesic effect during acute painful crises in sickle cell diseases. Ann Clin Med Case Rep 2024; V13(12): 1-12.
    View at Publisher | View at Google Scholar
  72. Miller ST, Sleeper LA, Pegelow CH, Enos LE, Wang WC, Weiner SJ, et al. Prediction of adverse outcomes in children with sickle cell disease. N Engl J Med 2000; 342(2): 83-9.
    View at Publisher | View at Google Scholar
  73. Balkaran B, Char G, Morris JS, Thomas PW, Serjeant BE, Serjeant GR. Stroke in a cohort of patients with homozygous sickle cell disease. J Pediatr 1992; 120(3): 360-6.
    View at Publisher | View at Google Scholar
  74. Cole TB, Sprinkle RH, Smith SJ, Buchanan GR. Intravenous narcotic therapy for children with severe sickle cell pain crisis. Am J Dis Child 1986; 140(12): 1255-9.
    View at Publisher | View at Google Scholar
  75. Miller BA, Platt O, Hope S, Dover G, Nathan DG. Influence of hydroxyurea on fetal hemoglobin production in vitro. Blood 1987; 70(6): 1824-9.
    View at Publisher | View at Google Scholar
  76. Platt OS. Is there treatment for sickle cell anemia? N Engl J Med 1988; 319(22): 1479-80.
    View at Publisher | View at Google Scholar
  77. Helvaci MR, Aydogan F, Sevinc A, Camci C, Dilek I. Platelet and white blood cell counts in severity of sickle cell diseases. Pren Med Argent 2014; 100(1): 49-56.
    View at Publisher | View at Google Scholar
  78. Charache S. Mechanism of action of hydroxyurea in the management of sickle cell anemia in adults. Semin Hematol 1997; 34(3): 15-21.
    View at Publisher | View at Google Scholar
  79. Charache S, Barton FB, Moore RD, Terrin ML, Steinberg MH, Dover GJ, et al. Hydroxyurea and sickle cell anemia. Clinical utility of a myelosuppressive
    View at Publisher | View at Google Scholar
  80. Steinberg MH, Barton F, Castro O, Pegelow CH, Ballas SK, Kutlar A, et al. Effect of hydroxyurea on mortality and morbidity in adult sickle cell anemia: risks and benefits up to 9 years of treatment. JAMA 2003; 289(13): 1645-51.
    View at Publisher | View at Google Scholar
  81. Lebensburger JD, Miller ST, Howard TH, Casella JF, Brown RC, Lu M, et al; BABY HUG Investigators. Influence of severity of anemia on clinical findings in infants with sickle cell anemia: analyses from the BABY HUG study. Pediatr Blood Cancer 2012; 59(4): 675-8.
    View at Publisher | View at Google Scholar
  82. Toghi H, Konno S, Tamura K, Kimura B, Kawano K. Effects of low-to-high doses of aspirin on platelet aggregability and metabolites of thromboxane A2 and prostacyclin. Stroke 1992; 23(10): 1400-3.
    View at Publisher | View at Google Scholar
  83. Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009; 373(9678): 1849-60.
    View at Publisher | View at Google Scholar
  84. Algra AM, Rothwell PM. Effects of regular aspirin on long-term cancer incidence and metastasis: a systematic comparison of evidence from observational studies versus randomised trials. Lancet Oncol 2012; 13(5): 518-27.
    View at Publisher | View at Google Scholar
  85. Macdonald S. Aspirin use to be banned in under 16 year olds. BMJ 2002; 325(7371): 988.
    View at Publisher | View at Google Scholar
  86. Schrör K. Aspirin and Reye syndrome: a review of the evidence. Paediatr Drugs 2007; 9(3): 195-204.
    View at Publisher | View at Google Scholar
  87. Pugliese A, Beltramo T, Torre D. Reye’s and Reye’s-like syndromes. Cell Biochem Funct 2008; 26(7): 741-6.
    View at Publisher | View at Google Scholar
  88. Hurwitz ES. Reye’s syndrome. Epidemiol Rev 1989; 11: 249-53.
    View at Publisher | View at Google Scholar
  89. Meremikwu MM, Okomo U. Sickle cell disease. BMJ Clin Evid 2011; 2011: 2402.
    View at Publisher | View at Google Scholar
  90. Mohamed S, Fong CM, Ming YJ, Kori AN, Wahab SA, Ali ZM. Evaluation of an initiation regimen of warfarin for international normalized ratio target 2.0 to 3.0. J Pharm Technol 2021; 37(6): 286-92.
    View at Publisher | View at Google Scholar
  91. Chu MWA, Ruel M, Graeve A, Gerdisch MW, Ralph J, Damiano Jr RJ, Smith RL. Low-dose vs standard warfarin after mechanical mitral valve replacement: A randomized trial. Ann Thorac Surg 2023; 115(4): 929-38.
    View at Publisher | View at Google Scholar
img

Harry Brooks

journal of Clinical Case Studies and Review 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 anu 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

Mark

My testimonial covering : the peer review process is qucick and effective,the support from the editorial office is very professional and friendly, quality of the Clinical Case Studies and Review Reports is scientific and publishers research.

img

Sinisa franjic

i would like to thank the editorial team for their timely responses and consideration in the publication of my paper . I would encourage to publish there research in ScienceFrontier.

img

Ritu Tiwari

I am pleased to submit my testimonials regarding the reviewer board and the editorial office. As a peer reviewer for the manuscript titled “A Novel Dissolution Method for Simultaneous Estimation of sennoside A and Sennoside B in Senna Tablet,” I was consistently impressed by the reviewers’ thorough analysis, insightful feedback, and unwavering commitment to enhancing the quality of the work. Their reviews were comprehensive and characterized by a respectful and collaborative approach, providing valuable suggestions that significantly improved the paper's outcome. Their dedication to the peer review process demonstrated their expertise and steadfast pursuit of excellence.

img

Qader Bawerdi

With all due respect, I would like to express my opinion on the peer review, editorial support, and the quality of the journal as follows: The peer review was conducted quickly and with great care, and my article was accepted for publication in less than a week. The editorial support regarding the status of the article process was excellent, and they informed me every day until the acceptance of the current status of the article version, and regarding how to answer questions, the editorial support was excellent, timely, and friendly, and they answered questions as soon as possible and did not hesitate. The quality of the journal was excellent and it made me proud to be acquainted with the journal, and I sincerely look forward to extensive scientific collaborations in any field. I hope for increasing success and pride for the International Journal of Social Science Research and Review and all scientific and knowledge-based communities. Thank you

img

Bhuvanagiri Sathya Sindhuja

"I would like to express my sincere appreciation for the opportunity to contribute to this esteemed journal. The publication process was smooth, well-coordinated, and the peer reviewers deemed highly professional. The editorial team demonstrated exceptional diligence and support at every stage, ensuring a seamless experience from submission to final publication. I am truly honored to be featured in such a reputable platform and look forward to future collaborations."

img

Safana Abdullah Algutaini

Testimonial for the Journal of Biomedical Research and Clinical Advancements It was a truly rewarding experience publishing our study, "Single-Surgeon Outcomes of Left Ventricular Aneurysm Repair in Wartime Syria: A 10-Year Retrospective Study at Damascus University Cardiac Surgery Hospital," with the Journal of Biomedical Research and Clinical Advancements. The editorial and peer-review process was both rigorous and efficient, demonstrating a high standard of academic integrity and scientific scrutiny. The journal’s commitment to open access and global health equity is evident in its support of research emerging from conflict-affected and resource-limited settings—making our work not only visible but impactful. The professionalism of the editorial team, the speed of communication, and the clarity of submission guidelines all contributed to a smooth publication process. We were particularly impressed by the quality of the publication layout and the prompt indexing of our article, which enhances its accessibility to clinicians, researchers, and policymakers worldwide. We are proud to have contributed to this journal and highly recommend it to fellow researchers seeking a reputable platform to disseminate clinically significant and globally relevant findings.