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Research Article | DOI: https://doi.org/10.31579/2578-8965/297
1 Department of Obstetrics and Gynaecology, Abia State University Teaching Hospital, Aba, Nigeria.
2 Department of Biochemistry, Lead City University, Ibadan, Oyo State, Nigeria.
*Corresponding Author: Emmanuel M. Akwuruoha, Department of Obstetrics and Gynaecology, Abia State University Teaching Hospital, Aba, Nigeria.
Citation: Emmanuel M. Akwuruoha and Augustine I. Airaodion, (2025), Assessment of the Efficacy of Metformin in Polycystic Ovarian Syndrome Management in Nigeria and its associated Risk Factors, J. Obstetrics Gynecology and Reproductive Sciences, 9(8); DOI:10.31579/2578-8965/297
Copyright: © 2025, Emmanuel M. Akwuruoha. 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: 24 November 2025 | Accepted: 08 December 2025 | Published: 19 December 2025
Keywords: metformin; polycystic ovarian syndrome; insulin resistance; hyperandrogenism; obesity; menstrual regulation; nigeria
Background: Polycystic Ovarian Syndrome (PCOS) is a common endocrine-metabolic disorder among women of reproductive age, characterized by ovulatory dysfunction, hyperandrogenism, and polycystic ovarian morphology. Metformin, an insulin sensitizer, is widely prescribed for PCOS management, yet its effectiveness and associated risk factors remain underexplored in Nigerian women.
Objective: To assess the efficacy of metformin in improving reproductive, metabolic, and biochemical outcomes in women with PCOS and to identify risk factors associated with poor treatment response in Nigeria.
Materials and Methods: This hospital-based, prospective, observational, and interventional study was conducted at Abia State University Teaching Hospital (ABSUTH), Aba, Nigeria. A total of 250 women aged 15–49 years diagnosed with PCOS using the Rotterdam 2003 criteria were recruited through systematic random sampling. Participants received metformin (500–1,500 mg/day) for six months with dietary and lifestyle counselling. Data on socio-demographics, clinical presentation, metabolic markers, and hormonal profiles were collected at baseline, three months, and six months. Primary outcome measures included menstrual cycle regulation and reduction in hyperandrogenism, while secondary outcomes assessed changes in body mass index (BMI), insulin resistance, lipid profile, and clinical symptoms. Statistical analysis was performed using SPSS version 25.0, employing paired t-tests, chi-square tests, and multivariable logistic regression at a significance level of p < 0.05.
Results: At baseline, 65.2% of participants had irregular cycles, 48.4% presented with hirsutism, and 39.2% had acne. After six months of metformin therapy, significant improvements were observed in menstrual regularity (χ² = 10.74, p = 0.013), fasting glucose (102.34 ± 18.45 vs. 93.78 ± 12.56 mg/dL; p < 0.001), insulin resistance (HOMA-IR: 4.20 ± 1.85 vs. 2.38 ± 1.12; p < 0.001), testosterone levels (75.23 ± 22.11 vs. 54.89 ± 18.43 ng/dL; p < 0.001), and Ferriman–Gallwey scores (9.45 ± 3.78 vs. 6.12 ± 3.01; p < 0.001). Logistic regression revealed that insulin resistance (HOMA-IR > 2.5; aOR = 3.12, 95% CI: 1.78–5.47, p < 0.001), obesity (BMI ≥ 30; aOR = 2.15, 95% CI: 1.22–3.80, p = 0.008), and elevated testosterone (>70 ng/dL; aOR = 1.95, 95% CI: 1.12–3.39, p = 0.018) were independent predictors of poor response to metformin.
Conclusion: Metformin significantly improved menstrual cyclicity, insulin resistance, hyperandrogenism, and metabolic outcomes among Nigerian women with PCOS. However, obesity, elevated insulin resistance, and high testosterone levels predicted poor response, underscoring the need for personalized treatment strategies in PCOS management.
Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age globally and is characterized by a heterogeneous cluster of reproductive, metabolic, and psychological features, including hyperandrogenism, ovulatory dysfunction, polycystic ovarian morphology and a markedly increased risk of insulin resistance, dyslipidaemia, type 2 diabetes and cardiovascular disease [1]. The syndrome’s clinical presentation and long-term health consequences mean that PCOS is not only a leading cause of infertility but also a major public-health concern because of its association with metabolic morbidity that can extend across the life course.
Epidemiological studies indicate that the prevalence and clinical phenotype of PCOS vary by population and by the diagnostic criteria applied, with estimates in many countries clustering in the single-digit to low-double-digit percentages of reproductive-aged women. In Nigeria, the reported prevalence and clinical phenotypes have been variable across hospital-based and community studies, with several Nigerian series and the Nigeria PCOS Epidemiology project documenting substantial local burden and heterogeneous phenotypes that include both metabolic-dominant and reproductive-dominant presentations. These findings suggest under-recognition and variable case-finding in clinical practice, and they highlight the need for context-specific data on disease burden, presentation and outcomes [2].
Insulin resistance is a central pathophysiological feature for a large subset of women with PCOS and underpins many of the metabolic and reproductive manifestations of the disorder; hyperinsulinaemia amplifies ovarian androgen production and interferes with normal follicular development, and the coexistence of obesity and insulin resistance substantially heightens cardiometabolic risk in affected women. Because insulin resistance is both common and clinically consequential in PCOS, therapeutic strategies that improve insulin sensitivity are of particular relevance [3].
Metformin, an insulin-sensitizing biguanide widely used in the management of type 2 diabetes, has been repurposed for PCOS management for decades. Its mechanisms in PCOS include reduction of hepatic gluconeogenesis, improvement in peripheral insulin sensitivity, potential direct effects on ovarian steroidogenesis and modest effects on weight and lipid metabolism. Clinically, metformin has been shown in randomized trials and meta-analyses to improve biochemical and some clinical outcomes in women with PCOS — including reductions in fasting insulin, improvements in menstrual regularity and, in some analyses, increased pregnancy rates when compared with placebo — although effect sizes vary by population, study design and concomitant interventions such as lifestyle modification. The cumulative evidence informed its inclusion among medical treatment options considered in international guidelines, particularly when metabolic abnormalities or glucose intolerance are present or when other first-line treatments are unsuitable [4].
Despite global evidence of benefit for selected outcomes, important uncertainties remain about the magnitude and consistency of metformin’s effects across different clinical endpoints (reproductive, metabolic, and cardiovascular), optimal dosing and duration, and the extent to which benefits observed in trial populations translate to routine care in diverse settings. Recent systematic reviews and guideline updates have stressed the importance of combining lifestyle interventions with pharmacotherapy and have emphasised patient-centred selection of therapy based on presenting problems (e.g., infertility vs metabolic risk) and individual risk profiles. Regional variation in baseline metabolic risk, patterns of obesity, access to diagnostic testing, and health-system factors means that findings from high-income countries cannot be uncritically extrapolated to low- and middle-income settings, including Nigeria [4].
In Nigeria, there are gaps in robust, population-level evidence about the real-world effectiveness of metformin for PCOS management and how local risk factors (for example, high prevalence of overweight/obesity in some urban populations, differing health-seeking behaviours, and limited routine screening for insulin resistance or impaired glucose tolerance) influence treatment response and outcomes. Preliminary national and hospital-based data have described the spectrum of PCOS phenotypes in Nigerian women and signalled a substantial prevalence of metabolic abnormalities among affected women, yet contemporary, well-designed evaluations of metformin’s efficacy across reproductive and metabolic outcomes in Nigerian clinical settings remain limited. This lack of context-specific evidence constrains local clinical decision-making and guideline implementation, and it undermines efforts to personalise care to the needs and risk profiles of Nigerian women with PCOS [5].
Accordingly, there is a clear and pragmatic need to assess metformin’s efficacy specifically in Nigerian populations and to identify associated risk factors that predict therapeutic response or adverse metabolic trajectories [6]. Generating local evidence on reproductive (e.g., menstrual regularity, ovulation, pregnancy rates), metabolic (e.g., insulin resistance indices, glycaemic status, lipid profile), anthropometric (e.g., weight and waist circumference) and patient-reported outcomes (e.g., quality of life, mental health) will inform whether international recommendations can be optimally applied in Nigeria or whether modifications—such as prioritising combined lifestyle and pharmacologic approaches for particular subgroups—are required. Moreover, identifying socio-demographic, clinical and biochemical predictors of response will aid clinicians in stratifying care, targeting resources and counselling patients about realistic expectations and risks of treatment [7,8].
Study Design
A hospital-based, prospective, observational, and interventional study design was employed. This design was chosen to assess both the efficacy of metformin in the management of PCOS and to evaluate associated risk factors among women diagnosed with the condition. The study consisted of two phases:
Baseline Assessment Phase – collection of socio-demographic, clinical, and biochemical data of participants prior to treatment.
Intervention Phase – administration of metformin to eligible participants and follow-up evaluation over a defined study period.
Study Area
This study was conducted at the Abia State University Teaching Hospital (ABSUTH), Aba, Abia State, Nigeria. ABSUTH is a tertiary health institution and referral centre located in the commercial city of Aba, serving a wide range of patients from within Abia State and neighbouring southeastern states. The hospital has specialized units, including obstetrics and gynaecology, endocrinology, and internal medicine, which provide diagnosis, treatment, and follow-up care for women with gynaecological and metabolic disorders such as Polycystic Ovarian Syndrome (PCOS).
Study Population
The study population comprised women of reproductive age (15–49 years) attending the gynaecology and endocrinology clinics of ABSUTH who were clinically or biochemically diagnosed with PCOS based on the Rotterdam 2003 diagnostic criteria [9], which require at least two of the following:
Oligo-ovulation or anovulation.
Clinical and/or biochemical signs of hyperandrogenism.
Polycystic ovaries detected by ultrasound.
Eligibility Criteria
Inclusion Criteria
Women aged 18–45 years diagnosed with PCOS according to Rotterdam criteria.
Patients who had not received metformin or any hormonal therapy for at least three months prior to recruitment.
Patients who consented to participate in the study and adhered to follow-up appointments.
Exclusion Criteria
Women with other endocrine disorders such as Cushing’s syndrome, congenital adrenal hyperplasia, or thyroid dysfunction.
Pregnant and lactating women.
Women with known contraindications to metformin use (renal, hepatic, or cardiovascular impairments).
Patients on concurrent medications known to interfere with glucose metabolism.
Sample Size Determination
The sample size was determined using Cochran's formula for estimating population proportions, as outlined by Akwuruoha et al. [10]:
n = 
The formula components are defined as follows:
n represents the minimum required sample size.
Z is set at 1.96, corresponding to a 95% confidence level.
P denotes the established prevalence of PCOS in Southeast Nigeria.
e signifies the allowable margin of error, fixed at 5% (0.05).
q = 1 - p
A recent study conducted by Ugwu et al. [11] reported the prevalence of PCOS in Southeast Nigeria as 18.1%
P = 18.1% = 0.181
q = 1 – 0.181
= 0.819
n = 
n = 
n = 
= 227.79
The minimum sample size was 228, but it was adjusted to 250 to account for a 10% non-response rate.
Sampling Technique
A systematic random sampling technique was used. Using the ANC attendance register, the sampling interval was determined by dividing the estimated number of eligible pregnant women attending ANC during the study period by the required sample size [12]. The first participant was selected randomly, and every 5th eligible woman was subsequently recruited until the sample size was attained.
Ethical Considerations
Written informed consent was obtained from each participant after adequate explanation of the study objectives, procedures, potential benefits, and risks. Confidentiality was strictly maintained, and participation was voluntary, with the option to withdraw at any time without consequences on medical care.
Study Instruments
Data were collected using a structured, interviewer-administered questionnaire consisting of four sections:
Intervention (Metformin Administration)
Participants were placed on metformin hydrochloride (500 mg orally, twice daily), titrated up to 1,500 mg/day depending on tolerance, for a period of six months. Standard dietary and lifestyle counselling were provided to all participants to complement pharmacological therapy. Adherence was monitored through pill counts and participant self-reports during clinic visits.
Outcome Measures
Primary Outcome
Improvement in menstrual cycle regularity (measured by self-reported cycle length and ovulation frequency).
Reduction in biochemical markers of hyperandrogenism (serum testosterone, LH/FSH ratio).
Secondary Outcome
Changes in body mass index (BMI) and waist-to-hip ratio.
Improvement in insulin resistance assessed using Homeostatic Model Assessment of Insulin Resistance (HOMA-IR).
Reduction in acne and hirsutism scores measured using the Ferriman–Gallwey scoring system.
Improvement in fasting blood glucose and lipid profile (total cholesterol, triglycerides, HDL, LDL).
Data Collection Procedures
At baseline, each participant underwent:
Anthropometric measurements – weight, height, waist, and hip circumference were measured using standard protocols. BMI was calculated as weight (kg)/height² (m²).
Clinical examination – evaluation of acne, hirsutism, and other PCOS features.
Laboratory investigations – venous blood samples were collected after overnight fasting for:
Fasting blood glucose (FBS).
Fasting insulin.
Lipid profile.
Hormonal assays (LH, FSH, total testosterone, prolactin, TSH).
Pelvic ultrasound – performed using a transabdominal or transvaginal probe to confirm polycystic ovarian morphology.
Follow-up assessments were conducted at 3 months and 6 months after initiation of metformin therapy.
Data Analysis
Data were entered and analyzed using Statistical Package for Social Sciences (SPSS) version 25.0. Descriptive statistics (frequencies, means, and standard deviations) were used to summarize socio-demographic and clinical characteristics. Inferential statistics included: Paired t-test for pre- and post-intervention continuous variables, Chi-square test for categorical variables, Multivariate logistic regression to identify risk factors associated with poor response to metformin therapy. A p-value of<0.05 was considered statistically significant.
The socio-demographic profile of participants (Table 1) showed that the majority were aged 25–34 years (36.8%), more than half were married (51.2%), and nearly half attained tertiary education (49.6%). The most common occupation was trading (31.2%).
Baseline clinical characteristics (Table 2) indicated that overweight (31.2%) and obesity (22.8%) were common. Irregular menstruation was reported by 65.2% of women, while 48.4% had hirsutism and 39.2% had acne. A history of infertility was reported by 29.6%, and ultrasound confirmed polycystic ovaries in 80.4% of cases.
Patient-reported outcomes on metformin use (Table 3) demonstrated high treatment adherence (mean = 4.16 ± 1.04). Most participants disagreed with experiencing bothersome side effects (mean = 2.84 ± 1.29), while 62.4% agreed their menstrual cycles improved after treatment (mean = 3.77 ± 1.30).
Key metabolic and hormonal outcomes significantly improved after 6 months of metformin therapy with lifestyle counselling (Table 4). There were reductions in BMI (30.12 ± 5.48 vs 28.75 ± 4.96, p < 0.001), fasting glucose (102.34 ± 18.45 vs 93.78 ± 12.56, p < 0.001), insulin (18.56 ± 7.89 vs 12.34 ± 5.67, p < 0.001), HOMA-IR (4.20 ± 1.85 vs 2.38 ± 1.12, p <0.001), testosterone (75.23 ± 22.11 vs 54.89 ± 18.43, p < 0.001), and Ferriman–Gallwey score (9.45 ± 3.78 vs 6.12 ± 3.01, p < 0.001).
Correlation analyses (Table 5) revealed that HOMA-IR strongly correlated with insulin (r = 0.78, p< 0.001) and moderately with BMI, WHR, and glucose (p <0.001). Testosterone was significantly associated with LH:FSH ratio (r = 0.40, p< 0.001) and Ferriman–Gallwey score (r = 0.34, p< 0.001), supporting the clinical link between biochemical and androgenic features.
Chi-square analyses (Table 6) showed significant associations between treatment response and BMI (χ²(3) = 10.74, p = 0.013), as well as hirsutism (χ²(1) = 11.54, p = 0.001). Women with normal BMI and those without hirsutism were more likely to achieve menstrual regularity after treatment.
Multivariable logistic regression (Table 7) identified insulin resistance (HOMA-IR > 2.5; aOR = 3.12, 95% CI: 1.78–5.47, p < 0.001), obesity (aOR = 2.15, 95% CI: 1.22–3.80, p = 0.008), and elevated testosterone (>70 ng/dL; aOR = 1.95, 95% CI: 1.12–3.39, p = 0.018) as significant independent predictors of poor response to metformin. Age and hirsutism showed trends but were not statistically significant in the adjusted model.
| Variable | Frequency (n = 250) | Percentage (%) |
| Age (years) | ||
| 18–24 | 57 | 22.80 |
| 25–34 | 92 | 36.80 |
| 35–44 | 61 | 24.40 |
| 45+ | 40 | 16.00 |
| Marital status | ||
| Single | 96 | 38.40 |
| Married | 128 | 51.20 |
| Divorced/Separated | 18 | 7.20 |
| Widowed | 8 | 3.20 |
| Highest education | ||
| No formal | 11 | 4.40 |
| Primary | 26 | 10.40 |
| Secondary | 89 | 35.60 |
| Tertiary | 124 | 49.60 |
| Occupation | ||
| Student | 34 | 13.60 |
| Trader | 78 | 31.20 |
| Civil servant | 61 | 24.40 |
| Unemployed | 35 | 14.00 |
| Others | 42 | 16.80 |
Table 1: Socio-demographic characteristics
| Variable | Frequency (n = 250) | Percentage (%) |
| BMI category | ||
| Underweight (<18.5 kg/m²) | 26 | 10.40 |
| Normal (18.5–24.9 kg/m²) | 89 | 35.60 |
| Overweight (25–29.9 kg/m²) | 78 | 31.20 |
| Obese (≥30 kg/m²) | 57 | 22.80 |
| Menstrual pattern (baseline) | ||
| Irregular (oligo/anovulatory) | 163 | 65.20 |
| Regular | 87 | 34.80 |
| Hirsutism (Ferriman–Gallwey score > certain cutoff) | ||
| Yes | 121 | 48.40 |
| No | 129 | 51.60 |
| Acne (clinical) | ||
| Yes | 98 | 39.20 |
| No | 152 | 60.80 |
| Self-reported infertility history | ||
| Yes | 74 | 29.60 |
| No | 176 | 70.40 |
| Oligomenorrhea | ||
| Yes | 141 | 56.40 |
| No | 109 | 43.60 |
| Ultrasound: Polycystic ovaries | ||
| Yes | 201 | 80.40 |
| No | 49 | 19.60 |
Table 2: Baseline Clinical Characteristics
| Item | Strongly Disagree | Disagree | Neutral | Agree | Strongly Agree | Mean ± SD |
| I adhered to metformin as prescribed (pill counts + self-report) | 8 (3.2%) | 14 (5.6%) | 29 (11.6%) | 78 (31.2%) | 121 (48.4%) | 4.16 ± 1.04 |
| I experienced bothersome side effects from metformin | 43 (17.2%) | 68 (27.2%) | 59 (23.6%) | 46 (18.4%) | 34 (13.6%) | 2.84 ± 1.29 |
| My menstrual cycles improved after treatment | 20 (8.0%) | 26 (10.4%) | 48 (19.2%) | 54 (21.6%) | 102 (40.8%) | 3.77 ± 1.30 |
Table 3: Patient-reported outcomes on metformin use
Legend: 1 = Strongly disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly agree. Values are frequencies (percentages). Means are calculated treating Likert responses as 1–5 scale (Mean ± SD).
| Variable | Baseline Mean ± SD | 6-month Mean ± SD | Mean difference (Baseline − 6-mo) | Paired t-test p |
| BMI (kg/m²) | 30.12 ± 5.48 | 28.75 ± 4.96 | 1.37 | p 0.001 (p = 0.000006) |
| Waist-hip ratio (WHR) | 0.86 ± 0.07 | 0.83 ± 0.06 | 0.03 | p 0.001 (p< 0.001) |
| Fasting blood glucose (mg/dL) | 102.34 ± 18.45 | 93.78 ± 12.56 | 8.56 | p 0.001 (p < 0.001) |
| Fasting insulin (µIU/mL) | 18.56 ± 7.89 | 12.34 ± 5.67 | 6.22 | p 0.001 (p < 0.001) |
| HOMA-IR | 4.20 ± 1.85 | 2.38 ± 1.12 | 1.82 | p 0.001 (p < 0.001) |
| Total testosterone (ng/dL) | 75.23 ± 22.11 | 54.89 ± 18.43 | 20.34 | p <0> (p < 0.001) |
| LH : FSH ratio | 2.10 ± 0.88 | 1.45 ± 0.62 | 0.65 | p 0.001 (p < 0.001) |
| Ferriman–Gallwey score | 9.45 ± 3.78 | 6.12 ± 3.01 | 3.33 | p 0.001 (p< 0.001) |
Table 4: Key continuous outcomes: Baseline vs 6-month
Values are expressed as Mean ± SD; n = 250
| BMI | WHR | Fasting glucose | Insulin | HOMA-IR | Testosterone | LH:FSH | Ferriman–Gallwey | |
| BMI | 1.00 | 0.62 (<0.001) | 0.30 (<0.001) | 0.42 (<0.001) | 0.48 (<0.001) | 0.18 (0.004) | 0.05 (0.431) | 0.10 (0.115) |
| WHR | 0.62 (<0.001) | 1.00 | 0.28 (<0.001) | 0.45 (<0.001) | 0.50 (<0.001) | 0.12 (0.058) | 0.06 (0.345) | 0.08 (0.207) |
| Fasting glucose | 0.30 (<0.001) | 0.28 (<0.001) | 1.00 | 0.46 (<0.001) | 0.55 (<0.001) | 0.16 (0.011) | 0.08 (0.207) | 0.09 (0.156) |
| Insulin | 0.42 (<0.001) | 0.45 (<0.001) | 0.46 (<0.001) | 1.00 | 0.78 (<0.001) | 0.14 (0.027) | 0.09 (0.156) | 0.07 (0.270) |
| HOMA-IR | 0.48 (<0.001) | 0.50 (<0.001) | 0.55 (<0.001) | 0.78 (<0.001) | 1.00 | 0.25 (<0.001) | 0.22 (<0.001) | 0.11 (0.083) |
| Testosterone | 0.18 (0.004) | 0.12 (0.058) | 0.16 (0.011) | 0.14 (0.027) | 0.25 (<0.001) | 1.00 | 0.40 (<0.001) | 0.34 (<0.001) |
| LH:FSH | 0.05 (0.431) | 0.06 (0.345) | 0.08 (0.207) | 0.09 (0.156) | 0.22 (<0.001) | 0.40 (<0.001) | 1.00 | 0.20 (0.001) |
| Ferriman–Gallwey | 0.10 (0.115) | 0.08 (0.207) | 0.09 (0.156) | 0.07 (0.270) | 0.11 (0.083) | 0.34 (<0.001) | 0.20 (0.001) | 1.00 |
Table 5: Pearson Correlation Matrix (Baseline Measures)
Format: r (p). p-values shown to 3 decimal places; where p< 0.001 shown as <0.001.
| Variable | Category | Responders (n) | Non-responders (n) | Row Total | χ² (df) | p-value |
| BMI category | Underweight | 18 | 8 | 26 | ||
| Normal | 66 | 23 | 89 | |||
| Overweight | 43 | 35 | 78 | χ²(3) = 10.74 | 0.013 | |
| Obese | 29 | 28 | 57 | |||
| Column totals | 156 | 94 | 250 | |||
| Hirsutism | Yes | 62 | 59 | 121 | ||
| No | 94 | 35 | 129 | χ²(1) = 11.54 | 0.001 | |
| Column totals | 156 | 94 | 250 |
Table 6: Chi-square Analyses of Categorical Associations Between Clinical Factors and Treatment Response (Menstrual Regularity at 6 Months)
| Predictor | aOR | 95% CI | p |
| Obesity (BMI ≥30) | 2.15 | 1.22 – 3.80 | 0.008 |
| Age > 35 years | 1.45 | 0.85 – 2.48 | 0.170 |
| HOMA-IR > 2.5 | 3.12 | 1.78 – 5.47 | <0> |
| Hirsutism (yes) | 1.62 | 0.98 – 2.68 | 0.058 |
| Testosterone > 70 ng/dL | 1.95 | 1.12 – 3.39 | 0.018 |
Table 7: Multivariable Logistic Regression (predictors of poor response to metformin)
This study evaluated the efficacy of metformin combined with lifestyle counselling for the management of polycystic ovary syndrome (PCOS) in Nigeria, and sought to identify predictors of poor response. Over six months, we observed statistically significant improvements across metabolic, hormonal, and reproductive parameters; yet response heterogeneity remained, and certain baseline factors, particularly obesity and insulin resistance, emerged as independent predictors of non-response in terms of menstrual regularization.
In interpreting the socio-demographic profile of the studied cohort, the age distribution (majority aged 25–34) and educational attainment (nearly half with tertiary education) reflect a relatively young, educated urban population. The marital status spread and occupational distribution are similar to profiles reported in Nigerian infertility/PCOS clinics. For example, Ugwu et al. [11], who documented infertility and oligomenorrhea as frequent presenting features in their PCOS patients in Enugu, with many women falling in the reproductive age group (mean ~30 years). The representation of obese and overweight women in our sample (combined ~54%) underscores the high prevalence of adiposity in PCOS populations, aligning with global observations that obesity often coexists with PCOS and magnifies its metabolic derangements.
At baseline, more than two-thirds had irregular (oligo-/anovulatory) cycles, and ~80% had ultrasound evidence of polycystic ovarian morphology, consistent with the classical PCOS phenotype widely described in literature [13]. The proportions with hirsutism (48 %) and acne (39 %) are also in keeping with the known clinical heterogeneity of androgen excess in PCOS populations.
The principal continuous outcomes demonstrated robust and consistent improvements. Mean BMI declined by 1.37 kg/m² (p < 0.001), waist-hip ratio fell, fasting glucose and insulin both decreased, and HOMA-IR dropped significantly. On the hormonal and reproductive side, total testosterone declined by ~20 ng/dL, LH:FSH ratio improved, and Ferriman–Gallwey scores decreased by over 3 points. Clinically, 40.8% “strongly agreed” and 21.6% “agreed” that their menstrual cycles had improved, yielding a mean of 3.77 on the Likert scale.
These findings echo earlier observational and interventional studies showing that metformin ameliorates insulin resistance, lowers androgen levels, and helps restore menstrual cyclicity [13]. In particular, our reductions in fasting insulin and HOMA-IR are consistent with prior meta-analyses and trials that have documented improved insulin sensitivity after several months of metformin therapy in PCOS [14]. However, some earlier work, such as Pau et al. [15], has argued that metformin’s effect may improve “glucose effectiveness” rather than classic insulin sensitivity, suggesting possible heterogeneity in mechanism depending on population or baseline metabolic state. Our data, obtained via surrogate fasting indices, cannot disentangle those mechanistic nuances, but the clear direction of improvement is strongly supportive.
The decline in BMI and WHR in our cohort is notable: some previous studies have reported modest weight loss or stabilization rather than significant reductions, particularly when baseline glycaemic indices are normal or when dietary adherence is suboptimal [16]. That our participants achieved meaningful anthropometric improvements suggests that the lifestyle counselling component may have been effective, and that in this Nigerian cohort, metformin’s weight-modulating effects were not entirely blunted.
On the androgenic front, the decline in total testosterone and Ferriman–Gallwey score aligns with the known capacity of metformin to reduce ovarian and adrenal androgen synthesis, directly and indirectly via insulin-lowering [17]. The improvement in LH:FSH is also consistent with a more favourable gonadotropin milieu emerging with reduced hyperinsulinemia, though in many trials the LH:FSH shift is more modest.
The degree of menstrual improvement (as self-reported) corroborates prior reports: many women on metformin experience restoration of ovulation and menses, though with variable percentages (often 40–60 %) depending on baseline factors [13]. Our data suggest that about 60–70% of the cohort showed some menstrual benefit (combining agree/strongly agree), which is within the expected range.
Our Pearson correlation matrix at baseline demonstrated that HOMA-IR strongly correlates with insulin (r = 0.78) and moderately with BMI, WHR, and fasting glucose, reaffirming the centrality of insulin resistance in the metabolic‐reproductive axis of PCOS. This pattern is consistent with multiple studies that highlight insulin resistance as a nexus linking obesity, hyperinsulinemia, and ovarian dysfunction [18]. The moderate correlation of BMI and WHR with insulin and HOMA-IR underscores that adiposity—especially central adiposity—is a plausible driver of insulin resistance in this population.
Total testosterone correlated with LH:FSH and Ferriman–Gallwey score (r = 0.40 and 0.34 respectively), supporting the expected relationship between biochemical androgen excess and clinical signs. This matches other works reporting such associations in PCOS populations [19].
Interestingly, baseline BMI and WHR had weaker correlations with clinical hirsutism scores. This suggests that although adiposity and insulin resistance influence androgenic and menstrual dysfunction, other factors (for example, ovarian steroidogenic sensitivity, individual genetic/epigenetic variation) modulate the phenotypic expression of hirsutism.
By six months, 156 women responded (i.e. achieved menstrual regularity), whereas 94 did not. The chi-square analyses revealed statistically significant relationships: women in the normal BMI range were more likely to respond than their overweight or obese counterparts (χ² = 10.74, p = 0.013). Similarly, absence of hirsutism was associated with higher response rates (χ² = 11.54, p = 0.001). These categorical associations align with the intuitive notion that lower baseline metabolic and androgenic burden might favour better responsiveness.
In multivariable logistic regression, independent predictors of poor response included obesity (aOR = 2.15), HOMA-IR > 2.5 (aOR = 3.12), and elevated baseline testosterone > 70 ng/dL (aOR = 1.95). Age > 35 and presence of hirsutism approached, but did not reach, conventional statistical significance in the adjusted model.
These predictors are biologically plausible and resonate with prior literature. Obesity as a negative predictor of metformin response has been reported by others. For instance, Palomba et al. [20] observed that insulin-resistant PCOS patients with lower BMI were more likely to respond to metformin, implying attenuated response in the context of greater adiposity and metabolic derangement. Elevated insulin resistance (high HOMA-IR) as a marker of poor response is also consistent with the idea that more severe insulin dysfunction may require greater or alternative therapeutic strategies (e.g., higher metformin dose, combination therapy) to overcome the metabolic barrier.
The finding that baseline testosterone over 70 ng/dL predicts poorer response is interesting and suggests that a heavier androgenic burden may blunt restoration of ovulation or menses despite metabolic improvements. Garzia et al. [19] similarly suggested that baseline hyperandrogenemia and menstrual irregularity are among the best predictors of metformin response, though in that study they focused more on androgen reduction and weight loss outcomes rather than menstrual normalization per se. In our setting, a higher androgen baseline may reflect a “harder-to-reverse” ovarian steroidogenic dysregulation.
The near-significant trend for hirsutism to predict non-response also fits with the notion that clinically manifest androgen excess may reflect a more entrenched endocrine disturbance less amenable to reversal by insulin sensitization alone.
In Nigeria, reports on the use and outcomes of metformin in PCOS are relatively sparse and often focused on infertility clinic populations rather than broad metabolic cohorts. For example, Omokanye et al. [21] described management of infertile women with PCOS using clomiphene, metformin, and laparoscopic interventions, reporting overall promising outcomes including pregnancy rates of 46 % over 6–12 months, though the contribution of metformin per se was not isolated. Ugwu et al. [11] found that only 22 % of women in their PCOS series in Enugu had been prescribed metformin as adjunctive therapy, reflecting that metformin was not universally adopted in Nigerian PCOS care at that time.
Our data strengthen the local evidence base by specifically quantifying metabolic, hormonal, and reproductive outcomes among a larger (n = 250) Nigerian PCOS cohort receiving metformin with lifestyle counsel, and by identifying local predictors of response. In doing so, we provide contextually relevant benchmarks for future comparative studies or clinical guidance in Nigeria.
The improvements in metabolic and endocrine parameters likely reflect a combination of mechanisms: metformin’s inhibition of hepatic gluconeogenesis, enhancement of peripheral glucose uptake, possible direct effects on ovarian theca cell steroidogenesis, and indirect effects via weight and adiposity reduction [13]. The degree to which each mechanism contributes may vary by individual phenotype, which likely underlies the observed heterogeneity in response.
The significant independent predictor role of HOMA-IR suggests that women with more severe insulin resistance may have a higher “barrier” to restoring ovulatory function despite metabolic improvements. It is plausible these women might benefit from higher metformin doses, combination insulin sensitizers, or longer duration of therapy. Some recent machine learning work has attempted to predict metformin efficacy using baseline metabolic and anthropometric features, though mostly in non-African populations [22]. Such approaches may eventually inform personalized PCOS therapy in Nigeria.
The observation that elevated baseline testosterone predicts poorer menstrual response suggests that hyperandrogenism may itself be a limiter of responsiveness, even when insulin is improved. It is possible that in such women, adding anti-androgen agents or ovulation induction adjuncts early might optimize outcomes.
Our study confirms that metformin combined with lifestyle counselling produces significant improvements in metabolic, hormonal, and menstrual parameters in Nigerian women with PCOS over six months. Yet, response is heterogeneous: obesity, elevated insulin resistance, and high androgen burden independently predict poorer menstrual regularization. These findings highlight the need for individualized risk stratification, adjunctive or intensified therapy for higher-risk subgroups, and further research tailored to the African context.
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.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Grace Pierce, International Journal of Clinical Case Reports and Reviews I appreciate the opportunity to review for Auctore Journal, as the overall editorial process was smooth, transparent and professionally managed. This journal maintains high scientific standards and ensures timely communications with authors, which is truly commendable. I would like to express my special thanks to editor Grace Pierce for his constant guidance, promt responses, and supportive coordination throughout the review process. I am also greatful to Eleanor Bailey from the finance department for her clear communication and efficient handling of all administrative matters. Overall, my experience with Auctore Journal has been highly positive and rewarding. Best regards, Sabita sinha
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
