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Herbal Medicine for the Treatmentof Viral Infections: A Systemic Review

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Review Article | DOI: https://doi.org/10.31579/2692-9406/088

Herbal Medicine for the Treatmentof Viral Infections: A Systemic Review

  • Amand Alekhya
  • Abbaraju Krishna Sailaja *

Department of pharmaceutics, RBVRR women’s college of pharmacy, affiliated to Osmania University, Hyderabad, India.

*Corresponding Author: Abbaraju Krishna Sailaja, Department of pharmaceutics, RBVRR women’s college of pharmacy, affiliated to Osmania University, Hyderabad, India.

Citation: A Alekhya, Abbaraju K Sailaja. (2022). Herbal Medicine for the Treatmentof Viral Infections: A Systemic Review. Biomedical Research and Clinical Reviews. 6(1); DOI: 10.31579/2692-9406/088

Copyright: © 2022 Abbaraju Krishna Sailaja, This is an open access article distributed under the Creative Commons Attributiosn License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 21 October 2021 | Accepted: 27 December 2021 | Published: 07 January 2022

Keywords: different antiviral herbs; viral diseases; marketed herbal products for viral infections

Abstract

The term “Antiviral agents” has been defined in very wide terms as substances other than a virus or virus containing vaccine or specific antibody which can build either a protective or therapeutic effect to the direct measurable advantage of the virus infected host. Viruses are simple in form which are very tiny germs. They comprise of genetic material inside of a protein coating. Viruses cause amicable infectious diseases like common cold, flu and warts. They also cause severe diseases such as HIV/AIDS, Ebola, avian influenzas, dengue virus and COVID-19. Viral diseases are very complex and are easily spread. Herbs and herbal medicines were the foremost in treating infections from centuries over the world in every civilization. Modern science has narrowed the importance of herbal medicine in the past two centuries. But, the side effects and new varieties of diseases creating challenges to modern science. So, usage of herbal medicines is again attaining interests these days. Herbal products for different treatments have achieved a lot of popularity in the last couple of decades. Thus, discovering novel antiviral drugs is of extremely important and natural products are an excellent source for such discoveries. There are many herbs which are excellent sources for the antiviral properties to treat viral infections. This review provides the verified data on the herbal substances with antiviral activity, and some of the herbal marketed antiviral agents like CORONIL TABLETS from Patanjali and different companies had made an attempt to treat viral infections in this pandemic situation. Therefore, herbal plants proved to be a major resort for the treatment of diseases and sickness by traditional healers in many societies.

Introduction

A virus is a tiny contagious agent that replicates inside the cells of living host. When infected, the host cell is enforced to rapidlygive rise to thousands of identical copies of the original virus. Unlike most living things, viruses do not have cells that divide; new viruses gather in the infected host cells. Viruses are made up of two or three parts which includes genes, these genes are composed of encoded biological information of the virus and are fabricated from either DNA or RNA. Genes present in the viruses are shielded with a protein coat [1].

A viral infection is a proliferation of a harmful virus inside the body which infect the host by launching their genetic material into the cells and hijacking the cells internal machinery to make more virus particles. Viral diseases are exceedingly widespread infections caused by viruses. They cause many transmissible diseases like common cold, influenza, yellow fever, rabbis, measles, many forms of diarrhea, hepatitis, polio. Even currently many viral infections are still causing huge threat to human being such as coronavirus, HIV, SARS, Ebola virus, Dengue virus, etc. where there are no efficient conventional medications or vaccines for most of these viruses. There are different kinds of viral infections which are as follows.

Types of viral infections:

There are many viral infections which effect the human body at different sites [2].

Respiratory viral diseases:

Respiratory viral infections are transmissible and commonly affect the upper or lower parts of respiratory tracts.Based on symptoms and local epidemiology viral infections are clinically determined. This is severely affected in older patients and infants. Common symptoms of respiratory viral infections include: body aches, fever, coughing or sneezing, runny or stuffy nose [3].

Examples: Coronavirus, severe acute respiratory syndrome (SARS), flu, common cold, parainfluenza virus infection, adenovirus infection, respiratory syncytial virus infection.

  • Respiratory viral infections usually heal on their own, but over the counter (OTC) medications, such as cough suppressants, nasal decongestants and pain relievers can help to lower the symptoms.
  • The best way to avoid respiratory viral infections is to practice good personal hygiene, wash your hands often, cover your mouth when you cough or sneeze and limit your interactions with the people who show symptoms.

Gastrointestinal viral diseases:

Gastrointestinal viral infections, in which the virus affects the digestive tract which usually lead to a condition called gastroenteritis, commonly called as stomach flu. Common symptoms of gastrointestinal viral infections include: vomiting, diarrhea, abdominal cramps [4].

Examples: norovirus infection, rotavirus infection, astrovirus infection.

Exanthematous viral diseases:

In this the viruses causes skin rashes and many more symptoms; these infections are highly contagious [5, 6].

Examples: Measles, rubella, chickenpox, smallpox, chikungunya virus infection.

  • Many exanthematous virus spread through respiratory droplets from the cough or sneeze of someone with virus.
  • Measles, rubella, chickenpox and smallpox these all can be prevented by vaccination.

Hepatic viral diseases:

The hepatic viral diseases which cause inflammation of the liver known as viral hepatitis. Sometimes it may be caused by other viruses such as cytomegalovirus and the yellow fever virus [7].

Examples: Hepatitis type A, B, C, D & E.

  • Hepatitis A &E can be transmitted by food and water that’s been contaminated with the virus, whereas Hepatitis B &C can be transmitted from person to person by bodily fluids and hepatitis B can be spread through sexual contact.
  • There are vaccines for both Hepatitis A & E, and by taking antiviral drugs which are prescribed by the physician.

Cutaneous viral diseases:

Cutaneous viral infections cause lesions or papules are formed on the skin. In many cases, these lesions can stick around for a long period of time or come back after disappearing for a while [8].

Examples: warts (including genital herpes), oral herbs, genital herbs, molluscum contagiosum. 

  • These viruses are transmissible which are usually outspread through close physical contact with someone who has the virus.
  • It can be prevented by maintaining good hygiene habits.

Hemorrhagic viral diseases:

Hemorrhagic viral infections are dreadful conditions that involves damage to your circulatory system. Symptoms by these infections include high fever, body aches, bleeding in internal organs, weakness, bleeding under the skin, bleeding from the mouth or ear [9].

Examples: Ebola, Lassa fever, dengue fever, yellow fever, Marburg hemorrhagic fever.

  • There’s no specific treatment for hemorrhagic viral diseases, researchers are in process of developing vaccines for several hemorrhagic viruses.
  • A yellow fever vaccine is available for people who are travelling to the areas where the yellow fever is common.

Neurologic viral diseases:

Some viruses even they can affect brain and surrounding tissues, causing neurologic viral diseases. This can result in the range of symptoms like fever, confusion, drowsiness, seizures, coordination problems [10].

Examples: polio, viral meningitis, viral encephalitis, rabies.

  • Polio virus and mumps virus, which can cause meningitis and encephalitis can be prevented by taking vaccine.
  • Rabies can be prevented from spreading by properly vaccinating our pets and avoid approaching wild animals.
Figure 1: Overview of different viral infections in the human body

Antivirals: An Herbal Approach

Herbal antiviral medicine: an introduction

The term “Antiviral agents” has been defined in very wide terms as substances other than a virus or virus containing vaccine or specific antibody which can build either a protective or therapeutic effect to the direct measurable advantage of the virus infected host. All over the world, herbal medicines are reviewed to be one of the most significant areas of interest in traditional medicine systems. Classic antiviral drugs are often costly and ineffective due to viral resistance and cause severe adverse effects, with that in mind naturally based herbal medicines will be a proper alternative for treating viral diseases. World Health Organization (WHO) has also highlighted in 1978, on the importance of scientific research into herbal medicine and all the developing countries has started research on their native medicinal plants and to get register to the WHOs list of “essential drugs” [11]. 

WHO has published a report in which it is mentioned that nearly 80% of people living in rural areas depends on medicinal plants as primary health care system and their practices entirely based on knowledge of traditional use of medicinal plants?  According to a FAO report, at least 25% of drugs used in modern pharmacopoeia are acquired from plant products. Some of the herbs or medicinal plants having antiviral properties against different viruses and these are used since ancient times because of their stronger therapeutic effect.

Herbal medicines and purified natural products furnish a rich resource for novel antiviral drug development. Recognition of the antiviral mechanisms from these herbal agents has shed light where these agents interact with the viral life cycle, such as viral entry, replication, assembly and release, furthermore on the targeting of virus host specific interactions.

Herbs with antiviral activity:

Since ancient times, many herbs have been used as natural treatments for various illnesses, including viral infections. Due to the presence of phytochemicals and potent plant compounds, many herbs help fight against viruses. Common kitchen herbs like basil, sage and oregano, as well as lesser-known herbs like Astragalus and Sambucus have powerful antiviral effects against numerous viruses that cause infections in humans. Many researchers have conducted research of herbs but they could not mention whether the small dose or high dose of the concentrated extract would have the same effects on humans. There are many herbs like basil, sage, ginger, ginseng, etc.; which have antiviral properties, some of them are mentioned below.

  1. Ginger: It has impressive antiviral, antibacterial and anti-inflammatory properties. Ginger contains compound such as gingerols and zingerone that helps to prevent the growth of the virus and this herb is effective in avian influenza, RSV and feline calicivirus (FCV). Fresh ginger of uplifted concentration could stimulate mucosal cells to release IFN-β that possibly contributed to counteracting viral infections [12, 13].
  2. Sage: This is an aromatic traditional herb of the mint family has long been used for the treatment of viral infections. The leaves and stem of this herb contain a compound called safficinolide, which shows antiviral properties. It is also used for treating different kinds of disorders icluding saizures, ulcers, gout, rheumatism, inflammation, dizziness, tremor, paralysis, dairrhea and hyperglycemia [14].
  3. Basil: It has both antiviral and anti-inflammatory properties that can help fight several viral infections. Basil leaves contains active constituents like apigenin and ursolic acid, which is helpful in treating virus like herpes, hepatitis B and enterovirus. The crude aqueous and ethanolic extracts of basil and selected purified components like apigenin, linalool and ursolic acid, exhibited a broad spectrum of antiviral activity [15].
  4. Oregano: It is an herb from mint family with powerful antiviral properties. The plant contains active phytochemical like carvacrol that alone exhibited high antiviral activity against rotavirus and even it has antibacterial and antifungal properties [16].
  5. Garlic: It is a superfood which is used for preparing medicines for various health conditions, it can be effective against influenza A and B, HIV, HSV-1, viral pneumonia and rhinovirus [17]. 
  6. Ashwagandha: It is scientifically known as “WITHANIA SOMNIFERA” (WS) is an important medicinal plant that has been used in ayurvedic and indigenous medicine for more than 3000 years.It is composed of an active chemical constituent called withaferin A, has been shown to have a broad range of medicinal properties including antiviral activity. The hydro alcoholic extract of withania somnifera roots showed the inhibition of virus at maximum 99.9% in its highest nontoxic concentration. It is mainly used for the treatment of influenza virus [18, 19]. This ancient medicinal herb provides almost every health benefit like from improving immunity to reducing stress, regulating blood sugar level and lowering cholesterol. A recent research showed that ashwagandha contains certain bio-actives that interacts with SARS-CO-2. This herb contains a natural compound called withanone (Wi-N), that can block the replication process of the novel virus and treat the condition [20].
  7. Giloy: It is scientifically called as “Tinospora cordifolia” and is commonly named as “Guduchi” in Sanskrit which has excellent applications in treating various diseases. This plant has many benefits and it is powerhouse of anti-oxidants which helps to neutralize free radicals and prevents from inflammation. It has other benefits like it purifies blood, boosts immunity, flushes out toxins from the body and fights against bacteria and viruses.Consuming giloy juice can help you get rid of fever, which is one of the signs of COVID-19 pandemic situation. Because of its anti-inflammatory properties it helps in dealing with the respiratory problems like cough, cold and breathing problems which are major signs of novel coronavirus infection [21, 22]. Marketed herbal medicines are given in figure2.
Figure 2: Herbal marketed medicines of Giloy ghanvati tablets and giloy-amla juice by PATANJALI pvt Ltd.
Table 1: list of plants showing anti-viral properties against various viruses [23]

Advantages of Herbal Medicines [23]

  • The wide prescription of herbal drugs is mainly due to their effectiveness, less side effects and relatively low in cost.
  • Therapeutic uses of herbal medicinal plants in numerous ailments also have a further important advantage of their easy availability.
  • Easy to manufacture and even with the small quantity they are more effective when compared to the synthetic medications.
  • Most herbal medicines are well tolerated by the patient, with little unintended consequences than the pharmaceutical drugs.

Disadvantages of Herbal Medicines

  • By using herbal medicines, we cannot treat sudden illness or accidents, whereas modern medicines are very effective in this case.
  • Another drawback of herbal medicine is that herbal treatments can interact with medications
  • Manufacturing herbal medicines is a time-consuming process and it is complicated too
  • Herbal drugs have slower effects as compare to Allopathic dosage forms, also it requires long term therapy & even it is difficult to mask taste and odor
  • Till date no pharmacopoeia defines any specific procedure or ingredients to be used in any herbal formulations.

Recent Marketed Herbal Medicine for the Treatment of Covid-19

Coronavirus disease 2019 (COVID-19) is a new communicable disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that belongs to the coronavirus family [24]. By using antiviral drugs and immunomodulators, the research has showed that the drugs were not remarkably effective against the disease. Then, people believed that herbal immunomodulators or natural medicinal compounds might show effective results for the treatment of COVID-19 than the synthetic antivirals. During this pandemic situation many institutions and researchers are working for the herbal agents which can show better results. Some herbal agents extracted from various plants includes Echinacea, Cinchona, Curcuma longa, withania somnifera, Tinospora cardifolia and Curcuma xanthorrhiza, are considered to be good for the treatment of COVID-19 [25].

Among infected patients, COVID-19 manifests various unspecific symptoms, ranging from mild to severe which includescough (76%), fever (98%), sputum production (28%) and headache (8%). Presently, there is no specific treatment for COVID-19, people in the society and researchers are trying to find best way to cure the disease by using herbal medicines [26].

Figure 3: Herbal medicine for COVID-19 (Divya swasari coronil kit)

Many researchers and institutions are trying hard for the medicine and everyone are waiting for the medicine at this pandemic situation, the first ever clinically tested, evidence based ayurvedic medicine for curing deadly coronavirus has launched into the market by Patanjali Ayurveda Limited using traditional medicinal herbs. It has been named “CORONIL” [27, 28].

The Coronil kit consist of 3 products which are divyaCoronil tablets, divyaSwasarivati which are oral tablets used as immunity boosting agent and third product is Anu tali which is a liquid dosage form taken as nasal drops [29]. This medicine is purely herbal medicine which includes herbs like Giloy (Tinospora cardifolia), Ashwagandha (Withania somnifera) and Tulsi (Ocimum sanctum), etc. This herbal medicine good impact on patients who are affected with the coronavirus. This herbal medicine has huge benefits in strengthening the immune system and also are effective in curing symptoms like sore throat, nasal congestion, fever etc. not only giloy, ashwagandha and tulsi they have used 100 herbal compounds for the preparation of Coronil, therefore it showed good effect in patients suffering from coronavirus at this pandemic time.

Figure 4: Marketed herbal medicine used for the treatment of HIV and herpes simplex viruses

Discussion

Development of antiviral resistance is mainly correlated with viral fitness and the potency and genetic barrier to resistance of anti-viral agents. Potency of a drug is defined by time taken by drug to repress the viral replication. More hurriedly a drug suppresses the replication, lower the risk of developing anti-viral resistance. The anti-viral agents generally obstruct steps in virus-specific replication. These agents are capable of targeting viral enzymes, thus interfering with viral nucleic acid synthesis. There are many novel anti-viral agents developed currently to treat viral infections. The problem of antiviral resistance makes most of the anti-viral drugs ineffective. Still a lot of work has to be done to further investigations in to its actual potential for human use. 

There is an urgent need for the development of new formulations having effective antiviral properties. In present scenario there are severe side effects for the pharmaceutical drugs, advanced antiviral herbal formulations with less side effects, inherently safer for all, more effective and less expensive herbal formulations should be developed for treating viral infections. Herbal medicines and purified natural products come up with a rich resource for anti-viral drug development. 

Conclusion

Altogether, the declaration submitted in this work supports the notion that medicinal plants have promising therapeutic potential, especially in case of herbal products against viral infections. Promising results were observed for herbal antiviral agents by conducting a number of epidemiological and animal model studies for cellular and sub-cellular targets. Knowledge based on traditional system of medicines, various herbal formulations from medicinal plants for treating different viral infections has still to be developed. Many countries around the world are depending on their research for the formulation of herbal medicines against viral infections. There are several infectious diseases caused by viruses, many western medications and vaccines are available but these are not fully effective against these infections due to the mutating strains of the viruses such as influenza virus. Herbal treatments help in stopping the viral replication and shortens the duration of illness. At this pandemic situation of COVID-19, herbal agents are useful for the treatment of infections like CORONIL TABLETS and many other herbal formulations has to developed because the herbs having low cost, minimum toxicity almost found everywhere in the country, it has potential to enhance immunity to fight against the COVID-19 and for treating different diseases which are causing severe impact and now a days individual are more interested in herbal and ayurvedic medicines.

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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.

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Andreas Filippaios

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

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Dr Suramya Dhamija

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

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Bruno Chauffert

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

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Baheci Selen

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

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Jesus Simal-Gandara

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

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Douglas Miyazaki

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

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Dr Griffith

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

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Dr Tong Ming Liu

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

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Husain Taha Radhi

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

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S Munshi

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

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Tania Munoz

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

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George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

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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.

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Khurram Arshad

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

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Gomez Barriga Maria Dolores

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

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Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

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Maria Dolores Gomez Barriga

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.

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Dr Maria Dolores Gomez Barriga