AUCTORES
Globalize your Research
Research article | DOI: https://doi.org/10.31579/2578-8868/222
1Neurosurgery department, EHS ALI AIT IDIR
2Chu Mustapha Bacha neurosurgery department
*Corresponding Author: Bouchenaki F, Neurosurgery department, EHS ALI AIT IDIR.
Citation: Bouchenaki F, Habchi N, Boustil K, Benachou S, Bakhti S. (2022). Management of Choroid Plexus Papillomas. J. Neuroscience and Neurological Surgery. 11(1); DOI:10.31579/2578-8868/222
Copyright: © 2022 Bouchenaki F, 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: 30 November 2021 | Accepted: 28 December 2021 | Published: 10 January 2022
Keywords: lipomyelomeningocele; attached lower marrow; occult spinal dysraphism; sphincter incontinence
The lipomyelomeningocele (LMMC) is a type of congenital occult spinal dysraphism consistent with the presence of lipomatous tissue adhering to the epinetic marrow, which falls through a defect of the vertical colon with the former meninges and the marrow under posture the skin.
LMMC is the cause of the most frequent congenital attache between the cadre of the syndrome of the attached cord and causes a neurological deterioration due to the compression of the medical bone and the root system which is superadded.
It is therefore about a girl from 6 years ago with a swelling located in the region of Lombardy after the birth of the size of a tangerine which has increased the size gradually with age.
He presented the interrogation of the signs of urinary incontinence and the fact that he confirmed that he left us to fellow therapists who sent him to us for support.
The local examination of the lumbosacral region revealed a single mass without other distinctive skin signs, spherical in shape, 12 × 10 cm, soft and fixed in consistency.
A medullary MRI with effect, which reveals a mass of lipomate consistency at the level of lumbosacral associated with a bone spina extending from L5 to S2.
Surgical treatment was indicated as the patient had urinary problems. There were no postoperative complications and after a few months postoperative symptoms improved.
Lipomyelomeningocele (LMMC) is a type of congenital occult spinal dysraphia consisting of the presence of lipomatous tissue attached to the spinal cord, which protrudes through a defect in the spine and meninges and spinal cord to form a posterior swelling under the skin which increases in size with age.
The neural ectoderm separates from the cutaneous ectoderm and the periaxial mesoderm enters intact with the unfused ventral neural ectoderm. The mesoderm then differentiates into adipose tissue, preventing the fusion of the neural canal and the posterior surface of the spine. [1]
CMMLs are lipomas that are tightly attached to the dorsal surface of a neural placode in the case of the dorsal variety and extend dorsally
through spina bifida to be continuous with subcutaneous fat.
The lipoma is located immediately outside the connective tissue in the extradural space.
The rate of CMML has been estimated at 2.5 per 10,000 births.
There is a slight predominance of women in the literature review.
Patients usually present before the age of six months, but sometimes the disease goes unnoticed in childhood.
LMMCs are generally found subcutaneously in the lumbosacral region; they can behave benign causing no neurological problem has remained asymptomatic and therefore presented only an aesthetic problem but can sometimes cause symptoms of compression of neighboring structures through a bone defect. [2, 3,4]
A 6-year-old male patient weighing 25 kg presented with a lipoma in the lumbosacral region which gradually increased in size from birth.
He presented signs of urinary incontinence by the persistence of nocturnal enuresis which gradually became diurnal since the age of 3 years and the installation of fecal incontinence around the age of 4 years. and a half according to the statements of the parents who were confirmed by the pediatrician who referred him to us for surgical treatment.
The child's development was normal for his age and he did not present any orthopedic deformity in the lower limbs, only the existence of a bone spina in the lumbar region.
There were no complaints of back pain or leg pain.
The vaccine history was satisfactory.
Local examination of the lumbosacral region revealed a single mass without redness on the left paramedian, spherical in shape, 18 × 14 cm, soft and fixed in consistency.
-The motor and sensory examination was normal.
The rectal examination revealed a decrease in the tone of the anal sphincter associated with urinary incontinence, the reason for his consultation with us.
According to the laboratory results, the blood count remains within normal limits and the ECB in the urine showed a confirmed infection which we treated beforehand.
In addition, he presented on the ultrasound of the urinary tract a dilation of the pyelocaliciel tracts already testifying to the repercussions of these disorders on the upper apparatus.
The patient has already performed a medullary MRI of the lumbosacral spine which revealed a mass of fat density at the lumbosacral level adhering to the dorsal surface and involving the cone which connected through a bone defect located at the level of the sacred region from L5 to S2.
The patient was operated on under general anesthesia in the prone position.
We made a vertical incision centered on the lipomatous mass of L4-S2.
The excision of the latter was carried out using the ultra sonic vacuum cleaner until the dura mater as well as the spinal cord which was located outside the dura mater, which we freed from the dura mater, was revealed. any lipomatous attachment and fibrous adhesions with the help of the ultrasonic aspirator and under the control of a nerve stimulator ; the section of the filum was the last stage of our intervention.
The dural closure was done by an enlargement plasty.
CMML is the most common cause of congenital attachment (attached spinal cord syndrome "SMA") and causes neurological deterioration due to compression of the spinal cord and radicular ischemia. [1.5]
The pathogenesis of clinical ADS syndrome is believed to arise from traction on the lower end of the spinal cord by a thick terminal filum.
Traction on the medullary cone then results in decreased blood flow and decreased oxidative metabolism, which can eventually cause the symptoms and clinical signs of ADS.
Its clinical features include neurologic, orthopedic, and urologic abnormalities which may be improved upon removal of the lipoma and detachment of the filum terminale.
There are several corollaries to the ischemic hypothesis in ADS.
The first is that the mechanical properties of the ponytail are important, so that a thicker terminal filum or with fatty infiltration causes higher tension.
Second, these mechanical properties prevent normal migration of the spinal cord, which exacerbates this traction. [5]
The most common presenting symptom is a fat mass positioned on the midline or paramedian line in the lumbosacral region.
In addition, in the majority of cases they present skin lesions associated with the lipoma, in particular skin hemangiomas, skin dimples and a hairy nevus among others.
Other symptoms mainly related to traction on the spinal cord include motor deficits, tone disturbances such as spasticity, sensory disturbances involving one or more root paths, urodynamic and / or urorectal dysfunctions and secondary orthopedic deformities.
Symptoms are progressive if left untreated. [4,5,6]
A series of 80 patients reported by Kanev et al. [7] have shown that bowel and bladder function deteriorates before motor function on physical examination.
The progression of the disease can lead to frequent urinary tract infections ; incontinence or even episodes of retention can be seen as well as intestinal disorders can appear such as neurogenic constipation until reaching the final stage of incontinence.
The urinary disorders in these children are secondary to an alteration of the innervation of the urinary system, either by malformation during embryogenesis or by a marrow attached by CMML.
Urinary dysfunction may be due to detrusor paresis, external sphincter dysfunction, or most commonly detrusor sphincter dyssynergy.
Urinary dysfunction can cause symptoms such as urinary incontinence, frequent urinary tract infections, urgent urination, and in severe cases of urological dysfunction hydronephrosis or pyelonephritis can cause damage to the upper urinary tract.
The initial symptom of a neurogenic bladder is frequently a change in the urination pattern.
Urodynamic tests to assess urologic dysfunction can help assess the severity of the dysfunction.
In addition, an abnormality of bladder function may be the only evidence of neurological damage in these children. [6]
Orthopedic deformities may accompany the picture such as limb shortening, foot deformities, gait abnormalities, scoliosis, spasticity, and back and leg pain.
Three categories of CMML exist, based on the relative anatomy of the lipoma and neural components: dorsal, transitional, and caudal.
Dorsal-type lipomas have an area of attachment to the dorsal spinal cord at the level of myeloschisis in the lower lumbar or lumbosacral levels of the spinal cord and are continuous with the subcutaneous tissue.
The lipoma passes through a fascial defect and may extend and involve the central canal.
A dural defect is present and the placode-lipoma interface may be located in the extradural space.
Caudal -type lipomas arise mainly from the caudal end of the medullary cone.
These lipomas can spread through a dural defect or can be enclosed in the dura. [5.6]
Transition lipomas have a tether that extends beyond the area of myeloschisis to the cone, with a less distinct lipoma-marrow interface.
The lipoma again spreads through a dural defect.
In addition, Pang et al. [8] Describes a chaotic type, which has an irregular border between the placodes and lipoma. The fat extends around the spinal cord and on its ventral surface.
Because the natural progression of CMMLs causes neurologic deficits and / or urologic disturbances, prophylactic surgery is recommended for these lesions by some authors. [2]
-The objectives of the surgery are four in number:
a / Excision of the fibro-adipose mass,
b / To relieve the effect of attachment on the spinal cord,
c / To preserve the nervous tissues
d / And to prevent the attachment of the spinal cord.
The basic surgical procedures are the same for each type of lipoma, but the degree of difficulty of the surgery is different for each type. [3].
The management of LMMC remains a challenge for the neurosurgeon. Should it be operated or wait for the symptoms to appear ?
Patients with clearly progressive symptoms should be treated surgically in order to stop the progression in the worst case.
When the surgical management is chosen, the experts recommend an aggressive resection of the lipoma, as well as a reconstruction of the placodes and a large expandable duraplasty, the evolution of our patient in postoperative did not present any complications and the symptoms improved after a few months and after rehabilitation.
Prophylactic surgery can theoretically prevent the onset of neurological deterioration or stabilize and reverse early-onset symptoms at diagnosis, particularly in infants with large intradural lipoma and associated syrinx involving the prognosis. functional.
Early surgery can prevent the onset of ischemic phenomena of the medullary tissue and the complications of severe urological dysfunction; however, according to some authors, this has not shown that it offers immunity against other additional deterioration that may develop later.
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.
