AUCTORES
Globalize your Research
Case Report
*Corresponding Author: Toumi. H., University hospital establishment Oran pharmacovigilance service Pharmaceutical development research laboratory, Oran University 1 Algeria.
Citation: Bekhtaoui. C., Bouguedra. H., Chadou. H., Boudia F., Derbale.F and Toumi.H, (2020) Hydroxychloroquine and chronic renal failure, J, Pharmaceutics and Pharmacology Research 3(1); DOI: 10.31579/2693-7247/012
Copyright: © 2020, Toumi. H. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 16 August 2020 | Accepted: 24 August 2020 | Published: 08 September 2020
Keywords: Keyword
In Algeria, the essentially hydroxychloroquine therapeutic protocol was adopted since March 23, 2020, to which patients with Covid-19 were subjected.
In Algeria, the essentially hydroxychloroquine therapeutic protocol was adopted since March 23, 2020, to which patients with Covid-19 were subjected. This protocol has proven its "almost total" effectiveness by noting a recovery of 98.2% out of a total of 16,000 cases treated [1].
Hydroxychloroquine (HCQ) is preferred for its better expected tolerance, based on the publications of preliminary work by several teams that we analyzed previously with a further three months' follow-up.
On the pharmaceutical level, the pharmacology of this molecule is of interest and emphasizes the interest of pharmacokinetic studies to define the optimal dosage regimen for patients with a particular statue (Renal Insufficiency - Hepatic Insufficiency - Fatty) COVID-19. On the basis of this work, dosage adjustments can be proposed and the chronology of administration can be optimized with therapeutic monitoring of the drugs to be performed to personalize the individual dosage regimen.
Therefore, the role of the hospital pharmacist is essential in the pandemic context to optimize and modify practices by developing new prescribing protocols while ensuring that adverse events are well managed.
This is an 18 year old patient with a weight of 65kg confirmed COVID-19 positive suffering from a malformative nephropathy, admitted on 05/11/2020 to the service COVID university hospital Establishment UHE, ORAN, Algeria after suspicion contamination whose father is confirmed positive.
The patient being asymptomatic with a general preserved state, diuresis 1100 ml, an arterial pressure = 120/80, a temperature: 36.2 ° c, a heart rate = 90 bpm, an oxygen saturation SAO2 = 98%, and presenting at l '' ECG a regular sinus rhythm (PR = 0.16 s, QRSfin, normal AXIS, QTc = 400ms).
The patient was put on specific treatment according to the national protocol. The latter will use the following drugs: Hydroxychloroquine 200mg at a rate of 200 mg x 3 times per day for 10 days in combination with Azithromycin 250 mg: 500 mg on the first day followed by 250 mg per day for the next 4 days,
In view of the severe renal impairment (clearance=8ml/min) it was recommended a dosage adjustment of HCQ following nephrological advice, i.e. a 50% reduction of the standard dose to 100mg HCQ three times daily.
After a request from the Therapeutic Optimisation Unit of the UHE Pharmacovigilance Department, capsules with the recommended dosage were prepared; combined with a pharmaceutical analysis of the patient's medical prescription by the clinical pharmacy team.
The evolution of the patient's clearance during the first five days of hospitalisation was as follow
Hydroxychloroquine is an anti-malarial from the class of amino-4-quinolines which has found its place in the ministerial protocol proposed by the expert committee in response to the COVID-19 pandemic [2].
This molecule is rapidly absorbed in the digestive tract after oral administration, it has a large volume of distribution and it is strongly linked to plasma proteins with a strong distribution in the following tissues: kidney, liver, lungs, cells containing melanin such as those of the eyes and the skin. It crosses the placenta. It is mainly metabolized in monodesethylchloroquine (cletoquine) and bisdesethylchloroquine in the liver. Monodesethylcholoroquine has been reported to have some activity.
Elimination is mainly renal: 50% in unchanged form and 10% in monodesethylchloroquine form. The half-life of hydroxychloroquine is approximately 30 days. This molecule therefore accumulates in the tissues and can be found several weeks to months in the tissues. Hydroxychloroquine is a substrate for CYP2C8, CYP3A4 and CYP2C6, possible pharmacokinetic drug interactions should be taken into account [2, 3].
The serious side effects that hydroxychloroquine can cause, mainly cardiac arrhythmias, are known, in particular the risk of prolonging the QTc interval. And these effects can be further enhanced by the simultaneous administration of other drugs such as azithromycin. In addition, these two active ingredients can damage the liver, kidneys or nervous system and cause a drop in blood sugar. Serious signs of cardiac toxicity have been reported in blood concentrations of hydroxychloroquine ranging from 2.05 to 29.40 mcmol / l. It is recommended to monitor plasma concentrations in patients receiving this treatment for COVID-19 and to provide cardiac monitoring [3, 4].
Whipple's disease, a systemic infectious disease caused by Tropheryma whipplei or the standard treatment, is the combination of doxycycline and hydroxychloroquine. In this indication, the HCQ is administered at the same dosage as in the proposed covid_19 protocol (600 mg per day). The target HCQ plasma levels described in the literature are 1 +/- 0.2 ug / ml [5].
HCQ is mainly excreted via the kidneys. Particular attention paid to patients with renal insufficiency conducive to developing early cardiotoxicity. It was recommended to use lower doses of HCQ [6,7] varying according to the glomerular filtration rate (table 1) and the type of dialysis (table 2) it is described in the literature that dialysis does not significantly lower plasma concentrations. The dose reductions illustrated in the tables are recommended in the context of systemic inflammatory pathologies such as lupus, an indication in which the taking of HCQ is long-term with low dosages (200 mg) and in single dose for objective of avoid cumulative retinal toxicity.Due to the lack of experience with dosage adjustment and in order to avoid early cardiac toxicity in patients with renal failure; a 50% reduction in HCQ has been proposed. Cardiac evaluation of this patient showed no abnormalities.
Therapeutic optimization of hydroxychloroquine
At the pharmacovigilance service for the therapeutic optimization unit, a preparation of hydroxychloroquine dosed at 100 mg was carried out according to the following steps:
I-Calculation of the total mass of the active principle
Total mass of the active ingredient = unit dosage requested * number of capsules to be prepared
= 100 * 30 = 3000mg
Knowing that:
The number of capsules to prepare = dosage * duration of treatment
= 3 * 10 = 30
II-Deconditioning of a specialty
It is the calculation of the number of tablets to be crushed or capsules to empty of their content:
N Cp = unit dosage requested * number of capsules to prepare
Initial drug dosage
N Cp = 100 * 30/200 = 15cp
III-Adjustment of the volume of the diluent to be added
Depending on the size of the desired capsule, the volume of the diluent to be added can be calculated.
For a capsule N ° 1 we need 0.5ml of diluent for each capsule.
For 30 capsules you need 15ml of diluent.
IV-Trituration with mortar of the active ingredient + diluent
V-Preparation of the capsule filler
VI-Filling and ejection of capsules
VII-Pillbox
VIII-Labeling
Medical prescription:
Our team carried out the pharmaceutical analysis, various problems related to the drug were detected:
Combination type not recommended (hydroxychloroquine / azithromycin).Hydroxychloroquine can prolong the QT interval. Theoretically, co-administration with other drugs that may prolong the QT interval (azithromycin) may result in additive effects and an increased risk of ventricular arrhythmias, including torsade de pointes and sudden death. In general, the risk of an individual drug or combination of drugs causing a ventricular arrhythmia associated with QT prolongation is largely unpredictable, but may be increased by certain underlying risk factors, such as congenital long QT syndrome, heart disease and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation depends on the drug involved and its dosage.Pharmaceutical intervention:
The calculated score of the patient in question being equal to 6 is equivalent to a low score: Low risk of prolongation of the QT interval; always consider that a higher risk may develop based on clinical course and drug interactions and pharmacokinetics.
On this basis we recommend:
- The ECG, repeated 8 to 12 hours after the start of QT prolongation therapy to look for signs of QT prolongation, with closer monitoring if observed.
- Correct electrolyte abnormalities and maintain blood potassium> 4.0 mEq / L and serum magnesium> 2.0 mg / d.
Lovenox 4000 IU / d / d for 10 days [12].Reminder:
The risk factors of patients who are candidates for prophylaxis are well known [13, 14 and 15]: age, acute infection, active cancer, history of venous thromboembolic disease (VTE), prolonged immobilization, chronic heart failure and insufficiency respiratory.
The patient in question has two risk factors (covid-19 infection and hospitalization); which calls for the need for thromboprophylaxis:
-Description of the problem with the drug treatment: the patient being insufficient renal end, it is not recommended to use heparin at low molecular weight because of the increase in the risk of haemorrhage.
The patient's clearance being less than 15 ml / min (8ml / min): a substitution with HNF SC (Calciparin according to the establishment's register) is recommended, the recommended dosage is shown in the table below for the thromboembolic risk:
High risk: in case of: active cancer, history of VTE, recent surgery, known thrombophilia.
That said, our patient with a low thromboembolic risk, we recommend a dosage of 5000U 2 * / d.
Kalemia, Platelet count before treatment and 2 * / week during treatment, Liver balance before treatment, monitoring of anti-Xa or TCA is not recommended when heparin is used for preventive purposes [16].
Cefotaxime (Claforan) 1G 3 * d for 10 days [17].
In patients with a clearance of less than 10 ml / min; after a normal starting dose, maintenance doses should be reduced by half compared to the normal dose without changing the dose interval. A dosage of 500 mg / 3 * d is recommended after an initial dose of 1G / 3 * d.
- Liver balance: hydroxychloroquine is metabolized in the liver, it is necessary to evaluate the liver balance before starting treatment. Liver failure causes an accumulation of hydroxychloroquine in the tissues, which is equivalent to an overdose [2].
- Magnesemia: it is necessary to perform magnesemia coupled with a kalemia for optimal cardiac monitoring [8].
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.
