Processing and Some Phsico-Chemical Properties of White Cheese Made From Camel Milk Using Capparis Decidua Fruits Extract As A Coagulant

research article

Processing and Some Phsico-Chemical Properties of White Cheese Made From Camel Milk Using Capparis Decidua Fruits Extract As A Coagulant

  • Hanaa I. J. Ishag
  • Ibtisam El Zubeir *

*Corresponding Author: Ibtisam E. M. El Zubeir, Department of Dairy Production, Faculty of Animal Production, University of Khartoum, Khartoum, P.O. Box 321, Sudan.

Citation: Ishag, H. I. J. and El Zubeir, I. E. M (2022). Processing and Some Phsico-Chemical Properties of White Cheese Made From Camel Milk Using Capparis Decidua Fruits Extract As A Coagulant. J. Nutrition and Food Processing. 5(3); DOI: 10.31579/2637-8914/096

Copyright: © 2022 Ibtisam E. M. El Zubeir. 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: 22 April 2022 | Accepted: 30 April 2022 | Published: 28 May 2022

Keywords: camel milk; Capparis decidue; cheese yield; plant coagulant phsico-chemical properties

Abstract

This study aimed to investigate the processing and some phsico-chemical properties of white cheese made from camel's milk using Capparis decidue fruits extract as a coagulant. The fruits extraction was prepared by weighting 20 grams of the crushed dry fruits that shacked with 100 ml distilled water before soaking in water for 24 hours (4°C). The camel milk was heated to 62ºC and then cooled for 5 minutes to 45ºC in an ice water. The extracted fruits of C. deciduas were added (3% and 5%). After cheese coagulant was formed, the cheeses were salted with NaCl salt (1% w/v) and stored for 5 weeks into small plastic cups in refrigerator (4°C). The chemical composition was conducted every week. Data were analyzed using statistic 8 programs using the LSD test. The cheese yield using 3% and 5% extract revealed 10.85% and 14.57%, respectively. The data showed significant (P<0.05) higher acidity (1.24% vs. 0.64%) in the cheese made using 5% fruits extract compared to that made using 3% fruits extract, respectively. Also, highly (P<0.001) significant pH (4.88 vs. 4.81) was found in the cheese made using 5% extract compared to 3% extract, while there was no- significant (P>0.05) variation in the protein and fat content. Also, lower total bacterial count was found for the cheese that was produced using 5% Capparise decidue compared to those made using 3%. This study showed that the fruits extract of Capparis decidue at 5% can be used as a coagulant for camel milk with good yield and acceptable shelf life (5 weeks). This is a promising result, which needs further research investigation for the possibility of the further uses and application Capparis decidue as a coagulant.

Introduction

Cheese making from camel milk is more complicated than that of cow, sheep or goat milk, this is mainly due to its low level of total solids, unique composition of casein with a lower amount of kappa casein [1]. Also, camel milk is not sensitive to coagulation with bovine chymosin, most likely due to the major variations between the primary k-casein structures compared to other species [2]. The low content of κ-casein and the large size of camel milk casein micelles compared with those of cow milk prolong the rennet-induced coagulation of camel milk [3]. Camel milk cheese is also characterized by having fragile curd that need longer time to be formed [4]. Camel milk cheeses has smooth and continuous casein network, thinner aggregate strands and smaller pore spaces in comparison to bovine milk cheeses [5]. 

The technical difficulties of camel’s milk coagulation might be due to the functional and coagulation properties of the camel’s milk proteins [6]. Also, camel milk cheese was described as having fragile and weak coagulum in addition to the poor yield [7, 8]. The potentiality of using gastric enzymes extracted from camel to coagulate camel’s milk was described [9, 10]. Also, camel milk cheese can be prepared by coagulating milk with the use of starter culture [11]. The usefulness of Camifloc enzyme and calcium chloride in making cheese from camel milk was described [4]. It was indicated that addition of lemon juice to camel milk could offer a suitable means for cheaply producing coagulated milk products such as cheese in pastoralist areas [12]. A mixture of Withania coagulans (W. coagulans) and camel chymosin was found to produce better quality camel and bovine milk cheeses than chymosin alone [13].

Capparis decidua L. (Tundub) is belonging to the Capparaceae family, which is one of the important medicinal plants of Sudan. The plant and its parts are widely used by traditional healers and tribal people for curing variety of ailments [14]. Moreover, Capparis decidua, in Sudan has been widely used in folk medicines to cure various illnesses and its biological studies revealed important antimicrobial, anti-oxidative, anti-inflammatory, immunomodulatory and antiviral properties [15]. Recently two novel germacranolides isolated from Capparis decidua (Forsk.) have been proved to be potential drug candidates for curing different diseases, e.g., tumors, through CA II inhibitory mechanism [16]. 

The fruits of Capparis deciduas are small, globular, glabrous, fleshy berry, beaked at the apex, resembling a cherry in shape and size [17]. Fresh berries are green, which turn pink on ripening and blackish on drying, moreover numerous seeds are embedded in the pulp of the fruit [17]. Capparis deciduas fruits are rich source of the major food components and the important electrolytic minerals [14].

Manufacturing of camel dairy products such as cheese using the same technology as for dairy products from bovine milk can result in processing difficulties and products of inferior quality [18]. This because the colloidal structure of camel milk is different from that of cow milk as it has larger casein micelles and smaller fat globules. This suggested the need for introduction of different processing methods and technologies for camel milk processing [19].

Production of cheese from camel milk has been challenging due to the lack of coagulants that can specifically cleave camel milk κ casein [13]. Recently there has been a steady increase in using plant enzymes in addition to the use of chymosin in the cheese industry because they are readily accessible and have simple extraction and refining processes [20]. This study was, therefore, conducted to assess the coagulating properties and some of the phsico-chemical properties of soft white cheese processed from camel milk using two levels of crude extract of Capparis decidua extract (3% and 5%).

Materials and Methods

Source of milk, C. decidua and salt

Fresh camels’ milk was obtained from Camel Research Center, University of Khartoum, and the C. decidua fruits were collected from Al-jayli, Khartoum State, Sudan during November 2016. Salt (commercial grade) was obtained from the local market.

Preparation of Capparis decidua extract

Twenty grams of the crushed dry fruits were shaken with 100 ml distilled water and soaked in water for 24 hours (4ºC).

Cheese processing

The cheese was made in the Department of Dairy Production, Faculty of Animal Production University of Khartoum. The milk (5.5 liters) was first filtered using clean white cheese cloth, and heated to 62°C then c ooled for 5 minutes in an ice water. The extracted fruits of C. decidua in water were added at a rate of 3% and 5% (w/v). After coagulation (during 48 hours), the curds were placed into clean cheese cloths and left to drain overnight. Next day, the cheese was salted with commercial NaCl salt (1% w/v) and kept for 5 weeks (4ºC) in the small plastic cups. Some technological and the phsico-chemical properties were assessed.

Analysis of cheese 

Coagulation time, cheese yield, the phsico-chemical properties and total bacterial count were estimated at the laboratory of Department of Dairy Production, Faculty of Animal Production-University of Khartoum.

Cheese yield

Cheese yield were calculated as the weight of cheese divided by weight of milk expressed as a percentage.

Physicochemical analysis

The pH values were measured using a pH-meter (Hanna Instrument-model 98107) after calibration of the instrument. Titratable acidity was determined according to the methods of the AOAC [21]. The fat content was determined by Gerber's method and the protein content was determined by the Kjeldahl method [21]. 

Microbial examination

The camel cheese samples were examined for total bacterial count. Sterilization of equipment; Petri dishes, test tubes, flasks, pipettes and bottles; were sterilized in an oven at 170 °C for two hours. However, the media, mixer, distilled water, and tips were sterilized by autoclaving for 15 minutes at 121°C [22]. Nutrient agar medium was used for determining the total bacterial count; it was obtained in a powdered form and prepared according to the manufacturer’s instructions.

Preparation of cheese samples was done by adding 1 gram of cheese to 9 ml of distilled water and blended for two minutes. Then ten folds serial dilution 10-1 to 105 were prepared [22]. The plates inoculated in duplicate and left for two minutes to dry, then were incubated at 32°C for 48 hours. The plates were examined and colonies were counted using manual colony counter.

Statistical analysis

Data were analyzed using statistic 8 program. The analysis was carried out by LSD test.

Results

Cheese yield

The yield of cheese was 10.85 for 3% and 14.57 for 5% of water extracted C. decidua (Table 1).

Cheese propertiesC. deciduas (3%)C. deciduas (5%)
Coagulation time 48 hours24 hours
cheese yield10.85%14.57%
pH 4.74.7

Table 1: Coagulation time, cheese yield of camel milk using C. deciduas extract

Coagulation time of camel cheese

The coagulation time of cheese was found as 24 hours for 5% and 48 hours using 3% of Capparis decidua fruits extracts, the pH was 4.7 (acid coagulations) as shown in Table 1.

The effect of the of C. decidua concentration on the fat content of camel milk cheese 

The means of fat content for cheeses made from camel's milk using 3% and 5% Capparise decidue were 11.30% and 12.50%, respectively (Table 2). There was non significant (P>0.05) difference in fat content between cheese made from camel milk coagulated with 3% and 5% Capparise decidue. However there were high significant (P<0> 

               Treatment

Chemical Complosition

Capparise decidue concentration (3%)Capparise decidue concentration (5%) SEL.S
Protein (%)13.19a13.35a0.45N.S
Fat (%)11.30a12.50 a0.71 N.S
Acidity (%)0.64 b1.24 a0.61*

a, b : Values in the same row bearing different superscript letters are significantly different (P<0>

L.S = Significant level     * = significant (P<0 xss=removed>

Table 2: The effect of C. decidue coagulant concentrations on the chemical composition of the processed cheese

Physico-chemical propertiesStorage period
Day 1Week 2Week 3Week 4Week 5SELS
Protein (%)14.9a10.10c16.76a18.09a14.73b0.71***
Fat (%)10.25b10.00b10.75b11.75b16.75a1.13***
Acidity (%)0.55a0.64a2.22a0.62a0.68a0.96NS
pH4.81d4.84c4.85bc4.86b4.88a6.18**

a, b,c : Values in the same row bearing different superscript letters are significantly different (P<0>

L.S = Significant level     **= significant (P<0 xss=removed>

Table 3: Effect of the storage period on Physico-chemical properties of cheeses made from camel milk using 3% and 5

Discussion

The present study has shown that the fruits of Capparise decidua are useful in making cheese from camel milk (Table 1). One reason that Capparis deciduasfruits are rich sources of calcium indicated the possibility of helping curd formation [14]. Moreover, the flowers and fruits of C. decidua are used in diet as vegetable and in pickle production because of their high nutritive ingredients like proteins, carbohydrate, minerals and vitamins [23, 24]. In folk medicine, mixture of equal quantity of fruit powder and sugar is prescribed in rheumatism and they are given in diarrhea in cattle and goats [25]. In Sudan, the fruit of C. deciduas is relished by camels and wherever within their reach, by goats and the fruits are also consumed by man [24]. Also, several some previous studies have been performed using plant-derived enzymes for cheese making [13, 26, 27]. These enzymes are present in almost all kinds of plant tissues and it appears to be a general rule that all proteolytic enzymes have the ability to clot the milk under the appropriate conditions [28].

More time is needed to coagulate camel milk using the 3% C. deciduas extract (48 hours) compared to that using 5% C. deciduas extract (24 hours) as shown in Table 1. This might be because the present study uses the crude whole fruits extract.  The antimicrobial and the anti-oxidative, properties of Capparis decidua were reported [15]. Hence this study recommended the important of isolating and purification of the active useful proteplytic enzymes for cheese making. Most of the plant proteases have limited use in cheese production due to their high proteolytic nature that resulted in defects flavors and texture in addition to the low cheese yields [29]. On the other hand, camel milk is known to have limiting ability for enzymatic coagulation as it exhibits a rennet-induced coagulation time two to three-fold longer compared with bovine milk [6]. The coagulation of camel milk could be possible only by the action of proteolytic activity of enzymes of plant extract juices rather than on the action of acidity of the juices [30]. Soft cheese can be prepared from camel milk, however the obtained cheese showed weak structures and the coagulation time for camel milk was longer than that for bovine milk, Moreover the specific coagulation behavior of camel milk was attributed to the differences between the composition of the casein fraction in camel milk and that in bovine milk [5].

The yield of cheese from camel milk was higher when using 5% C. deciduas extract (14.57%) compared to 3% C. deciduas extract (10.85%). The later yield was similar to that mentioned 10.5–11.5% [31]. Also, only 8.70±1.22 cheese yield was obtainedwhen using ginger crude extract compared to 11.4±0.36a when using chymosin [32]. However, the camel milk coagulated by the addition of the starter culture gave higher cheese yield (13.22±4.487%) compared to the cheese prepared by direct acidification (11.70±2.345%) [11]. On the other hand, a yield of 11.3% was obtained using Camifloc enzyme with addition of calcium chloride, against 10.2% without addition of calcium chloride [4]. The low yield of camel milk cheese might be due to the high temperature that affected dry matter intake that reduced total solids in milk, which is the main factor in cheese processing [33]. Moreover, the presence of high concentration of lysozymes and lactoferrins that are mainly affected by the hot seasons and a shortage of feed and water, making cheese from camel milk more difficult and complicated [33]. The reason could also be due to the longer coagulation time and the weak fragile coagulum of camel milk [4, 33]. Also, the production of camel milk soft cheese is very challenging compared to the milk from cow as camel milk has slight size fat globules and meager coagulation property [34]. This behavior is probably due to the large size of casein micelles [35] and most likely due to the major variations between the primary k-casein structures compared to other species [2, 3]. Also, the naturally occurring antimicrobial lactoferrins in camel milk retard microbial starter activities, thus hindering curd formation [36].

In the present study (Table 1) a yield of 14.57% was obtained from camel milk using 5% C. decidua extract, which is similar to the conclusion that soft cheese of an acceptable quality and a cheese yield of 14.57% could be produced by adjusting the fat content of camel milk to 1.82%, total solids level to 14% and using rennet powder at a ratio of 1.5 mg (100 g)-1 [30]. It was demonstrated that supplementing camel milk with increasing volumes of lemon juice enhanced cheese yield along with an added shelf life by extending the benefit of higher acidity [12]. However, W. coagulans extract protease alone is not sufficient to produce good quality cheese especially camel milk cheese but a mixture of W. coagulans and camel chymosin produced better quality camel and bovine milk cheeses than chymosin alone [13].

The fat content of camel's milk cheese obtained in this study revealed 11.3% and 12.5% for 3% and 5% C. decidua extract, respectively. This is agreed with 12.90±0.14%, which was obtained when prepared soft unripened cheese using ginger crude extract [32]. However fat content of 13.6±0.20% and 13.4±0.10% were obtained when prepared soft white cheese from camel milk using linear programming technique for two levels of rennet [30]. The data presented previously revealed non-significant increase in the level of fat for camel cheese [4]. Similar to the present study, Similar to the present study, the fat content showed non-significant (P>0.05) differences during storage period for camel’s milk cheese [8]. The fat content of camel milk cheese decreased during the storage period because the size of fat globules of camel milk is very small and most of it may retain in the whey liquid. This was explained as that the reduction of fat content of camel milk cheese might be due to the smaller size of fat globules and the fragility of the casein micelle network [33]

Table 2 and 3 showed that the protein content of camel's milk cheese revealed 13.19% and 13.35% using 3% and 5% C. decidua extract. This is in agreement with the values, which was reported previously (13.35%) for camel milk cheese using ultrafiltration process [37]. However, 29.15±2.62% and 22.15±2.32% were reported for cheese obtained from camel milk by using Camifloc without and with addition of calcium chloride, respectively [4]. Also, significantly higher amount of protein content was found in the cheese prepared by the addition of the starter culture (21.30±0.638%) compared to that prepared by the direct acidification (17.67±1.528%) [11]. Camel milk cheese showed significant (P<0>

The protein content decreased after 15 days towards 21 days of storage [38]. The camel milk is reported useful component of the diet for individuals who show allergic reactions to the protein fraction of cow, ewe or goat milk, as camel milk does not contain beta-lactoglobulin and the content of alpha-casein is much lower than in milk of other herbivores mentioned [39]. A variation among the individual casein was reported for the camel milk compared to other livestock species [40]. It was also confirmed that camel milk contains higher protein (especially casein), while lower in whey milk than human milk [41]. Moreover, compared with bovine milk, camel milk exhibited a lower degree of hydrolysis after reaction with pancreatic enzymes [42]. This will strengthen the capacity of camel milk products as functional foods as was mentioned before [43, 44]. The enzymatic digestibility and antioxidant activity of camel -lactalbumin were highlighted [45]. Camel milk proteins contained satisfactory balance of essential amino acids. It contains disease-fighting immunoglobulins, which are small in size, allowing penetration of antigens and boosting the effectiveness of the immune system [46]. 

The acidity of the cheeses was estimated as 0.64% and1.24% for the camel cheese obtained using 3% and 5% Capparise decidue fruits extract, respectively (Table 2). Also, the acidity was found as 1.09% when producing cheese from camel milk using different levels of salt [7] and was 0.57±0.06% for soft unripened cheese using chymosin [32]. The lower levels of camel milk acidity might be due to the presence of the antimicrobial agents in the camel milk [47]. Similarly, C. decidua has antimicrobial properties [15, 48]. Moreover, the texture of the cheese prepared by using the starter culture was specifically highly preferred in comparison to the cheese, which was obtained by citric acid addition [11]. There was non-significant increase in the level of acidity for camel cheese during the storage (Table 3), as was reported earlier [4]. However, the increase in the acidity of camel cheese during the storage period, probably due to the growth of bacteria in the cheese during storage [49]. 

The pH of the cheese was found as 4.8 and 4.88 (Figure 1), this result agreed with that reported 4.87±0.04 for the soft unripened cheese using ginger crude extract [32]. However, this finding disagreed with their result when they prepared soft unripened cheese using chymosin; the pH was 5.27±0.02. Similarly, 5.55, 5.93 and 6.00 were reported for camel milk cheese using 0%, 0.5% and 1% salt, respectively [7]. However lower pH value (3.48) after 180 minutes for camel milk gels was obtained, this decline in the pH value of milk gels is related to the added glucono-δ-lactone [35].

The lower TBC reported for the cheese produced from camel milk using 5% Capparise decidue compared to those made using 3% Capparise decidue (Figure 1) indicated the antimicrobial and antioxiadant properties of Capparise decidue [15, 48].

The average means of total bacterial count for the two concentrations of Capparise decidue fruit extract were increased during the storage period (Figure 2). The obtained values for the TBC in the present study was lower than that reported in a previous study [7, 49] dealing with camel milk cheese. Similar to the present study, camel milk cheese was significantly (P<0>Capparise decidua fruit extract compared to 3% (Figure 1 and 2) indicating the antibacterial properties of Capparis decidua as was explained above.

References

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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

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¨.

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Dr Maria Regina Penchyna Nieto

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.

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Dr Marcelo Flavio Gomes Jardim Filho

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!”

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Zsuzsanna Bene

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

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Dr 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.

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Lin-Show Chin

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.

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Sonila Qirko

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.

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Luiz Sellmann