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Review | DOI: https://doi.org/10.31579/2768-0487/179
1Medical Microbiology Department, College of Health Sciences, Hawler Medical University.
2Midwifery department, Erbil technical medical institute, Erbil polytechnic university, Kurdistan region/Erbil/ Iraq.
3Department of Biology, College of Education, Salahaddin University-Erbil, Kurdistan Region, Iraq.
4Medical Laboratory Technology Department, Kalar Technical College, Garmian Polytechnic University, Kalar, Iraq.
*Corresponding Author: Fattma A. Ali., Medical Microbiology Department, College of Health Sciences, Hawler Medical University.
Citation: Fattma A. Ali., Medical Microbiology Department, College of Health Sciences, Hawler Medical University.
Copyright: © 2025, Fattma A. Ali. 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: 04 June 2025 | Accepted: 16 June 2025 | Published: 24 June 2025
Keywords: drug resistant; malaria; antifolate; chloroquine; combination therapies
The following is an explanation of the main factors that theoretical models suggest influence the emergence of drug resistance in malaria. The development and pace of drug resistance propagation are significantly influenced by the proportion of infected hosts receiving medication treatment. The second important effect is the medication's capacity to eliminate parasites. The average transmission rate, recombination, the biological cost of resistance, and the mode of gene action are among the factors that also impact the rate of spread, albeit very slightly. the artemisinin derivatives. The process by which drug pressure selects resistant parasites, the following local transmission of those parasites, and the migration of reservoirs are all crucial components in the dynamics of drug resistance. Pharmacokinetics, pharmacodynamics, immunological factors, and the human host all play a major part in the selection effect of parasite interactions. Resistance spread is influenced by eco-epidemiological variables, such as migration. The goal of eliminating malaria is being hampered by the emergence and dissemination of drug resistance to antimalarials, which is also shortening the time that these medications can effectively treat patients. Treatment for malaria parasite infections in human hosts mostly consists of chemotherapy and chemoprophylaxis; nevertheless, medication selection pressure has been discovered to play a role in the emergence and dissemination of resistance. The restricted supply of compounds that have been shown to be suitable for therapeutic use throughout the preceding 75 years since the introduction of synthetic antimalarials has been seriously harmed by the emergence of drug-resistant parasite strains.
The parasitic tropical disease malaria is carried by vectors in 91 countries worldwide. Only six Plasmodium species are known to regularly infect people out of the over 120 species that infect birds, reptiles, and mammals. Plasmodium falciparum produces high quantities of blood-stage parasites that sequester in important organs in all age groups and cause severe anemia in African children, who make up the majority of malaria fatalities (Ashley et al., 2018) . The latter question is addressed by theoretical models of drug resistance. It is intended that by doing this, drug use policies that maximize a drug's useful life will be put into place (Mackinnon, 2005). Malaria treatment and control are severely hampered by medication resistance, particularly multiple drug resistance. The tropical world is seeing an increase in the propagation of resistance to practically all medications, including mefloquine, pyrimethamine, and chloroquine. As a result, there is an urgent need for new medications as well as a preventative measure (Mackinnon and Hastings, 1998). Plasmodium richen (which infects chimpanzees), Plasmodium cynomolgus (which infects Macaca fascicular), Plasmodium bergheim (which infects rodents), Plasmodium chabad (which infects Mus musculus), and Plasmodium gallinacean (which infects birds) are some of the models used in malaria research (Su et al., 2019) . Southeast Asia is home to the zoonotic Plasmodium knowlesi, a species that jumps from macaque monkeys. Recently, human instances of the zoonotic Plasmodium simoom and Plasmodium cynomolgus have been detected by molecular diagnostics; nevertheless, the prevalence and clinical significance of these species remain uncertain (Plewes et al., 2019) . A few species of anopheline mosquitoes carry the parasitic Mato protozoan infection known as malaria (Figure 1). Although people are frequently infected by four different species of Plasmodium, the majority of cases of illness and mortality are caused by Plasmodium falciparum (White, 2004a). The recently made-available P. falciparum genome offers intriguing new directions for medication research and valuable information for comprehending resistance mechanisms (Arav-Boger and Shapiro, 2005) . For circumstances when trustworthy microscopy would not be accessible, antigen detection techniques have been devised. Based on the identification of histidine-rich protein-2 (HRP-2; ICT malaria P.f.), these innovative, quick techniques for treating Plasmodium falciparum (Huong et al., 2002).
Figure 1: The life cycle of malaria parasites in humans and their vector, anopheline mosquitoes (White, 2004a).
2. The Diagnosis
Effective treatment and containment of malaria require a prompt and accurate diagnosis. Among the contemporary methods for diagnosing malaria include flow cytometry, molecular approaches, automated blood cell analyzers, serology-antibody detection, laser desorption mass spectrometry, and fluorescence microscopy (Murray et al., 2003). Lateral flow immunochromatographic technique is used in both malaria rapid diagnostic tests (RDTs) and rapid pregnancy tests (RPTs). In these tests, the clinical sample migrates as a liquid across the surface of a nitrocellulose membrane through capillary action. Two sets of monoclonal or polyclonal antibodies are used for a particular targeted parasite antigen: a capture antibody and a detection antibody. Monoclonal antibodies have the ability to be exceedingly selective, in contrast to polyclonal antibodies, which may be more sensitive. Furthermore, depending on the source of antigen used—peptides, recombinant proteins, or pure native protein—the performance characteristics of RDT can vary greatly (Murray and Bennett, 2009).
2. 1. Microscopy
Microscopic slide analysis of peripheral blood is still the most popular and reliable test for identifying malaria parasitemia in the majority of endemic locations. According to the WHO estimate from 2011, there were 165 million microscopic slide exams conducted globally in 2010. Diagnostic sensitivity estimates for microscopic slide examination vary depending on the type of infecting species, region, and other criteria. However, generally speaking, diagnostic sensitivity is considered to be no more than 75%. Based on the proportion of patients with clinical malaria who had parasitemia detected, this number was calculated (Wilson, 2013) . The most reliable method for determining whether someone has malaria is still microscopy. The methods for preparing slides, staining them, and reading them are widely accepted and standardized. An additional benefit of microscopy is the ability to estimate parasite density, which may be done with ease on a thick film (Figure 2) (Bisoffi et al., 2012).
Figure 2: Giemsa-stained thick film containing a high P. falciparum parasite density (Photo courtesy of CTD Negrar; Maria Gobbo) (Bisoffi et al., 2012).
2.2. Antigen Detection Tests
The first blood sample obtained from each patient was a fingerpick sample, which served as a control for thick and thin smears and ICT malaria P.f./P.v.Ò (AMRAD, NSW, Australia), Precheck Ò (Orchid Biomedical System, Goa, India), and Optimal (DioMed AG, Switzerland) tests. There is an expiration date on each test that is used. Three knowledgeable technicians—each in charge of a particular test type—performed antigen testing in accordance with the manufacturer's instructions (Huong et al., 2002). Based on consensus reference genomic sequence alignment, the LAMP-PfK13 LAMP primer set was created for the detection of P. falciparum's gene Kelch 13. All human-infective Plasmodium species were among them, along with a few zoonotic species like P. Knowles and P. cynomolgus that have lately spread to infect human hosts (Malpartida-Cardenas et al., 2019).
3. Medications Available to Treat Malaria
3 .1. Quinine and Related Compounds
A member of the aryl amino alcohol class of medicines, quinine is a cinchona alkaloid. It is always provided as salt because it is a very basic chemical.
There are several different formulations available, such as the gluconate, bicolpate, sulphate, dihydrochloride, and hydrochloride salts; the dihydrochloride is the one that is most frequently utilized. Quinine works against intraerythrocytic malaria parasites as a fast-acting schizonticide. Furthermore, it is not gametocytocidal against Plasmodium falciparum but gametocytocidal against Plasmodium vivax and malaria. Quinine also acts as an analgesic, but not as an antipyretic. It is uncertain how quinine works as an anti-malarial agent (Achan et al., 2011). Quinine, a naturally fluorescent substance, has been used for many years to treat malaria infections. Quinine's mode of action is still unknown, despite some data indicating that it functions in the parasite food vacuole. The multidrug resistance of Plasmodium falciparum (Bohórquez et al., 2012).
3.2. Antifolate combination Drugs
By blocking dihydrofolate reductase (DHFR), antifolate antimalarial drugs like cycloguanil and pyrimethamine (Fig.3) rob the parasite of essential cofactors for folate. In Plasmodium falciparum and other protozoa, DHFR serves as a bifunctional enzyme in conjunction with thymidylate synthase (TS), which uses methylenetetrahydrofolate to methylate d-UMP to d-TMP (Yuthavong, 2002).
2.2. Antigen Detection Tests
The first blood sample obtained from each patient was a fingerpick sample, which served as a control for thick and thin smears and ICT malaria P.f./P.v.Ò (AMRAD, NSW, Australia), Precheck Ò (Orchid Biomedical System, Goa, India), and Optimal (DioMed AG, Switzerland) tests. There is an expiration date on each test that is used. Three knowledgeable technicians—each in charge of a particular test type—performed antigen testing in accordance with the manufacturer's instructions (Huong et al., 2002). Based on consensus reference genomic sequence alignment, the LAMP-PfK13 LAMP primer set was created for the detection of P. falciparum's gene Kelch 13. All human-infective Plasmodium species were among them, along with a few zoonotic species like P. Knowles and P. cynomolgus that have lately spread to infect human hosts (Malpartida-Cardenas et al., 2019).
3. Medications Available to Treat Malaria
3 .1. Quinine and Related Compounds
A member of the aryl amino alcohol class of medicines, quinine is a cinchona alkaloid. It is always provided as salt because it is a very basic chemical.
There are several different formulations available, such as the gluconate, bicolpate, sulphate, dihydrochloride, and hydrochloride salts; the dihydrochloride is the one that is most frequently utilized. Quinine works against intraerythrocytic malaria parasites as a fast-acting schizonticide. Furthermore, it is not gametocytocidal against Plasmodium falciparum but gametocytocidal against Plasmodium vivax and malaria. Quinine also acts as an analgesic, but not as an antipyretic. It is uncertain how quinine works as an anti-malarial agent (Achan et al., 2011). Quinine, a naturally fluorescent substance, has been used for many years to treat malaria infections. Quinine's mode of action is still unknown, despite some data indicating that it functions in the parasite food vacuole. The multidrug resistance of Plasmodium falciparum (Bohórquez et al., 2012).
3.2. Antifolate combination Drugs
By blocking dihydrofolate reductase (DHFR), antifolate antimalarial drugs like cycloguanil and pyrimethamine (Fig.3) rob the parasite of essential cofactors for folate. In Plasmodium falciparum and other protozoa, DHFR serves as a bifunctional enzyme in conjunction with thymidylate synthase (TS), which uses methylenetetrahydrofolate to methylate d-UMP to d-TMP (Yuthavong, 2002).
Figure 3: The structures of P. falciparum dihydrofolate reductase (DHFR) substrate and inhibitors (pyrimethamine and cycloguanil). Proguanil is the prodrug from which cycloguanil is generated in vivo (Yuthavong, 2002).
3.3. Antibiotics
Any substance that has been used to treat bacterial infections, as well as any analogues created if they were effective against Plasmodium falciparum, were considered antibiotics in this review. Two families, previously covered in two reviews, have been the subject of numerous investigations during the past thirty years: tetracyclines and macrolides and their derivatives. In the future, though, more medications that combat malaria parasites might be created. The activity of co-trimoxazole, quinolones, tigecycline, mirginiamycin, ketolides, fusaric acid, and thiopeptides against P. falciparum was detailed in this third and last review on the use of antibiotics as anti-malarial medications (Gaillard et al., 2016). The broad-spectrum antibiotics known as tetracyclines were discovered at the beginning of 1940. They are highly effective against a variety of bacteria, including intracellular bacteria and protozoa like Plasmodium, as well as lymphatic filariasis (Briolant et al., 2008).
4. Causes of Resistance
4.1 Definition of Antimalarial Drug Resistance
In non-falciparum species, antimalarial resistance has been slower to develop. This is likely because there are less parasites in the human host, which leads to fewer mutation events. For P. vivax and P. oval, this is because they can avoid blood schizonticides by generating hypnozoites in the liver (White, 2004b). Antimalarial drugs work primarily by eliminating the erythrocytic stages of malaria parasites, which infect humans and cause illness. The two most prevalent malaria parasites, P. falciparum and P. vivax, require distinct medication regimens for treatment. Because artemisinin-based combination therapy (ACT) is commonly resistant to earlier versions of the drug, it is currently recommended in almost all locations for the treatment of uncomplicated falciparum malaria. Chloroquine plus
primaquine is still the standard first-line treatment for vivax malaria in most regions. The two medications that make up ACT are a potent artemisinin component that rapidly kills most parasites and a partner drug that acts more gradually to eliminate any remaining parasites and stop the emergence of artemisinin resistance (Cui et al., 2015).
4.2. Mechanism of antimalarial resistance
A closer examination of the parasite's metabolism and the antimalarial medications' method of action is required to appropriate the physical nature of resistance. Hemoglobin is taken up by the malaria parasite's intra-erythrocytic stage and stored in its feeding vacuoles. Here, hemoglobin is broken down into hemozoin pigment by exopeptidases and endopeptidases, of which ferriprotoporphyrin IX's cytotoxicity is a significant component (Farooq and Mahajan, 2004) . The effective use of antimalarial medications depends on their price, accessibility in endemic areas, short course regimens, good tolerance, and safety (especially in young children). Nowadays, almost all antimalarials must be used in combination with one another, with each medicine focusing on a distinct parasite pathway in order to prevent the emergence of parasites that are resistant to drugs (Petersen et al., 2011). Even after years of usage, little is understood about the majority of the malarial medicines currently on the market, including their mechanisms of resistance and manner of action. Even though this wasn't thought to be a big deal when these treatments worked well, it's becoming painfully clear that our capacity to come up with a solution is greatly constrained by our lack of understanding. Further understanding of parasite sensitivity spots, basic drug action mechanisms, and the development of resistance is necessary to not only create new medications with unique modes of action (Olliaro, 2001). Different antimalarial drugs function at different rates, or Figure 4 illustrates how the growth of drug-resistant parasites is accompanied with a relative increase in the likelihood of carrying gametocytes, which initiates a "vicious cycle." (Nosten and Brasseur, 2002) .
Figure 4: ‘A vicious circle of medication resistance to antimalarials (Nosten and Brasseur, 2002).
4.3. Chloroquine
The detoxication of heme is how chloroquine and the other 4-substituted quinolines kill malaria parasites. Hemoglobin is one of the main nutritional sources for the parasite during its intraerythrocytic development and proliferation. It is carried into the acidic food vacuole where it is progressively broken down into smaller peptide fragments by metalloid, aspartic, and cysteine proteases. Free hem is a hazardous result of hemoglobin breakdown (Arav-Boger and Shapiro, 2005). Similar to antifolate resistance, chloroquine (CQ) resistance has been recognized for more than 40 years, but less progress has been made in identifying the underlying mechanism or mechanisms. Fast infection and hyde/microbes. The significantly slower onset and spread of CQ resistance suggested that its genetic makeup was probably more complex than that of antifolate resistance. As with any medication, understanding how it works is crucial to comprehending how an organism develops resistance, even though its final target and the molecules that mediate resistance to it don't always have to be linked, as the antifolates amply demonstrate (Hyde, 2002). For simple P. vivax malaria, the WHO recommends either ACTs or chloroquine (although chloroquine is no longer used in certain countries, such as Indonesia). Acts are being used more frequently due to the rising prevalence of chloroquine-resistant P. vivax, especially in Asia. While only artesunate-pyronaridines are licensed to treat P. vivax malaria in the blood stage, other ACTs are similarly useful and are used off-label. Relapses of P. vivax malaria pose a challenge to the management of malaria (Phillips et al., 2017). The most often used antimalarial medication in the world is still chloroquine. Every year, 200–400 million doses are taken. Despite broad resistance, it remains the medicine of choice for almost all cases of Plasmodium vivax, P. malaria, and P. oval malaria. It is also still widely used to treat falciparum malaria. Ten years ago in Papua New Guinea, resistance in P. vivax was first recorded, while in the late 1950s, resistance in P. falciparum emerged separately in South-East Asia and South America (White, 1999). Westerner I recently investigated the epidemiological elements linked to the emergence and transmission of drug-resistant malaria in a work in which he examined the parasite-drug human-vector interactions that influence the occurrence and dynamics of drug resistance (Schapira et al., 1993). There have been no reports of dormant parasites in humans after ART treatment, in contrast to evidence from in vitro studies. This might just be the result of researchers failing to notice these strange-looking parasites in patients' blood smears following therapy. Another possibility is that human organs like the spleen eliminate highly injured and dead parasite-infected red cells, leaving only a very tiny percentage of latent parasites circulating at densities below microscope detection thresholds (Cheng et al., 2012).
5. Detection of resistance
5.1 In vivo tests
The effectiveness of ACT is waning in several domains. Traditional 48-hour in vitro assays are not useful as an epidemiological tool for tracking artemisinin resistance since they have not shown comparable decreases in vitro susceptibility, despite clear resistance in vivo. We postulated that the observed discrepancy could be clarified by a reduction in vulnerability during the ring stage, devoid of a commensurate decline in sensitivity during the more developed stages of the parasite. Consequently, we developed a simple adaptation of the standard WHO in vitro 48-hour antimalarial drug susceptibility test, focusing on the growth of the parasite's ring stage, and assessed its efficacy as an indicator of artemisinin resistance in vivo (Chotivanich et al., 2014).
5.2 In vitro tests
an in vivo susceptibility tests. Artesunate (Guilin Pharmaceutical Co., Ltd., China) was prepared as 60 mg/ml of stock solution diluted in 1 ml of 5% NaHCO3. was stored at 30°C and utilized within a month of production. After being further diluted to 1 mg/ml in RMPI-1640 culture medium (which was then kept at 4°C and used within a week after production), artesunate (ATS) was then serially diluted twice to get final concentrations ranging from (Chotivanich et al., 2014). It is poorly known how P. vivax malaria affects expectant mothers, who are particularly susceptible to P. falciparum malaria. There is conflicting evidence regarding a higher morbidity of P. vivax malaria during pregnancy. In contrast, neither the risk nor the severity of malarial infection was shown to be significantly impacted by pregnancy or the infant in a recent study carried out in an area of Sri Lanka where P. vivax is the main endemic (Witkowski et al., 2013). In vitro techniques have been employed to track medication resistance against malaria. Radioisotope uptake is one of the methods utilized for P. falciparum in vitro growth inhibition investigations. Artemisinin resistance testing methods include serological assays, fluorescence-based assays, and, more recently, ring-stage survival assays. In laboratories with limited resources, radioisotope and serological assays are unfeasible due to their specific equipment and supply requirements (Cheruiyot et al., 2016) The primary basis for antimalarial drug susceptibility testing methods is the in vitro culture of the parasite. The malarial parasite can be cultured in vitro using one of two methods: continuous culture or short-term culture. The short-term culture approach is easy to use in the field, involves minimal laboratory equipment, and is straightforward. The continuous cultivation approach is more complex and requires technical, logistical, and well-equipped laboratory support. It is a vital tool for basic research, efficacy trials, and the development of anti-malarial drugs. Early in the 20th century, the first short-term culture technique for Plasmodium falciparum was described (Bass, 1911).
6. Combination Therapies and Resistance Mitigation
6.1. Artemisinin-based combination therapies
With an expected 241 million infections and 627,000 deaths from malaria in 2020, the disease is still a serious worldwide health concern. Approximately 98% of cases are caused by Plasmodium falciparum, the most virulent causative species. On the plus side, the total disease burden has significantly decreased during the previous 20 years. This is partially due to the fact that artemisinin-based combination therapies (ACTs)—such as dihydroartemisinic-piperaquine (DHA-PPQ), artemether-lumefantrine (AL), artesunate-amodiaquine (ASAQ), artesunate-mefloquine (AS-MQ), artesunate-sulfoxide-pyrimethamine (AS-SP), and artesunate-pyronaridine (AS-PND)—have been adopted as the primary treatment for uncomplicated P. falciparum malaria in endemic nations across the globe. While AS-MQ and DHA-PPQ have been the most widely used ACTs in Southeast Asia, almost 98% of doses given worldwide are delivered with AL and ASAQ (Table 1) (Ward et al., 2022).
| derivative of ART | Associated medication | Shorthand | World use | areas where first-line | ||||
|---|---|---|---|---|---|---|---|---|
| Artemether | Lumefantrine | AL | 74% | AFRO | AMRO | SEARO | EMRO | WPRO |
| Artesunate | Amodiaquine | ASAQ | 24% | AFRO | ||||
| Dihydroartemisinic | Piperaquine | DHA-PPQ | 1% | AFRO | SEARO | WPRO | ||
| Artesunate | Pyronaridine | AS-PND | 0.1% | SEARO | WPRO | |||
| Artesunate | Mefloquine | AS-MQ | 1% | AMRO | SEARO | WPRO | ||
Table 1: The WHO recommends artemisinin-based combination therapy as initial treatments for P. falciparum malaria that is not complex (Ward et al., 2022).
As ACTs, which are currently the first-line treatment for P. falciparum throughout the world where malaria is endemic, artemisinin derivatives are well-tolerated, fast-acting medications that are frequently combined with longer-acting partner medications. Southeast Asia has seen the emergence of artemisinin resistance, which shows up as a delayed clearance of parasitemia after treatment with an artemisinin derivative (Takala-Harrison and Laufer, 2015). which pair a medication with a prolonged half-life with the quick potency of an artemisinin derivative. However, resistance to both artemisinin and its companion medications has once more expanded throughout Southeast Asia, and there have been isolated reports of artemisinin-resistant parasites in other areas.2- 6. As ACTs are currently the sole therapy option accessible in Africa that is still universally effective, well-designed surveillance measures are required to safeguard artemisinin and its partner drugs throughout the continent (Ehrlich et al., 2020). Researchers have found over 20 distinct mutations in P. falciparum that confer artemisinin resistance. Artemisinin resistance is produced by mutations in the parasite gene kelch13. It is challenging to monitor the spread of resistance using standard molecular marker techniques due to the variety of mutations involved and the possibility that the same mutation may emerge independently in many places (Project, 2016).
7- Future plans for combating drug-resistant malaria
The majority of malaria control programming have been threatened by the significant challenge posed by drug resistance in malaria parasites. Drug-resistant malaria is a global issue, but it is particularly bad in Africa. When resistance to chloroquine develops, SP combination is used as a first-line medication in a number of countries worldwide. Particularly in some areas of east Africa, the widespread use of SP combination has quickly led to sensitivity loss, raising the possibility of multidrug resistance developing there. A variety of presumptions describe the future antima35.larial drug
resistance and measures to combat it. First, antimalarial medications will be required for a very long time (Farooq and Mahajan, 2004). Countries shifted to SP as their nationally approved treatment once resistance to CQ spread. Countries returned to using artemisinin combination treatments (ACTs), as advised by the World Health Organization (WHO), when resistance to SP also increased. Future attempts to control malaria must focus on creating and executing control techniques to impede the spread of resistance, as it will likely take a minimum of ten years for a new compound to achieve the efficacy of artemisinins. There have now been reports of resistance to medications in the artemisinin class, suggesting the potential establishment of resistance (Klein, 2013). The population genetic structure and malaria control are being studied at different regional scales and with different concepts. A first theory is to identify genetically different parasite populations, suggesting little gene flow between them (Koepfli and Mueller, 2017).
Methodology
To determine the chloroquine-resistant P. falciparum strains that are actively spreading malaria in Orissa, India, we have tried screening the main malaria vectors in the area for the presence of resistant parasite strains. Female Anopheles mosquitoes that were sleeping indoors were collected from a variety of malaria-endemic areas in the Indian state of Orissa using CDC light traps and mechanical aspirators. Areas with high endemicity were selected for the study (Mohanty et al., 2009).
Qualities for inclusion
Male or female, at least eighteen years old, and willing to provide informed consent to participate in the study will be the inclusion criterion.
Disqualification standards
If a participant's intellectual and/or cognitive handicap has been diagnosed, it may hinder their capacity to understand the project's information and prevent them from being recruited for the study.
As shown in Table2, a purposive sample of five types of respondents was chosen for interviews in each of the chosen countries (Tindana et al., 2021).
Table 2: Sample for semi-structured interviews and focus group discussions (FGDs) in Nigeria (Tindana et al., 2021).
Thailand's efforts to combat malaria have been quite successful, as seen by the more than 80% drop in incidence between 2007 and 2017. Nonetheless, the prevalence of malaria remains a problem for public health. The Thai government has set a 2024 deadline for the national eradication of malaria, with a strategy that emphasizes early detection and efficient treatment for asymptomatic cases. Thailand's socioeconomic structure and geographic location present considerable obstacles to the eradication of malaria. Controlling malaria is made more difficult in areas that border other endemic countries due to human and vector migration, as well as the fact that most of these areas are rural, which increases transmission and results in a lack of health services (Noisang et al., 2019). The current study shows how pesticide resistance to pyrethroids, which are used to control malaria vectors, is quickly emerging, especially in Tanzanian regions where ITNs have been in use for more than 20 years. The results of this study showed that the mosquito population's reactions to WHO insecticide-treated paper differed depending on the sentinel site. In contrast to organochlorine, some vector populations were able to withstand exposure to all three synthetic pyrethroid compounds that were tested: permethrin, deltamethrin, and lambda cyhalothrin., chemicals include carbamate and organophosphate, to which the vectors were completely sensitive. The Moshi and Muheza mosquito populations of Anopheles gambiae s.l. demonstrated resistance to deltamethrin, whilst the Rumeru, Dar es Salaam, Handeni, and Kilombero mosquito populations were suspected of having resistance. Additionally, compared to those in the other four sentinel districts, the mosquito population in Arumeru, Moshi, and Muleba districts was resistant to lambda cyhalothrin (Kisinza et al., 2011). The ex vivo evaluation of medication susceptibility can help track and monitor antimalarial drug resistance. Assessing the parasites' reaction in the absence of host factors that can influence a therapy's in vivo efficacy is made possible by measuring ex vivo susceptibility. Several techniques, including those based on DNA and antigens (Chotivanich et al., 2014). This is the first paper that we are aware of regarding the use of the SYBR green I assay in conjunction with the WWARN standardized procedure for 384-well fast ex vivo testing to profile drug responses in field isolates via in vitro malaria medication sensitivity. The WWARN test was improved by using higher quantities of dye, detergent, and culture time (Cheruiyot et al., 2016). Your findings show that the created LAMP assays in conjunction with the LoC platform are excellent choices for clinical settings, offering great promise for point-of-care integration. This is accomplished by utilizing an ISFET-based platform and a Lab-on-Chip technique to modify amplification chemicals to be compatible with electronic detection (Malpartida-Cardenas et al., 2019). Despite being the first medication used to treat malaria, QN's exact mode of action has never been established (Bohórquez et al., 2012). While humans rely solely on salvage mechanisms to meet their metabolic demands, many infections rely on their own metabolic route to create folate. This makes targeting the folic acid synthesis route for the treatment of several illnesses in humans appealing. While drug-resistant microorganisms can proliferate rapidly, the effective life of individual medications is extended when they are combined to treat diseases (Ding et al., 2013).
Drug laws should ideally vary depending on the regions of a nation and the degree of resistance present. This could be challenging based on how the health services are set up. However, during epidemics at least, programs to control malaria should be ready to step in and provide more potent medication, which may be required when entire communities are unexpectedly exposed to very high transmission levels. The clear historical pattern of the availability and use of inferior antimalarials coinciding with the evolution and propagation of resistance is particularly alarming if we are to meet the objectives of the WHO's Global Technical Strategy for Malaria 2016–2030. We propose to use mathematical modeling to evaluate the urgent need for P. vivax and P. falciparum drug resistance surveillance in Southern Thailand's rural and border regions, given the scarcity of complete datasets available. Continuous molecular surveillance reaching community malaria centers may be the most efficient way to achieve this given the conditions covered in this paper, which include the concealment of early treatment failure, inherent resource constraints, and sociopolitical obstacles to malaria control in these areas. The Thai and Southeast Asian plans for the eradication of malaria would suffer if this important region was not completely covered. Malaria is a potentially fatal virus that affects both the world's most industrialized nations and those with inadequate access to basic medical care. Rapid and accurate diagnosis of malaria patients is becoming more important due to the rising disease burden, the emergence of antimalarial drug resistance, and the widespread use of antimalarial therapy (ACT). Alternative diagnostic approaches are required because to the challenges associated with doing microscopy, particularly in endemic locations. However, the majority of fevers linked to malaria can already be detected by the majority of currently available techniques, making them sufficiently sensitive for therapeutic care. The issue is the clinical malaria test's poor specificity, particularly in areas with high transmission rates. Both the identification of clinically important malaria biomarkers and the detection of malaria infection would make an ideal diagnostic tool (capable of discriminating illness from simple infection). There are already known potential biomarkers. Furthermore, a more sophisticated RDT for malaria would provide a semi-quantitative evaluation of the parasite density. As an alternative, research should concentrate on combining many disease markers into a single device, such as adding a bacterial illness biomarker to a malaria RDT. The main foundation for all antimalarial drug susceptibility assay techniques is the growth and maturation of parasites in in vitro culture medium with various known concentrations of antimalarial agents. Every method has different costs, costs of sensitivity, and costs of practicality. For a long time, the radioisotope assay method was the gold standard; nevertheless, its widespread application was constrained by the risks involved in the disposal of radioactive materials. DNA-specific fluorochrome assaying techniques such as flowcytometry and fluorometric assay are very sensitive, fast, automated, and highly DNA-specific; nevertheless, they require expensive equipment, and the presence of leukocytes increases background noise.
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Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
