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Review Article | DOI: https://doi.org/10.31579/2692-9406/223
School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona.
*Corresponding Author: Leonard B. Goldstein, School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona.
Citation: Aidan T. Radzat, James Keane, Leonard B. Goldstein, (2025), A Narrative Review of Kratom in the Emergency Department: Presentation, Diagnosis, and Treatment, J. Biomedical Research and Clinical Reviews, 10(5); DOI:10.31579/2692-9406/223
Copyright: © 2025, Leonard B. Goldstein. 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: 02 July 2025 | Accepted: 09 July 2025 | Published: 16 July 2025
Keywords: opioid and stimulant properties; opioid dependency; mood disorders; kratom’s pharmacology; tachycardia; hypertension; agitation
Background: Kratom (Mitragyna speciosa), a psychoactive plant with both opioid and stimulant properties, has gained popularity in the U.S. for self-treatment of a wide range of conditions, including pain, opioid dependency, withdrawal, and mood disorders. Despite its increasing use, kratom toxicity remains poorly understood by many healthcare providers, complicating emergency care. While evidence does exist supporting the benefits of kratom for conditions such as pain and withdrawal, it remains an under-studied substance with a potential for abuse. Objective: This review aims to summarize the current literature on kratom’s pharmacology, clinical presentation, diagnostic considerations, and management in the ED. Methods: A systematic review of case reports, observational studies, and toxicology literature will be conducted using PubMed, Embase, and Google Scholar. Relevant studies on kratom-related ED visits, adverse effects, withdrawal syndromes, and treatment strategies will be analyzed. Discussion: Kratom toxicity presents variably, ranging from mild symptoms (tachycardia, hypertension, agitation) to severe effects (seizures, respiratory depression, hepatotoxicity). Diagnostic challenges arise due to the absence of standardized testing. Management is primarily supportive, but opioid withdrawal treatment and benzodiazepines for agitation or seizures may be necessary. The potential for drug interactions and adulterants further complicates care. Conclusion: Kratom use poses an emerging challenge in emergency medicine, necessitating greater awareness and standardized treatment protocols. This review aims to provide ED providers with an evidence-based understanding of kratom use, its clinical effects, diagnostic challenges, and best practices for management in acute care settings.
Mitragyna speciosa, known colloquially as kratom, is a species of evergreen tree native to Southeast Asia. It has been used in traditional herbal medicine for hundreds of years, valued for its analgesic and stimulant properties. The leaves can be chewed fresh, dried into powders or teas, or processed into a tar-like extract. [1] At low doses, kratom has a stimulatory effect, activating dopaminergic, serotonergic and adrenergic receptors, causing users to feel increased energy and alertness. At higher doses, it acts on the opioid receptor, causing sedation, analgesia, and euphoria. [1] In the past decade, kratom has gained increasing popularity in the United States, with consumers viewing it as a "natural" alternative for common stimulant and opioid medications. It has been studied in the treatment of pain, fatigue, opioid withdrawal, diarrhea and stomach pain but has emerging popularity as a recreational substance. [2] Despite these benefits, kratom remains poorly regulated, and has been implicated in many instances of toxicity, overdose, and even withdrawal. [2] It is estimated that every year, around 2 million Americans use kratom.3 In 2023, kratom metabolites were detected in drug overdose deaths of over 1150 people. [3]
As of 2017, the Drug Enforcement Administration (DEA) has listed kratom as a drug of concern, and the Food and Drug Administration (FDA) has issued warnings regarding its potential for addiction and adverse effects. [4] Kratom is currently federally legal, but has been banned in select states such as Alabama, Arkansas, Indiana, Rhode Island, Vermont and Wisconsin. [1] Additionally, it has been banned for human consumption in a few major cities such as San Diego and Denver, while remaining legal in the rest of the respective state. In other states, it is protected by age restrictions. [1] It can be obtained at specialty shops and online, and this poor regulation and complicated legal status contributes to variability in product purity and the potential for contamination with other substances.
Pharmacology
There are over 40 alkaloids that have been isolated from kratom, however the primary active compound found in kratom is mitragynine (MG) (66% crude mass), and the primary metabolite 7-hydroxymitragynine (7-MP) [1][5]. 7-MP has exhibited 5x higher affinity for the u-opioid receptor compared to MG, and was demonstrated to be 10x as potent in antinociception compared to morphine. [6] Speciociliatine is another commonly implicated alkaloid that is present in smaller concentrations, but appears to play a significant role in the pharmacologic effects of kratom, and has a 3-fold higher binding affinity versus MP. These alkaloids act as partial agonists at the μ-opioid receptor, and competitive antagonists at the κ- and δ opioid receptors. [7] They have also been shown to exhibit activity at adrenergic, serotonergic and dopaminergic receptors. In addition to their complex variety of central nervous system effects, kratom alkaloids have demonstrated dose dependent effects. [7] At low doses of around 1-3 g, kratom has a stimulatory effect, causing users to feel increased energy and alertness. At higher doses of 5 g and up, it exhibits opioid-like effects, causing sedation, analgesia, and euphoria. [1,7] Unlike traditional opioids, it does not initiate the β-arrestin-2 pathway that results in the respiratory depression seen with full μ-opioid agonists such as fentanyl or morphine. [7]
Kratom is hepatically metabolized and reaches peak serum concentrations in 50 minutes. It has a half-life of 2-3 hours, and is eliminated in the urine via zero-order kinetics, making the duration and severity of symptoms highly dose-dependent. The phase 1 metabolism of mitragynine to 7-MP is mediated by CYP34A, causing inhibitory effects on the P450 pathway. [7] No LD50 or TD50 for kratom in humans exists at this time, though various sources estimate that between 10 - 30 grams would be considered a high enough dose to induce adverse effects. [8]
Presentation in the Emergency Department
While proponents tout its benefits for pain relief, opioid dependence and withdrawal, and mood disorders, the increased use of kratom has led to growing concerns over toxicity, dependence, and adverse events, many of which present in the emergency department. Among single substance exposures, kratom was associated with a 34% hospitalization rate and a 57.6% rate of having a serious medical outcome. One third of exposures were for treatment of opioid withdrawal, and users are far more likely to be male (68%). [3]
Patients presenting to the emergency department (ED) with kratom overdose or toxicity often exhibit a mix of stimulant and opioid-like effects, depending on the dose consumed. At lower doses (1-5 grams), they may report anxiety, agitation, tachycardia, and hypertension, while higher doses (5+ grams) more commonly lead to sedation, confusion, nausea, and vomiting. Some patients may experience seizures, hallucinations, or altered mental status, particularly if kratom is combined with other substances such as opioids, benzodiazepines, or alcohol. In severe cases, serotonin syndrome or hepatotoxicity have been reported, though rare.
Kratom dependence has been documented, and over half of patients with 6+ months of heavy use (3-4 times a week) have shown symptoms similar to opioid withdrawal. [9] Neonatal abstinence syndrome has also been reported with prolonged kratom use during pregnancy. [10,11]
Like in any toxicity, attempting to quantify dosing and patterns of use is an important step of history taking and may help inform clinical decision making.
Laboratory Testing
Mitragynine and its metabolites cannot be detected using a standard hospital urine drug screen. However, assays can be obtained for confirmatory or forensic purposes, and may help contribute to existing literature surrounding kratom use and toxicity. Kratom alkaloids can be detected in body fluids 1-9 days after ingestion, depending on the route, volume and frequency of administration. Additionally, kratom metabolites have been successfully detected in hair samples of chronic users. [12] While hair analysis is not utilized in the ED, this remains a viable consideration from a forensic perspective.
Preferred analytical testing methods have not been well established, but typically include GS-MS or HPLC-MS using blood or urine samples. [6] These methods are highly sensitive and specific and provide the ability to separate out individual alkaloids. Despite the drawback of slower turnaround times, these methods are currently the gold standard for confirmatory testing. In some studies, ELISA testing has also shown good sensitivity and specificity for detecting kratom alkaloids. While much quicker and more inexpensive than HPLC-MS, the ELISA method is less commonly used due to poor quantification and the increased risk of error. [12,13]
While standard UDS (urine drug screens) are unable to detect kratom metabolites, they are also still indicated in instances of suspected kratom toxicity, considering the majority of toxicities involving kratom occurred in the setting of polysubstance abuse. [14] Commonly implicated substances included opioids such as fentanyl and heroin, benzodiazepines, and alcohol, and opioids are detected in an estimated 80% of kratom associated fatalities. [15] It is also important to note that kratom metabolites may trigger a false positive for the methadone metabolite EDDP on UDS. [16]
Complications
Concerning sequelae of kratom toxicity as a sole agent is not well documented, but trends have emerged over the years. Case study review shows that complications such as rhabdomyolysis, AKI, cholangitis, liver failure, and respiratory depression can occur. [5,6] Many of the fatalities in which kratom was implicated included co-ingestion of substances such as benzodiazepines, opioids, THC, and antipsychotics. [14] The phase 1 metabolism of mitragynine to 7-MP is mediated by CYP34A, inhibiting P450. [7] This is highly suggestive that kratom can exacerbate toxicities of other medications when taken in combination.
Withdrawal
Kratom is often used by patients to help manage symptoms of opioid withdrawal. However, chronic or heavy use can result in dependence and ultimately in withdrawal. Symptoms have been documented to begin within 12-24 hours of cessation, and similar to opioid withdrawal. [9] Anxiety, irritability, tremors, rhinorrhea, and myalgias are the most commonly reported symptoms. [17] Neonatal abstinence syndrome has also been reported with prolonged kratom use during pregnancy. [10,17]
Fatalities
As of 2021, kratom has been associated with a total of 152 known deaths. [18] In 65% of these deaths, fentanyl was listed as a co-ingestion, and was listed as the cause of death. The exact mechanism for which it may cause death is unknown, but it is postulated to be related to respiratory depression or seizures. More research is needed to further understand the role of kratom in fatal toxicities and polypharmacy.
Management [20]
Due to the current lack of rapid detection capabilities, confirmatory testing of kratom in acute settings is not possible, and diagnosis is clinical. Luckily, treatment for kratom toxicity is primarily supportive, and may depend on presenting symptoms. Treatment of kratom withdrawal would be similar to the treatment of opioid withdrawal.
Stabilization first. As with any acute patient, primary management should consist of stabilizing the airway, breathing, and circulation. In any patient with concerning symptoms such as respiratory depression, sedation, seizures, or hemodynamic instability, peripheral IV access and continuous cardiac monitoring should be obtained. Oxygen should be administered as indicated.
Decontamination is not indicated. Use of GI decontamination with activated charcoal is not currently recommended, since mitragynine is rapidly absorbed, and charcoal use has not been shown to have any benefits.
Respiratory Depression should be addressed quickly. Naloxone (0.8 - 2 mg IV) is recommended for use in any patient with sedation or respiratory depression, particularly considering the high rates of opioid coingestion in kratom users. Intubation should be considered for any patients with intractable respiratory depression.
Flumazenil is not indicated due to no expected benefit, and increased risk of seizures with unknown benzodiazepine coingestion.
Agitation can be managed per standard protocols. Benzodiazepines (lorazepam 2-4 mg IV/IM) can be used as needed for patients requiring pharmacological sedation. Careful monitoring of respiratory parameters is required in these scenarios due to the increased risk of respiratory depression.
Nausea and Vomiting should be managed with antiemetics such as ondansetron. IV fluids can be given to improve fluid status.
Seizures can be managed with standard treatments such as midazolam (0.2 mg/kg IM) or lorazepam (2-4 mg IV). For refractory seizures, agents such as phenobarbital or propofol can be considered. These agents are considered to have increased efficacy for toxin induced seizures.
Hepatotoxicity typically resolves after cessation of use.
Disposition
Patients that are cardiovascularly stable, alert and oriented, and without concerning signs and symptoms, may be observed for 4-6 hours and discharged following an ambulation trial. [20]
Patients with respiratory or hemodynamic instability, or with toxic co-ingestions, should be monitored in a critical care setting. Any patient who has suffered a seizure related to kratom use should be monitored for a minimum of 24 hours prior to discharge. [20]
Kratom use disorder, including management of withdrawal symptoms, can be managed with buprenorphine. Limited evidence exists to date for dosing in the setting of kratom withdrawal, however maintenance doses of 4-8 mg have shown efficacy. [19] In patients who decline buprenorphine, clonidine can be used to mediate withdrawal symptoms. [19]
Special thank you to Stephanie Castillo MD for her insight and assistance with writing this review.
Case Studies:
| Case Citation | Patient demographics | Co-Ingestion | Signs and Symptoms | Outcome |
| Tobarran N, Wolf C, Cumpston KL, Wills BK. Pressure Necrosis Requiring Fasciotomy After Kratom Overdose. J Addict Med. 2022;16(2):252-253. doi:10.1097/ADM.0000000000000873 | 31 YOM | None | Sedation, loss of consciousness, compartment syndrome | Treatment for rhabdomyolysis, AKI, acute hepatic injury, discharge after 18 days. |
| Sangani V, Sunnoqrot N, Gargis K, Ranabhotu A, Mubasher A, Pokal M. Unusual Presentation of Kratom Overdose with Rhabdomyolysis, Transient Hearing Loss, and Heart Failure. J Investig Med High Impact Case Rep. 2021; 9:23247096211005069. doi:10.1177/23247096211005069 | 45 YOF | None | Lethargy, confusion, transient hearing loss, right LE swelling and pain. | Treatment for rhabdomyolysis, compartment syndrome, AKI, liver dysfunction, cardiomyopathy. |
| Shi T, Shea JL. A case of fatal overdose involving both hydromorphone and kratom. J Forensic Sci. 2024;69(1):355-358. doi:10.1111/1556-4029.15394 | 44 YOM | Hydromorphone, olanzapine | Found deceased with abdominal ascites > 4L | Tox screen showing 79 ng/mL of hydromorphone, 560 ng/mL of mitragynine, and 240 ng/mL of olanzapine |
| Hughes RL. Fatal combination of mitragynine and quetiapine - a case report with discussion of a potential herb-drug interaction. Forensic Sci Med Pathol. 2019;15(1):110-113. doi:10.1007/s12024-018-0049-9 | 27 YOM | Quetapine | Found deceased with autopsy evidence of hyperthermia and seizure activity | Tox screen with fatal levels of quetiapine in the presence of mitragynine suspected secondary to altered pharmacokinetics. |
| Matson M, Schenk N. Fatality of 33-Year-Old Man Involving Kratom Toxicity. J Forensic Sci. 2019;64(6):1933-1935. doi:10.1111/1556-4029.14082 | 33 YOM | Caffeine, cotinine, naloxone, THC | Found unresponsive, unable to resuscitate. | Tox screen with 1.9 mg/L mitragynine suspected toxicity |
| Kapp FG, Maurer HH, Auwärter V, Winkelmann M, Hermanns-Clausen M. Intrahepatic cholestasis following abuse of powdered kratom (Mitragyna speciosa). J Med Toxicol. 2011;7(3):227-231. doi:10.1007/s13181-011-0155-5 | 25 YOM | None | Presented 10 days after stopping 2 weeks of kratom ingestion with subjective fever, chills, abdominal pain, jaundice, pruritis. *14-21 g /day | Patient treated for intrahepatic cholestasis with full recovery |
| Allison DR, Mubarak M, Sharma N, Rao DS. Kratom (Mitragyna speciosa)-Induced Hepatitis. ACG Case Rep J. 2022;9(4): e00715. Published 2022 Apr 7. doi:10.14309/crj.0000000000000715 | 23 YOM | THC | Jaundice, pruritis, pale stool, dark urine, diffuse abdomnal discomfort, fatigue and bruising. | Hepatitis (DILI) with resolution after 3 months. |
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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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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
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
