A mother injures her baby: Münchausen syndrome by proxy

Review Article

A mother injures her baby: Münchausen syndrome by proxy

  • O. Moyano

*Corresponding Author: O. Moyano, Ph D (Psychopathology and Clinical Psychology) Clinical Psychologist of the Ministry of Justice France.

Citation: O. Moyano, (2024), A mother injures her baby: Münchausen syndrome by proxy, Psychology and Mental Health Care, 8(8): DOI:10.31579/2637-8892/291

Copyright: © 2024, O. Moyano. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 01 August 2024 | Accepted: 22 August 2024 | Published: 02 September 2024

Keywords: munchausen syndrome by proxy ; dysparentality ; baby

Abstract

Munchausen syndrome by proxy (MSBP) is a very special pathology where an adult produces symp-toms of illness in baby or child/adolescents under his care. Il is a factitious disorder generally produ-ced by the mother. Mother’s intention is to obtain medical treatment and to give part of these treatments. We present a single case of a baby who has been hospitalized four times. 

Introduction

Münchausen syndrome by proxy (MSBP) refers to the notion of dysparentality, or even inaccessible parentality. The first description dates back to 1977 by Meadow in the journal Lancet. Since then, the international literature lists only a few cases (300 cases in 2006 according to De Becker). This picture strikes people by the discrepancy between the maternal feelings displayed and the aggressive nature of the acts committed against her child. The imagination, the strategies displayed to hide the disorder or symptom of the child are always remarkable. The child, a source of pathogenic fantasies on the part of one of the parents, becomes a victim, in whole or in part: 

* a simulated disease (passive form) or deliberately produced by the parent (active form), usually the mother according to scientific sources.

* repeated medical investigation with the intention of recognition for the well-being of the child.

* there is still a denial from the parent as to the origin of the symptom.

* an amendment to the symptomatology presented by the child when separated from the parent concerned.

Typically, this syndrome is more common in families where the mother practises a medical or para-medical profession, with infants who have had repeated consultations, mothers very present during the hospitalization of their child, a mother’s medical history related to her child’s illness, symptoms that may involve different physiological spheres and cover the entire pediatric nosography (Binet E.,2001, De Becker E., 2006).  Diagnosis is important because of the high associated morbidity and mortality (Yalcin and al., 2022).

Recall that the Münchausen syndrome by proxy (MSBP) is rarely reported in the scientific literature and that there is no scientific consensus about a psychopathological picture in the offending adult. As mysterious as it is fascinating, this disorder often approaches horror and inevitably induces a strong malaise in the clinician confronted with the suffering of a child whose origin is in parental gestures. Originally the name of the syndrome (taken from the Baron de Münchausen, famous affabulator) gave the troubles a fictitious character reported by the parent. In fact, most often these are parental behaviours that are characterized by psychological or somatic symptoms in the child, intentionally produced by the parent.

Currently, the recommendation is that the term MSBP should be used to define the abuse itself, whereas the psychopathology of the perpetrator is referred to as FDIA, factitious disorder imposed on another (Abdurrachid, Marques, 2022).

This syndrome is not common but it is ultimately a quasi-systematic reason for reporting, when suspected or detected, to the judicial authorities. In this article we present a situation encountered during a judicial measure of educational investigation (MJIE) in educational assistance, in order to share the singularity of this endangerment of a child by a parent.

A hospitalized baby for the fourth time:

The situation of Paulin, aged 12 months, is very worrying. The report comes from the hospital where the baby is hospitalized following a burn caused by the mother during the bath. This one is using the pretext of unintentional wrongdoing. But this gesture is unfortunately not isolated.

Paulin will be hospitalized all the time of the investigation, supported by very specialized hospital services: service of major patients at first, then regional hospitalization in specialized rehabilitation center. Telephone interviews with the various staff of the departments concerned will take place. The stakes of this investigation lie in the personality examinations of the parents, in the absence of knowledge on my part, in the writing of the report and the sending to the magistrate, of the conclusions of the criminal investigation.

During the investigation period, the Chamber of Minors of the Court of Appeal issued a judgment confirming Paulin’s order of placement, denying the parents of their request for a lifting of the placement. The judgment of the Court of Appeal recalls that it is essential to determine the origin of the multiple accidents suffered by Paulin. This legitimate question seems to have gone awry, since the context of the accidents is either vague or based on contradictory versions which I cannot verify. I have neither the competence nor the charge.

Paulin’s story includes several incidents/accidents observed by the medical community:

- Femur fracture at 5 weeks

- the break in the 3-month weight curve without a rational explanation from the parents

- a hematoma on the thigh at 5 months

- bruises on forehead and cheeks during the eighth month

- a new state of malnutrition at 9 months in hospital

- 1 black eye at 10 months

- burns (2° and 3° degrees) at 12 months over 40% of body surface

The succession of these episodes is more than worrying: either the parental couple fails to adapt to the fact of raising a child in a safe environment and shows an obvious disability, or the child is mistreated. In this last hypothesis, in view of the parental discourse, it is there that the Münchausen syndrome by proxy could be evoked from the hospitalization of the child by the staff of the hospital and the center of reception of the victims.

Mother’s personality : 

In educational assistance proceedings, the magistrate is given the opportunity to ask the psychologist conducting the judicial investigation for an examination of the parent or parents of the minor named on the order. 

The mother is present at all the appointments offered. His words are freely expressed, without reticence or pathological distrust. Aged 25, she is an only child. She practises as a caregiver in a medical facility. Of very small stature, she makes the link between her own weight/height ratio and the concern evoked about the break in the weight curve of Paulin: mother and son could be carriers of the same genetic disease said-This is a factor that is frequently identified in the Münchausen syndrome by proxy: the mother’s medical history is related to the child’s disease or diseases. The mother repeatedly evokes a psychological and physical abuse against her during her childhood, perpetrated by her mother. When I ask her to clarify, she talks about severe punishment, hair drawn, a very bad maternal character in a context that seems to be more on the side of more or less continuous moral harassment than serious physical harm. No one would have taken into account the girl’s suffering at the time. 

Concerning all the somatic episodes of Paulin, the mother develops arguments to counter the hypotheses of a failure or a will to want to harm her child: on weight, in particular, She made amends and explained that she misunderstood the composition of the bottle and that she needed clarification from medical staff to correct the error. She had continued to give him too liquid bottles instead of feeding the baby with a spoon. But it is noted that Paulin presents twice weight loss. This repetition makes sense: either the mother does not understand the needs of an infant, or it is an unconscious manoeuvre to «shape» her child in her image, like a true double narcissist, the image of the child’s body becoming an analogy to the image of the maternal body, through disturbed feeding. In this perspective, the weight ratio of the baby will become consistent with that of the mother. This type of pathogenic cross-identification has already been identified in the context of disrupted mother/child interactions, including in the case of proxy Münchausen syndrome, where difficulties in differentiating a paradoxically symbiotic mother/child situation are noted (Binet, 2001).

The origin of the fracture of the femur cannot be more fuzzy: either it is due to parental maneuvers to relieve Paulin of gastric pain, or it is due to improper handling of the manipulator in radiology according to the mother. The latter claims that there was medical negligence with a first diagnosis of non fracture, then a radiological X-ray that confirms the injury.

We can note, in the maternal discourse, this occurrence on several occasions, that is, the questioning of other people to explain the incidents that happened to his son: as another example there was not, According to her, from blue to thigh before going to the kindergarten assistant, suggesting that it was at her that her son was injured.

Regarding the burns, the mother evokes an unfortunate gesture on her part. The baby was in the bathtub, and as he retreated, leaning over him, his hip activated the hot water lever. It takes time to react, takes out the child, the swaddle and the diaper. In the morning, she discovers the burns on most of the body of her child who would not complain during the night. The emergency department blames him for the too long delay between the burn and the drive to the hospital which occurs only the next day. The mother denies any intention and never takes offence at this type of question. I’m probing her again. She very passively accepts all my questions. It evokes the event without too much affect. She says she represses them so as not to have to crack, especially at work. The story of events is very factual, it includes a lot of rationalizations.

 

On examination, the young woman does not have a sleep disorder. She brings back a few memories of dreams, not nightmares. On the other hand, since his absence, the parents sleep with a Paulin comforter in the parental bed. In terms of food, the mother describes herself as a “soft drink addict” and a fan of snacking. It does not consume coffee, tobacco or any narcotic. She only drinks alcohol on rare family occasions. 

The psychological examination refers to vocabulary in the standard. It does not present any disorder of the current thought, no dam, no cocks to the donkey, no diffluence of the thought, no confusion. It does not declare any organized phobia. She has never experienced a depressive turn and, even now, she describes rather a gloom waiting for the return of her son, than a true depressive collapse. Nor does she suffer from any surge of anxiety, either now or before in her biography. She is free from any symptom of the psychotic series: no hallucination, no break in the course of thought, no delirium, no strangeness in contact, no immoderate smile, no break in contact with reality.

The testing makes it possible to specify the organization of his personality (Rorschach tests, Scale of Dissociative Experiments, Alexithymy questionnaire). The young woman does not present any alexithymy: she brings, she says, an important consideration to the place of emotions in her life (even if she seems to put aside her emotions), she says she is able to identify them in her as to express them, even if she doesn’t do it often. In spite of everything, there is a more or less constant repression of its affects in its communication. She reported no dissociative experiences, no memory problems, and never had partial or lacunar amnesia. Productivity at Rorschach is quite low. This young mother is able to put the projective process into action, but she fights against this projection, again by repressing her abilities. These are more conscious mechanisms of repression and control than a real mechanism of repression (which, in turn, is unconscious). Sometimes the mentalization abilities are in difficulty and the answers are replaced by multiple manipulations of the test boards (motor activity comes to support and replace faulty thinking). We observe the recurrence of anatomical responses to the point that it itself makes the remark «I focus on the human body» and in particular the belly/uterus area. No disorganization of thought appears through this protocol.

I ask the young mother about the notion of pleasure in her daily life and her life choices, given the relatively disused character that emerges during the interviews: the most important for her was to build a family, a family cocoon, «I wanted this family cocoon quickly». « I set myself goals to achieve them, it’s not really a pleasure ». She says she feels a certain pleasure in sexuality. She does not necessarily get any oral pleasure from eating, or even from drinking the sodas of which she calls herself «addict». Rather, she describes herself as someone who maintains a restraining attitude.

She plans her son’s return home, with his continued presence to provide the necessary care. She projects herself into this return, ignoring the suffering of her son. She speaks as a care technician, which she is through her profession (often raised in Münchausen syndrome by proxy). Hospital services confirm the strong parental investment in the care and follow-up of the child. At no time during our meetings did she spontaneously address the suffering that her baby endured. Not for burns, not for fractures or bruises. This point questions me, because it shows a self-centred or self-centred maternal preoccupation, with as its main driver what she has done, must do and will do for her son, as a perfect organizer. What matters today is the facts: do and do well. The decentralization on the intimate experience and the baby’s affects were not spontaneously evoked by this young mother. It questions me about his ability to feel commiseration for others outside of himself. This young mother, after having known a childhood described as unhappy, by the presence of a rejecting mother and the quolibets of her peers in relation to her small stature, presents an atypical emotional expressiveness, not really absent from this woman’s psychic field, but muted. She feels affects and emotions, but she represses them. One can thus note a certain coldness in the contact and an egocentric centering of his needs and concerns. She is not worried about possible legal action (with her possible indictment). Paulin is very present in his speech which is built today only on the project of exit and all the time that she will devote to him for the care that he will need. It is an operational project in which the intimate experience of the child, past present and future has not yet its place (for example, she did not discuss what her child’s experience or questions might be in relation to burns, when he is older, his after-effects, etc.).

Meetings with the father

The father is met alone. Paulin has been in a rehabilitation center more than two hundred kilometers away for a few weeks, he goes to see him as soon as possible, that is to say very often despite the distance, almost every weekend.

This man is very affected by what happened to his son. He understands the response of the Court of Appeal (confirmation of the emergency placement of his son) and does not dispute it. He remembers that a magistrate had told the parents during the hearing that if the child was returned to them, she would be remiss to discover the name of the family in the various facts a few months later. I ask the father about this remark : what can this really mean? Has he understood the fear of the magistrate? What does he think about ? The father is unable to answer my question and remains very evasive. He stays outside of a full understanding of the issues that revolve around his son's situation. He read the various reports, he inquired with his wife on the internet to verify what this Münchausen syndrome was which had been mentioned in certain writings, but, at no time, did he make the link with his story and that of his wife. He does not even protest the possibility of this hypothesis raised by some. When I ask him if, at one time or another, he doubted the actions of his wife, he answers without waiting that he never doubted her. He retains his full confidence in her. The episode has not damaged his love for her and he does not express any resentment towards the person responsible for the burns, even if they were involuntary.

This man has sleep disorders, because he is very anxious about the legal consequences to come. He does not use tobacco, no alcohol or any narcotics. His speech is clear, without pathological construction. He describes his temperament having certain reactive impulsivity, but without any pathological character. Moreover, no biographical element exists to detect impulsivity tracts. His emotional control is very good during the interview, the mood remains stable throughout the exchanges. He easily stares at his interlocutor, I detect no nervous reaction, no pathological distrust, no interpretive speech, no delusional ideas. His Speech is always in tune with reality. No psychotic element is observed during the interview. The mood remains constant. Apart from since his son's hospitalization, he had never experienced a depressive turn. We can highlight a certain psychoaffective immaturity, but this does not hinder his relational or social capacities. The father remains very close to his wife and his speech does not raise any questioning either of the couple or of one of the two parents with regard to the traumatic history of Paulin.

The interviews with each of the two parents confirm the absence of a disturbing psychopathological profile in either the mother or the father (which will be confirmed by the psychiatric expertise of the mother ordered in parallel by the judge). The parental couple is strained towards a single goal, the return of Paulin to the house. I regret to see that very little questioning around the accidents of the baby's life to date. There is no evidence to confirm that the violence was intentional, but there is nothing to verify that parental abilities are now able to provide Paulin with a safe environment at home. A last telephone conversation with the psychologist from the rehabilitation center was an opportunity to take stock: the parents are always very present, extremely compliant, they always take care of Paulin under the presence of a member of the hospital. They always accept the obligation to have a nurse with them and Paulin. In fact, they are perceived by the team as quite passive and very little expressive, even smooth. Paulin benefits rehabilitation in physiotherapy, occupational therapy, and an ongoing psychomotor assessment. He still requires significant care for burns. The exit of the center of rehabilitation is not up to date.

In conclusion

This situation illustrates the difficulty to consider the Münchausen syndrome by proxy with the main interested parties: the absence of speech on the part of the parents is disarming, a father who is oblivious, passive, a mother who offers no justification for his questioning and, above all, do not use any energy to shout his innocence.

We had the feeling of witnessing a tacit agreement between the two parents, based on the father's submission to his wife and the trust, or at least the apparent trust that he granted her. As if the survival of this couple exceeded, in the the father psyche, the desire for the child to return home. The mechanisms at work are powerful and devastating and can put a strain on clinicians faced with this type of dramatic situation. Justice has decided: if maternal guilt could not be demonstrated, the parental ability to ensure the safety of the child was, in fact, also denied. The decree of the judgments recalled that the child was injured on several occasions, which testifies to the failure of the capacity of a couple to protect their child. So, logically, Paulin did not return to his home after the judicial investigation.

Problem of diagnosing Münchausen syndrome by proxy is pointed out in all the literature devoted to this subject. Thus, diagnostic vigilance and interdisciplinary collaboration are essential for the diagnosis and prevention of complications (Bouchalta and al., 2022)

Indeed, even though the parental abuse (mainly maternal) observed can be encountered from birth, the diagnosis is rarely made before 30 months (Binet, 2001). It is a serious, potentially very dangerous psychological illness, the objective of which is always to draw attention to the perpetrator through the victim (Hoisey and al., 2017). There is no typical parental psychological profile in this syndrome. The recurrence of cases shows that it is most often mother who is concerned. The future of these children has been the subject of few publications, the most recent in French dates from 2016 (Binet, Tarquinio, 2016) and reports numerous disorders in adults who have suffered Münchausen syndrome by proxy during the childhood, including particularly complex post-traumatic disorders, with symptomatic expression in particular centered around dissociative disorders (traumatic amnesia).

Abbreviations:

MSBP :  Munchausen syndrome by proxy

References

Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.

img

Virginia E. Koenig

Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.

img

Delcio G Silva Junior

Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.

img

Ziemlé Clément Méda

Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.

img

Mina Sherif Soliman Georgy

We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.

img

Layla Shojaie

The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.

img

Sing-yung Wu

Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.

img

Orlando Villarreal

Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.

img

Katarzyna Byczkowska

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.

img

Anthony Kodzo-Grey Venyo

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.

img

Pedro Marques Gomes

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.

img

Bernard Terkimbi Utoo

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.

img

Prof Sherif W Mansour

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.

img

Hao Jiang

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.

img

Dr Shiming Tang

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.

img

Raed Mualem

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.

img

Andreas Filippaios

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.

img

Dr Suramya Dhamija

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.

img

Bruno Chauffert

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!

img

Baheci Selen

"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".

img

Jesus Simal-Gandara

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.

img

Douglas Miyazaki

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.

img

Dr Griffith

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.

img

Dr Tong Ming Liu

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.

img

Husain Taha Radhi

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.

img

S Munshi

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.

img

Tania Munoz

“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”.

img

George Varvatsoulias

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.

img

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.

img

Khurram Arshad

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

img

Gomez Barriga Maria Dolores

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

img

Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

img

Maria Dolores Gomez Barriga

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.

img

Dr Maria Dolores Gomez Barriga

Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.

img

Dr Maria Regina Penchyna Nieto

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.

img

Dr Marcelo Flavio Gomes Jardim Filho

Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”

img

Zsuzsanna Bene

Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner

img

Dr Susan Weiner