\r\n\tGlobalization does not represent a pure and generous process for humanity or other species, but rather it implies social exclusion and also provokes situations of vulnerability in groups of people, forced exclusion, and apartheid: poor job opportunities, lack of access to education, worse socio-sanitary conditions. Specifically, it can be said that social segregation entails the apartheid of social groups of different ages, genders, and ethnicities; these groups live a reality manifested through the deepening of poverty, in terms of increased vulnerability of the poor and groups with little economic, social, cultural, labor and health stability.
\r\n\r\n\tThis book aims to talk about some topics that are neglected in the discourses of academic communities and political elites. The inequality process is deeply rooted among humans and is part of many people's lives in the form of modern apartheid, gender segregation, lack of health access, and cultural gap. All those structural inequality processes are the product of the biopower perpetuated and produced in the macrosystem, exosystem, mesosystem, and microsystem. For many people from the academy, the information-consuming public, and the society in general, it is a problem to talk about these processes, since they have either lost interest or have normalized the structural and social inequity. For this reason, we see it as transcendental to explain how this situation occurs from the most internal fibers to the most evident processes, intending to make it more visible and thus expose the situation for possible solutions.
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Today, it is recognized that GDB is most probably a consequence of complex and quite diverse interactions between genetic-epigenetic-environmental factors [1, 2, 3]. This diagnosis of gestational diabetes does not include pregnant women who have unrecognized pre-existing diabetes, which today accounts for about 1% of diabetes cases during gestation [4].
GDM is characterized by aberrant fetoplacental vascular function, insulin resistance, and impaired insulin production [5]. Numerous fetal issues have been linked to GDM, for example, macrosomia (birthweight over 4000 g), a higher stillbirth risk, birth trauma, a higher percentage of Cesarean delivery, and newborn hypoglycemia [6]. Most of these have been particularly positively linked to considerable maternal weight fluctuations in GDM [7]. Although today it has become very clear that timely screening and diagnosis (even before 20 weeks gestation) of GDM in at-risk women is more than required for clinically desirable maternal and fetal outcomes [8], in this context, new predictive and diagnostic biomarkers for GDM represent a critical state-of-the-art topic [9].
To circumvent hyperglycemia and its negative effects on fetal growth, pregnant women diagnosed with gestational diabetes are initially managed with individualized medical nutrition therapy and light exercise. Although the majority of scientific associations propose the thresholds for fasting glucose levels of 95 mg/dL and 140 mg/dL at 1-h postprandial, recent findings suggested that decreasing a threshold for blood glucose at 1 h after a meal to less than 120 mg/dL in GDM women lowers the risk of large for gestational age infants and macrosomia, and at the same time without the increased occurrence of small for gestational age infants [10, 11]. This promising finding certainly requires further elucidation.
Insulin has generally been recognized as the first-line drug because it is effective and does not cross the placenta. Other treatment strategies, oral antidiabetic drugs (OAD) such as metformin or glyburide, have been used in recent years given that insulin therapy has several downsides in GDM. Some of them are the absence of a clear dose definition, the need for multiple daily injections, the risk of hypoglycemia, and elevated maternal weight gain [12]. Although oral medications are easy to use and even though they have a high efficacy in the treatment of women with GDM, failure to attain glycemic control appears in around 20% of women, leaving opportunities for new therapeutic optimization [13]. In accordance with previous facts, up-to-date results of available meta-analyses on the effects of antidiabetic pharmaceuticals estimated that if we look to the majority of adverse neonatal outcomes, metformin was ranked to be the superior treatment over insulin or glyburide, whereas the lower risk of adverse maternal outcomes was primarily linked to glyburide administration [14]. These divergent effects require additional caution in their use [8].
Lots of knowledge has been accumulated regarding GDM screening and timely treatment; however, the secondary prevention in women following GDM, as well as in their offspring, represents an important scientific challenge for all of us in many years to come [15].
In this review, we look at how insulin and other oral hypoglycemic medications are used to treat women with GDM, emphasizing on their efficacy and safety. Supplement-related and other alternative pharmacotherapy will be addressed, as well.
Insulin, due to its huge molecular size, does not pass the placenta unless at extremely high doses [16]. It has a great fetal safety profile; it attains tight maternal glucose control and is therefore recommended as a gold standard, and the first-line treatment for women with GDM. Insulin is not teratogenic, and there is also no evidence that any of them are excreted in human milk [17].
Currently, available insulin analogs are rapidly acting analogs, including aspart and lispro, short-acting regular insulin, intermediate-acting NPH insulin, or longer-acting insulin analogs, such as glargine and detemir [18, 19].
Insulin is the therapy of choice for women who have failed to meet their glycemic treatment goals despite making lifestyle changes—diet and exercise [2]. It can also be used by those who are unable to tolerate the adverse effects of other OADs.
The dose and timing of insulin use are determined by the women’s body weight, gestational age, and the time of day when hyperglycemia occurs. Insulin dosage is modified often during pregnancy based on blood glucose values, hypoglycemia, physical activity, nutritional intake, infection, and patient’s compliance.
Based on the time of recurrent hyperglycemia, there are two major ways of prescribing insulin. Insulin can be given in divided doses throughout the day or as a single daily dose. Intermediate insulin, such as NPH or detemir, should be given as a single dose at bedtime in GDM women who have hyperglycemia solely in the morning fasting state. Rapid-acting insulin should be administered before a meal in women who have postprandial hyperglycemia. Hyperglycemia during the day should be controlled with a combination of intermediate- or long-acting and short-acting insulin [20].
Close blood glucose monitoring is required while prescribing insulin to avoid hypoglycemia or hyperglycemia. GDM women should bring their self-monitored blood glucose logs to the doctor’s office so that the insulin regimen can be adjusted when necessary.
Rapid-acting insulin analogs, often known as bolus insulin, are used to imitate endogenous insulin’s response to meal intake. They reach a concentration peak sooner than regular insulin and show a shorter duration of action (3–5 h) [21]. In comparison with human insulin, which must be administered 30 minutes before a meal, rapid-acting insulin analogs can be given 5–10 minutes before a meal, making them more convenient [22]. Basal insulin, also known as intermediate-acting and long-acting insulin, is primarily used to give a constant supply of the modest amounts of insulin to regulate lipolysis and avoid hepatic gluconeogenesis, regardless of meal intake.
Although insulin treatment has traditionally been the drug of choice for treating hyperglycemia in GDM after medical nutrition and physical exercise, it is not without limitations. Many pregnant women face issues with insulin administration, including gaining weight, balancing dosage, diet, and, for some, the frequency of hypoglycemic episodes. For that reason, there are quite a few reports currently suggesting metformin as the first-line agent having an equivalent efficacy
Short-acting insulin has been connected to an augmented risk of hypoglycemia and glycemic control changes in those with GDM. Aspart’s recent experience has been positive, although lispro has been linked to higher birth weight and a greater rate of large for gestational age newborns [24]. In randomized clinical investigations comparing detemir to NPH for intermediate- and longer-acting insulin, there was no difference in glucose management or perinatal outcomes. Detemir has been linked to a lower risk of hypoglycemia in diabetics who are not pregnant [25].
Metformin, an oral biguanide, works by reducing liver gluconeogenesis, increasing peripheral insulin sensitivity, and also promoting glucose uptake in peripheral tissues while lowering glucose absorption in the gut [26]. Several mechanisms are responsible for higher insulin sensitivity including the augmented activity of insulin receptor tyrosine kinase, enhanced synthesis of glycogen, reduction of glycogenolysis, decreased activity of hepatic glucose-6-phosphatase, and an increase in the recruitment and activity of GLUT4 glucose transporters [27]. It decreases fasting serum insulin by 40% (thus lowers the risk of hypoglycemia) and leads to a 5.8% weight loss on average [28]. Despite identical glycemic control, metformin was related to lower cardiovascular, as well as all-cause mortality if paralleled to sulphonylureas and insulin in a long-term prospective study of type 2 diabetes. The RISK pathway activation
Organic cation transporters (OCTs) transport metformin across the mitochondrial membrane at the cellular level. Since the placenta expresses many OCT isoforms, metformin crosses the placenta easily during pregnancy. Concerns about potential negative effects on fetal development arise from transport
Only recently there has been evidence to support the use of metformin for the management of GDM. It has, however, been used in early pregnancy and all through pregnancy for additional indications for decades. Metformin can help women with the polycystic ovarian syndrome to establish regular ovulation and to enhance conceiving odds, and by using it during the first trimester to lower the incidence of spontaneous abortion [34]. Metformin’s use and effectiveness in the management of insulin-dependent T2DM in pregnancy have been supported by early research [35]. Despite this, it was not until the metformin in Gestational Diabetes trial, presented by Rowan et al. in 2008, was widely reported as an effective treatment for GDM [36].
In the gestational diabetes trial [36], women were randomly assigned to either metformin or standard treatment, that is, insulin. Supplemental insulin was required by a large percentage of women using metformin (46%), however at much lower doses than GDM-women using insulin as monotherapy. The key outcome was a combination of neonatal hypoglycemia (2.6 mmol/L), respiratory distress, requirement for phototherapy, 5-minute Apgar score of 7, or premature birth (before 37 weeks), and it was similar in both treatment groups. Women who took metformin gained considerably less weight from enrolment to term than those who took insulin. Other parameters considered in the metformin and insulin clusters were similar, including birth weight, neonatal anthropometrics, and odds for large for gestational age. However, when compared to insulin therapy, the incidence of severe hypoglycemia (1.6 mmol/L) was lower in the metformin group. This research also discovered that patient acceptability for metformin was substantially better than with insulin; when questioned if they would select it yet again for future pregnancies, 77 percent of metformin users replied yes, compared to only 27 percent of insulin users. Metformin’s gastrointestinal side effects caused 32 women (8.8%) to cut their dose, although only 7 (1.9%) had to discontinue taking it.
A group of 100 GDM women merely treated with metformin
Post-prandial glycemic levels may indeed be of importance when comparing metformin to other treatment options. A meta-analysis of three randomized controlled studies of GDM women found lower post-prandial glucose in metformin as opposed to insulin-treated patients, though these disparities did not meet statistical significance [38].
Metformin did not raise the risk of preterm delivery or Cesarean section, as reported in a latest systematic review, nor did it raise the risk of small for gestational age newborns. Metformin, on the other hand, was linked to a lower risk of preterm birth, newborn hypoglycemia, and admission to neonatal intensive care units, as well as a decreased prevalence of pregnancy-induced hypertension [39].
Because metformin is not stimulating the secretion of insulin, it does not provoke maternal hypoglycemia, which is a side effect that remains a concern with glyburide. For the same reason, severe neonatal hypoglycemia is less likely to occur after metformin administration compared to insulin [14]. Accordingly, hypoglycemia is a greater risk if taking insulin, than with OAD [40]. Metformin, on the other hand, crosses the placental barrier easily due to its low molecular mass, hydrophilic nature, and lack of protein binding [41]. Metformin concentrations in the fetus are likely minimal and no fetal side effects, such as congenital malformations, have been detected [42]. It is not thought to be teratogenic, as evidenced by decades of use in preconception and early pregnancy. There have been no reports of newborn lactic acidosis, and neonatal hypoglycemia has been related to maternal hyperglycemia during delivery rather than a direct side effect of metformin. It belongs to the FDA’s Pregnancy Category B.
Before starting metformin treatment, patients should be informed about the potential for maternal adverse effects. Although its mechanism of action does not produce hypoglycemia directly, symptoms are observed in 0–10% of women who administered the drug. A 5 percent to 15% of women experienced gastrointestinal side effects, such as flatulence, nausea, diarrhea, and vomiting. Lactic acidosis, the most worrying potential side effect, was prevented by gradually raising the dose [43].
One final question could be certainly related to the eventual advantageous co-administration of metformin and insulin in GDM. Scarce reports have been published over the past decade; however, Chaves et al. [44] recently addressed this issue through the retrospective investigation with an evaluation of the Portuguese National Registry of GDM (2012–2017) with a very interesting report that in GDM women the concomitant use of metformin and insulin resulted in comparable obstetric and neonatal adverse events if paralleled with insulin monotherapy. Moreover, the authors reported that expected beneficial effects on weight gain and insulin dose were simply not detected if both drugs were used in a parallel manner [44].
Glyburide is a second-generation sulfonylurea that acts mainly by increasing the secretion of insulin from the pancreas and improving the insulin sensitivity of peripheral tissues. These actions can be detected after a block of the sulfonylurea receptor, which is actually a part of the ATP-sensitive potassium channel in the pancreatic beta cells [45]. Glyburide is lipophilic and significantly bound to albumin [46].
At first, it was assumed that glyburide did not cross the placenta. Langer et al. (2000) did not detect glyburide in umbilical cord serum of neonates whose mothers were taking glyburide during pregnancy, thus confirming
There is an obvious option to glyburide and that is insulin administration. Even though glyburide is an FDA category C drug, compared to insulin analogs (lispro, detemir, and aspart) that are all pregnancy risk factor B medications, glyburide is still widely used. The situation where glyburide is a better choice is where self-monitoring of glucose blood levels needed for insulin or insulin storage is not possible or where a patient has a severe needle phobia.
Another benefit of using glyburide is that it is a low-cost oral agent, easy to take with few side effects. Also, glyburide is, as an oral agent just like metformin, easier to use compared to insulin [41]. Nevertheless, the other use of glyburide during pregnancy for GDM patients is still unclear and needs to be comprehensively elucidated [48].
The New England Journal of Medicine published a clinical investigation comparing glyburide versus insulin in management of GDM in 2000, which transformed the management of GDM. Namely, Langer et al. (2000) conducted the first randomized, controlled study where they compared glyburide to insulin by dividing 404 women with GDM into two groups, 201 receiving glyburide and 203 receiving insulin [49]. Results did not show any significant difference between the two clusters in neonatal outcomes by measuring high blood glucose concentrations, the incidence of macrosomia, admission to neonatal intensive care unit, etc. The authors also noted that the extent of glycemic control between the two groups was similar. A different study comparing macrosomia, neonatal hypoglycemia, and hyperbilirubinemia in two groups found no evidence that using glyburide instead of subcutaneous insulin leads to a higher rate of perinatal problems [50]. On the contrary, a retrospective cohort study analyzed data from 9173 women diagnosed with GDM and treated with glyburide opposite to insulin 150 days before delivery [37]. It was found that newborns delivered by women treated with glyburide were more expected to have complications than those delivered by mothers who were taking insulin. Complications noted were preterm birth, Cesarean delivery, hypoglycemia, respiratory distress, jaundice, birth injury, large for gestational age, and hospitalization in the neonatal ICU [51].
Seven trials comparing glyburide (
A group of 457 glyburide-managed pregnancies and 467 insulin-treated pregnancies were evaluated in the Jiang meta-analysis comparing the efficacy and safety of OAD for GDM [52]. Despite no dissimilarity in glycemic control, the authors found that glyburide caused considerably more macrosomia than insulin (OR: 3.09, 95% CI: 1.59–6.04,
Finally, it has to be underlined that glyburide was ranked the worst in the recent meta-analysis, with the highest rates of macrosomia, hyperbilirubinemia, preeclampsia, neonatal hypoglycemia, low birth weight, preterm birth, and metformin (plus insulin when needed) had the lowest rates of pregnancy hypertension, macrosomia, LGA, RDS, preterm birth, and low birth weight [53]. Besides, one has to be very cautious with glyburide use, which was shown to be associated with weight gain, as well as maternal hypoglycemia, especially when taken without any food [45].
Acarbose is an alpha-glucosidase inhibitor, which means it prevents enzymes found on the small intestine’s brush border from breaking down complex starches into oligosaccharides and oligosaccharides, trisaccharides, and disaccharides into glucose. As a result, the rise in postprandial glucose concentrations is lowered. Its use is usually linked to gastrointestinal complications. Although just 2% of acarbose is absorbed as an active medication, 34% of its metabolites were found in the systemic circulation [54].
Acarbose is not usually recommended for the treatment of GDM, because it has not been thoroughly researched during pregnancy and considering safer and more acceptable options, with more information regarding treating GDM, such as insulin and metformin.
One small randomized prospective study (
Although in this short trial, failure to achieve glycemic control with acarbose was higher if compared to glyburide, the decreased incidence of hypoglycemia and macrosomia underlines acarbose as an appealing agent to investigate in future GDM treatment studies. Accordingly, in the recent investigation published by Jayasingh et al. (2020), it was proposed that acarbose can be seen as an effective and adequately tolerated choice for the management of GDM [56]. Namely, this prospective, open-label, and controlled study was designed to compare the fetomaternal outcomes in pregnant women with GDM designated to insulin or acarbose group. Thus, no difference was found if the following parameters were paralleled in between the groups: the incidence of recurrent infections, preeclampsia, or premature rupture of membranes; then the modes of delivery, mean postoperative random blood glucose, fasting blood glucose level at day 7 and after 6 weeks; and finally difference in the mean birth weight of offspring born to mothers treated with either of the two pharmacological agents.
Even though using acarbose in diabetic patients has been linked to abnormal liver enzymes and hepatic failure, a newer study did not show a higher risk of liver injury during acarbose treatment [57]. Acarbose can pass through the placenta. In pregnant animal investigations, doses up to 32 times higher than the human dose were not proven to be teratogenic. On the other hand, it induces stomach cramps and may raise prostaglandin E, suggesting that it possess the potential ability to induce labor [58].
The efficacy of vitamin and mineral supplementation in GDM patients is still under investigation. However, today is known that in GDM, low levels of vitamin D, vitamin E, and magnesium have been detected, whereas glucose metabolism, anti-inflammatory, and anti-oxidative stress have been all positively regulated after vitamin D, vitamin E, magnesium, and selenium supplementation, which was also confirmed in the very recent meta-analysis reported by Li et al. [59]. In the same manner, 6-week-long Mg-Zn-Ca-vitamin D co-supplementation reduced biomarkers of inflammation and oxidative stress in GDM women [60]. To continue, the improvement in glycemic control and decline of adverse fetomaternal outcomes after vitamin D supplementation (including Cesarean section, postpartum hemorrhage, maternal hospitalization, neonatal hyperbilirubinemia, giant children, fetal distress, polyhydramnios, premature delivery) was underlined by Wang et al. [61].
Dietary adjustments accompanied with lifestyle modifications are known to achieve normoglycemia in a majority of women with GDM, especially underlining careful attention to type and amount of dietary carbohydrates [62]. In this context, myoinositol, a dietary supplement knowing to decrease insulin resistance, became extensively investigated [63]. It represents inositol isomer organically present for example in legumes or nuts, but also synthesized in kidneys and liver to a certain extent. Accordingly, recent findings pointed out that, if started shortly after the GDM diagnosis, myoinositol (1000 mg twice daily,
Traditional Chinese medicine and herbal products, known to be broadly utilized during human history, now belong to a very interesting field currently investigated in the frame of GDM [65]. So far, herbs such as
Finally, probiotics supplementation in improving glycemic control and attenuating some of the adverse events related to GDM is a very interesting and appealing scientific issue that needs further elucidation [68, 69].
Even though new and promising results are published every day, novel investigations and, most of all, well-designed standardized protocols are needed for obtaining original, comparable, and sustainable results in this field of adjuvant GDM treatment.
In the twenty-first century, GDM poses a significant challenge to health care professionals. The short- and long-term effects of successfully controlling GDM are important for both the mother and the fetus. This chapter provided data related to proposed pharmacological treatment options for GDM, further evaluating each therapy’s unique characteristics, benefits, and drawbacks in comparison with the alternatives. Most guidelines recommend oral pharmacological therapy, such as glyburide and metformin, and it is now widely used, with data on efficacy and safety. They can both be used as the first-line option; however, metformin appears to be preferable to glyburide in terms of newborn and maternal outcomes, while it is associated with a higher incidence of failure to achieve appropriate glycemic control. Analogs such as detemir, aspart, and lispro, which have been thoroughly proved for their safety and efficacy during pregnancy, are indicated as first-line therapy or when oral medication fails to achieve optimal glucose control. Glargine can be used during pregnancy, while there is not as much data to back it up as there is for other long-acting analogs and human insulins.
Therefore, the pharmacological treatment for GDM should be adapted to the patient’s characteristics, glycemic profile, and preferences, as well as local professional body guidelines. While insulin has typically been used to treat GDM, both metformin and glyburide may be used, but patients should be informed about the risks and advantages.
Pharmacotherapy of GDM is still under investigation, even though much is known about GDB itself. We can witness that the molecular understanding of GMB has been constantly translated to more efficacious and safer therapeutic options. Still, we expect that coordinated and well-focused basic and clinical investigations will provide even more precise information regarding future choices for prevention and adequate, as well as timely treatment of GDM.
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Herein, we point out pieces of evidence revealing the primary molecular mechanisms involved with impairment of neutrophil functions in diabetes, with relationship with high susceptibility to bacterial infections.",book:{id:"8798",slug:"cells-of-the-immune-system",title:"Cells of the Immune System",fullTitle:"Cells of the Immune System"},signatures:"Daniella Insuela, Diego Coutinho, Marco Martins, Maximiliano Ferrero and Vinicius Carvalho",authors:[{id:"296748",title:"Dr.",name:"Vinicius",middleName:null,surname:"Carvalho",slug:"vinicius-carvalho",fullName:"Vinicius Carvalho"},{id:"303254",title:"Dr.",name:"Daniella",middleName:null,surname:"Insuela",slug:"daniella-insuela",fullName:"Daniella Insuela"},{id:"303255",title:"Dr.",name:"Diego",middleName:null,surname:"Coutinho",slug:"diego-coutinho",fullName:"Diego Coutinho"},{id:"303256",title:"Dr.",name:"Maximiliano",middleName:null,surname:"Ferrero",slug:"maximiliano-ferrero",fullName:"Maximiliano Ferrero"},{id:"303257",title:"Dr.",name:"Marco Aurelio",middleName:null,surname:"Martins",slug:"marco-aurelio-martins",fullName:"Marco Aurelio Martins"}]},{id:"42857",doi:"10.5772/53035",title:"Atherosclerosis and Current Anti-Oxidant Strategies for Atheroprotection",slug:"atherosclerosis-and-current-anti-oxidant-strategies-for-atheroprotection",totalDownloads:3106,totalCrossrefCites:4,totalDimensionsCites:6,abstract:null,book:{id:"3396",slug:"current-trends-in-atherogenesis",title:"Current Trends in Atherogenesis",fullTitle:"Current Trends in Atherogenesis"},signatures:"Luigi Fabrizio Rodella and Gaia Favero",authors:[{id:"118762",title:"Prof.",name:"Luigi Fabrizio",middleName:null,surname:"Rodella",slug:"luigi-fabrizio-rodella",fullName:"Luigi Fabrizio Rodella"},{id:"160911",title:"Dr.",name:"Gaia",middleName:null,surname:"Favero",slug:"gaia-favero",fullName:"Gaia Favero"}]},{id:"42907",doi:"10.5772/54636",title:"MicroRNAome of Vascular Smooth Muscle Cells: Potential for MicroRNA-Based Vascular Therapies",slug:"micrornaome-of-vascular-smooth-muscle-cells-potential-for-microrna-based-vascular-therapies",totalDownloads:1820,totalCrossrefCites:2,totalDimensionsCites:4,abstract:null,book:{id:"3396",slug:"current-trends-in-atherogenesis",title:"Current Trends in Atherogenesis",fullTitle:"Current Trends in Atherogenesis"},signatures:"Kasturi Ranganna, Omana P. Mathew, Shirlette G. Milton and Barbara E. Hayes",authors:[{id:"63103",title:"Dr.",name:"Katsuri",middleName:null,surname:"Ranganna",slug:"katsuri-ranganna",fullName:"Katsuri Ranganna"}]},{id:"71468",doi:"10.5772/intechopen.91730",title:"Multiplex Technology for Biomarker Immunoassays",slug:"multiplex-technology-for-biomarker-immunoassays",totalDownloads:663,totalCrossrefCites:4,totalDimensionsCites:4,abstract:"The simultaneous measurement of different substances from a single sample is an emerging area for achieving efficient and high-throughput detection in several applications. Although immunoanalytical techniques are established and advantageous over alternative screening analytical platforms, one of the challenges for immunoassays is multiplexing. While ELISA is still commonly used to characterise a single analyte, laboratories and organisations are moving towards multiplex immunoassays. The validation of novel biomarkers and their amalgamation into multiplex immunoassays confers the prospects of simultaneous measurement of multiple analytes in a single sample, thereby minimising cost, time and sample. Therefore, the technological advancement in clinical sciences is helpful in the identification of analytes or biomarkers in test samples. However, the analytical bioanalysers are expensive and capable of detecting only a small amount or type of analytes. The simultaneous measurement of different substances from a single sample called multiplexing has become increasingly important for the quantification of pathological or toxicological samples. Although multiplex assays have many advantages over conventional assays, there are also problems that may cause apprehension among clinicians and researchers. Hence, many challenges still remain for these multiplexing systems which are at early stages of development.",book:{id:"8959",slug:"innate-immunity-in-health-and-disease",title:"Innate Immunity in Health and Disease",fullTitle:"Innate Immunity in Health and Disease"},signatures:"Haseeb Ahsan and Rizwan Ahmad",authors:[{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad"},{id:"412254",title:"Dr.",name:"Haseeb",middleName:null,surname:"Ahsan",slug:"haseeb-ahsan",fullName:"Haseeb Ahsan"}]},{id:"78026",doi:"10.5772/intechopen.99541",title:"Immune System of Fish: An Evolutionary Perspective",slug:"immune-system-of-fish-an-evolutionary-perspective",totalDownloads:319,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"Fishes are the most successful and diverse group of vertebrate animals, first appeared during Devonian period. Despite of certain differences, the immune system of fish is physiologically similar to that of higher vertebrates. The heterogenous group of fishes are the apparent link between innate immunity and the first appearance of the adaptive immune response. Importantly, fishes have immune organs homologous to that of mammalian immune system. In comparison to higher vertebrates, fishes live free in their environment from the early embryonic stage and during that time mostly they are dependent on non-specific immune system for their survival. In the fishes, non-specific immunity is the fundamental defense mechanism, therewith acquired immunity also plays key role in maintaining homeostasis by activation though a system of receptors proteins, which identify pathogen associated molecular pattern typical of pathogenic microorganism includes lipopolysaccharides, peptidoglycans, DNA, RNA and other molecules that are typically not present on the surface of multicellular organism. There are several external factors like environmental factors, biological factors, stress and internal factors like genetic makeup, age and sex, maternal effect etc. can affect immunological defense capabilities of the fishes.",book:{id:"9848",slug:"antimicrobial-immune-response",title:"Antimicrobial Immune Response",fullTitle:"Antimicrobial Immune Response"},signatures:"Sujata Sahoo, Husne Banu, Abhinav Prakash and Gayatri Tripathi",authors:[{id:"416237",title:"Associate Prof.",name:"Sujata",middleName:null,surname:"Sahoo",slug:"sujata-sahoo",fullName:"Sujata Sahoo"},{id:"416634",title:"Mrs.",name:"Husne",middleName:null,surname:"Banu",slug:"husne-banu",fullName:"Husne Banu"},{id:"416636",title:"Mr.",name:"Abhinav",middleName:null,surname:"Prakash",slug:"abhinav-prakash",fullName:"Abhinav Prakash"},{id:"416637",title:"Dr.",name:"Gayatri",middleName:null,surname:"Tripathi",slug:"gayatri-tripathi",fullName:"Gayatri Tripathi"}]}],mostDownloadedChaptersLast30Days:[{id:"70362",title:"Resident Memory T Cells",slug:"resident-memory-t-cells",totalDownloads:948,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Until recently, T cells were thought to remain in circulation until recruitment of the inflammation and only a small number of T cells remained in the peripheral tissues without inflammation. However, studies have found that a group of T cells settled in the tissues and remained there for a long time. Those cells are named as tissue-resident memory T cells (TRM). TRM cells are transcriptionally, phenotypically, and functionally distinct from other T cells, which recirculate between blood, secondary lymphoid organs, and non-lymphoid tissues. They undergo a distinct proliferation that discriminates them from circulating T cells and their main cell surface markers are CD69, CD103, and CD49a. Upon exposure to the same or similar diseases, TRM cells provide a first line of adaptive cellular defense against infection in peripheral non-lymphoid tissues, such as skin, lungs, digestive, and urogenital tracts. This approach forms the basis of a novel vaccination strategy called “prime and pull”, which ensures long-term local immunity. On the other hand, abnormal activated and malignant TRM may contribute to numerous human inflammatory diseases such as psoriasis and vitiligo. Here in this chapter, we aimed to emphasize TRM cell location, migration, phenotypic structure, maintenance, and diseases associated with TRM cells.",book:{id:"8798",slug:"cells-of-the-immune-system",title:"Cells of the Immune System",fullTitle:"Cells of the Immune System"},signatures:"Hasan Akbaba",authors:[{id:"260489",title:"Dr.",name:"Hasan",middleName:null,surname:"Akbaba",slug:"hasan-akbaba",fullName:"Hasan Akbaba"}]},{id:"71769",title:"Immune Dysfunction during Enteric Protozoal Infection: The Current Trends",slug:"immune-dysfunction-during-enteric-protozoal-infection-the-current-trends",totalDownloads:780,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Enteric protozoa usually cause severe morbidity and mortality in humans. Protozoal infections contribute to the high burden of infectious diseases. Despite recent advances in the epidemiology, diagnostic tool, molecular biology, and treatment of protozoan illnesses, gaps in knowledge still exist; hence, protozoal infections require further research. We are describing here some important enteric protozoal infections along with the immune dysfunction produced by them. Genus- 1. Entamoeba; 2. Giardia; 3. Cryptosporidium; 4. Cyclospora; 5. Cystoisospora; 6. Dientamoeba; 7. Blastocystis; 8. Balantidium.",book:{id:"8959",slug:"innate-immunity-in-health-and-disease",title:"Innate Immunity in Health and Disease",fullTitle:"Innate Immunity in Health and Disease"},signatures:"Renu Kumari Yadav, Shalini Malhotra and Nandini Duggal",authors:[{id:"176430",title:"Dr.",name:"Shalini",middleName:null,surname:"Malhotra",slug:"shalini-malhotra",fullName:"Shalini Malhotra"},{id:"315666",title:"Dr.",name:"Renu",middleName:null,surname:"Kumari Yadav",slug:"renu-kumari-yadav",fullName:"Renu Kumari Yadav"}]},{id:"69233",title:"Innate Immune Defense in the Male Reproductive System and Male Fertility",slug:"innate-immune-defense-in-the-male-reproductive-system-and-male-fertility",totalDownloads:799,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"To protect the male germ cells from adverse immune reaction, the male reproductive system adopts special immune environment such as immunoprivileged status. The male genital organs can be infected by various microorganisms via hematogenous dissemination and ascending genitourinary tracts. To overcome the immunoprivileged status, the male genital organs also adopt their own innate defense against microbial infection. The tissue-specific cells in the male reproductive system are well equipped with innate immune machineries, including pattern recognition receptors (PRRs) and their negatively regulatory system. PRR-initiated immune responses must be tightly regulated by the negative regulatory system for the maintenance of immune homeostasis. The immune homeostasis can be disrupted by unrestrictive innate immune response, which may lead to inflammatory conditions in the male genital tracts, an important etiological factor contributing to male infertility. This chapter describes the current understanding of the innate immune responses in the male reproductive system and their effects on male fertility.",book:{id:"8959",slug:"innate-immunity-in-health-and-disease",title:"Innate Immunity in Health and Disease",fullTitle:"Innate Immunity in Health and Disease"},signatures:"Fei Wang, Ran Chen and Daishu Han",authors:[{id:"295978",title:"Dr.",name:"Daishu",middleName:null,surname:"Han",slug:"daishu-han",fullName:"Daishu Han"},{id:"303373",title:"Dr.",name:"Fei",middleName:null,surname:"Wang",slug:"fei-wang",fullName:"Fei Wang"},{id:"309874",title:"Dr.",name:"Ran",middleName:null,surname:"Chen",slug:"ran-chen",fullName:"Ran Chen"}]},{id:"71781",title:"Innate Immunity and Autoimmune Diseases",slug:"innate-immunity-and-autoimmune-diseases",totalDownloads:797,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The innate immune response is responsible for the initial defense against invading pathogens and signs of damage; in turn, it activates the adaptive immune response to result in highly specific and lasting immunity, mediated by the clonal expansion of antigen-specific B and T lymphocytes. Inflammation is the acute response to infection and tissue damage to limit aggression to the body. It is a complex reaction of vascularized tissues to infection, toxin exposure or cell injury that includes extravasation of plasma proteins and leukocytes. Paradoxically, uncontrolled and prolonged inflammation can result in secondary damage and the development of immune pathology in the host. The components of the innate immune system have recently been studied as responsible mechanisms in various chronic diseases such as diabetes mellitus, atherosclerosis, asthma and allergies, among others. Autoimmune disease is an attack on auto tissues by the adaptation of the immune system. In general, such diseases are characterized by autoantibodies and/or autoreactive lymphocytes directed at antigens against themselves. The innate immune system is often considered an effector of self-reactive lymphocytes, but also provides protection. Studies in mice with specific gene-directed mutations show that defects in innate immune system proteins may predispose to the development of a systemic lupus erythematosus-like syndrome (lupus) characterized by autoantibodies against double-stranded DNA (ds DNA) or nuclear components. This seems to be due to a failure in the removal of apoptotic cells or nuclear waste. These observations imply that the innate immune system has a general protective role against autoimmune disease. For example, in systemic diseases such as lupus, innate immunity is important in the elimination of nuclear antigens and, therefore, in the improvement of tolerance to B lymphocytes. Alternatively, in specific organ disorders such as type diabetes 1 o Crohn’s disease, the innate immune system can be protective by eliminating pathogens that trigger or exacerbate the disease or regulate the presentation of antigens for T lymphocytes. Discuss various disease models in which the innate immune system could provide a protective role, deficiencies in the regulation of B lymphocyte signaling through the antigen/receptor or in the clearance of lupus antigens, (dsDNA and nuclear proteins), can lead to a disease similar to lupus. The repertoire of B cells seems to be very biased toward self-activity, as, possibly, that of the T-cell. This tendency toward self-activity is not surprising because B and T cells are positively selected against highly conserved autoantigens.",book:{id:"8959",slug:"innate-immunity-in-health-and-disease",title:"Innate Immunity in Health and Disease",fullTitle:"Innate Immunity in Health and Disease"},signatures:"Marcela Catalina Fandiño Vargas",authors:[{id:"312253",title:"M.D.",name:"Marcela Catalina",middleName:null,surname:"Fandiño Vargas",slug:"marcela-catalina-fandino-vargas",fullName:"Marcela Catalina Fandiño Vargas"}]},{id:"69097",title:"Assessment of Immune Reconstitution Following Hematopoietic Stem Cell Transplantation",slug:"assessment-of-immune-reconstitution-following-hematopoietic-stem-cell-transplantation",totalDownloads:998,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potential curative treatment for both congenital and hematological malignancies. Immune reconstitution after allogeneic hematopoietic stem cell transplantation is implicated in successful transplant outcomes such as overall survival and relapse-free survival. The reconstitution of immune cell subsets after HSCT occurs in different phases at different time points encompassing pre-engraftment, engraftment, and post-engraftment. The recovery of innate cellular immunity with the appearance of monocytes, dendritic cells, and natural killer cells in peripheral blood correlates with initiation of cellular engraftment. The cellular adaptive immunity is characterized by both thymic-independent expansion of T cells infused with graft and thymus-dependent expansion of naïve T cells derived from donor stem cells. The humoral immunity consists of B-cell reconstitution, which consists primarily of transitional and naïve subsets with the recovery of memory B cells that occur much later. In this review, we highlight the factors affecting immune reconstitution, the reconstitution of innate and adaptive immunity, techniques to assess immune reconstitution, and ways to enhance it.",book:{id:"8798",slug:"cells-of-the-immune-system",title:"Cells of the Immune System",fullTitle:"Cells of the Immune System"},signatures:"Meenakshi Singh, Selma Z. D’Silva and Abhishweta Saxena",authors:[{id:"217471",title:"Dr.",name:"Selma",middleName:null,surname:"D\\'Silva",slug:"selma-d'silva",fullName:"Selma D\\'Silva"},{id:"267032",title:"Dr.",name:"Meenakshi",middleName:null,surname:"Singh",slug:"meenakshi-singh",fullName:"Meenakshi Singh"},{id:"310438",title:"Dr.",name:"Abhishweta",middleName:null,surname:"Saxena",slug:"abhishweta-saxena",fullName:"Abhishweta Saxena"}]}],onlineFirstChaptersFilter:{topicId:"1034",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:320,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:133,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:17,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"7",title:"Biomedical Engineering",doi:"10.5772/intechopen.71985",issn:"2631-5343",scope:"Biomedical Engineering is one of the fastest-growing interdisciplinary branches of science and industry. The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. This series is intended for doctors, engineers, and scientists involved in biomedical engineering or those wanting to start working in this field.",coverUrl:"https://cdn.intechopen.com/series/covers/7.jpg",latestPublicationDate:"June 25th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:12,editor:{id:"50150",title:"Prof.",name:"Robert",middleName:null,surname:"Koprowski",slug:"robert-koprowski",fullName:"Robert Koprowski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTYNQA4/Profile_Picture_1630478535317",biography:"Robert Koprowski, MD (1997), PhD (2003), Habilitation (2015), is an employee of the University of Silesia, Poland, Institute of Computer Science, Department of Biomedical Computer Systems. For 20 years, he has studied the analysis and processing of biomedical images, emphasizing the full automation of measurement for a large inter-individual variability of patients. Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:3,paginationItems:[{id:"7",title:"Bioinformatics and Medical Informatics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",isOpenForSubmission:!0,editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",slug:"slawomir-wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",biography:"Professor Sławomir Wilczyński, Head of the Chair of Department of Basic Biomedical Sciences, Faculty of Pharmaceutical Sciences, Medical University of Silesia in Katowice, Poland. His research interests are focused on modern imaging methods used in medicine and pharmacy, including in particular hyperspectral imaging, dynamic thermovision analysis, high-resolution ultrasound, as well as other techniques such as EPR, NMR and hemispheric directional reflectance. Author of over 100 scientific works, patents and industrial designs. Expert of the Polish National Center for Research and Development, Member of the Investment Committee in the Bridge Alfa NCBiR program, expert of the Polish Ministry of Funds and Regional Policy, Polish Medical Research Agency. Editor-in-chief of the journal in the field of aesthetic medicine and dermatology - Aesthetica.",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null},{id:"8",title:"Bioinspired Technology and Biomechanics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",isOpenForSubmission:!0,editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",slug:"adriano-andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",biography:"Dr. Adriano de Oliveira Andrade graduated in Electrical Engineering at the Federal University of Goiás (Brazil) in 1997. He received his MSc and PhD in Biomedical Engineering respectively from the Federal University of Uberlândia (UFU, Brazil) in 2000 and from the University of Reading (UK) in 2005. He completed a one-year Post-Doctoral Fellowship awarded by the DFAIT (Foreign Affairs and International Trade Canada) at the Institute of Biomedical Engineering of the University of New Brunswick (Canada) in 2010. Currently, he is Professor in the Faculty of Electrical Engineering (UFU). He has authored and co-authored more than 200 peer-reviewed publications in Biomedical Engineering. He has been a researcher of The National Council for Scientific and Technological Development (CNPq-Brazil) since 2009. He has served as an ad-hoc consultant for CNPq, CAPES (Coordination for the Improvement of Higher Education Personnel), FINEP (Brazilian Innovation Agency), and other funding bodies on several occasions. He was the Secretary of the Brazilian Society of Biomedical Engineering (SBEB) from 2015 to 2016, President of SBEB (2017-2018) and Vice-President of SBEB (2019-2020). He was the head of the undergraduate program in Biomedical Engineering of the Federal University of Uberlândia (2015 - June/2019) and the head of the Centre for Innovation and Technology Assessment in Health (NIATS/UFU) since 2010. He is the head of the Postgraduate Program in Biomedical Engineering (UFU, July/2019 - to date). He was the secretary of the Parkinson's Disease Association of Uberlândia (2018-2019). Dr. Andrade's primary area of research is focused towards getting information from the neuromuscular system to understand its strategies of organization, adaptation and controlling in the context of motor neuron diseases. 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Science",value:19,count:5}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:3},{group:"publicationYear",caption:"2021",value:2021,count:3},{group:"publicationYear",caption:"2020",value:2020,count:3},{group:"publicationYear",caption:"2019",value:2019,count:1},{group:"publicationYear",caption:"2018",value:2018,count:1}],authors:{paginationCount:229,paginationItems:[{id:"318170",title:"Dr.",name:"Aneesa",middleName:null,surname:"Moolla",slug:"aneesa-moolla",fullName:"Aneesa Moolla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/318170/images/system/318170.png",biography:"Dr. Aneesa Moolla has extensive experience in the diverse fields of health care having previously worked in dental private practice, at the Red Cross Flying Doctors association, and in healthcare corporate settings. She is now a lecturer at the University of Witwatersrand, South Africa, and a principal researcher at the Health Economics and Epidemiology Research Office (HE2RO), South Africa. Dr. Moolla holds a Ph.D. in Psychology with her research being focused on mental health and resilience. In her professional work capacity, her research has further expanded into the fields of early childhood development, mental health, the HIV and TB care cascades, as well as COVID. She is also a UNESCO-trained International Bioethics Facilitator.",institutionString:"University of the Witwatersrand",institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"419588",title:"Ph.D.",name:"Sergio",middleName:"Alexandre",surname:"Gehrke",slug:"sergio-gehrke",fullName:"Sergio Gehrke",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038WgMKQA0/Profile_Picture_2022-06-02T11:44:20.jpg",biography:"Dr. Sergio Alexandre Gehrke is a doctorate holder in two fields. The first is a Ph.D. in Cellular and Molecular Biology from the Pontificia Catholic University, Porto Alegre, Brazil, in 2010 and the other is an International Ph.D. in Bioengineering from the Universidad Miguel Hernandez, Elche/Alicante, Spain, obtained in 2020. In 2018, he completed a postdoctoral fellowship in Materials Engineering in the NUCLEMAT of the Pontificia Catholic University, Porto Alegre, Brazil. He is currently the Director of the Postgraduate Program in Implantology of the Bioface/UCAM/PgO (Montevideo, Uruguay), Director of the Cathedra of Biotechnology of the Catholic University of Murcia (Murcia, Spain), an Extraordinary Full Professor of the Catholic University of Murcia (Murcia, Spain) as well as the Director of the private center of research Biotecnos – Technology and Science (Montevideo, Uruguay). Applied biomaterials, cellular and molecular biology, and dental implants are among his research interests. He has published several original papers in renowned journals. In addition, he is also a Collaborating Professor in several Postgraduate programs at different universities all over the world.",institutionString:null,institution:{name:"Universidad Católica San Antonio de Murcia",country:{name:"Spain"}}},{id:"342152",title:"Dr.",name:"Santo",middleName:null,surname:"Grace Umesh",slug:"santo-grace-umesh",fullName:"Santo Grace Umesh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/342152/images/16311_n.jpg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"333647",title:"Dr.",name:"Shreya",middleName:null,surname:"Kishore",slug:"shreya-kishore",fullName:"Shreya Kishore",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333647/images/14701_n.jpg",biography:"Dr. Shreya Kishore completed her Bachelor in Dental Surgery in Chettinad Dental College and Research Institute, Chennai, and her Master of Dental Surgery (Orthodontics) in Saveetha Dental College, Chennai. She is also Invisalign certified. She’s working as a Senior Lecturer in the Department of Orthodontics, SRM Dental College since November 2019. She is actively involved in teaching orthodontics to the undergraduates and the postgraduates. Her clinical research topics include new orthodontic brackets, fixed appliances and TADs. She’s published 4 articles in well renowned indexed journals and has a published patency of her own. Her private practice is currently limited to orthodontics and works as a consultant in various clinics.",institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"323731",title:"Prof.",name:"Deepak M.",middleName:"Macchindra",surname:"Vikhe",slug:"deepak-m.-vikhe",fullName:"Deepak M. Vikhe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/323731/images/13613_n.jpg",biography:"Dr Deepak M.Vikhe .\n\n\t\n\tDr Deepak M.Vikhe , completed his Masters & PhD in Prosthodontics from Rural Dental College, Loni securing third rank in the Pravara Institute of Medical Sciences Deemed University. He was awarded Dr.G.C.DAS Memorial Award for Research on Implants at 39th IPS conference Dubai (U A E).He has two patents under his name. He has received Dr.Saraswati medal award for best research for implant study in 2017.He has received Fully funded scholarship to Spain ,university of Santiago de Compostela. He has completed fellowship in Implantlogy from Noble Biocare. \nHe has attended various conferences and CDE programmes and has national publications to his credit. His field of interest is in Implant supported prosthesis. Presently he is working as a associate professor in the Dept of Prosthodontics, Rural Dental College, Loni and maintains a successful private practice specialising in Implantology at Rahata.\n\nEmail: drdeepak_mvikhe@yahoo.com..................",institutionString:null,institution:{name:"Pravara Institute of Medical Sciences",country:{name:"India"}}},{id:"204110",title:"Dr.",name:"Ahmed A.",middleName:null,surname:"Madfa",slug:"ahmed-a.-madfa",fullName:"Ahmed A. Madfa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204110/images/system/204110.jpg",biography:"Dr. Madfa is currently Associate Professor of Endodontics at Thamar University and a visiting lecturer at Sana'a University and University of Sciences and Technology. He has more than 6 years of experience in teaching. His research interests include root canal morphology, functionally graded concept, dental biomaterials, epidemiology and dental education, biomimetic restoration, finite element analysis and endodontic regeneration. Dr. Madfa has numerous international publications, full articles, two patents, a book and a book chapter. Furthermore, he won 14 international scientific awards. Furthermore, he is involved in many academic activities ranging from editorial board member, reviewer for many international journals and postgraduate students' supervisor. Besides, I deliver many courses and training workshops at various scientific events. Dr. Madfa also regularly attends international conferences and holds administrative positions (Deputy Dean of the Faculty for Students’ & Academic Affairs and Deputy Head of Research Unit).",institutionString:"Thamar University",institution:null},{id:"210472",title:"Dr.",name:"Nermin",middleName:"Mohammed Ahmed",surname:"Yussif",slug:"nermin-yussif",fullName:"Nermin Yussif",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210472/images/system/210472.jpg",biography:"Dr. Nermin Mohammed Ahmed Yussif is working at the Faculty of dentistry, University for October university for modern sciences and arts (MSA). Her areas of expertise include: periodontology, dental laserology, oral implantology, periodontal plastic surgeries, oral mesotherapy, nutrition, dental pharmacology. She is an editor and reviewer in numerous international journals.",institutionString:"MSA University",institution:null},{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",biography:"Dr. Al Ostwani Alaa Eddin Omar received his Master in dentistry from Damascus University in 2010, and his Ph.D. in Pediatric Dentistry from Damascus University in 2014. Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. He is also a Member of the Reviewer Board of International Journal of Dental Medicine (IJDM), and the Indian Journal of Conservative and Endodontics since 2016.",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",country:{name:"India"}}},{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null},{id:"178412",title:"Associate Prof.",name:"Guhan",middleName:null,surname:"Dergin",slug:"guhan-dergin",fullName:"Guhan Dergin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178412/images/6954_n.jpg",biography:"Assoc. Prof. Dr. Gühan Dergin was born in 1973 in Izmit. He graduated from Marmara University Faculty of Dentistry in 1999. He completed his specialty of OMFS surgery in Marmara University Faculty of Dentistry and obtained his PhD degree in 2006. In 2005, he was invited as a visiting doctor in the Oral and Maxillofacial Surgery Department of the University of North Carolina, USA, where he went on a scholarship. Dr. Dergin still continues his academic career as an associate professor in Marmara University Faculty of Dentistry. He has many articles in international and national scientific journals and chapters in books.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178414",title:"Prof.",name:"Yusuf",middleName:null,surname:"Emes",slug:"yusuf-emes",fullName:"Yusuf Emes",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178414/images/6953_n.jpg",biography:"Born in Istanbul in 1974, Dr. Emes graduated from Istanbul University Faculty of Dentistry in 1997 and completed his PhD degree in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery in 2005. He has papers published in international and national scientific journals, including research articles on implantology, oroantral fistulas, odontogenic cysts, and temporomandibular disorders. Dr. Emes is currently working as a full-time academic staff in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery.",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"192229",title:"Ph.D.",name:"Ana Luiza",middleName:null,surname:"De Carvalho Felippini",slug:"ana-luiza-de-carvalho-felippini",fullName:"Ana Luiza De Carvalho Felippini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192229/images/system/192229.jpg",biography:null,institutionString:"University of São Paulo",institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"256851",title:"Prof.",name:"Ayşe",middleName:null,surname:"Gülşen",slug:"ayse-gulsen",fullName:"Ayşe Gülşen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256851/images/9696_n.jpg",biography:"Dr. Ayşe Gülşen graduated in 1990 from Faculty of Dentistry, University of Ankara and did a postgraduate program at University of Gazi. \nShe worked as an observer and research assistant in Craniofacial Surgery Departments in New York, Providence Hospital in Michigan and Chang Gung Memorial Hospital in Taiwan. \nShe works as Craniofacial Orthodontist in Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi, Ankara Turkey since 2004.",institutionString:"Univeristy of Gazi",institution:null},{id:"255366",title:"Prof.",name:"Tosun",middleName:null,surname:"Tosun",slug:"tosun-tosun",fullName:"Tosun Tosun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255366/images/7347_n.jpg",biography:"Graduated at the Faculty of Dentistry, University of Istanbul, Turkey in 1989;\nVisitor Assistant at the University of Padua, Italy and Branemark Osseointegration Center of Treviso, Italy between 1993-94;\nPhD thesis on oral implantology in University of Istanbul and was awarded the academic title “Dr.med.dent.”, 1997;\nHe was awarded the academic title “Doç.Dr.” (Associated Professor) in 2003;\nProficiency in Botulinum Toxin Applications, Reading-UK in 2009;\nMastership, RWTH Certificate in Laser Therapy in Dentistry, AALZ-Aachen University, Germany 2009-11;\nMaster of Science (MSc) in Laser Dentistry, University of Genoa, Italy 2013-14.\n\nDr.Tosun worked as Research Assistant in the Department of Oral Implantology, Faculty of Dentistry, University of Istanbul between 1990-2002. \nHe worked part-time as Consultant surgeon in Harvard Medical International Hospitals and John Hopkins Medicine, Istanbul between years 2007-09.\u2028He was contract Professor in the Department of Surgical and Diagnostic Sciences (DI.S.C.), Medical School, University of Genova, Italy between years 2011-16. \nSince 2015 he is visiting Professor at Medical School, University of Plovdiv, Bulgaria. \nCurrently he is Associated Prof.Dr. at the Dental School, Oral Surgery Dept., Istanbul Aydin University and since 2003 he works in his own private clinic in Istanbul, Turkey.\u2028\nDr.Tosun is reviewer in journal ‘Laser in Medical Sciences’, reviewer in journal ‘Folia Medica\\', a Fellow of the International Team for Implantology, Clinical Lecturer of DGZI German Association of Oral Implantology, Expert Lecturer of Laser&Health Academy, Country Representative of World Federation for Laser Dentistry, member of European Federation of Periodontology, member of Academy of Laser Dentistry. Dr.Tosun presents papers in international and national congresses and has scientific publications in international and national journals. He speaks english, spanish, italian and french.",institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"260116",title:"Dr.",name:"Mehmet",middleName:null,surname:"Yaltirik",slug:"mehmet-yaltirik",fullName:"Mehmet Yaltirik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/260116/images/7413_n.jpg",biography:"Birth Date 25.09.1965\r\nBirth Place Adana- Turkey\r\nSex Male\r\nMarrial Status Bachelor\r\nDriving License Acquired\r\nMother Tongue Turkish\r\n\r\nAddress:\r\nWork:University of Istanbul,Faculty of Dentistry, Department of Oral Surgery and Oral Medicine 34093 Capa,Istanbul- TURKIYE",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"256417",title:"Associate Prof.",name:"Sanaz",middleName:null,surname:"Sadry",slug:"sanaz-sadry",fullName:"Sanaz Sadry",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256417/images/8106_n.jpg",biography:null,institutionString:null,institution:null},{id:"272237",title:"Dr.",name:"Pinar",middleName:"Kiymet",surname:"Karataban",slug:"pinar-karataban",fullName:"Pinar Karataban",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272237/images/8911_n.png",biography:"Assist.Prof.Dr.Pınar Kıymet Karataban, DDS PhD \n\nDr.Pınar Kıymet Karataban was born in Istanbul in 1975. After her graduation from Marmara University Faculty of Dentistry in 1998 she started her PhD in Paediatric Dentistry focused on children with special needs; mainly children with Cerebral Palsy. She finished her pHD thesis entitled \\'Investigation of occlusion via cast analysis and evaluation of dental caries prevalance, periodontal status and muscle dysfunctions in children with cerebral palsy” in 2008. She got her Assist. Proffessor degree in Istanbul Aydın University Paediatric Dentistry Department in 2015-2018. ın 2019 she started her new career in Bahcesehir University, Istanbul as Head of Department of Pediatric Dentistry. In 2020 she was accepted to BAU International University, Batumi as Professor of Pediatric Dentistry. She’s a lecturer in the same university meanwhile working part-time in private practice in Ege Dental Studio (https://www.egedisklinigi.com/) a multidisciplinary dental clinic in Istanbul. Her main interests are paleodontology, ancient and contemporary dentistry, oral microbiology, cerebral palsy and special care dentistry. She has national and international publications, scientific reports and is a member of IAPO (International Association for Paleodontology), IADH (International Association of Disability and Oral Health) and EAPD (European Association of Pediatric Dentistry).",institutionString:null,institution:null},{id:"202198",title:"Dr.",name:"Buket",middleName:null,surname:"Aybar",slug:"buket-aybar",fullName:"Buket Aybar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202198/images/6955_n.jpg",biography:"Buket Aybar, DDS, PhD, was born in 1971. She graduated from Istanbul University, Faculty of Dentistry, in 1992 and completed her PhD degree on Oral and Maxillofacial Surgery in Istanbul University in 1997.\nDr. Aybar is currently a full-time professor in Istanbul University, Faculty of Dentistry Department of Oral and Maxillofacial Surgery. She has teaching responsibilities in graduate and postgraduate programs. Her clinical practice includes mainly dentoalveolar surgery.\nHer topics of interest are biomaterials science and cell culture studies. She has many articles in international and national scientific journals and chapters in books; she also has participated in several scientific projects supported by Istanbul University Research fund.",institutionString:null,institution:null},{id:"172009",title:"Dr.",name:"Fatma Deniz",middleName:null,surname:"Uzuner",slug:"fatma-deniz-uzuner",fullName:"Fatma Deniz Uzuner",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/172009/images/7122_n.jpg",biography:"Dr. Deniz Uzuner was born in 1969 in Kocaeli-TURKEY. After graduating from TED Ankara College in 1986, she attended the Hacettepe University, Faculty of Dentistry in Ankara. \nIn 1993 she attended the Gazi University, Faculty of Dentistry, Department of Orthodontics for her PhD education. After finishing the PhD education, she worked as orthodontist in Ankara Dental Hospital under the Turkish Government, Ministry of Health and in a special Orthodontic Clinic till 2011. Between 2011 and 2016, Dr. Deniz Uzuner worked as a specialist in the Department of Orthodontics, Faculty of Dentistry, Gazi University in Ankara/Turkey. In 2016, she was appointed associate professor. Dr. Deniz Uzuner has authored 23 Journal Papers, 3 Book Chapters and has had 39 oral/poster presentations. She is a member of the Turkish Orthodontic Society. 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Fungal infectious illness prevalence and prognosis are determined by the exposure between fungi and host, host immunological state, fungal virulence, and early and accurate diagnosis and treatment. \r\nPatients with both congenital and acquired immunodeficiency are more likely to be infected with opportunistic mycosis. Fungal infectious disease outbreaks are common during the post- disaster rebuilding era, which is characterised by high population density, migration, and poor health and medical conditions.\r\nSystemic or local fungal infection is mainly associated with the fungi directly inhaled or inoculated in the environment during the disaster. The most common fungal infection pathways are human to human (anthropophilic), animal to human (zoophilic), and environment to human (soilophile). Diseases are common as a result of widespread exposure to pathogenic fungus dispersed into the environment. \r\nFungi that are both common and emerging are intertwined. In Southeast Asia, for example, Talaromyces marneffei is an important pathogenic thermally dimorphic fungus that causes systemic mycosis. Widespread fungal infections with complicated and variable clinical manifestations, such as Candida auris infection resistant to several antifungal medicines, Covid-19 associated with Trichoderma, and terbinafine resistant dermatophytosis in India, are among the most serious disorders. \r\nInappropriate local or systemic use of glucocorticoids, as well as their immunosuppressive effects, may lead to changes in fungal infection spectrum and clinical characteristics. Hematogenous candidiasis is a worrisome issue that affects people all over the world, particularly ICU patients. CARD9 deficiency and fungal infection have been major issues in recent years. Invasive aspergillosis is associated with a significant death rate. Special attention should be given to endemic fungal infections, identification of important clinical fungal infections advanced in yeasts, filamentous fungal infections, skin mycobiome and fungal genomes, and immunity to fungal infections.\r\nIn addition, endemic fungal diseases or uncommon fungal infections caused by Mucor irregularis, dermatophytosis, Malassezia, cryptococcosis, chromoblastomycosis, coccidiosis, blastomycosis, histoplasmosis, sporotrichosis, and other fungi, should be monitored. \r\nThis topic includes the research progress on the etiology and pathogenesis of fungal infections, new methods of isolation and identification, rapid detection, drug sensitivity testing, new antifungal drugs, schemes and case series reports. 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International Union of Microbiological Societies (IUMS) Fellow, and International Emerging Infectious Diseases (IEID) Fellow, Centers for Diseases Control and Prevention (CDC), Atlanta, USA. Diploma of Dermatological Scientist, Japanese Society for Investigative Dermatology. Ph.D. of Juntendo University, Japan. Bachelor’s and Master’s degree, Medicine, West China University of Medical Sciences. Chair of Sichuan Medical Association Dermatology Committee. General Secretary of The 19th Annual Meeting of Chinese Society of Dermatology and the Asia Pacific Society for Medical Mycology (2013). In charge of the Annual Medical Mycology Course over 20-years authorized by National Continue Medical Education Committee of China. Member of the board of directors of the Asia-Pacific Society for Medical Mycology (APSMM). Associate editor of Mycopathologia. Vice-chief of the editorial board of Chinses Journal of Mycology, China. 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