\r\n\t- BMD measurement technology
\r\n\t- Osteoporosis and fracture risk
\r\n\t- Bone growth and remodeling
\r\n\r\n\t
\r\n\tThe submission is also open to any other original study related to these research topics.
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Introduction
Sjögren’s syndrome (SS) is a chronic, autoimmune, systemic, inflammatory disease that develops as a result of lymphocytic infiltration, destruction and dysfunction of the exocrine glands, and the lacrimal and salivary glands in particular. In 1933, Swedish ophthalmologist Henrik Sjögren described the clinical and histological findings associated with SS in 19 patients with rheumatoid arthritis, 13 of whom had dry mouth and dry eye symptoms [1]. SS predominantly affects middle-aged women who are within the fourth to sixth decade of their lives. The male/female ratio in patients with SS is approximately 6:1 to 9:1. SS is usually diagnosed in the fifth decade of life, but the first symptoms may appear years before diagnosis [2]. The incidence and prevalence rates of SS were estimated approximately as 6.92 cases per 100.000 persons/year and as 60.82 cases per 100.000 persons, respectively [3]. Geographical location and ethnicity have a strong influence on the biological and clinical phenotype of the disease. The onset of diagnosis of Sjogren syndrome and the gender preference may be affected by racial variation: the diagnosis can be accomplished up to 7 years earlier in patients of black/African American origins compared to Caucasians. Furthermore, the female to male ratio might reach 27:1 in patients of Asian descent [4]. There are two types of SS; first type, that is the primary SS, is the type without any concomitant connective tissue disorder, whereas the second type, that is the secondary SS, is the type observed together with other autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) or systemic sclerosis (SSc). SS is characterized by a wide spectrum of signs and symptoms, ranging from glandular involvement, structural symptoms, extraglandular manifestations and systemic autoimmune features. SS can be seen in association with both joint and muscle manifestations, including arthralgia and arthritis, as well as myopathy, which is usually asymptomatic. SS mostly involves the bone, the synovium and the cartilage tissue [5].
2. Pathogenesis
The etiology and pathogenesis of SS has not been clarified, as is the case with other autoimmune diseases [6]. Until now, it has been widely accepted that environmental factors play a role in the pathogenesis of SS [7]. Nevertheless, a thorough review of the recently published studies available in the literature revealed that the complex interaction between epithelial cells and targets of the autoimmune response and genetic and epigenetic changes also play a role in the pathogenesis of SS, in addition to the activated innate and adaptive immune system [8, 9].
The genetic component of SS are yet to shed light on. However, recent studies have begun to elucidate the familial links of the disease, identify specific risk alleles, and even classify patients according to their global gene expression levels. In these studies, many risk alleles for SS have been highlighted. Identification of these risk alleles helps in early diagnosis and choice of treatment options. Patients with extra-glandular manifestations (EGM) were found to have higher expression of genes involved in innate (apoptosis, TLR and interferon signaling) and adaptive (T and B cell activation) immune responses that play a key role in SS. On the other hand, patients with glandular features (GF) and diffuse pain (WP) were found to have the highest differential gene expression related to sensory perception and pain [10]. In complex diseases such as SS, the on and off signals of gene expression related to inflammatory pathways are managed by epigenetic mechanisms. Several epigenetic mechanisms, i.e., DNA methylation, miRNAs, and lncRNAs, contribute to turning on and off the expression of genes involved in inflammatory pathways and may target amelioration of SS therapy [11].
Considerable efforts have been made to elucidate the role of the innate immune system in the pathogenesis of SS. Plasmacytoid dendritic cells (pDC) are the predominant type I interferon (IFN) producing cells. The transcriptional profile of SS plasmacytoid dendritic cells (pDCs) has been investigated and interestingly, it was found to be associated with enhanced cytokine production of pDCs. TLR7 dominant innate immunity may be associated with the development of sialadenitis in SS. Additionally, the few evidence supporting the role of TLR7-dominant innate immunity in the development of sialadenitis in SS [12].
The role of B and T cell subsets, particularly, of T follicular helper cells (Tfh) and of their regular counterparts, that is the T follicular regulatory cells (Tfr) cells, has been extensively investigated. The recent data on the subject revealed an increase in the proportion of Tfr and Tfh cells in SS patients as compared to the healthy control subjects, and an imbalance between proinflammatory and immune regulatory pathways in SS. Tertiary or ectopic lymphoid structures (TLS) are lymphoid clusters of T and B cells that form in non-lymphoid organs in response to chronic inflammation. TLS form in the target organ of autoimmune diseases, including SS, and is generally associated with worse disease progression. New insights into TLS formation and care are paving the way for new therapeutic approaches to SS [13].
3. Articular involvement
Most SS patients exhibit musculoskeletal symptoms such as arthralgia, myalgia, and morning stiffness. SS directly affects the peripheral joints, causing arthralgia in approximately 90% of the patients. Up to 17% arthritis incidence has been reported in SS patients. [14, 15]. Arthritis is often symmetrical, intermittent, non-erosive and does not leave deformity. SS mainly affects the metacarpophalangeal joints located in the upper extremity, particularly the metacarpophalangeal joints with non-erosive synovitis, but also affects the wrists, knees, shoulders, and metatarsophalangeal joints [16]. Clinical symptoms of SS are similar to those of rheumatoid arthritis (RA), with the exception of bone erosion, which is very rare in SS [17]. Joint symptoms associated with primary Sjögren’s syndrome (pSS) were reported as synovitis, which can mimic rheumatoid arthritis but were distinguished based on the absence of structural damage [18]. Joint involvement may precede the onset of SS in 10–20% of patients, but in a large amount of SS patients (40–50% of the cases) its onset is concurrent with the onset of sicca symptoms [19]. Ultrasonographic US imaging has proven to be of great value in identification of inflammatory synovitis and detection of erosions. Patients with SS were evaluated by ultrasonography(US), the prevalences of synovitis and erosion were found as 21.7% and 34.8%, respectively [20]. The incidence of synovitis in the metacarpophalangeal joints was found as 41.6% [21]. Additionally, a significant correlation was found between the ESSDAI scores of the SS patients whose disease activities were determined according to European League Against Rheumatism (EULAR) Sjogren’s Syndrome Disease Activity Index (ESSDAI) and the frequency of synovitis and tenosynovitis detected by US. Based on these findings, it has been suggested that US is a useful method in the evaluation of joint involvement in SS [22]. SS is a complex and heterogeneous disease and has pleomorphic symptoms that can manifest in many different ways [23]. Joint involvement was present in 31.4% of the diagnosed patients, and was manifested as the first symptom in 17% of the patients [24]. Joint involvement is also associated with the presence of many serological markers such as cryoglobulins characterized by extraglandular manifestations, hypergammaglobulinemia, rheumatoid factor (RF) and anti-Sjögren’s-syndrome-related antigen A (anti-SSA/Ro) or anti-Sjögren’s-syndrome-related antigen B (anti-SSB/La) antibodies [25]. Apart from RA, the highest percetange of RF positivity is seen in SS patients. Approximately 40% of the SS patients, and even a higher percentage if only the SS patients with joint involvement were considered, were found to have RF positivity [25]. Another serological marker associated with arthritic manifestations is anti-citrullinated protein antibodies (ACPAs). ACPAs were found in 5–10% of the SS patients. SS patients with ACPAs were found to have a higher incidence of arthritis than those without ACPAs (43.7% vs. 12.2%). In addition, during a follow-up period of 5–10 years, 43.8% of the SS patients with ACPAs were found to have developed RA [26]. SS patients with ACPAs had a higher tendency to have arthritis and were at a higher risk of developing RA [27]. Joint involvement such as arthralgia and arthritis negatively affects the quality of life in patients with SS [28], creating the need for pharmacological treatment or surgical intervention [29]. It has been emphasized that SS causes higher disease activity scores, which are expressed using scoring systems such as ESSDAI, due to joint involvement, and that joint involvements an important clinical feature in predicting long-term disease outcome in SS [30]. Arthritic manifestations of the SS are mild, but course of SS in association with other diseases varies greatly. However, it is still unclear whether this variation is due to any change directly associated with SS or the combined effect of the disorders accompanying SS. Findings that prove the association of SS with other autoimmune diseases have been demonstrated by epidemiological and genetic studies. SS was accompanied by RA and SLE in 19.5% and 13.6% of the patients, respectively [31]. There are also studies that revealed an epigenetic relationship linking such diseases. In one of these studies, a gene-expression meta-analysis study in respect of RA, SLE and SS, a common gene-expression was identified for these diseases [32]. It is a common concern that such disease combinations will worsen joint problems and adversely affect the course of the disease. The frequency of RA and SS association and the effects of this association on the course of the disease and comorbid conditions, it was found that 31.2% of the RA patients were also diagnosed with SS, and that the coexistence of these two diseases led to higher disease burden, higher disease activity, higher number og comorbidities (hypertension, cardiovascular diseases, malignancy and infections) and a higher degree of erosive changes [33]. Therefore, type of SS, whether it is primary or secondary SS, should be carefully considered and it should be kept in mind that other autoimmune diseases, including RA, can accompany SS during the course of the disease. Thus, the attending clinician should be able to also characterize these other patient populations.
4. Muscles
Muscle pain has been reported in approximately 45–50% of the patients with SS [34]. A thorough literature review reveals that a mild inflammatory myopathy with subclinical or insidious onset has been observed in SS. Generally, this condition manifests itself as muscle pain and proximal muscle weakness. Histopathological examination was performed in SS patients with muscle pain, inflammation was found in 72% of the patients, and signs of degeneration/regeneration (i.e., histological findings of myositis) were found in 47% of the patients along with inflammation [35]. In that regard, it has been shown that although rare, inflammatory muscle diseases (particularly, inclusion body myositis and polymyositis) may be associated with SS. Accordingly, patients with more insidious onset muscle weakness and low muscle enzyme elevations in particular should be suspected of inflammatory muscle diseases. There are case reports, which argued that inflammatory muscle diseases and SS can progress together in patients with SS, and that the possible cause of the co-existence of these diseases is a common autoimmune pathway [36, 37]. Additionally, it was reported that cytosolic 5′-nucleotidase 1A, which is a specific marker for inclusion body myositis, can be detected in approximately 30% of the patients with SS [38]. Given this finding, SS patients with muscle weakness should also be screened for inflammatory muscle diseases.
5. Fibromyalgia and fatigue
Fibromyalgia (FM) is a common disease characterized by widespread chronic body pain, sleep disturbance, weakness, and mood disorders. One of the hypotheses put forward in respect of the formation of FM disease is chronic inflammation. It was reported in many studies that pro-inflammatory cytokines and mediators are higher in patients with FM than in general population [39]. Frequency of FM is high in rheumatic diseases such as ankylosing spondylitis and rheumatoid arthritis. One-third of FM patients (about 33%) with sicca syndrome and/or xerostomia tested positive for Sjögren’s syndrome biomarkers [40]. In parallel, association of FM with these autoimmune diseases is common. To give an example, in a recent study, in which the frequency of FM was investigated in patients with inflammatory arthritis (IA), it was found that frequency of FM in IA patients was found to be 15–20% more than the frequency of FM in general population [41]. When it comes to FM and SS, it is seen that these two diseases share common symptoms such as muscle aches, fatigue, and dry mouth and eyes, and there are many studies available in the literature that investigated the relationship between the two. In one of these studies, in which SS-related auto-antibodies in FM patients presented with dry mouth and/or dry eye complaints were investigated, SS biomarkers were found to be positive in 32% of the FM patients. It was suggested by the authors of the study that SS may play a role in the pathophysiology of FM [40]. The comorbidities and clinical symptoms of the two diseases largely overlap. To give a few examples; in a cross-sectional study conducted by Choi et al., which investigated the frequency and clinical effect of FM onpatients with SS, as well as FM frequency, disease activity scales such as Eular Sjogren’s Syndrome Patient Reported Index (ESSPRI) and Eular Sjogren Syndrome Disease Activity Index (ESSDAI), and depression in patients with pSS, FM was detected in 31% of the SS patients, and both ESSPRI and ESSDAI scores and depression scores were found to be higher in patients who have both SS with FM, as compared to patients without FM [42]; and in a very recent population-based retrospective-cohort study conducted with 149.706 participants, in which the future risk of developing SS in patients with FM was investigated, patients with FM were found to have a higher risk of developing SS as compared to the control subjects without FM [43]. Given the results of these studies, which suggest that the relationship between SS and FM affects the disease activity and diagnosis, clinicians should consider the two-way relationship between SS and FM in the management of SS or FM. Fatigue is one of the most common symptoms of both SS and FM. The pathophysiology in SS is not fully understood. Patients with SS suffer from sleep disorders as they feel the urge to drink excess water due to dry mouth resulting in sleep disruptions. Fatigue in patients with SS has been associated with the coexistence of sleep disorders and FM. The pathophysiology in SS is not fully understood. Patients with SS suffer from sleep disorders, since they feel the urge to drink excess water due to dry mouth. Fatigue in patients with SS has been associated in the literature with the coexistence of sleep disorders and FM. To give an example; ina large cohort study conducted with 437 patients with pSS, it was found that patients with both FM and pSS manifested significantly more structural, fatigue, and arthralgia symptoms than patients with only pSS [44]. The presence of such symptoms substantially impairs the quality of life in patients with SS. As a matter of fact, it was concluded as a result of a cross-sectional study conducted using questionnaires to measure quality of life of patients with SS that the main determinants of the poor quality of life in patients with SS were pain and fatigue, and that disease activity scores were higher in patients with a high incidence of the said symptoms [45]. For this reason, sleep quality of SS patients should be improved against the symptom of fatigue, which is very common in patients with SS. In addition, in the event that SS accompanied by FM, disease management should be adjusted accordingly.
6. Bones
SS impairs the bone metabolism not just because it is a systemic autoimmune disease, but also because of some other factors associated with SS such as interstitial nephritis, renal tubular acidosis, steroid use, coexistence with other autoimmune diseases, and low vitamin D levels. As is the case with other autoimmune diseases, SS also causes osteoporosis (OP) and osteomalacia (OM). SS plays a role in metabolic bone diseasesby causing variations in the signaling pathways of the Wingless-type (Wnt) and Nf-κB receptor activating factor (RANK), its ligand (RANKL) and osteoprotegerin (OPG) [46]. It has been reported in the pathophysiological studies conducted on the aforementioned signaling pathways that autoimmune diseases such as SS inhibits bone formation, since it reduces the levels of DKK1 (Dickkopf-related protein 1), a protein which is involved in the Wnt pathway and plays a role in bone formation. In addition, it has been shown that the RANKL/RANK/OPG signaling pathway, which features the main osteogenic factors and plays an important role in bone homeostasis, is activated in many autoimmune diseases, and it has been suggested that this leads to bone destruction [47, 48]. Furthermore, the Wnt/b-catenin signaling pathway plays a key role also in the development and regulation of the immune system, in addition to organogenesis and morphogenesis of the exocrine gland. In that regard, it was found in a study by Fernandez-Torres et al. on the genetic polymorphisms of the Wnt/b-catenin signaling pathway in SS patients that some genes associated with the Wnt/b-catenin signaling pathway, such as LRP5 (low-density lipoprotein receptor-related protein 5), FRZB (frizzled related protein), and ADIPOQ (adiponectin), significantly increase the risk of developing SS [49]. In another study, in which impaired bone metabolism in SS was investigated, osteoporosis/osteopenia was detected in ⅔ (two-thirds) of the SS patients. In the same study, it has been shown that DKK1, one of the Wnt signal mediators, was low in SS patients and that this low level is associated with a decrease in bone mineral density, suggesting that Wnt signaling mediators are potentially involved in the pathogenesis of SS [50]. In a case-control study conducted by Pasoto et al. with 71 SS patients and 71 healthy control subjects of matching age, sex, and race, study participants were screened for bone mineral density (BMD), vertebral fracture (VF), and bone microarchitecture (by means of high-resolution peripheral quantitative computer tomography (HR-pQCT)). Consequentially, as compared to the healthy control subjects, it was found that patients with SS had lower mean BMD values in both hip and lumbar vertebrae, and less cortical bone thickness, and that a higher frequency of SS patients (approximately 20% of the SS patients) had VF and significantly impaired bone microarchitecture [51]. Additionally, in the same study, HR-pQCT revealed significant cortical deterioration in SS patients. However, the final assessment on the primary causative factor for osteoporosis (OP) could not be made, due to the fact that all SS patients were on corticosteroid therapy at the time of the study. There is a significant relationship between corticosteroid use and the development of OP. In a recent large-scale cross-sectional study, in which the frequency of OP, risk factors and fragility fractures were investigated in relation to SS, a significant correlation was found between the development of OP and factors such as age, duration of disease, corticosteroid use, presence of anti-La antibodies and ESSDAI scores in patients with SS. Up to 8.5% of the patients with SS were found to have fragility fractures, and a significant correlation was observed between the SS disease duration and age, ESSDAI scores and fragility fracture [52]. Osteomalacia (OM) is a disease characterized by impaired bone mineralization. The development of OM in SS patients has been associated with tubulointerstitial nephritis (TIN) or distal renal tubular acidosis (dRTA). There areseveral studies available in the literature to that effect thathighlight the effect of TIN and dRTA in patients with SS and its contribution to the development of osteomalacia [53, 54]. Patients with OM are susceptible to pseudo-fractures. Therefore, diagnosis of OM in patients with SS is very important. It is not yet known whether these findings can be directly attributed to the relationship between SS, OP and OM, pathophysiologically. Nevertheless, the direct clinical relevance between these conditions should not be overlooked. The exact mechanism of the effect of SS on bone metabolism has not been determined, but it is obvious that there is a relationship, albeit an indirect one. The part which is not yet clear is whether it is the SS itself or the drugs used for the treatment of SS or the target organs affected in relation thereto are the main factors creating the said effect.
7. Available therapeutic options with possible benefit in musculoskeletal disease
There is no curative treatment for SS, thus the aim in the treatment of SS is to alleviate the symptoms of exocrinopathy and also to get the extraglandular manifestations of the disease under control. Management of SS patients requires a multidisciplinary approach involving collaboration with specialist doctors from different specializations, such as clinical immunologists, rheumatologists, ophthalmologists, otolaryngologists and/or dentists. Centers such as The Sjögren’s Foundation, The British Society for Rheumatology, and EULAR publish guidelines for the management of SS [55, 56, 57]. Nevertheless, no specific therapeutic goal other than symptomatic relief has been put forward in these guidelines. Fatigue, one of the major symptoms targeted to be relieved by the treatment modalities used for the treatment of SS, is a symptom that significantly impairs quality of life in patients with SS. However, the effectiveness of the current medical treatments used to contain this symptom is still not up to the level. Available guidelines suggest regular physical activity as the best approach to improve fatigue [56, 57]. Hydroxychloroquine (HCQ) is usually recommended as the first-line treatment for musculoskeletal pain relief. On the other hand, methotrexate (MTX) is recommended to be used as a stand-alone medication or in combination with HCQ in patients who do not respond to HCQ, and particularly in those with severe inflammatory arthritis [56]. In cases where the combination of HCQ and MTX has proven ineffective in the treatment of inflammatory musculoskeletal symptoms, alternative options such as use of corticosteroids, leflunomide, sulfasalazine, azathioprine, cyclosporine, or biologic drugs may be considered [55, 57].
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SS can be seen in association with both joint and muscle manifestations, including arthralgia and arthritis, as well as myopathy, which is usually asymptomatic. Besides, it may include bone metabolic disorders, fatigue and fibromyalgia. The diagnosis of Sjögren’s syndrome is based on characteristic clinical signs and symptoms. The etiology and pathogenesis of SS is elusive and has not yet been clarified. There is no curative treatment for SS, thus the aim in the treatment of SS is to alleviate the symptoms.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/79798",risUrl:"/chapter/ris/79798",signatures:"Ridvan İşik and Ferhat Ege",book:{id:"11033",type:"book",title:"Sjögren’s Syndrome",subtitle:null,fullTitle:"Sjögren’s Syndrome",slug:null,publishedDate:null,bookSignature:"Prof. Reem Hamdy A. Mohammed",coverURL:"https://cdn.intechopen.com/books/images_new/11033.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:null,printIsbn:"979-953-307-X-X",pdfIsbn:null,isAvailableForWebshopOrdering:!0,editors:[{id:"36290",title:"Prof.",name:"Reem Hamdy A.",middleName:null,surname:"Mohammed",slug:"reem-hamdy-a.-mohammed",fullName:"Reem Hamdy A. Mohammed"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Pathogenesis",level:"1"},{id:"sec_3",title:"3. Articular involvement",level:"1"},{id:"sec_4",title:"4. Muscles",level:"1"},{id:"sec_5",title:"5. Fibromyalgia and fatigue",level:"1"},{id:"sec_6",title:"6. Bones",level:"1"},{id:"sec_7",title:"7. Available therapeutic options with possible benefit in musculoskeletal disease",level:"1"}],chapterReferences:[{id:"B1",body:'[Henrik S. Zur Kenntnis der keratoconjunctivitis sicca. 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Gene expression profiles in primary Sjögren’s syndrome with and without systemic manifestations. ACR Open Rheumatology. 2019;1:603-613]'},{id:"B11",body:'[Imgenberg-kreuz J, AlmlÖF JC, Leonard D, et al. Shared and unique patterns of DNA methylation in systemic lupus erythematosus and primary Sögren’s syndrome. Frontiers in Immunology. 2019;10:1686]'},{id:"B12",body:'[Davıes R, Sarkar I, Hammenfors D, et al. Single cell based phosphorylation profiling identifies alterations in toll-like receptor 7 and 9 signaling in patients with primary Sjögren’s syndrome. Frontiers in Immunology. 2019;10:281]'},{id:"B13",body:'[Luo S, Zhu R, Yu T, et al. Chronic inflammation: A common promoter in tertiary lymphoid organ neogenesis. Frontiers in Immunology. 2019;10:2938]'},{id:"B14",body:'[Baldini C, Pepe P, Quartuccio L, et al. Primary Sjogren\'s syndrome as a multi-organ disease: Impact of the serological profile on the clinical presentation of the disease in a large cohort of Italian patients. Rheumatology (Oxford, England). 2014;53(5):839-844]'},{id:"B15",body:'[Ramos-Casals M, Brito-Zerón P, Solans R, et al. Systemic involvement in primary Sjogren\'s syndrome evaluated by the EULAR-SS disease activity index: Analysis of 921 Spanish patients (GEAS-SS Registry). Rheumatology (Oxford, England). 2014;53(2):321-331]'},{id:"B16",body:'[Amezcua-Guerra LM, Hofmann F, Vargas A, et al. Joint involvement in primary Sjögren\'s syndrome: An ultrasound "target area approach to arthritis". BioMed Research International. 2013;2013:640265]'},{id:"B17",body:'[Jacques T, Sudoł-Szopińska I, Larkman N, O\'Connor P, Cotten A. Musculoskeletal manifestations of non-RA connective tissue diseases: Scleroderma, systemic lupus erythematosus, Still\'s disease, dermatomyositis/polymyositis, sjögren\'s syndrome, and mixed connective tissue disease. Seminars in Musculoskeletal Radiology. 2018;22(2):166-179]'},{id:"B18",body:'[Mirouse A, Seror R, Vicaut E, et al. 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\\n"}]'},components:[{type:"htmlEditorComponent",content:'Copyright is the term used to describe the rights related to the publication and distribution of original Works. Most importantly from a publisher's perspective, copyright governs how Authors, publishers and the general public can use, publish, and distribute publications.
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\n\nAll Video Lectures under IntechOpen's production are subject to copyright and are property of IntechOpen, unless defined otherwise, and are licensed under the Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license. This grants all others the right to:
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\n\t- Distribution of remixed or transformed material building on the original termed derivatives is not permitted.
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\n\nUsers wishing to repost and share the Video Lectures are welcome to do so as long as they acknowledge the source in the following manner:
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\n\nAll software used on the IntechOpen platform, any used during the publishing process, and the copyright in the code constituting such software, is the property of IntechOpen or its software suppliers. As such, it may not be downloaded or copied without permission.
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It has played a vital role in human evolution and is an imperative constituent of a well-balanced diet. It is a good source of proteins, zinc, iron, selenium, and phosphorus followed by vitamin A and B-complex vitamins. Average value of meat protein is about 23% that varies from higher to lower value according to the type of meat source. Meat fat and its fatty acid profile is point to worry, with respect to its consumption, but its moderate usage is always advised by doctors and nutritionists, in order to lead a healthy life. Fat content of animal carcasses ranges between 8 and 20%. Quality traits of meat along with its nutritional composition become dependent upon animal breed type, feeding source (grains, pasture and grass), genetics of animal and post mortem techniques. This chapter will mainly focus on the variant aspects of nutritional constituents of meat including proteins and essential amino acids, fats and fatty acid profile, carbohydrates, vitamins and minerals along with their health benefits to human health.",book:{id:"6669",slug:"meat-science-and-nutrition",title:"Meat Science and Nutrition",fullTitle:"Meat Science and Nutrition"},signatures:"Rabia Shabir Ahmad, Ali Imran and Muhammad Bilal Hussain",authors:[{id:"235082",title:"Dr.",name:"Ali",middleName:null,surname:"Imran",slug:"ali-imran",fullName:"Ali Imran"},{id:"239057",title:"Dr.",name:"Rabia Shabir",middleName:null,surname:"Ahmad",slug:"rabia-shabir-ahmad",fullName:"Rabia Shabir Ahmad"},{id:"243634",title:"Mr.",name:"Muhammad Bilal",middleName:null,surname:"Hussain",slug:"muhammad-bilal-hussain",fullName:"Muhammad Bilal Hussain"}]},{id:"19983",doi:"10.5772/20101",title:"Dietary Effect of Soybean (Glycine max) Products on Gut Histology and Microbiota of Fish",slug:"dietary-effect-of-soybean-glycine-max-products-on-gut-histology-and-microbiota-of-fish",totalDownloads:4496,totalCrossrefCites:6,totalDimensionsCites:47,abstract:null,book:{id:"497",slug:"soybean-and-nutrition",title:"Soybean and Nutrition",fullTitle:"Soybean and Nutrition"},signatures:"Daniel L. Merrifield, Rolf Erik Olsen, Reidar Myklebust and Einar Ringø",authors:[{id:"37424",title:"Prof.",name:"Einar",middleName:null,surname:"Ringø",slug:"einar-ringo",fullName:"Einar Ringø"},{id:"37436",title:"Dr.",name:"Daniel",middleName:null,surname:"Merrifield",slug:"daniel-merrifield",fullName:"Daniel Merrifield"},{id:"91338",title:"Dr.",name:"Rolf Erik",middleName:null,surname:"Olsen",slug:"rolf-erik-olsen",fullName:"Rolf Erik Olsen"},{id:"91341",title:"Prof.",name:"Reidar",middleName:null,surname:"Myklebust",slug:"reidar-myklebust",fullName:"Reidar Myklebust"}]},{id:"60270",doi:"10.5772/intechopen.75961",title:"Antioxidants from Natural Sources",slug:"antioxidants-from-natural-sources",totalDownloads:4478,totalCrossrefCites:25,totalDimensionsCites:45,abstract:"Antioxidants are the defense system of the body against the damage of reactive oxygen species, which is normally produced during the various physiological processes in the body. There are various sources of these antioxidants like endogenous antioxidant present in the body and exogenous food source. In recent decades, alternate of synthetic food antioxidants by natural ones has fostered interest on vegetable sources and the screening of inexpensive raw materials particularly from the agriculture for identifying new antioxidants. Polyphenols are the significant plant compounds with antioxidant activity, though not the only ones. Some but not only restricted to biological properties such as anticarcinogenicity, antimutagenicity, antiallergenicity, and antiaging activity have been reported for natural and synthetic antioxidants. Among the sources of natural antioxidants, the most important are those coming from routinely consuming vegetables and fruits; however, antioxidant from other plant and agriculture waste should not be ignored.",book:{id:"6678",slug:"antioxidants-in-foods-and-its-applications",title:"Antioxidants in Foods and Its Applications",fullTitle:"Antioxidants in Foods and Its Applications"},signatures:"Haseeb Anwar, Ghulam Hussain and Imtiaz Mustafa",authors:[{id:"240684",title:"Dr.",name:"Haseeb",middleName:null,surname:"Anwar",slug:"haseeb-anwar",fullName:"Haseeb Anwar"},{id:"244522",title:"Dr.",name:"Ghulam",middleName:null,surname:"Hussain",slug:"ghulam-hussain",fullName:"Ghulam Hussain"},{id:"244523",title:"Ms.",name:"Jaweria",middleName:null,surname:"Nisar",slug:"jaweria-nisar",fullName:"Jaweria Nisar"},{id:"244524",title:"Mr.",name:"Imtiaz",middleName:null,surname:"Mustafa",slug:"imtiaz-mustafa",fullName:"Imtiaz Mustafa"}]},{id:"19751",doi:"10.5772/18808",title:"From Soybean Phytosterols to Steroid Hormones",slug:"from-soybean-phytosterols-to-steroid-hormones",totalDownloads:11647,totalCrossrefCites:19,totalDimensionsCites:39,abstract:null,book:{id:"496",slug:"soybean-and-health",title:"Soybean and Health",fullTitle:"Soybean and Health"},signatures:"Feng-Qing Wang, Kang Yao and Dong-Zhi Wei",authors:[{id:"32646",title:"Dr.",name:"Feng-Qing",middleName:null,surname:"Wang",slug:"feng-qing-wang",fullName:"Feng-Qing Wang"},{id:"32662",title:"MSc.",name:"Kang",middleName:null,surname:"Yao",slug:"kang-yao",fullName:"Kang Yao"},{id:"32663",title:"Prof.",name:"Dong-Zhi",middleName:null,surname:"Wei",slug:"dong-zhi-wei",fullName:"Dong-Zhi Wei"}]}],mostDownloadedChaptersLast30Days:[{id:"64570",title:"Banana Pseudo-Stem Fiber: Preparation, Characteristics, and Applications",slug:"banana-pseudo-stem-fiber-preparation-characteristics-and-applications",totalDownloads:9549,totalCrossrefCites:16,totalDimensionsCites:20,abstract:"Banana is one of the most well-known and useful plants in the world. Almost all the parts of this plant, that are, fruit, leaves, flower bud, trunk, and pseudo-stem, can be utilized. This chapter deals with the fiber extracted from the pseudo-stem of the banana plant. It discusses the production of banana pseudo-stem fiber, which includes plantation and harvesting; extraction of banana pseudo-stem fiber; retting; and degumming of the fiber. It also deals with the characteristics of the banana pseudo-stem fiber, such as morphological, physical and mechanical, durability, degradability, thermal, chemical, and antibacterial properties. Several potential applications of this fiber are also mentioned, such as the use of this fiber to fabricate rope, place mats, paper cardboard, string thread, tea bags, high-quality textile materials, absorbent, polymer/fiber composites, etc.",book:{id:"7544",slug:"banana-nutrition-function-and-processing-kinetics",title:"Banana Nutrition",fullTitle:"Banana Nutrition - Function and Processing Kinetics"},signatures:"Asmanto Subagyo and Achmad Chafidz",authors:[{id:"257742",title:"M.Sc.",name:"Achmad",middleName:null,surname:"Chafidz",slug:"achmad-chafidz",fullName:"Achmad Chafidz"},{id:"268400",title:"Mr.",name:"Asmanto",middleName:null,surname:"Subagyo",slug:"asmanto-subagyo",fullName:"Asmanto Subagyo"}]},{id:"61245",title:"Nutritional Composition of Meat",slug:"nutritional-composition-of-meat",totalDownloads:4531,totalCrossrefCites:33,totalDimensionsCites:60,abstract:"Meat ranks among one of the most significant, nutritious and favored food item available to masses, which aids in fulfilling most of their body requirements. It has played a vital role in human evolution and is an imperative constituent of a well-balanced diet. It is a good source of proteins, zinc, iron, selenium, and phosphorus followed by vitamin A and B-complex vitamins. Average value of meat protein is about 23% that varies from higher to lower value according to the type of meat source. Meat fat and its fatty acid profile is point to worry, with respect to its consumption, but its moderate usage is always advised by doctors and nutritionists, in order to lead a healthy life. Fat content of animal carcasses ranges between 8 and 20%. Quality traits of meat along with its nutritional composition become dependent upon animal breed type, feeding source (grains, pasture and grass), genetics of animal and post mortem techniques. This chapter will mainly focus on the variant aspects of nutritional constituents of meat including proteins and essential amino acids, fats and fatty acid profile, carbohydrates, vitamins and minerals along with their health benefits to human health.",book:{id:"6669",slug:"meat-science-and-nutrition",title:"Meat Science and Nutrition",fullTitle:"Meat Science and Nutrition"},signatures:"Rabia Shabir Ahmad, Ali Imran and Muhammad Bilal Hussain",authors:[{id:"235082",title:"Dr.",name:"Ali",middleName:null,surname:"Imran",slug:"ali-imran",fullName:"Ali Imran"},{id:"239057",title:"Dr.",name:"Rabia Shabir",middleName:null,surname:"Ahmad",slug:"rabia-shabir-ahmad",fullName:"Rabia Shabir Ahmad"},{id:"243634",title:"Mr.",name:"Muhammad Bilal",middleName:null,surname:"Hussain",slug:"muhammad-bilal-hussain",fullName:"Muhammad Bilal Hussain"}]},{id:"67214",title:"Microbial Contamination in Milk Quality and Health Risk of the Consumers of Raw Milk and Dairy Products",slug:"microbial-contamination-in-milk-quality-and-health-risk-of-the-consumers-of-raw-milk-and-dairy-produ",totalDownloads:3607,totalCrossrefCites:13,totalDimensionsCites:24,abstract:"The dairy products industry is going toward safe milk and its products in the food market. Milk quality and food safety concern in the consumers’ health and nutrition in public health surveillance prevent food-borne diseases, food poisoning, and zoonosis risk by raw milk and fresh dairy products. The aim of this work is focused on milk microbial contamination and its impacts on milk production and dairy industry with their implications in milk product quality, food-borne diseases from raw milk, and unpasteurized milk by food-borne pathogen microbial contamination and milk and dairy product spoilage. The microbial milk contamination source comes from herd hygiene and health status, mastitis prevalence, production environment, and milking parlor and milk conserving practices in dairy farm. Moreover, these facts are implicated in milk quality and milk spoilage and unsafe dairy products. The milk production system and the dairy plant operations keep track in pasteurized milk and fresh dairy products reviewing the traceability in field situational diagnosis report.",book:{id:"7943",slug:"nutrition-in-health-and-disease-our-challenges-now-and-forthcoming-time",title:"Nutrition in Health and Disease",fullTitle:"Nutrition in Health and Disease - Our Challenges Now and Forthcoming Time"},signatures:"Valente Velázquez-Ordoñez, Benjamín Valladares-Carranza, Esvieta Tenorio-Borroto, Martín Talavera-Rojas, Jorge Antonio Varela-Guerrero, Jorge Acosta-Dibarrat, Florencia Puigvert, Lucia Grille, Álvaro González Revello and Lucia Pareja",authors:[{id:"15423",title:"Qco.",name:"Lucia",middleName:null,surname:"Pareja",slug:"lucia-pareja",fullName:"Lucia Pareja"},{id:"199849",title:"Dr.",name:"Velazquez",middleName:"Ordoñez",surname:"Valente",slug:"velazquez-valente",fullName:"Velazquez Valente"},{id:"280178",title:"Dr.",name:"Esvieta",middleName:null,surname:"Tenorio-Borroto",slug:"esvieta-tenorio-borroto",fullName:"Esvieta Tenorio-Borroto"},{id:"280179",title:"Dr.",name:"Benjamín",middleName:null,surname:"Valladares-Carranza",slug:"benjamin-valladares-carranza",fullName:"Benjamín Valladares-Carranza"},{id:"280184",title:"Dr.",name:"Jorge",middleName:null,surname:"Acosta-Dibarrat",slug:"jorge-acosta-dibarrat",fullName:"Jorge Acosta-Dibarrat"},{id:"285302",title:"Dr.",name:"Martín",middleName:null,surname:"Talavera Rojas",slug:"martin-talavera-rojas",fullName:"Martín Talavera Rojas"},{id:"285303",title:"Dr.",name:"Lucia",middleName:null,surname:"Grille",slug:"lucia-grille",fullName:"Lucia Grille"},{id:"291633",title:"Dr.",name:"Alvaro",middleName:null,surname:"González Revello",slug:"alvaro-gonzalez-revello",fullName:"Alvaro González Revello"},{id:"301478",title:"Ph.D. Student",name:"Jorge Antonio",middleName:null,surname:"Varela-Guerrero",slug:"jorge-antonio-varela-guerrero",fullName:"Jorge Antonio Varela-Guerrero"},{id:"301479",title:"Ph.D. Student",name:"Florencia",middleName:null,surname:"Puigvert",slug:"florencia-puigvert",fullName:"Florencia Puigvert"}]},{id:"60461",title:"Biological Activities of the Doum Palm (Hyphaene thebaica L.) Extract and Its Bioactive Components",slug:"biological-activities-of-the-doum-palm-hyphaene-thebaica-l-extract-and-its-bioactive-components",totalDownloads:4287,totalCrossrefCites:7,totalDimensionsCites:14,abstract:"The doum palm (Hyphaene thebaica) is a type palm tree which has a wood texture and has edible oval fruits and the origin native to upper Egypt. The trunk of this small palm is dichotomous. It is one of the most important useful plants in the world. All parts of doum palm have a useful role such as fiber and leaflets which used to weave baskets and doum nuts which have antioxidants and secondary metabolites such as tannins, phenols, saponin, steroids, glycosides, flavonoid, terpenes and terpinoids. Also, roots, stems and leaves are used in medicine, ropes and baskets. Studies on anti-inflammatory, antioxidant, antimicrobial, anticancer and pharmacological potential of Hyphaene thebaica extracts and its major phytoconstituents like the phenolic, essential oil and flavonoid compounds are extensively discussed in this review.",book:{id:"6678",slug:"antioxidants-in-foods-and-its-applications",title:"Antioxidants in Foods and Its Applications",fullTitle:"Antioxidants in Foods and Its Applications"},signatures:"Hossam S. El-Beltagi, Heba I. Mohamed, Hany N. Yousef and Eman\nM. Fawzi",authors:[{id:"138817",title:"Dr.",name:"Heba",middleName:null,surname:"Mohamed",slug:"heba-mohamed",fullName:"Heba Mohamed"},{id:"240003",title:"Prof.",name:"Hossam",middleName:"Saad",surname:"El-Beltagi",slug:"hossam-el-beltagi",fullName:"Hossam El-Beltagi"},{id:"251695",title:"Prof.",name:"Eman",middleName:null,surname:"Fawzi",slug:"eman-fawzi",fullName:"Eman Fawzi"},{id:"251950",title:"Dr.",name:"Hany",middleName:null,surname:"Yousef",slug:"hany-yousef",fullName:"Hany Yousef"}]},{id:"71665",title:"Global Prevalence of Malnutrition: Evidence from Literature",slug:"global-prevalence-of-malnutrition-evidence-from-literature",totalDownloads:2132,totalCrossrefCites:8,totalDimensionsCites:17,abstract:"Malnutrition is a widespread problem, affecting the global population at some life stage. This public health epidemic targets everyone, but the most vulnerable groups are poverty-stricken people, young children, adolescents, older people, those who are with illness and have a compromised immune system, as well as lactating and pregnant women. Malnutrition includes both undernutrition (wasting, stunting, underweight, and mineral- and vitamin-related malnutrition) and overnutrition (overweight, obesity, and diet-related noncommunicable diseases). In combating malnutrition, healthcare costs increase, productivity is reduced, and economic growth is staggered, thus perpetuating the cycle of ill health and poverty. The best-targeted age for addressing malnutrition is the first 1000 days of life as this window period is ideal for intervention implementation and tracking for the improvement of child growth and development. There is an unprecedented opportunity to address the various forms of malnutrition, especially the 2016–2025 Decade of Action on Nutrition set by the United Nation. 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\r\n\r\n\t1. Sustainable Economy and Fair Society that relates to SDG 1 on No Poverty, SDG 2 on Zero Hunger, SDG 8 on Decent Work and Economic Growth, SDG 10 on Reduced Inequalities, SDG 12 on Responsible Consumption and Production, and SDG 17 Partnership for the Goals
\r\n\r\n\t
\r\n\r\n\t2. Health and Wellbeing focusing on SDG 3 on Good Health and Wellbeing and SDG 6 on Clean Water and Sanitation
\r\n\r\n\t
\r\n\r\n\t3. Inclusivity and Social Equality involving SDG 4 on Quality Education, SDG 5 on Gender Equality, and SDG 16 on Peace, Justice and Strong Institutions
\r\n\r\n\t
\r\n\r\n\t4. Climate Change and Environmental Sustainability comprising SDG 13 on Climate Action, SDG 14 on Life Below Water, and SDG 15 on Life on Land
\r\n\r\n\t
\r\n\r\n\t5. Urban Planning and Environmental Management embracing SDG 7 on Affordable Clean Energy, SDG 9 on Industry, Innovation and Infrastructure, and SDG 11 on Sustainable Cities and Communities.
\r\n\r\n\t
\r\n\r\n\tThe series also seeks to support the use of cross cutting SDGs, as many of the goals listed above, targets and indicators are all interconnected to impact our lives and the decisions we make on a daily basis, making them impossible to tie to a single topic.
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He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. 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She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. 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He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. 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He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"117248",title:"Dr.",name:"Andrew",middleName:null,surname:"Macnab",slug:"andrew-macnab",fullName:"Andrew Macnab",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"322007",title:"Dr.",name:"Maria Elizbeth",middleName:null,surname:"Alvarez-Sánchez",slug:"maria-elizbeth-alvarez-sanchez",fullName:"Maria Elizbeth Alvarez-Sánchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",country:{name:"Mexico"}}},{id:"337443",title:"Dr.",name:"Juan",middleName:null,surname:"A. 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The area covers many techniques that offer solutions to emerging problems in robotics and enterprise-level software systems. Collaborative intelligence is highly and effectively achieved with multi-agent systems. Areas of application include swarms of robots, flocks of UAVs, collaborative software management. Given the level of technological enhancements, the popularity of machine learning in use has opened a new chapter in multi-agent studies alongside the practical challenges and long-lasting collaboration issues in the field. It has increased the urgency and the need for further studies in this field. We welcome chapters presenting research on the many applications of multi-agent studies including, but not limited to, the following key areas: machine learning for multi-agent systems; modeling swarms robots and flocks of UAVs with multi-agent systems; decision science and multi-agent systems; software engineering for and with multi-agent systems; tools and technologies of multi-agent systems.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/27.jpg",hasOnlineFirst:!0,hasPublishedBooks:!1,annualVolume:11423,editor:{id:"148497",title:"Dr.",name:"Mehmet",middleName:"Emin",surname:"Aydin",slug:"mehmet-aydin",fullName:"Mehmet Aydin",profilePictureURL:"https://mts.intechopen.com/storage/users/148497/images/system/148497.jpg",biography:"Dr. Mehmet Emin Aydin is a Senior Lecturer with the Department of Computer Science and Creative Technology, the University of the West of England, Bristol, UK. His research interests include swarm intelligence, parallel and distributed metaheuristics, machine learning, intelligent agents and multi-agent systems, resource planning, scheduling and optimization, combinatorial optimization. Dr. Aydin is currently a Fellow of Higher Education Academy, UK, a member of EPSRC College, a senior member of IEEE and a senior member of ACM. In addition to being a member of advisory committees of many international conferences, he is an Editorial Board Member of various peer-reviewed international journals. 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