\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"7830",leadTitle:null,fullTitle:"Consumer Behavior and Marketing",title:"Consumer Behavior and Marketing",subtitle:null,reviewType:"peer-reviewed",abstract:'This Edited Volume "Consumer Behavior and Marketing" is a collection of reviewed and relevant research chapters, offering a comprehensive overview of recent developments in the field of psychology. The book comprises single chapters authored by various researchers and edited by an expert active in the research area. All chapters are complete in itself but united under a common research study topic. This publication aims at providing a thorough overview of the latest research efforts by international authors and open new possible research paths for further novel developments.',isbn:"978-1-78923-856-3",printIsbn:"978-1-78923-855-6",pdfIsbn:"978-1-78985-468-8",doi:"10.5772/intechopen.77647",price:119,priceEur:129,priceUsd:155,slug:"consumer-behavior-and-marketing",numberOfPages:142,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"0e4352b32821c0ddf89a7933c6fc119f",bookSignature:"Matthew Reyes",publishedDate:"March 4th 2020",coverURL:"https://cdn.intechopen.com/books/images_new/7830.jpg",numberOfDownloads:12693,numberOfWosCitations:1,numberOfCrossrefCitations:15,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:17,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:33,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"September 4th 2018",dateEndSecondStepPublish:"September 25th 2018",dateEndThirdStepPublish:"November 24th 2018",dateEndFourthStepPublish:"February 12th 2019",dateEndFifthStepPublish:"April 13th 2019",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"260089",title:"Dr.",name:"Matthew",middleName:"G.",surname:"Reyes",slug:"matthew-reyes",fullName:"Matthew Reyes",profilePictureURL:"https://mts.intechopen.com/storage/users/260089/images/system/260089.JPG",biography:"Dr. Reyes received his Ph.D. from the University of Michigan in 2011, performing research into data compression and processing of Gibbs fields. From 2010 through 2014, Dr. Reyes worked at MIT Lincoln Laboratory, on problems ranging from tracking, multi-sensor fusion, simulation, and data analysis. Since 2015, Dr. Reyes has\nworked as an Independent Researcher and Consultant. He is interested in modeling decision-making on social networks and applying his background in data analysis and simulation to marketing analytics. For example, under a random utility logit model of consumer choice, decision-making on a social network can be modeled as Glauber dynamics. Dr. Reyes is interested in incorporating more realistic models of consumer choice into models of dynamic decision-making on a social network, and using such dynamics models to mine social media and guide marketing resource allocation.",institutionString:"University of Michigan",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"1",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"74",title:"Marketing",slug:"marketing"}],chapters:[{id:"66823",title:"Consumer Life Cycle and Profiling: A Data Mining Perspective",doi:"10.5772/intechopen.85407",slug:"consumer-life-cycle-and-profiling-a-data-mining-perspective",totalDownloads:1162,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:1,abstract:"With the development of technology and continuously increasing of the market demand, the concept to produce better merchandises is generated in the companies. Each customer wants an individual approach or exclusive product, which creates the concept: “one customer one product.” The implementation of the one-to-one approach in the current days is the main exciting task of companies. Millions of customers lead to millions of exclusive products from the manufactures’ views. It is the primary step to study the needs of customers in the market economy. The main task for a company is to know the customer and to provide their desired products and services. In order to get knowledge ahead of the customers’ wishes, a system of profiling potential customers is created accordingly. This chapter provides the review of the customer lifetime from the reach customer (claim future customer’s attention) to the loyalty customer (turn a customer into a company advocate). During the discussion about the customer lifetime, readers will get acquainted with such technologies as funnel analysis, data management platform, customer profiling, customer behavior analysis, and others. The listed technologies in a complex will be created as the one-to-one product or service with a high Return on Investment (ROI).",signatures:"Kushnazarov Farruh",downloadPdfUrl:"/chapter/pdf-download/66823",previewPdfUrl:"/chapter/pdf-preview/66823",authors:[{id:"274175",title:"Dr.",name:"Farruh",surname:"Kushnazarov",slug:"farruh-kushnazarov",fullName:"Farruh Kushnazarov"}],corrections:null},{id:"68786",title:"Unpacking the Digital Consumer Mindset",doi:"10.5772/intechopen.88567",slug:"unpacking-the-digital-consumer-mindset",totalDownloads:826,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The digital economy is recasting global commerce. The digital drive is often attributed to millennial and Gen Z technology adoption, purchase power, and societal habits (urbanization and discretionary income). For e-commerce, when defined as the sale of physical product(s) mediated by a digital platform, the pivot point is the consumer mindset. The consumer mindset is the root cause of purchase intent. That collective demand spurs all levels of sellers (firm) to behavioral strategies aimed to complete the commerce circuit; a good or service is sought and sold. During the reign of retail, advances in consumer research and neuromarketing led to a deeper competence (never complete) of the consumer in the retail context, which led to successful strategies of the firm. The consumer mindset in the digital economy can prove vexing for the firm that cannot identify the new cognitive schemas that define the digital path to purchase. This chapter presents no original research but synthesizes the research, existing subject matter expert insight and direct industry experience to give vision to the emerging mindset of the digital consumer, the social context of e-commerce, and the imperative behavioral strategies of the firm in the digital economy.",signatures:"Matthew Dingee",downloadPdfUrl:"/chapter/pdf-download/68786",previewPdfUrl:"/chapter/pdf-preview/68786",authors:[{id:"288225",title:"Mr.",name:"Matthew",surname:"Dingee",slug:"matthew-dingee",fullName:"Matthew Dingee"}],corrections:null},{id:"66643",title:"Social Media, Consumer Behavior, and Service Marketing",doi:"10.5772/intechopen.85406",slug:"social-media-consumer-behavior-and-service-marketing",totalDownloads:3527,totalCrossrefCites:3,totalDimensionsCites:0,hasAltmetrics:1,abstract:"This study examined the impact of social media platforms and brand awareness in relation to the consumer decision-making and buying behavior patterns influenced by social media. It also depicts how companies can effectively make use of social media platforms as marketing strategy tools in business performances. Social media platforms seem to be increasingly and effectively bringing brand awareness and influence consumers’ purchase decision-making and later on realize repeat purchases that bring about customer loyalty. Social media also has some influence to both the consumer and the marketers and is becoming the most welcomed online selling point by the millennial. Marketers/producers have noticed the rise in social media consumers; however, most of the business entities have not yet utilized social media to its fullest in their marketing activities and business strategies and performances. The study highlights the benefits of using social media platforms and brand awareness strategies that can be utilized through the online social media systems and gives a contemporary research gap, in how frequent businesses are engaging with social media.",signatures:"Abigail Chivandi, Michael Olorunjuwon Samuel and Mammo Muchie",downloadPdfUrl:"/chapter/pdf-download/66643",previewPdfUrl:"/chapter/pdf-preview/66643",authors:[{id:"267975",title:"Dr.",name:"Abigail",surname:"Chivandi",slug:"abigail-chivandi",fullName:"Abigail Chivandi"},{id:"275118",title:"Prof.",name:"Michael Olorunjuwon",surname:"Samuel",slug:"michael-olorunjuwon-samuel",fullName:"Michael Olorunjuwon Samuel"},{id:"275121",title:"Prof.",name:"Mammo",surname:"Muchie",slug:"mammo-muchie",fullName:"Mammo Muchie"}],corrections:null},{id:"65836",title:"Tourism 4.0: Challenges in Marketing a Paradigm Shift",doi:"10.5772/intechopen.84762",slug:"tourism-4-0-challenges-in-marketing-a-paradigm-shift",totalDownloads:2539,totalCrossrefCites:8,totalDimensionsCites:12,hasAltmetrics:1,abstract:"Since the early beginnings people have been traveling and tourism industry has been always adapting to the social and technological development. In the era of digitalization, it needs to adapt again. Around 1.3 billion persons are traveling yearly around the world. Thus, a small change in this sector has a huge impact on the whole society. We propose a new paradigm, Tourism 4.0, appearing with the quest to unlock the innovation potential in the whole tourism sector. This will be done with the help of key enabling technologies from the Industry 4.0, such as Internet of Things, Big Data, Blockchain, Artificial Intelligence, Virtual Reality and Augmented Reality. By establishing a collaborative ecosystem involving local inhabitants, local authority, tourists, service providers and government, we can co-create an enriched tourism experience in both the physical and the digital world. With this, we can shift from tourist-centered focus to a tourism-centered focus around the local community. Who is the consumer in this new paradigm of tourism and what is the role of marketing in a paradigm shift? The chapter will analyze the current development and present the main shifts due to it.",signatures:"Urška Starc Peceny, Jurij Urbančič, Simon Mokorel, Vesna Kuralt and Tomi Ilijaš",downloadPdfUrl:"/chapter/pdf-download/65836",previewPdfUrl:"/chapter/pdf-preview/65836",authors:[{id:"217400",title:"Dr.",name:"Urška",surname:"Starc Peceny",slug:"urska-starc-peceny",fullName:"Urška Starc Peceny"},{id:"286485",title:"Dr.",name:"Vesna",surname:"Kuralt",slug:"vesna-kuralt",fullName:"Vesna Kuralt"},{id:"286486",title:"Dr.",name:"Jurij",surname:"Urbančič",slug:"jurij-urbancic",fullName:"Jurij Urbančič"},{id:"286632",title:"Dr.",name:"Simon",surname:"Mokorel",slug:"simon-mokorel",fullName:"Simon Mokorel"},{id:"288765",title:"M.Sc.",name:"Tomi",surname:"Ilijas",slug:"tomi-ilijas",fullName:"Tomi Ilijas"}],corrections:null},{id:"66200",title:"Mobile App Marketing Communication for B2B and B2C: Ingoes as a Case Study",doi:"10.5772/intechopen.85008",slug:"mobile-app-marketing-communication-for-b2b-and-b2c-ingoes-as-a-case-study",totalDownloads:1118,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"In today’s marketing world, there are highly competitive business environments in every industry. The companies try to survive, and their strategical conceptual thinking and entrepreneurship levels help them to be unique in their industry. The innovative ideas and alterations on consumer behavior create success stories in the future survival of the companies. Ingoes is a real estate platform that brings real estate buyers and sellers together and must be research case since it is the first mobile application for property market in Northern Cyprus. Thus, this chapter is helpful as a literature source for mobile application sector usage of marketing communication strategies when they are newly entering in their markets. Diffusion of innovation theory is considered while analyzing Ingoes brand. The aim of this study is to focus on the diffusion of innovation for mobile application marketing perspectives. This chapter covers both quantitative and qualitative research method content analyses by focusing on Ingoes new media usage while they are reaching their current and potential consumers.",signatures:"Umut Ayman, Anıl Kemal Kaya and İpek Halim",downloadPdfUrl:"/chapter/pdf-download/66200",previewPdfUrl:"/chapter/pdf-preview/66200",authors:[{id:"210512",title:"Dr.",name:"Anıl",surname:"Kemal Kaya",slug:"anil-kemal-kaya",fullName:"Anıl Kemal Kaya"},{id:"210632",title:"Dr.",name:"Umut",surname:"Ayman",slug:"umut-ayman",fullName:"Umut Ayman"},{id:"278489",title:"MSc.",name:"İpek",surname:"Halim",slug:"ipek-halim",fullName:"İpek Halim"}],corrections:null},{id:"66347",title:"Building on eWOM to Understand Service Quality in Hotel Services",doi:"10.5772/intechopen.85403",slug:"building-on-ewom-to-understand-service-quality-in-hotel-services",totalDownloads:970,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"In recent years the volume and the reach of available online content in the form of electronic word-of-mouth (eWOM) has grown at an unprecedented pace. eWOM exerts an important influence for consumption decisions of consumers, and is acknowledged to be more accessible and trustworthy than other commercial information provided by companies by means of advertising and sales. The sophistication and widespread of communication technologies is making the volume of information released online by customers to become overwhelming. For consumers and for business managers alike, making sense of the available information is a challenge that needs to be met urgently in order to keep the pace with the expectations of consumers whom, as engaged providers of feedback require their observations to be taken into account. This advances with a contribution to support the development of methods for the analysis and visualization information from online sources, by adapting an importance-performance analysis for identifying salient quality attributes from eWOM, offering an efficient approach for extracting information and identifying priorities for service improvement.",signatures:"Marlene Amorim and Mário Rodrigues",downloadPdfUrl:"/chapter/pdf-download/66347",previewPdfUrl:"/chapter/pdf-preview/66347",authors:[{id:"190959",title:"Dr.",name:"Marlene",surname:"Amorim",slug:"marlene-amorim",fullName:"Marlene Amorim"},{id:"215092",title:"Prof.",name:"Mario",surname:"Rodrigues",slug:"mario-rodrigues",fullName:"Mario Rodrigues"}],corrections:null},{id:"70610",title:"Lifestyle Demographic and Food Label Consumption",doi:"10.5772/intechopen.86022",slug:"lifestyle-demographic-and-food-label-consumption",totalDownloads:781,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"The lifestyle aspect can influence people buying intention on food label products and services. This paper is conducted to examine on the lifestyle demographic of consumer that need to be highlighted before consumer come up with the buying decision on food labelling products. Knowing how consumer lifestyle pattern is important in order to gain information on food label products about what they most preferred in purchasing the products or services. Furthermore, this study also helps in fulfilling the national agenda in Malaysia National Agro Food Policies 2011–2020. Hence 200 respondents were given a structured questionnaire to know the lifestyle aspect in consumer behaviour of food label consumption the result of this study shows that attitude and awareness of consumer play a crucial role in deciding the food labelling products that contains nutritious, healthy and most important is halal certificate. The major finding shows there are different awareness and attitude of consumers on food labelling towards buying decision when they are in the different of lifestyle aspect. In addition result also shows that consumers are concern about the quality, safety, and nutritional content of food labelling on food products enable to obtain healthy lifestyles.",signatures:"Zul Ariff Abdul Latiff",downloadPdfUrl:"/chapter/pdf-download/70610",previewPdfUrl:"/chapter/pdf-preview/70610",authors:[{id:"229141",title:"Dr.",name:"Zul Ariff",surname:"Abdul Latiff",slug:"zul-ariff-abdul-latiff",fullName:"Zul Ariff Abdul Latiff"}],corrections:null},{id:"65247",title:"Profiling Green Consumers with Data Mining",doi:"10.5772/intechopen.83373",slug:"profiling-green-consumers-with-data-mining",totalDownloads:1067,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Concern about the environment has led to a new segment of consumers called green consumers. Because not all the consumers are equally green, using target marketing for persuading them to buy green product is essential. The first step in target marketing strategy is to segment the market and then develop profiles of the resulting market segments. This study aims to identify distinct green market segments based on demographic, psychographic, and behavioral variables and also investigate the relationship between each variable and green consumer behavior. This study uses self-organizing maps (SOM) to segment and then develop profiles of Iranian green consumers. Based on the results, four market segments have been identified and were named intense greens, potential greens, egoist browns, and intense browns based on profiles of consumers in each segment. The results of this study also indicate that the level of education and income together with egoistic value and environmental unfriendly habits correlate negatively with the greenness (intent and intense of green behaviors) of Iranian consumers and the age of consumers together with environmental attitude and knowledge, biospheric and altruistic values, and religiosity correlate positively.",signatures:"Alireza Ziaei-Bideh and Mahsa Namakshenas-Jahromi",downloadPdfUrl:"/chapter/pdf-download/65247",previewPdfUrl:"/chapter/pdf-preview/65247",authors:[{id:"276052",title:"Ph.D.",name:"Alireza",surname:"Ziaei-Bideh",slug:"alireza-ziaei-bideh",fullName:"Alireza Ziaei-Bideh"},{id:"277331",title:"Dr.",name:"Mahsa",surname:"Namakshenas-Jahromi",slug:"mahsa-namakshenas-jahromi",fullName:"Mahsa Namakshenas-Jahromi"}],corrections:null},{id:"66905",title:"STARZ-DRP: Improving Efficiency of Patient Care in Community Pharmacies",doi:"10.5772/intechopen.86021",slug:"starz-drp-improving-efficiency-of-patient-care-in-community-pharmacies",totalDownloads:703,totalCrossrefCites:1,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Customers are always becoming the center of interest among the physicians, dentists, and pharmacists in the healthcare system. However, they are always having favorable feeling with the community pharmacists (CPs) as the first spot to seek advice. For that reason, it is essential to determine the character, behavior, and habit of customers toward the CPs and their extended pharmacy services. In addition, it is critical to determine the possible factors, which might have an effect on their characters, behaviors, and habits. The outcome of the analysis might help the CPs to understand the scenario in a particular way. Afterward, a structured and systematic approach known as “STARZ-DRP” is instigated as a basic skill to ensure whether each pharmacist has the self-confidence and self-competence to interact with the customers. The entire course of action shall empower the strength of personality among the CPs in the healthcare system.",signatures:"Nazri Nordin and Mohamed Azmi Hassali",downloadPdfUrl:"/chapter/pdf-download/66905",previewPdfUrl:"/chapter/pdf-preview/66905",authors:[{id:"213739",title:"Prof.",name:"Mohamed Azmi",surname:"Ahmad Hassali",slug:"mohamed-azmi-ahmad-hassali",fullName:"Mohamed Azmi Ahmad Hassali"},{id:"229101",title:"Dr.",name:"Nazri",surname:"Nordin",slug:"nazri-nordin",fullName:"Nazri Nordin"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"5762",title:"Agricultural Value Chain",subtitle:null,isOpenForSubmission:!1,hash:"4b4b9668fe6fff8891429bfe61afc4af",slug:"agricultural-value-chain",bookSignature:"Gokhan Egilmez",coverURL:"https://cdn.intechopen.com/books/images_new/5762.jpg",editedByType:"Edited 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El-Kased and Ahmed El-Shaarawy",coverURL:"https://cdn.intechopen.com/books/images_new/5155.jpg",editedByType:"Edited by",editors:[{id:"72383",title:"Prof.",name:"Hesham",surname:"Abdeldayem",slug:"hesham-abdeldayem",fullName:"Hesham Abdeldayem"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],publishedBooksByAuthor:[]},onlineFirst:{chapter:{type:"chapter",id:"77180",title:"Epidemiology of Idiopathic Pulmonary Fibrosis",doi:"10.5772/intechopen.98482",slug:"epidemiology-of-idiopathic-pulmonary-fibrosis",body:'IPF is a rare pulmonary disease affecting patients often in their sixth or the seventh decade of life. The disease course is progressive, causing permanent damage to the pulmonary tissue resulting in restrictive lung disease and hypoxia. Pharmacological therapeutic options are sparse and limited to new medications such as nintedanib and pirfenidone [1]. Without lung transplantation, IPF is lethal, and the patient dies from acute pulmonary failure in two to four years on average [1]. Lung transplantation has altered the disease course and improved longevity. As it is a rare disease, an accurate, consistent epidemiological methodology needs to be followed for data collection to measure the incidence and prevalence of IPF [1]. The consensus evidence-based guidelines in 2011 guide how to arrive at a diagnosis after ruling out other ILD causes and the need for multidisciplinary specialist’s input.
As the patient’s age increases, the IPF incidence increases with a more significant occurrence in men than women as per epidemiological studies [2]. The mean age at which diagnosis was established was 66 years. On average, most patients diagnosed with IPF lie between the age of 40 to 70 years [3]. Occurrence in younger patients (< 40 years) is rare. In most studies, men accounted for most cases except for a Norwegian study which disclosed a higher prevalence in females [4]. A recent study with an IPF score algorithm was generated using logistic regression to measure the exact incidence and prevalence values of 14.6/100,000 person-years and 58.7/100,000 person-years. The IPF score algorithm had a positive predictive value (PPV) of 83.3% [1].
The Gender-Age-Physiology (GAP) index calculated to predict IPF mortality by dividing the IPF into three stages GAP one, two, and three did not anticipate a decline in pulmonary function based on the severity of the GAP index [5]. IPF disproportionately affecting 71% of males was observed in a recent retrospective cohort study [6]. Age-adjusted males were strongly linked to an increased risk (40%) for lung transplantation or death [6]. In males, the cough was associated with dyspnea due to smoking-related airway disease, whereas in females, it was due to acid reflux disease. A lower diffusion capacity than predicted for age, senility, dry or productive cough with phlegm correlated with a decreased survival in males free of transplant compared to females. This may be due to excessive male exposure to risk factors in the environment, such as cigarette or occupational smoke particulate material and sex hormones [6]. Sex hormones modulate the immune system with a humoral immune response augmentation by estrogen and androgens, suppressing the cell-mediated and humoral immune response [7].
Age is a substantial independent predictor of IPF [8]. Aging lung undergoes anatomical and physiological changes predisposing it to IPF. The elderly may have abnormal recruitment of protective mesenchymal cells and fibrocytes in response to acute lung injury [9]. Increased endoplasmic reticulum oxidative stress, unfolded protein response lead to apoptosis of type 2 alveolar epithelial cells increasing susceptibility to IPF in the elderly [10]. Immune changes are seen in adaptive than in innate immunity. Adaptive immunity changes affect the T lymphocytes more than the B lymphocytes. There is a decrease in differentiation, antibody affinity, and interaction with T cells & B cells. There is a decline in naïve T cells (with short telomere and restricted repertoire), transition to Th2 response phenotype, an abnormal increase in memory, and effector cells with large CD28 deficient CD8 endstage clonal population [11, 12]. The T cell response leads to an inadequate vaccination and abnormal viral response [13, 14]. Many IPF patients have a shorter telomere with no detectable mutation in telomerase [15]. The elderly with a short telomere on exposure to susceptible environmental exposure may trigger apoptosis resulting in fibrosis. Old lungs may provide the appropriate local milieu for gammaherpesvirus or any other virus to cause fibrosis [9]. Smoking promotes epigenetic changes in deoxyribonucleic acid methylation, histone modifications, and microribonucleic acid [16].
Increased mortality in IPF is associated with a consecutive increase in oxygen desaturation episodes during a six-minute walk test. Males during their disease course experienced frequent faster desaturation events than females. In contrast to males, the disease progression rate is slower, in females contributing to survival differences. This may contribute to but does not entirely inform more remarkable female survival in IPF. Even in fibrotic diseases, females have lesser fibrosis than males, possibly due to sex hormone exposure [17]. Most females at their diagnosis of IPF are in a postmenopausal state with diminished estrogen levels. The precise role of hormonal imbalance on the fibrotic process needs clarification with further studies.
Smoking is a practice of burning raw or refined tobacco plant leaves and breathing in the resulting smoke for taste. Smoking is an ancient frequent recreational drug use still in practice. Tobacco smoke contains multiple active chemicals which are either absorbed in the mucosa or delivered to the lungs. Tobacco smoke exposure results in multiple lung diseases such as chronic obstructive pulmonary disease (COPD) and lung cancer. Tobacco smoke contains numerous chemicals exerting various delirious cellular effects on multiple organs affecting their metabolic function. As a primary intermediary, the lung faces the brunt of tobacco smoke exposure in active and passive smokers. Tobacco smoke exposure contains acrolein, benzene, benzopyrene, acetaldehyde, formaldehyde, carbon monoxide, 1,3-butadiene, and tobacco-specific nitrosamines with human toxicity potential. Additionally, the long-term effects of flavors and additives used in cigarettes on tobacco smoke and lung are unknown. Another issue is the lack of regulation regarding performance standards for ingredients used in making cigarettes [18].
Smoking has been included as a potential etiologic agent recently over the last few decades due to its significant prevalence among the IPF patient population [19]. However, the association was proposed as early as 1969, which independently increases the significant risk of IPF disease [20]. Another disease that shares the pathological features of COPD and IPF, known as combined pulmonary fibrosis and emphysema (CPFE), is seen predominantly in male smokers. Smoking may also enhance the systemic immune response to numerous environmental etiological agents, increasing the IPF risk by 60% in smokers [21]. The cytological effect of smoking in IPF can be direct or indirect, impacting the clinical course and survival. The evidence for a direct effect of smoking causing pulmonary fibrosis is minimal [22]. Tobacco use prevalence in IPF patients ranges from 41–83%, the range attributed to the definition criteria used in various studies [3, 23]. Alveoli is the main target of the IPF, resulting in diminished diffusion capacity for carbon monoxide. Alveolar wall fibrosis seen in smokers is due to cigarette smoke exposure, and there is an increase in fibrosis based on the duration and intensity of exposure [24]. Increased oxidative stress in current and ex-smokers may promote IPF disease progression [25]. IPF is also known as senescence disease due to its occurrence in tobacco smoke exposure patients’ in an age-dependent style [26].
Smoking results in a small airway inflammatory cell recruitment comprising neutrophils, macrophages, and langerhans cells, resulting in severe immune and other lung cell defects. However, only a few patients end up having clinically significant diffuse lung disease. Probably only a minority of patients progress into a vicious inflammation cycle resulting in IPF due to constant environmental stimuli and lapse of anti-inflammatory mechanisms [23]. A brief outline of the IPF pathogenesis is explained in Figure 1[19]. Persistent cigarette smoke exposure (CSE) leads to a predominant M2 macrophage activation in the lung. In contrast to the M1 Phenotype, the M2 macrophages are ineffective in host defense, inadequately clear noxious agents, and increase fibrotic mediators synthesis.
Pathogenesis of idiopathic pulmonary fibrosis. RONS, reactive oxygen and nitrogen species; TGF, transforming growth factor; EGF, epidermal growth factor; MMP, matrix metalloproteinase; IL, interleukin.
This results in a vicious, inflammatory cascade causing an increased expression of transforming growth factor α 1 (TGF α 1), epidermal growth factor (EGF), and mixed metalloproteinase (MMP) expression on epithelial cells leading to an epithelial to mesenchymal transition of the epithelial cells. This increases the pulmonary myofibroblasts, which are relatively resistant to apoptosis, have a lower activation threshold, augmented profibrotic response, and are activated by apoptosis debris. This leads to an abnormal increase in lung parenchyma myofibroblasts, profibrotic mediators, profibrotic receptor expression, and epithelial cell apoptosis. Finally, the lung parenchyma changes kick in with increased extracellular matrix (ECM) deposition making it difficult for gas exchange. The thick ECM increases lung contractility and decreases lung compliance.
Telomere dysfunction noted in the epithelial precursor cells simulating senescence can be seen sporadically and in patients with genetic abnormalities [27]. In IPF, the primary cell type affected is the alveolar epithelial precursor cell. The Wnt and the Notch signal pathways are essential in sustaining and separating the precursor cells (epithelial and mesenchymal). Defective functioning of these pathways results in pneumocyte loss followed by significant inflammation during defective attempts at repair due to molecular signals’ release [27]. Smoking causes a decrease in histone acetylation and methylation, resulting in the antifibrotic cyclooxygenase-2 gene and interferon-gamma inducible protein suppression [19].
In an earlier study comparing survival disparities and smoking status in IPF patients, smokers had lower survival than nonsmokers [27]. Lifetime nonsmokers had a better outcome than prior smokers and the combination of all smokers, including active and ex-smokers. This survival disparity suggests that smoking results in a decrement of IPF patient’s survival. Current smokers had better survival than former smokers due to a healthy smoker effect [27]. The reasoning for this effect is that a smoker with the advanced symptomatic disease will quit smoking for health benefits. In a recent study analyzing differences in severity adjusted survival among active and prior smokers, active smokers’ minimal survival benefit diminished on adding age to the model [28]. The healthy smoker effect was absent in this study. The earlier study’s survival disparity was not apparent after a composite physiologic index (calculated from the pulmonary function tests) was added to the severity adjustment [27].
Current smokers are younger than ex-smokers and nonsmokers, explaining the more prolonged survival seen in these patients [28]. Smoking-associated comorbidities were frequent in current smokers with more pack-years of smoking than ex-smokers [28]. The frequent comorbidities associated with smoking include cardiovascular disease (CVD), coronary artery disease, hypertension, cerebrovascular disease, diabetes, and heart failure may affect IPF mortality. Females had a higher incidence of asthma and diabetes than males, while active smokers had a higher incidence of COPD and lung cancer than nonsmokers. In the recent study, only a diagnosis of CVD, COPD at any time, and insulin use at the time of diagnosis resulted in a poor survival on severity adjustment analysis [28]. Smoking prevention is an important cause to decrease mortality and morbidity in the western and third world.
Occupational disclosure to surrounding elements contributes around 26% population attributable fraction (PAF) of total cases of IPF [29]. This suggests that IPF is a heterogeneous disease. Exposure to environmental agents occurs during the occupation, residence in a specific area, and recreational activities. The exposure may be due to a single agent or multiple agents, which is difficult to quantify. Recently air pollution has been recognized as a critical etiology and an exacerbating factor for IPF [30]. In comparison to the population size exposed to these agents, only a few develop IPF. IPF occurs more so in individuals with genetic susceptibilities exposed to these environmental agents. There are three factors essential in the pathogenesis of IPF; one is the environmental agent exposure, the second is the duration of exposure, while the third is the host response to the persistent exposure controlled by genetic susceptibility. Persistent environmental agent exposure results in a biochemical reaction (in most cases oxidative stress) followed by an insistent immune response to the agent, causing lung fibrosis [31]. As IPF is a rare disease, case–control studies are best suited for it. They come with many challenges regarding data collection as they are subjected to multiple factors that dilute the study’s purpose. These factors include disease misclassification (pneumoconiosis classified as IPF), exposure misclassification (recall bias), and variable susceptibility to fibrogenic agents(dose and duration of exposure along with genetic susceptibilities) [31]. Adequate clinical significance is denied to occupational and environmental history when clinical information is obtained from the patients. Pulmonary tissue biopsy analysis in IPF patients with Particle induced X-ray emission revealed a high content of silicon, magnesium, titanium, and high surface silicon to a sulfur ratio [32, 33]. Elementary analysis of hilar and mediastinal lymph nodes using fluorescent x-ray analysis disclosed high nickel content and a minimum silicon elevation [34]. Over the last two to three decades, multiple case–control investigations have identified various environmental agents suspected to be a causative factor for IPF [35]. These include metal dust (brass, aluminum, arsenic, cadmium, copper, molybdenum, tungsten, cobalt, uranium, vanadium, lead, and steel), raising birds, farming, wood dust, hairdressing, stone cutting/polishing, and organic dust from livestock & vegetation.
A southern European case–control study found two occupations with an increased prospect of having IPF, which increased with the exposure duration. One group included the farmers, veterinarians, gardeners, and the other group included metallurgical and steel industry workers [36]. A self-reported exposure history correlated with the increased risk, and the authors evaluated the history with a job-exposure matrix (JEM). Although an American multicenter study identified multiple jobs related to an increased risk of IPF, the multivariate regression model revealed the strongest link between raising birds and exposure to vegetable or animal dust [37]. Three occupations in the United States of America (USA), namely metal mining, wood building (mobile homes), and structured metal fabricated products, had an increased IPF mortality risk based on the mortality data [38]. A Korean study on dust exposure divulged its impact on IPF patient’s prognosis. Patients with exposure had an earlier IPF diagnosis, prolonged symptom duration at diagnosis, and increased mortality than those with no exposure [39].
Organic dust involves farming, gardening, animal husbandry, poultry farming, carpentry, and pesticides. Animal husbandry is an agriculture branch related to animal rearing for food and other products with significant exposure to animal feeds, products, and waste. A multicenter case–control study done in Egypt was the first to reveal an increased IPF risk in females than males [40]. Females were at a higher risk while working in poultry farming, farming with organic dust, and occupational pesticide exposure. Males carried an increased risk in carpentry, chemical, and petrochemical industries occupations. Both sexes had an increased risk with cat or bird exposure. IPF risk was minimal in sales and clerical jobs [40]. A Belgian multidisciplinary team studied 244 IPF patients, divided them based on prior exposure to molds or birds, and simultaneously compared them to chronic hypersensitivity pneumonitis patients. Patients exposed to birds or molds were associated with a decreased fatality than unexposed patients [41].
Mineral and metal dust exposure are well known to increase the IPF risk. A British study done in a major engineering company evaluated IPF mortality in employees exposed to occupational metal exposure. It revealed a strong association between IPF fatality and metal exposure strength and duration [42]. A multicenter Japanese study disclosed that patients with clerical occupations had a lower risk of IPF than patients with prior metal exposure [43]. Hilar lymph nodes histopathological analysis in IPF patients compared to controls revealed excess aluminum and silicon related to an increased risk of IPF [44]. Two smaller South Korean case–control studies revealed an increased IPF risk with exposure to stone, sand, silica, and metal dust [45, 46]. Asbestos occupational exposure results in asbestosis are well established; however, the effects of mild to moderate exposure on IPF are unclear. A study comparing United Kingdom (UK) asbestos imports per year to IPF mortality for any relationship was done. The overall asbestos exposure outcome was not addressed in this study. Linear regression models revealed a significant positive linear association between imports and IPF mortality, suggesting an association between IPF mortality and asbestos exposure [47]. UK is undergoing a national study by the name IPF Job Exposure study (IPF-JES) to evaluate the IPF risk associated with occupational asbestos exposure.
Wood dust exposure during carpentry and woodworks is related to a higher IPF risk and follows a dose–response association in UK based case–control study [48]. A Swedish multicenter case–control study on occupational exposure revealed a higher IPF risk in males with birch dust and hardwood dust exposure and no increased risk with metal exposure [49]. A similar increased association was observed in an Italian case series and an Egyptian multicenter case–control study [40, 50]. Air pollutants present in the environment may have an important role apart from smoking in IPF incidence. An Italian study evaluated the relationship between IPF occurrence in patients persistently exposed to ambient air pollutants (nitrogen dioxide, particulate matter [aerodynamic diameter less than 10 μm], and ozone) [30]. Final results were not adjusted for smoking which was a limitation of this study. An increment in nitrogen dioxide concentration resulted in a significant IPF incidence rate increase with no association observed with ozone and particulate matter. IPF acute exacerbation risk is higher in patients exposed to nitrogen dioxide and ozone in the prior six weeks [51]. Conflicting results of studies on lung function decline on ambient particulate matter (APM) exposure have been observed. One study revealed an accelerated lung function decrement in patients exposed to APM with an aerodynamic diameter of less than 10 μm, and no relationship was noted with APM with an aerodynamic diameter of less than 2.5 μm [52]. No association with a lung function decrease rate and ambient air pollutant exposure was identified in a 25 patient prospective group study [53]. A large French cohort study evaluated the effect of air pollutants on IPF disease outcomes [54]. Patients exposed to ozone had a higher risk of IPF acute exacerbations, whereas those exposed to APM with an aerodynamic diameter of less than 10 or 2.5 μm had increased mortality. In conclusion, APM exposure regularly can play a role in pathophysiology and may affect IPF disease progression.
A 2019 meta-analysis reviewed the literature and case–control studies. The following exposures (metal dust, silica, wood dust & vapor, gas, dust, or fumes) were significant statistically [29]. The pooled odds ratio for agricultural work was elevated with no significance. A recent South Korean meta-analysis revealed a statistically significant association with pesticide, metal, and wood dust exposure. No significance was observed with stone or sand dust and textile dust exposure. Agricultural workers and woodworkers had a significant increase in IPF risk statistically, whereas no significance was seen in textile workers [55]. In this Japanese study, consumption of fish rich in polyunsaturated fatty acids had a significantly lower odds ratio with regards to IPF, and it may have a suppressive effect on lung fibrosis [56]. A decline in IPF rate is achievable if environmental exposure is modified. It is a demanding process to obtain a detailed exposure history as it is subject to recall bias, difficulty in quantifying heterogeneous exposure intensity and its cumulative variation [57]. Also, it is difficult to identify a specific exposure effect when multiple are in play. For obtaining accurate epidemiological data, a standard operational definition for occupational and environmental history needs to be arrived at based on consensus so that it is easier to compare multiple studies (case–control and cohort) precisely to understand the IPF occurrence. If occupational and environmental exposure results in IPF, implementing measures to alter the exposure or improve the occupational environment may decrease IPF risk, and prevention may become a public health issue.
Gastroesophageal disease is a suspected risk factor for IPF development and progression currently under intense debate [58, 59]. The prevalence of pulmonary fibrosis was statistically significant in veterans with GERD history compared to healthy controls [60]. GERD incidence in IPF is higher than the average population and ranges from 8–87%. The variation is due to the methods used in diagnosis, diagnosis definition used and the types of data collected [61, 62, 63]. The greater incidence could be due to the common risk factors such as smoking and aging [64]. The gastroesophageal abnormalities seen in IPF patients include transient lower esophageal sphincter (LES) relaxations, decreased upper esophageal sphincter tone, and significantly greater proximal esophageal acid exposure cumulatively [65]. The decreased lung compliance in IPF due to fibrosis creates a negative intrapleural pressure which on transmission to the intrathoracic area decreases the LES tone resulting in reflux [66]. In animal models, the burden of proof is most substantial for GERD associated with IPF [67]. Chronic microaspiration insults may lead to pulmonary parenchyma damage attracting persistent inflammation resulting in fibrotic remodeling [68, 69]. Tracheal pepsin is a predictable indicator of aspiration [70]. The presence of bile salts and pepsin in bronchoalveolar lavage (BAL) suggests both acidic and nonacidic refluxate as risk factors for IPF disease [71]. BAL pepsin levels in post-transplant IPF patients were higher than in other chronic lung diseases [72].
PPI (Proton pump inhibitors) used in GERD are a reactive oxygen species scavenger, stimulate antioxidant production, decrease pro-inflammatory cytokines, inhibit profibrotic molecule expression, and decelerate pulmonary epithelial cell apoptosis [73]. Multiple studies and metanalysis have reviewed the use of PPI in IPF patients for GERD. Initial studies revealed PPI use was associated with fewer acute exacerbations, lower hospitalization rates, lesser radiological fibrosis score, stable or improved lung function, and more extended transplant-free survival [59, 74, 75, 76]. GERD symptoms and pathophysiology are well addressed by LARS (Laparoscopic antireflux surgery) as it restores the gastroesophageal junction anatomy and controls both acidic and nonacidic reflux [65]. IPF patients post-LARS had a nonsignificant decline in acute exacerbations, hospitalization related to pulmonary issues, and death than the nonsurgical group in a small group of 72 patients [77]. A pooled analysis on the antacid treatment effect on disease progression in IPF placebo patients included in the pirfenidone trials revealed no improved outcomes [78]. Instead, advanced IPF patients on antacid therapy had a greater risk of pulmonary and nonpulmonary infections. PPI use in IPF patients has given mixed results in studies, possibly due to their inability to correct the GERD anatomy. PPI can only alter the gastric refluxate’s pH, making it more alkaline with no acidic and nonacidic microaspiration prevention [65]. A meta-analysis and systematic review evaluated the efficacy and safety of GERD therapy in IPF [79]. It revealed a significant decline in acute exacerbations, mortality related to IPF, and improved transplant-free survival. GERD pharmacological therapy did not result in all-cause mortality reduction. Another meta-analysis via systematic review analyzed the GERD and IPF association, and it revealed a possible association confounded by smoking [80].
In a post-hoc data evaluation of the INPULSIS trials, IPF acute exacerbations frequently occurred on antacid therapy than those not on it [81]. PPI use results in alkaline gastric pH, which loses its bactericidal effect and increases respiratory infections on aspiration [69]. The clinical data available does not agree with a GERD and IPF relationship [82]. In most patients, refluxes are silent with the absence of any symptoms, and the best way to diagnose them is via esophageal MII-pH or high-resolution manometry. Alternatively, bronchoscopy with BAL presence of pepsin and bile salts can be used in IPF [69]. During meta-analysis, a lack of clarity with GERD diagnostic definitions was identified. It was difficult to pinpoint which criteria were used to select the patient and how many met them. [78]. The heterogeneous methods used have made it difficult to assess the association. Meta-analysis always encounters various issues with case–control studies and requires accurate interpretation of the association, however small it may be [83]. More extensive randomized trials are needed to study the effect of LARS in IPF patients. Future prospective studies would be better suited to accurately evaluate the evidence and analyze the PPI effect on the IPF clinical course.
The role of viral infections in IPF pathogenesis is unclear. It could either be an initiator of IPF or could exacerbate a preexisting disease based on the type of viral infection. Immunosenescence predisposes old lungs to viral infections due to T cell inefficiency. Lack of improved outcomes on the treatment of IPF with immunosuppressants indicates the need for an intact immune system to control the disease process [84]. IPF therapy with antiviral medications has improved pulmonary function [85, 86]. Herpesvirus deoxyribonucleic acid (DNA) was recovered in 97% of IPF subjects compared to 36% of controls. This supports the idea of a herpes virus causing chronic antigenic stimulation in lung tissue [85]. Multiple animal models have supported a virus as an etiology for IPF. Experimental horse infection with an equine gammaherpesvirus resulted in pulmonary fibrosis [87]. Murine infection with a
Serological evidence against herpes virus was detected in IPF patients, including
Two studies evaluated the presence of viral infection in acute IPF exacerbation. In the first study, most cases of acute exacerbation did not have any viral infections. Only TTV was identified in a substantially small number of cases [105]. In the second study, viruses were detected on the nasopharyngeal swabs in 60% of acute IPF exacerbation cases than 43.3% of stable patients. In this study, none of the patients were on any corticosteroids or antimicrobials. In acute cases, the inflammatory cytokines were elevated than in stable IPF and controls [110]. A meta-analysis of retrospective studies disclosed that chronic infection with CMV, EBV, HHV 7 & 8 substantially increased the risk of IPF without acute exacerbation of IPF. HHV 6 was not related to any significant risk of IPF. A nonsignificant greater risk of IPF was seen in younger patients with viral infections [111]. Viral infections predispose aged lungs to fibrosis, either by reactivating the infection or via latency promoting epithelial to mesenchymal transition. Latent infections alter the local milieu by increasing profibrotic mediators but cannot cause fibrosis by themselves and need another local lung insult. Latent viral infection is ineffective in causing acute exacerbations in animal models. The viral ability to increase exacerbations involves lytic replication in animal models not observed in all human patients [99]. CMV and Influenza are unable to use this mechanism to cause exacerbations.
Bacterial infections are suspected to be a cause for acute IPF exacerbations. In mouse lung fibrosis models,
To better understand the etiology of IPF, it is ideal for identifying geographical areas with more significant cases and evaluate the involved triggers. A study from Spain analyzed the IPF cases location and consistently highly polluted areas to recognize any risk factors [115]. Locations associated with the higher prevalence of IPF cases correlated maximally with the APM 2.5 μm exposure than other risk factors. Patients in such areas may need screening for IPF to identify these cases early in the disease course. A Japanese study identified substantial ethnic differences regarding the IPF disease course [116]. These studies are essential as they reveal the genetic trait polymorphisms associated with IPF. The incidence of IPF in males is 2.7 times higher than in females in Japan, possibly due to more male smokers than females. Males also have higher mortality than females, with a mortality ratio of 2.68 compared to that of 1.59 in the USA [117]. Clinical data on ethnic disparities with regards to IPF mortality are limited. Acute IPF exacerbation accounts for most deaths in IPF patients, and cardiac disease is a less frequent cause than in Western countries. The variable used in the prognostification of IPF, such as age and gender, did not perform well in Japanese [118]. The GAP system fared poorly, and no substantial survival differences were noted in different IPF stages. Most Japanese carry single nucleotide polymorphisms (SNPs) rs2736100 in intron 2 of the TERT (Telomerase reverse transcriptase) gene, codes for the telomerase reverse transcriptase.
A retrospective study reviewed the ethnic and racial disparities in USA IPF outcomes using Organ Procurement and Transplantation Network data from 1995 to 2003 [119]. Black and Hispanic patients tended to be female and younger at diagnosis than whites. More significant medical comorbidities (hypertension, diabetes mellitus, and poor performance) were observed in Black and Hispanic patients. Whites had more private insurance, college education and lived in better neighborhood areas. The age-adjusted mortality rate and risk of having double lung transplantation were higher in Blacks and Hispanics. The poor mortality was partly attributed to the poor lung function when they were listed for lung transplantation. Race might be a proxy marker for the genetic makeup producing a specific phenotype [119]. Another retrospective study done in the USA evaluated the ethnic and racial differences based on National Center for Health Statistics data from 1989 to 2007 [120]. Among the IPF total census, 87.2% were Whites,5.4% Hispanics, 5% Blacks, and others 2.2%. As mentioned in the prior study, Blacks and Hispanics were younger at diagnosis and death. When age and gender were controlled, the race was a significant predictor for IPF death with a similar IPF risk in all races. Hispanics were at an increased death risk from IPF than Whites and Blacks. Blacks had a higher risk of death from pulmonary hypertension and lung cancer than Whites and Hispanic patients. Hispanics were more likely to be coded with IPF than Whites and Blacks. The differences mentioned above are due to blacks dying at an early age and less likely to smoke than Whites. Access to health care has been inadequate due to the lack of medical insurance in Blacks.
Familial causes of IPF constitute less than 5% of all cases, with at least two family members being affected [121]. The diagnostic criteria used to identify cases are similar to the one used for sporadic cases. Familial inheritance is via an autosomal dominant pattern with partial penetrance [122]. In 15% of familial cases, the cause is gene mutations encoding the ribonucleic acid (RNA)(TERC) or protein component (TERT) of the telomerase enzyme [123, 124]. Another 25% have sporadic or familial IPF with no telomerase RNA component (TERC) or telomerase reverse transcriptase (TERT) mutation but have circulating leucocyte telomere shortening [125]. A substantial congregation of familial cases was observed in the Finnish population [126]. ELMOD2, a gene on chromosome 4q31, has been identified as a susceptible gene for familial IPF [127]. A significant familial association has been detected with surfactant protein C and A2 gene mutation [121, 128]. Sporadic mutations of surfactant protein C gene are rarely associated with IPF [129]. A Mucin 5B (MUC5B) gene polymorphism of the promoter (rs35705950) is substantially associated with familial and sporadic IPF [130]. MUC5B promoter polymorphism presence can be used for IPF prediction and prognostification; however, it is not seen in 40% of cases [131, 132]. New loci (FAM13A, DSP, OBFC1, ATP11A, DPP9) and prior associations (TERT, MUC5B, TERC) were confirmed by a genome-wide association study in White patients. The newer loci were essential in immune defenses, DNA repair, and cell adhesion [133]. Peripheral blood markers may be used to identify a protein signature made up of MMP 1, MMP 7, MMP 8, Insulin-like growth factor-binding protein 1(IGFBP1) & tumor necrosis factor receptor superfamily member 1A (TNFRSA1F), which was able to differentiate IPF patients from healthy controls with a specificity of 98.1% and sensitivity of 98.6% [134]. Higher plasma concentrations of MMP 7, vascular cell adhesion molecule 1 (VCAM-1), IL-8, Intercellular Adhesion Molecule 1 (ICAM-1), and S100 calcium-binding protein A12 (S100A12) predict poor survival in IPF patients [135]. The gene microarray expression process can help in understanding the pathophysiology and therapeutic target candidates [136]. Currently, no genetic factors are associated with sporadic IPF in a consistent pattern.
Epidemiologic studies carried out before 2013 are highly heterogeneous in their methods and cannot be compared [137]. Even with this heterogeneity, the incidence shows a gradual increase across the world [138]. The IPF incidence has increased in all studies except for two quality studies, one each from Denmark and USA [139, 140]. When all studies are considered, the IPF incidence ranges from 0.22 to 93.7 per 100,000 per year. After removing underreported, South American and Asian studies, the incidence was 2.8 to 9.3 per 100,000 per year for the USA and European studies together [138]. In Europe, the higher rates were observed in the UK, while Scandinavia and Southern Europe revealed lower rates [4, 139, 141, 142, 143]. In the USA, using the narrow criteria, the incidence rates were lower at an incidence of 5–8 per 100,000 per year [38, 144, 145]. Incidence rates in South America were at 0.4 to 1.2 per 100,000 per year [146, 147]. East Asia studies based on insurance claims indicate an incidence rate of IPF at 1.2–3.8 per 100,000 per year [148, 149]. In contrast, in Japan, the mortality statistics suggest a greater incidence rate and an adjusted mortality rate of 10.26 per 100,000 [150]. Age-adjusted mortality has accelerated from 3.2 per 100,000 in 1979 to 7.57 per 100,000 from 1999 to 2003 in USA [38, 151]. In the UK, age-adjusted mortality has increased from 2.54 per 100 000 (1968–2008) to 5.5.10 per 100 000 (2005–2008) [141]. In Brazil, mortality had risen from 0.65 per 100 000 in 1996 to 1.21 per 100 000 in 2010 [146].
Overall, increased incidence rates are observed in the UK, European, South American, and East Asian epidemiological studies [141, 146, 147, 148, 152, 153]. USA mortality rates have declined as in Denmark after reaching a plateau [2, 139, 154]. Younger patients have a more prolonged median survival due to earlier treatment of recognized comorbidities and avoiding the use of ineffective treatment such as immunosuppressants and corticosteroids [117]. IPF diagnosis and treatment are getting more specific, and widespread acceptance of IPF international guidelines will improve accurate, comparable IPF clinical data [155]. National IPF registries from different countries will yield valuable data on IPF epidemiology. In general, the current IPF epidemiological data does not have substantial consistency.
The ideal sample should be large to validate the clinical diagnosis by medical records review [138]. Uncertainty of diagnosis can be avoided by using internationally accepted guidelines and consolidate its use in all studies. Other things to be considered are liberal use of imaging techniques, avoid broad diagnostic codes to identify IPF, and reinforce clinical guidelines in practicing physicians [138]. IPF score algorithm improved the positive predictive value by incorporating the IPF risk factors to identify fewer false-positive cases accurately [1]. The increasing prevalence can be attributed to the IPF patients living longer than ten years before [117]. Prevalence is affected by disease definition, guidelines used for diagnosis, the difference in methodology, and health care systems. Gender differences are due to smoking habit variations and occupational exposure. Incidence is influenced by diagnostic improvements, population age, availability of drugs, and improved health care. Mortality is affected by clinical recognition of IPF and diagnostic coding [155]. Insurance databases reveal an underrepresentation of lower socioeconomic strata and non-White patients, impacting the overall incidence and prevalence [1]. Care should be ascertained during medical record review for confirmation as they can be inaccurate. Using medicare beneficiary data excludes younger IPF patients, which a national IPF registry can avoid [117].
IPF datasets currently overestimate the prevalence, whereas the questionnaire studies underestimate it. Obtaining the correct epidemiological data is essential in identifying IPF clinical course and prognosis. Initiation and maintenance of a national registry with appropriate epidemiology data collection is an excellent beginning. An attempt should be garnered towards using algorithms or other tools in epidemiological studies to establish their efficacy. Epidemiological studies should attempt to use a similar case definition standardized across multiple countries to compare effectively and decrease the heterogeneity. As the IPF incidence increases, it has become a substantial public health concern. Future studies need to stress clinical epidemiology, pathophysiology & diagnostic biomarkers for an accurate understanding of epigenetic mechanisms and their pathways to provide a clue about future therapeutic targets. Clinical research into the epigenetic processes, disease pathophysiology, and diagnostic procedures needs to be encouraged and supported to improve life quality, prolong survival, and ultimately find a cure.
“None, No external funding was received in preparation of this manuscript.”
“The author declares no conflict of interest.”
“A special thanks to the editor for allowing me to author this manuscript.”
IPF | Idiopathic pulmonary fibrosis |
ILD | Interstitial lung disease |
PPV | Positive predictive value |
GAP | Gender-Age-Physiology |
COPD | Chronic obstructive pulmonary disease |
CPFE | Combined pulmonary fibrosis and emphysema |
CSE | Cigarette smoke exposure |
TGF | Transforming growth factor |
EGF | Epidermal growth factor |
MMP | Mixed metalloproteinases |
ECM | Extracellular matrix |
CVD | Cardiovascular disease |
PAF | Population attributable fraction |
JEM | Job-exposure matrix |
USA | United States of America |
IPF-JES | IPF-Job Exposure study. |
UK | United Kingdom |
APM | Ambient particulate matter |
GERD | Gastroesophageal reflux disease |
LES | Lower esophageal sphincter |
BAL | Bronchoalveolar lavage |
PPI | Proton pump inhibitor |
LARS | Laparoscopic antireflux surgery |
DNA | Deoxyribonucleic acid |
MHV | Murine herpesvirus |
EBV | Epstein–Barr virus |
CMV | Cytomegalovirus |
HHV | Human herpesvirus |
HCV | Hepatitis C virus |
TTV | Torque-Teno virus |
SNP | Single nucleotide polymorphism |
TERT | Telomerase reverse transcriptase |
RNA | Ribonucleic acid |
TERC | Telomerase RNA component |
MUC5B | Mucin5b |
FAM13A | Family with sequence similarity 13, Member A |
DSP | Desmoplakin |
OBFC1 | Oligosaccharide-binding fold-containing Protein 1 |
ATP11A | ATPase Phospholipid Transporting 11A |
DPP9 | Dipeptidyl Peptidase 9 |
IGFBP | Insulin-like growth factor-binding protein |
TNFRSA1F | Tumor necrosis factor receptor superfamily member 1A |
VCAM | Vascular cell adhesion molecule |
IL | Interleukin |
ICAM | Intercellular adhesion molecule |
S100A12 | S100 calcium-binding protein A12 |
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On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. 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Since the regulatory requirements and management strategies are required to be established and complied, sources of impurities shall be carefully classified prior to take subsequent steps such as development of analytical methods and acceptance criteria. Current international regulatory requirements for the management of impurities in pharmaceuticals were reviewed. Procedures for the identification of DPIs in pharmaceuticals, i.e., ethyl cysteinate dimer, (R)-N-methyl-3-(2-bromophenoxy)-3-phenylpropanamine, sestamibi, etc., using high-performance liquid chromatography tandem mass spectrometry (LC-MS/MS) were studied. Scheme for the establishment of analytical methods and acceptance criteria of process-related impurities (PRIs) and DRIs in accordance with the requirements of International Council for Harmonization (ICH) and algorithm to perform the identification of DPIs by using LC-MS/MS has been proposed. Practice of kinetic study to distinguish PRIs and DRIs, determination of the potential core fragments coupled with a predicted list of relevant transformations for conducting MS/MS scans, applications of stable isotope distribution patterns or natural abundances, practice of mass balance, etc., have been well demonstrated to justify the reliabilities of identification results.",book:{id:"7710",slug:"quality-management-and-quality-control-new-trends-and-developments",title:"Quality Management and Quality Control",fullTitle:"Quality Management and Quality Control - New Trends and Developments"},signatures:"Kung-Tien Liu and Chien-Hsin Chen",authors:[{id:"36122",title:"PhD.",name:"Kung-Tien",middleName:null,surname:"Liu",slug:"kung-tien-liu",fullName:"Kung-Tien Liu"},{id:"153497",title:"Dr.",name:"Chien-Hsin",middleName:null,surname:"Chen",slug:"chien-hsin-chen",fullName:"Chien-Hsin Chen"}]},{id:"58966",title:"Quality Management Systems for Laboratories and External Quality Assurance Programs",slug:"quality-management-systems-for-laboratories-and-external-quality-assurance-programs",totalDownloads:4611,totalCrossrefCites:2,totalDimensionsCites:5,abstract:"A quality management system (QMS) plans, controls, and improves the elements that impact on the achievement of the desired results by the laboratory and on the satisfaction of the users. There are different standards that establish requirements for the implementation of a quality management system for laboratories, and a cross comparison between them is shown. Additionally, external quality assurance or assessment (EQA) programs offer multiple benefits to laboratories: method validation, comparing of results with other laboratories, testing problem identification, accreditation requirement compliance, and credibility. In order to control the quality of the procedures, these programs are a tool to keep the laboratory procedures and every variable involved in (staff, equipment, and method) well controlled. In the frame of a quality management system, benefits from external quality assurance programs are discussed, and different available designs are reviewed. On the other hand, previous benefits will be real only if reported results for each program are analyzed in detail. Because additional advantages are achieved when the EQA results are integrated in the quality management system of the laboratory, a procedure is proposed. In addition, results from external quality assurance programs corroborate the usefulness of internal controls implemented by the laboratory as part of its quality management system.",book:{id:"6325",slug:"quality-control-in-laboratory",title:"Quality Control in Laboratory",fullTitle:"Quality Control in Laboratory"},signatures:"Verónica Valdivieso-Gómez and Rocío Aguilar-Quesada",authors:[{id:"217457",title:"Ph.D.",name:"Rocio",middleName:null,surname:"Aguilar-Quesada",slug:"rocio-aguilar-quesada",fullName:"Rocio Aguilar-Quesada"},{id:"217467",title:"Ms.",name:"Veronica",middleName:null,surname:"Valdivieso-Gomez",slug:"veronica-valdivieso-gomez",fullName:"Veronica Valdivieso-Gomez"}]},{id:"41063",title:"Cosmetics’ Quality Control",slug:"cosmetics-quality-control",totalDownloads:12643,totalCrossrefCites:2,totalDimensionsCites:12,abstract:null,book:{id:"3276",slug:"latest-research-into-quality-control",title:"Latest Research into Quality Control",fullTitle:"Latest Research into Quality Control"},signatures:"Bruna Galdorfini Chiari, Maria Gabriela José de Almeida, Marcos Antonio Corrêa and Vera Lucia Borges Isaac",authors:[{id:"35801",title:"Dr.",name:"Vera",middleName:null,surname:"Isaac",slug:"vera-isaac",fullName:"Vera Isaac"},{id:"56070",title:"MSc.",name:"Bruna",middleName:null,surname:"Chiari",slug:"bruna-chiari",fullName:"Bruna Chiari"},{id:"56072",title:"Dr.",name:"Marcos Antonio",middleName:null,surname:"Corręa",slug:"marcos-antonio-correa",fullName:"Marcos Antonio Corręa"},{id:"154324",title:"BSc.",name:"Maria Gabriela José De",middleName:null,surname:"Almeida",slug:"maria-gabriela-jose-de-almeida",fullName:"Maria Gabriela José De Almeida"}]},{id:"58071",title:"Systematic Error Detection in Laboratory Medicine",slug:"systematic-error-detection-in-laboratory-medicine",totalDownloads:1751,totalCrossrefCites:4,totalDimensionsCites:4,abstract:"Measurements in laboratory medicine have a degree of uncertainty; this uncertainty is often called “error” and refers to imprecisions and inaccuracies in measurement. This measurement error refers to the difference between the true value of the measured sample and the measured value. One of the types of error is systematic error, also called bias, because these errors errors are reproducible and skew the results consistently in the same direction. A common approach to identify systematic error is to use control samples with a method comparison approach. An alternative is use of statistical methods that analyze actual patient values either as an “Average of Normals” or a “Moving Patient Averages.” Fundamental questions should be decided before a quality control method is used: how are weights assigned to the results? Is preference given to more recent samples or to the older samples? How sensitive should the model be? 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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). 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. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). 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. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. 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). 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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. 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