Human cannabinoid toxicities: Comparison of synthetic cannabinoid toxicities with botanical marijuana by systems.
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Barely three months into the new year and we are happy to announce a monumental milestone reached - 150 million downloads.
\n\nThis achievement solidifies IntechOpen’s place as a pioneer in Open Access publishing and the home to some of the most relevant scientific research available through Open Access.
\n\nWe are so proud to have worked with so many bright minds throughout the years who have helped us spread knowledge through the power of Open Access and we look forward to continuing to support some of the greatest thinkers of our day.
\n\nThank you for making IntechOpen your place of learning, sharing, and discovery, and here’s to 150 million more!
\n\n\n\n\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{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"}]},book:{item:{type:"book",id:"740",leadTitle:null,fullTitle:"Neck Dissection - Clinical Application and Recent Advances",title:"Neck Dissection",subtitle:"Clinical Application and Recent Advances",reviewType:"peer-reviewed",abstract:"Neck Dissection - Clinical Application and Recent Advances is a leading book in neck surgery and represents the recent work and experiences of a number of top international scientists. 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He has had many publications and contribution to science by advocating many surgical procedures and research in cancer surgery and flap reconstruction, TMJ surgery and maxillofacial injuries, orbit tumors and missile war injuries of the face with advancing surgery of war injuries of the face worldwide. He has contributed to research in cancer and has developed post graduate studies in maxillofacial surgery in Iraq. He is the Editor of Neck Dissection - Clinical Application and Recent Advances (February, 2012, IntechOpen), Surgical Reconstruction of the Temporomandibular Joint (2013), Germany, Editor of the book Disease of the TMJ, Surgical Reconstruction, Clinical & Experimental Studies (April, 2014, Science PG), Missile War Injuries of the Face, Maxillofacial Injuries in Road Traffic (book published by Science PG, 2014), and Jaw Lymphoma and Orofacial Tumors (2015, book published by Science PG), editor of the book "Bone Grafting - Recent Advances with Special References to Cranio-Maxillofacial Surgery" (December, 2018, IntechOpen), editor of the book Craniofacial Deformity and Normal Variations of Jaws Relationship (OMICS International, in press). He is Co-editor of the book Maxillofacial Surgery and Craniofacial Deformity (2020, IntechOpen). 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Marais",authors:[{id:"112229",title:"Prof.",name:"Chris",middleName:null,surname:"Aldrich",fullName:"Chris Aldrich",slug:"chris-aldrich"},{id:"112232",title:"Prof.",name:"Hansie",middleName:null,surname:"Knoetze",fullName:"Hansie Knoetze",slug:"hansie-knoetze"},{id:"135327",title:"Ms.",name:"Corne",middleName:null,surname:"Marais",fullName:"Corne Marais",slug:"corne-marais"}]},{id:"36189",title:"Optical Technologies for Determination of Pesticide Residue",slug:"optical-technology-for-determination-of-pesticide-residue",signatures:"Yankun Peng, Yongyu Li and Jingjing Chen",authors:[{id:"113343",title:"Prof.",name:"Yankun",middleName:null,surname:"Peng",fullName:"Yankun Peng",slug:"yankun-peng"},{id:"116636",title:"Dr.",name:"Yongyu",middleName:null,surname:"Li",fullName:"Yongyu Li",slug:"yongyu-li"},{id:"116637",title:"Dr.",name:"Jingjing",middleName:null,surname:"Chen",fullName:"Jingjing Chen",slug:"jingjing-chen"}]},{id:"36190",title:"High Resolution Far Infrared Spectra of the Semiconductor Alloys Obtained Using the Synchrotron Radiation as Source",slug:"high-resolution-spectra-of-semiconductor-s-alloys-obtained-using-the-far-infrared-synchrotron-radi",signatures:"E.M. 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Based on the etiology of the cannabinoids, they are generally separated into three groups: endocannabinoids, phytocannabinoids and synthetic cannabinoids. Endocannabinoids (eCB) are endogenously produced in the human body and are lipid ligands that interact with at least two “G-protein” coupled receptors (CB1 and CB2) located in the brain and peripheral nervous system. The activation of these receptors causes an inhibition of the release of neurotransmitters (acetylcholine and glutamate) and indirectly effecting many other receptors. The CB1 and CB2 receptors are located presynaptically which means that cannabinoids modulate neurotransmitter release [7]. The concern during prenatal and post birth development through the adolescent years is that exogenous cannabinoids may alter the neurodevelopment of the brain since evidence points to CB1 receptors being more prevalent during developing years than in the adult [8]. Phytocannabinoids are naturally occurring cannabinoids found in the cannabis plant with the four most abundant cannabinoids already mentioned above. Finally, synthetic cannabinoids (SCs) are human-made (chemically engineered) mind altering chemical agonists that structurally may or may not be similar to naturally occurring phytocannabinoids but are full agonists at cannabinoid receptors, unlike THC which is a partial agonist of CB1 and CB2 receptors [9]. It is the CB1 receptor and its interaction with THC or similar ligands such as SCs that leads to the psychotropic effects. Through antagonistic effects on the CB1 receptor, marijuana induces its mental and behavioral effects. The initial research into biologically active analogs (essentially SCs) were performed by pharmaceutical companies pursuing biological activity but lacking psychoactive side effects. At present, there are two SCs derived from cannabis that are used medically and regulated and those are dronabinol and nabilone [10]. Dronabinol is a scheduled III drug and Nabilone is a schedule II drug with the former used for nausea and vomiting related to chemotherapy, anorexia or AIDS, and the latter is also used for nausea or vomiting from chemotherapy. Unfortunately, underground laboratories have utilized this research and produced illicit compounds used as alternatives for marijuana. The physiology of the human endocannabinoid system makes it possible to be exploited and makes it receptive to exogenous synthetic compounds, making it an easy target for abuse [11].
The endocannabinoid system consists of the endocannabinoids and the cannabinoid receptors. Cannabinoid receptors (CB1) are expressed in the brain, peripheral nervous system and peripheral tissues such as the heart, gut, liver, reproductive system, immune system and the respiratory system [12]. CB2 subtype is expressed in peripheral organs with immune function such as spleen, thymus, tonsils, and in cells such as macrophages and leukocytes. Despite what is known about cannabinoid receptors, what is still subject to debate is the physiologic function of these receptors. Of importance however, is that CB1 receptors are the most prevalent G-protein coupled receptors in the human brain and is highly expressed in cognitive processing regions and in the reward regions of the brain [13]. CB1 and CB2 receptors play a key part in a yet to be fully understood endogenous cannabinoid signaling system. The principal lipid ligands known as anandamide (AEA) and 2-arachidonyl glycerol (2-AG) are responsible for signal transduction but may also themselves be acted upon by specific and important enzymes during signal transduction. Although the components of the endocannabinoid system may remain consistent through life, its function is drastically different during nervous system development as eCB play important roles in neurodevelopment and synaptic plasticity [14, 15]. Unfortunately, it is also under appreciated that brain development does not stop until late adolescence (18–24 years old) [16].
In the brain, the endocannabinoid system is involved in sleep regulation, anxiety control, reward reaction, appetite control, neuroprotection and neural development. During adolescence, eCB and their respective receptors play a vital role in neurodevelopment processes such as pruning and synaptic plasticity [17, 18]. During fetal growth and development and during continued maturation post birth, eCB play an important role in central nervous system (CNS) development with neuro progenitor cells which are multipotent stem cells that can form new cells in the nervous system. So eCB system plays a critical regulatory role throughout development, from the determination of cell fate determined by progenitor cells and neuronal migration to regulation of synaptic transmission and signaling pathways of the fully developed CNS [19]. The precise mechanism by which eCB system molds adolescent brain development however is not clear.
What is clear, however, is that cannabis use is commonly initiated during adolescence and that the exogenous THC psychotropic impact is experienced through the developing eCB system during a vulnerable period of neurodevelopment. One of the concerns, during this neurodevelopment transition period is that marijuana will “over activate” the eCB system resulting in behavioral abnormalities and possibly addiction [7, 20]. Adolescence is a critical time period for brain development which involves the eCB system and there is some evidence noted below that would indicate that this age group’s mental health may be particularly vulnerable to the effects of exogenous THC. Some of the behavioral abnormalities that have been linked to cannabis use in younger people, before the age of 17, are schizophrenia, psychosis, bipolar disorders and addiction [15]. More specifically, Goggi and coworkers found that there was an association of cannabis use during adolescence (age < 18 years) and depression, suicidal ideation and suicide attempts [21]. The authors’ meta-analysis suggest that cannabis could be a significant factor, among many, contributing to depression in young adulthood and is consistent with the negative influence of cannabis in brain plasticity during development.
Adolescent impulsivity associated with prolonged myelination process and the lack of prefrontal inhibitory control during this period of growth and development could set this population up for some mental health issues precipitated by cannabis. Kristen Schmidt and colleagues [22], in their systematic review of adolescent cannabis use and suicide, found there to be a significant relationship among suicidal thoughts, behavior and suicide attempts with adolescent cannabis users. The UCLA psychiatric group suggests that cannabis is an independent predictor of suicide in this age group and that frequency of cannabis use is associated with increased suicide attempts. Consistent with this finding in adolescents was the study by Hosseini and Oremus from Canada showing earlier age-of-initiation of cannabis use was associated with a higher risk of psychosis [23]. Indeed, early-onset cannabis use (age < 18) but not late onset cannabis use was associated with a higher risk for major depressive disorder by Schoeler and colleagues out of London, especially for individuals with higher frequency cannabis use [24]. Although the causality of cannabis use and mental health issues remain unclear among adolescent studies [25], there are other issues that are also important for clinicians to counsel adolescents and parents regarding cannabis use: cannabis may have detrimental effects on cognition, brain and educational outcomes that can persist beyond acute intoxication and second, improvement of these detrimental effects appear possible with sustained abstinence [26].
The most frequent negative effect of chronic cannabis exposure is addiction and regular cannabis users may develop a cannabis use disorder called CUD. CUD is defined as the inability to stop consuming cannabis even when it is causing physical or psychological harm, generally including compulsive use and neglect of obligations [27]. In many regular cannabis users, cannabis withdrawal syndrome (CWS) may occur with cessation of cannabis use and is an indicator of CUD. Signs and symptoms of CWS include cravings, irritability, sleep disruption, aggression, weight loss, depression, anxiety, sweating, headaches, tremors and fatigue and may occur within days of stopping cannabis [15]. There are no approved medications for either CUD or CWS. However, initial treatment would be similar to many other withdrawal syndromes. Supportive care and treatment for CWS for those with no prior psychiatric history, has included a tapering dose of phenobarbital (seizures), Escitalopram and low dose benzodiazepines (anxiety), clonidine, (generalized withdrawal symptoms), Naltrexone (cravings), and Metoclopramide (nausea) [28].
Although the temperament of the above information may imply some form of consensus that regular cannabis use during adolescence has uniformly negative consequences for cognitive impairment, the evidence is very complex and evolving and will likely take years to elucidate. For adolescents or young adults who come in for cannabis related toxicity and appear to be “regular or heavy users”, the clinician may want to offer advice regarding the potential for adverse cognitive, neural, and educational effects from daily cannabis use [26]. There is some evidence, however, for cognitive recovery after 4–6 weeks of abstinence from cannabis use [29], although there may be some folly in that recommendation to quit as many adolescences and adults who are regular users find it difficult to end their cannabis addiction because of possible neuroadaptation that may occur with regular use [30, 31]. Current evidence would suggest that initiation of cannabis use should be delayed until much later in adolescence, use should be occasional and not daily, high potency marijuana should be low, and use occurs in ways other than smoking [32].
THC is the primary psychoactive chemical in cannabis that is responsible for producing the subjective “high”, feelings of euphoria, as well as the adverse effects caused by overdosing such as panic, anxiety, paranoia, and psychosis [33, 34]. The somatic or physiologic effects such as changes in heart rate (HR) and Blood pressure (BP) along with increased cardiac output, cardiac workload, and consequently oxygen workload are also an effect of THC [35]. CBD (acid metabolite THC-COOH) is non psychotropic.
In 12th graders, cannabis has the lowest rate of abeyance of all substances used by this age group [36]. In 2018, over 1/3 of 12 graders used cannabis with 28% of 10 graders and 11% of 8th graders also admitting to cannabis use to some extent, with prevalence starting to move downward in 2021 [37]. Now the effects of cannabis legalization on availability and diminished perceived risk, especially by 12th graders, may be associated with increased adolescent cannabis use. Complicating the increased use is the enhanced potency of the cannabis flower of today because of specialized cultivation techniques resulting in at least a threefold increase in THC from 4% in 1995 to 12% in 2014 [38] with some cannabis flower strains containing upwards to 30% [39]. The effect of legalization of Cannabis has reduced prices and increased sales of high potency cannabis products such as edibles, oils, extracts, and waxes containing even higher amounts of THC (> 70%) [40]. Although changes are likely coming regarding marijuana, cannabis is classified as a Schedule 1 drug by the United States Drug Enforcement Agency (USDEA) and therefore is not regulated except for dronabinol, nabilone and CBD.
One of the underappreciated effects of decriminalization and legalization of cannabis is the impact it has on both the unintentional and intentional exposure to infants and young children [41, 42]. Widespread use of cannabis simply translates to greater access to children. In contradistinction to numerous neurologic manifestations of cannabis intoxication in adolescents and young adults, such as mood and attention alterations, acute psychosis, ataxia, tremor, nystagmus, excessive motor activity or muscle relaxation, infants and young children may exhibit primarily impaired consciousness or sudden, unexplained acute encephalopathy. If intoxicants such as cannabis are not considered in the differential along with infectious, trauma, and metabolic dysfunction or dysregulation (hypoglycemia) then this necessitates larger and more invasive workups or procedures that otherwise might be obviated if only a urine tox screen was considered. Many times parents may not be forthcoming in providing information because of social or legal concerns for child abuse and many adults consider cannabis to be harmless [43]. A very recent publication comparing pre versus peri-post legalization of cannabis found children presenting to the emergency department peri-post legalization were significantly more likely to have altered mental status and respiratory involvement that required pediatric intensive care admissions. Additional clinical findings include behavioral changes of the child, ataxia, respiratory depression, seizures, apnea and coma [42].
Regarding psychiatric issues and cannabis, research has shown a dose-dependent linking between THC and psychosis although cause and effect has not been established [44]. Acute cannabis use or intravascular THC administered to normal healthy adults produces psychotomimetic effects similar to that seen in chronic psychosis [45]. In adolescents, cannabis use at 15 years of age is associated with greater likelihood of psychosis later in life but remains unclear if early onset cannabis use is an independent predictor of adverse events later in life. Indeed, most adverse events observed in individuals reporting early-onset use involve frequent and or high potency cannabis use as the most relevant factor [32].
There are many different modes of consumption of cannabis and each comes with its own risks and benefits. It behooves the user to understand, and novice users in particular, need to appreciate the differences that route of exposure can have in the initiation of effects, the duration of psychoactive effects or the intensity of the “high” [46, 47].
The main reason most people smoke cannabis is to experience the so-called high, which typically includes relaxation, some euphoria, perceptual alterations including time distortions and enhancing every day experiences such as eating, watching movies, listening to music and engaging in sex [48]. In a social context, the high could be accompanied by infectious laughter, talkativeness which enhances sociability coinciding with the peak effects within 30 minutes and ending in 1–2 hours [49]. Acute adverse effects of cannabis use include anxiety and panic attacks, psychotic symptoms and automobile accidents due to the effects on coordination, alertness, and judgment [49].
Smoking marijuana leaves or cannabis plant material is, by far, the most popular means by which to obtain the desired psychoactive effects. In Colorado, USA, approximately 2 ounces of marijuana is sufficient to make 50 marijuana cigarettes [50]. Compared to other forms of consumption, such as vaporization, ingestion, transcutaneous, rectal or vaginal routes, smoking generates the most efficient, consistent and instantaneous “high” in delivering THC in a dose dependent manner to the brain. Bioavailability by smoking ranges between 10 and 35% depending upon the regularity of smoking, depth of inhalation, breath hold and puff duration [35]. Combustion (Smoking) which occurs at a higher temperature than aerosolization and can consistently produce a similar level of cannabinoids, is generally the preferred method of delivery for many adolescents [51].
Alternative (non-combusted) methods of aerosolization such as vaporization may be more appealing for some adolescents because of their availability in youth-friendly palatable preparations. The perception of some adolescents is that vaping is more appealing because it is more discreet, healthier, better tasting, less harsh, lower cost, and resulted in better effects [52]. Devices that generate vapor for inhalation of marijuana such as table top and pocket pen devises do so by heating (electronic or otherwise) cannabis products to a vapor that can be inhaled. Even devices such as e-cigarettes that were designed for nicotine can be modified to deliver marijuana products [53]. E-liquids with flavoring can be used to mask the odor of cannabis and make it less detectable [54]. Many of cannabis extracts (oils, vape cartridges, hash) that are vaporized can contain 60% THC, with solid extracts such as wax, budder, shatter, or crumble can exceed 90% [55, 56]. Any of these extracts can be vaporized through an electronic delivery system and e-cigarettes. “Dabbing” which typically involves heating a small amount of extract (dried, concentrated cannabis) either with a tabletop vaporizer (200°C) without combustion (combustion or pyrolysis can destroy a major fraction of THC) by heating a glass rod or nail head with a blowtorch resulting in a vapor to inhale [57]. This can be a complicated method of vaporizing cannabis concentrates that can include a dab rig (modified water pipe for oils and concentrates) a nail attached to the rig to heat the concentrate, a dabber to apply the dab of concentrate to the nail, a dome placed over the nail to contain the vapor, and a blow torch to heat the nail [36]. But dabbing can be simplified with the use of a modified vape pen also known as dab or wax pen. A “dab” is a colloquial name for butane hash oil (BHO) which is a concentrated THC extract generated using butane as a solvent. The concentrate is then vaporized quickly and the user inhales the vapors and swiftly feels the effects. It’s unclear if this method of “dabbing” is inherently more dangerous than ingesting or inhaling flower cannabis (smoking) because of the more concentrated extract. These concentrated extracts can be 20–25% THC to upwards of 80% THC in comparison to smoking dried marijuana leaves which is likely 10–20%. Individuals may “dab” anywhere from a few times to 25–50 times in a brief period until the desired effect is obtained [58]. Similar to the adverse effects of smoking marijuana, risks include blackouts, tachycardia, paranoia, and hallucinations.
Hash, is the oldest form of cannabis extract, is composed of purified trichomes (the tiny hair-like outgrowths on cannabis leaves/flower that appear like sugar dusting on the plant) [39]. Inhalable or vaporized plant, oil or extract that is aerosolized by an electronic heating device may be able to generate a higher blood concentration of THC and likely a corresponding subjective effect although vaping devices can vary in their efficiency in delivering the product. It is important to note that the “strength” of a cannabis product often has few, if any, visual cues so the self-made THC/cannabis products obtained on the streets will likely have variable cannabinoid composition [59].
The pharmacokinetics of smoked and vaporized cannabis/THC produce peak blood concentrations within 3–10 minutes after onset of inhaling with THC being detectable in plasma within seconds after the first puff [35]. Both vaporized and smoked THC produce rapid peak blood concentrations in 30–90 minutes that return to baseline within 2–4 hours [39]. The pharmacodynamic onset of inhaled THC is dose related and the self-reported experiences of intoxication match, to some extent, the onset of peak blood concentration. However, because its high lipophilicity, THC is rapidly redistributed to the tissues, including the brain where it produces its neurocognitive effects. The high lipophilicity of THC also contributes to prolong detection in urine for chronic, everyday users. In certain situations, it may be imperative to obtain blood levels of THC as well as to obtain confirmation for detection of marijuana. It’s important to know that false positive urine screens for THC are possible and include: medications such as Naproxen, Ibuprofen, Promethazine, Riboflavin, Pantoprazole and Ketoprofen; and some baby shampoos and soaps [20].
There is evidence that passive inhalation by an infant can indeed result in toxicity as shown in a 13-month-old who appeared altered and ill [60]. The infant was sleeping in the parent’s room where 20 cannabis smokers were engaged in a party for many hours. The infant was subsequently discharged from the hospital and showed marked improvement after 48 hours with just supportive care. Compared to adults, infants have increased minute ventilation relative to their size, which can result in increased absorption. This likely was an enclosed area with poor ventilation and if blood levels and a urine tox screen had been performed on the infant, a THC level and a positive urine screen would have been found. The exposure of the infant to second-hand cannabis smoke is consistent with a systematic review involving passive exposure to second-hand smoke involving adults [61]. In this “meta-analysis”, adults passively exposed to increasing amounts of THC from smoked cannabis, will in kind, also report stronger drug effects and higher levels of THC and metabolites can be found in their urine.
Ingestion of “edibles” are food items made with marijuana or oils infused with THC and come in a variety of forms such as baked goods (brownies, muffins and cookies); candies including gummies, caramels, hard candies, and chocolates; lozenges; or infused beverages [62]. Edibles are becoming more popular because the products are more discreet and convenient, produce no smoke or smell, it eliminates the respiratory risk of inhalation (bronchial irritants and carcinogens), generates no secondhand smoke concerns, and it produces a more prolonged and intense psychoactive effect [47]. Many adolescents are less likely to use edibles because they report more negative effects from edibles [51]. Regardless, data appears to indicate that approximately two thirds of adolescents who use cannabis (smoking) also have used edibles [52]. In addition, edibles pose a more unique problem, especially to the unsuspecting or naive, because there are no other foods, appetizing forms or palatable products in which a drug is purposely infused into it generating the final product. Contributing to the possibility of toxicity is the delayed effects when cannabis products are ingested compared to inhalation. Other concerns include accidental ingestions (especially children), and dose titration as edibles can vary in THC within and across products making it difficult among users to estimate the THC concentration that may lead to overconsumption.
The pharmacokinetics of edible cannabis differ from the profile of inhaled cannabis resulting in peak psychoactive effects being delayed hours after ingestion. As noted above, the effects of inhaled cannabis can be felt within 10 minutes, peak blood concentrations within an hour and complete clearance from the blood within 4 hours. Since adolescents or any adult can feel the effects (pharmacodynamics) of inhaled cannabis within minutes, significant toxicity can occur from consuming edibles if the user expects the same time line. When taken orally, THC (Delta-9 THC) undergoes “first pass effect” as the digestive system absorbs and further bio transforms (metabolize) the drug in the liver and in the process, decreases the availability of the active drug (THC) and generates another active equipotent metabolite (11-OH-THC) as well as the inactive carboxylic acid (THC-COOH) [35]. The hydroxylation of THC by the liver cytochrome P450 system to form 11-OH-THC is a potent psychoactive metabolite that readily crosses the blood brain barrier [63], and may be responsible for the stronger and longer lasting drug effects of edibles in comparison to comparable doses of smoked cannabis [64, 65].
The bioavailability of THC when ingested is 10–20% as much of the cannabinoids contained in cannabis are degraded [20]. The process of absorption, metabolism, and re-distribution generates variable time delay in the onset of effects which may result in the adolescent consuming more than initially intended. Although edibles can produce the same dose-related increments in peak THC blood concentrations and subjective high as inhalation, oral THC may take at least 30 minutes to reach significant blood levels with a peak at 3 hours and clearance from the blood at 12 or more hours [35, 39]. Consequently, oral consumers of edibles generally report longer lasting effects of the cannabis than inhalation as well as more intense and unpleasant side effects which can result in significant toxicity [62, 66, 67].
Cannabis toxicity from edibles probably results in the majority of visits to the health care system simply because it encompasses all age groups, both young and old. The very young, because toddlers are human vacuum cleaners destined to clean up after adults who left their gummy bears within reach, an unsmoked joint or THC resin on the coffee table or half-eaten cannabis cookie on the floor. If 10 to 30 mg of oral THC is the recommended dose for intoxication in an adolescent/young adult, then a cookie containing approximately 100 mgs of THC that a toddler eats could die from respiratory failure [68]. The adolescent or adult comes to the emergency department because of failure to appreciate the differing THC pharmacokinetic profiles of ingestion vs. inhalation and the user consumed the entire edible cookie after not experiencing the initial effects from ¼ of the intended dose of cookie he was to consume but did not because of delayed effects. Now the anxious adolescent who consumed the entire edible cookie is delirious or severely impaired and is experiencing an unexpected adverse effect in need of at least supportive medical care.
The majority of patients seen for cannabis ingestion will not require any treatment [42, 68, 69]. However, compared to toxicity from inhalation (cannabis), cannabis ingestion will be the mode of exposure that most likely will cause concerning signs and symptoms. Adolescents as well as adults were more likely to intentionally ingest edibles due to overconsumption and poor understanding of the delayed effects and experience tachycardia and CNS excitation that ranged from anxiety, paranoia and panic attacks to altered mental status, psychosis, and seizures with benzodiazepines being the most commonly used medication during care [67, 69]. Treatment for cannabis psychosis in the acute stage including agitation, auditory and visual hallucinations included intramuscular antipsychotics (haloperidol and droperidol), oral risperidone and olanzapine, seclusion as well as benzodiazepines [70]. Most of the other minor interventions will be for nausea and vomiting, fluid hydration and supplemental oxygen. There is no antidote for cannabis toxicity and no way to alter or hasten its metabolism, nor to increase its rate of excretion. The majority of these patients were discharged home from the emergency department with some (<10%) needing hospitalization. Clinical findings in older children and adolescents may include psychosis, ataxia, tremors, nystagmus, mood and attention alterations, excessive motor activity and muscle relaxation [43]. Children (<12 years) were more likely to unintentionally ingest edibles at home and experience CNS sedation with a higher risk of ICU admission and an occasional intubation for CNS depression [42, 69]. For children under the age of 6 years, the most common clinical effects from ingestion included, drowsiness or lethargy, ataxia, agitation or irritability and confusion. The less common but serious effects included respiratory depression, coma and seizure [71]. It is important to realize that cannabis intoxication may be life threatening, especially in the very young [72, 73].
Cannabis intoxication in children should be suspected in an afebrile child, previously known to be healthy, with a clinical presentation that includes drowsiness, lethargy, or coma with no focal neurological findings [72]. Most of the other minor interventions will be for nausea and vomiting, fluid hydration and supplemental oxygen. Although edibles being the most commonly ingested substance, other ingested substances included botanical, concentrates and resins.
There are several studies now that are associating the high percentage of THC with a considerable increase in acute toxicity, especially with an increased risk of psychosis [32, 74, 75].
Cannabis-derived drugs (marijuana) are the most widely used illicit drug in pregnancy and is frequently used to minimize the symptoms of morning sickness [76]. Although marijuana is not listed as a known teratogen, it’s conceivable that THC, acting through the eCB system could result in perturbations of the developing fetus that could adversely affect neurodevelopment. Cannabis exposure during pregnancy does not cause congenital defects such as mental retardation and developmental disabilities as with fetal alcohol syndrome [77]. Very early in the peri-conception period there is some evidence that in utero cannabis exposure may increase the risk of anencephaly [78], although evidence on possible adverse impacts on fetal development and neonatal outcomes is inconsistent. However, there are studies that implicate cannabis in causing neurological impairment, hyperactivity, poor cognitive function, and changes in dopaminergic receptors in children when exposed in utero [79].
Marijuana constituents do pass freely across the placenta and has been shown to concentrate in breastmilk at levels 8 times of that of plasma THC [80]. Endocannabinoids (AEA and 2-AG) are also found in breast milk [81]. While there is clear data showing cannabinoids are expressed in breast milk, there is no concrete evidence that infants exposed to such breast milk have any potential health effects [82]. Although the pharmacokinetics are known regarding the metabolism and plasma concentration after inhalation, intravenous and oral cannabis administration, less is known about the distribution of cannabinoids in breast milk. There is also a tendency for breast feeding moms to increase their cannabis use during the postpartum period and this increase translates to enhanced levels of THC in breast milk [83]. Because there is so little information on cannabis use during pregnancy and postpartum use while breast feeding, the clinician may want to consider harm reduction approach to reduce cannabis use during pregnancy and postpartum [18]. The perception during pregnancy and with postpartum mothers using cannabis that little harm is to come from cannabis use is simply not known and further research is urgently needed. Lower birthweight of the newborn is associated with smoking marijuana during pregnancy, as is smoking cigarettes [84]. Whether or not the oxidative stress caused by smoke is a mechanism of low birth weight or if it is a direct effect of cigarette or marijuana is not known [85].
Synthetic cannabinoids (SCs) are chemically engineered agonists to the CB1 receptor in the endocannabinoid system and are biochemically similar to THC in its post receptor activity but may be chemically/structurally quite different to the THC molecule making it undetectable in urine drug screens. It emerged in the 1970s when researchers were hopeful in developing new treatments for cancer and were synthesized in academic centers and pharmaceutical industries [4]. It wasn’t until 2008 however that investigators first detected the synthetic cannabinoid (JWH-018) in a herbal product that was related to a forensic investigation [5]. Since then, and actually greatly underappreciated before that, SCs have mushroomed in their prevalence and are now readily available on the streets for abuse purposes. SCs are commonly known as synthetic marijuana or synthetic cannabinoid receptor agonists and are sold in brightly colored foil packages and contain finely cut plant material that has been adulterated or ‘sprayed” or soaked with SCs. As such, these SCs are not regulated, there are no “good laboratory practice” associated with the production of SCs by clandestine laboratories, and are classified as Schedule I in the United States based on their chemical structures by the USDEA. The dried plant material used for smoking has no inherent psychotropic effects and are solely a vehicle for delivering the synthetic cannabinoid effect. Initially it was the illegality of marijuana that likely motivated the production of SCs by drug distributers and entrepreneurs to produce compounds that could be marketed to users of marijuana or prospective new users to provide a “legal” alternative to marijuana but still with the desired effects including mood elevation, relaxation, euphoria, or creative thinking [86]. It remains to be seen what impact legalization of marijuana may have in the future regarding the continued use of SCs as the toxicities associated with SCs use by younger audiences are greatly underappreciated.
There are likely over 500 SCs that have been introduced into the recreational markets and they are among the most abused psychoactive substances in Europe and United States [79]. The prevalence of synthetic cannabinoid agonists use by adolescents is reported to be less than 2% in 2021, down from 3 to 10% the year before [37]. Most SCs are very potent and are high-efficiency/full agonists of the CB1 receptors unlike THC, which is considered a partial agonist at the CB1 receptor [3]. However, it is important to realize that the similarities in effects between marijuana and SCs are assumed based only on their receptor binding to CB1 and CB2 as no comparison dosing studies have ever been done. Consequently, the toxicities of SCs are likely underappreciated especially when the adverse effects of marijuana are considered low risk beyond the intoxication effects of low potency cannabis [87]. One author estimates that the risk of an emergency room visit is approximately 30-fold higher with SCs than with cannabis [88]. There is evidence that being a partial or a full agonist of the CB1 receptor along with their binding affinities may correlate with the level of exaggerated psychoactivity [89]. Both SCs and THC activate CB1 receptors which trigger the psychotomimetic effects. Speculation is that the adverse effects and unpredictability of SCs stem from the greater affinity for and increased efficacy at the CB1 receptors, compared to THC, but the relationship is complex [44]. Indeed, the full agonist activity and higher potency of the SCs at the SC1 and SC2 receptors may account in part, for their greater toxicities [90] as it has been estimated that SCs may be 5–80 times more potent at the CB1 receptor than natural cannabis [91]. Besides difference in receptor affinities and whether it is a full or partial agonist at the CB1 receptor, there are likely other differences that may assist in explaining greater toxicity with SCs. First, a remarkable difference in metabolism is that THC has only one active metabolite (11-OH-THC) while SCs can have many metabolites that retain binding affinity and activity at the CB1 receptor [92]. Most of the phytocannabinoids such as THC or cannabinol are metabolized through the liver P450s (CYP2C9, CYP2C19, and CYP3A4) while metabolism of SCs is likely through several metabolic pathways including P450s that may generate metabolites that are injurious to tissues. Although both cannabis and SCs go through the cytochrome P450 system that mediate the phase I reaction, much of the similarities in phase II reaction likely end there as most of cannabis undergoes glucuronidation while SCs undergo multiple processes in both phase I and phase II. However, much of the metabolism of SCs have limited data available. Second, when cannabis is smoked or ingested, all of the additional cannabinoids along with various terpenoids are also inhaled which may provide some complementary or synergistic activity, so called entourage effects [33]. As an example, with increasing potency of cannabis there has been a decrease in CBD levels (increasing THC/CBD ratio) which has been implicated in potentially causing health complications, perhaps because of lessoning of the “entourage effects”. In abusing SCs, there are no other cannabinoids or terpenoids ingested (but many other chemicals certainly could be ingested with SCs) that could “off set”, blunt, modify the activity at the CB1 receptor or provide some neuroprotective effect or some other non-receptor effect, thereby altering the pharmacodynamic full effects of the SCs.
To be clear, SCs are inherently more dangerous, the production of SCs in clandestine labs do not honor the Good Manufacturing Practice regulations so user beware, and the toxicity of SCs can lead to multiple end organ adverse events, including CNS, which can be classified as either physical or psychological effects. Because there are new SCs flooding the markets to avoid the legal system, the likely presence of multiple SCs being ingested at once is likely. No controlled dosing studies have ever been done in humans with SCs, consequently, the pharmacokinetics and pharmacodynamics of SCs are difficult to report with any assurance. Clinicians should suspect the possibility of SCs in an adolescent or young adult who arrives for evaluation with adverse effects similar to cannabis with a neg urine drug screen, including THC. The clinical effects can be highly variable and this diversity of findings may be attributed to the continued variability in composition and concentration of chemicals within SCs [93]. These findings include cardiovascular events, kidney injuries, gastrointestinal problems, neurological events, pulmonary effects, ocular, or psychiatric conditions [3, 86, 94, 95, 96, 97, 98, 99]. At present, the unpredictable effects of SCs and the lack of a clear toxidrome to distinguish SCs from other drugs of abuse makes the differential broad and requires the clinician to first eliminate diverse conditions before settling on the possibility of SCs. In addition, it is also unclear whether the below toxicities are due to the SCs parent molecule, metabolites, or contaminants. See Table 1 for summary of toxicities: synthetic cannabinoids vs. botanical marijuana (Modified from Ford BM, et al) [98].
Human cannabinoid toxicities | ||
---|---|---|
Synthetic cannabinoids | Botanical marijuana | |
Cardiovascular | ||
Tachycardia | frequent | uncommon |
Arrythmias | possible | rare |
Hypertension | possible | rare |
Chest pain | possible | rare |
Myocardial Infarction/Toxicity | possible | uncommon |
Renal | ||
Acute Kidney Injuries | possible | rare |
Gastrointestinal | ||
Nausea | frequent | rare |
Vomiting (hyperemesis) | frequent | rare |
Neurological | ||
Euphoria | frequent | frequent |
Appetite Stimulation | frequent | frequent |
Nystagmus | possible | possible |
Slurred Speech | possible | possible |
Lethargy/Ataxia | possible | possible |
Confusion | frequent | rare |
Seizures | possible | rare |
Cerebral Ischemia | possible | rare |
Panic Attacks | frequent | rare |
Memory Issues | uncommon | frequent |
Pulmonary | ||
Acute Resp Distress Syn | possible | rare |
Respiratory Depression | possible | possible |
Ocular | ||
Conjunctival hyperemia | common | frequent |
Psychiatric | ||
Hallucinations (vis/aud) | frequent | rare |
Delusions | frequent | rare |
Excited Delirium | frequent | rare |
Psychosis | possible | uncommon |
Agitation | frequent | rare |
Anxiety | frequent | rare |
Human cannabinoid toxicities: Comparison of synthetic cannabinoid toxicities with botanical marijuana by systems.
Tachycardia and hypertension are the most common clinical effects reported. Associated with tachycardia, there can also be cardiac arrythmias, strokes, chest pain, and myocardial infarctions have also been reported even in adolescents and young adults with no previous cardiac issues. Both bradycardia and hypotension are possible. Other than tachycardia, in comparison to toxicity from marijuana, the other associated cardiovascular toxicities from SCs are not generally reported with marijuana. However, myocardial infarctions have been reported in marijuana smokers and appears to be especially noted during the first hour of exposure.
In the settings of acute toxicity from SCs, there have been numerous reports of acute kidney injuries including elevated serum creatinine, proteinuria, hematuria, acute tubular injury and acute tubular nephritis, hypokalemia, and rhabdomyolysis. Other metabolic disturbances have also been noted in SCs including metabolic/respiratory acidosis and alkalosis. Similar to the cardiovascular toxicities, no renal toxic effects have generally been reported from marijuana.
Nausea and vomiting are frequently reported with toxicity from SCs and has occurred with cannabis although not as frequently. In fact, it remains unclear why cannabis may suppress emesis in some people and appears to induce it in others. There is a phenomenon of cannabinoid hyperemesis syndrome (CHS) or cyclic vomiting syndrome (CVS), that appears mostly with inhalation of cannabis/SCs but has been observed most frequently with SCs. This is the result of chronic abuse and symptomatic relief can be obtained with hot showers. The most effective means to end CVS is through complete cessation of cannabis use which may take 2 weeks of abstinence. Patients being evaluated for this should be monitored for dehydration and kidney issues as well as Mallory-Weiss tears. Intravenous Haloperidol or Droperidol or application of capsaicin cream to the abdomen appear to be the most effective drugs to control nausea as conventional antiemetics do not appear to offer much relief [100]. Abdominal pain, diarrhea, xerostomia have been reported and resolve. Mouth issues including periodontal bone disease with gingival enlargement have also been seen in chronic use in both CBs and cannabis [101]. Hepatotoxicity has been noted with the use of some SCs [102]. Few GI issues have been reported with cannabis other than related to emesis.
There are a multitude of neurological clinical effects that are possible with toxicity from SCs. Some of the neurological toxicity findings are found in both acute effects of cannabis and SCs and these include, euphoria, appetite stimulation, slurred speech, ataxia/lethargy, and nystagmus. Acute toxicity from SCs is more likely to exhibit the following neurological findings in comparison to cannabis: confusion, anxiety, panic attacks, agitation, irritability, and seizures. Very recently, there was a publication citing evidence that cannabis may have proconvulsant effects [103]. In addition, the following have been reported in acute toxicity from SCs including self-mutilation, catatonia or psychomotor retardation, and memory disturbances. It should be noted that memory disturbances are commonly observed in cannabis abuse.
Severe respiratory depression or tachypnea has been observed, along with pneumothorax and acute respiratory distress syndrome can occur with SCs use. In 2019, there was an outbreak of product use-associated lung injury (so called e-cigarette, or vaping, product use associated lung injury, EVALI) [54]. It was not found to be from any particular cannabis or cannabis extact or SCs, but rather from Vitamin E acetate, a diluent and thickening agent in cannabis-based products. Severe respiratory depression can certainly occur with cannabis ingestion as noted above, especially in toddlers and children. Pneumothorax can also occur from both cannabis and SCs use and may be more of a function in maximizing pulmonary absorption by taking very deep and prolonged breaths. Someone with panic attacks or anxiety may be overlooked when an astute clinician or a chest xray may reveal a reason for their anxiety or panic attack and that is a pneumothorax.
Conjunctival hyperemia and mydriasis have been noted in both toxicity from SCs and cannabis.
Hallucinations (visual and auditory), anxiety, delusions, excited delirium, and psychosis in susceptible individuals have been noted to be more common in SCs users than in cannabis users regarding acute effects. Psychosis is a condition in which the individual is not able to think clearly, unable to distinguish between reality and false beliefs or delusions. Similar to psychosis with high potency THC, there may be a dose effect that exists for SCs although research is lacking for SCs and absolute confirmation linking cause and effect regarding THC and psychosis is lacking.
As noted above under “neurological”, more individuals with toxicity from SCs were found to have confusion, anxiety, agitation, irritability, and panic attacks compared to cannabis users [104]. Suicidal thoughts and attempts have also been noted in toxicity from SCs. In some, the overall effects of SCs can resemble those of cannabis, but those presenting to the hospital are doing so because of behavioral abnormalities (agitation, psychosis or severe anxiety) or because of acute illnesses such as those listed above involving other end organs. Psychosis or psychosis-like conditions appear relatively frequently with the use of SCs and may be a direct or indirect effect (parent SCs or metabolites) of their high potency or perhaps due to the absence of CBD, the so-called entourage effect with marijuana. There is now evidence that SCs exposure in adolescents is associated with higher odds of neuropsychiatric morbidity than cannabis exposure [105].
Clinical management frequently involves supportive care, intravenous fluids, electrolyte replenishment, benzodiazepines for seizures, neuroleptics (Haldol or Droperidol) for psychotic symptoms, or agitation not responsive to benzodiazepines. Many patients may need to be admitted if unstable, or if acute agitation/psychosis is not clearing. In most patients, the effects noted above are not life threatening and generally cease in around 8 hours after consumption [106]. It should also be noted that unlike cannabis, SCs are not detected by common urine drug screens.
Cannabis use is long standing and is not going away. There are currently two major driving forces that may dictate the health of a subset of our adolescence if allowed. First, are the socioeconomic and legislative changes that are generating cheaper and legally available cannabis products, perhaps under the guise of a falsely reassuring perception in lack of harm. The second driving force that is also concerning is higher potency cannabinoids, whether they be botanically derived or synthetic in derivation, that acutely cause toxicity in the CNS and other end organs where cannabinoid receptors are abundantly expressed and has been discussed in this review with management recommendations. With continued use, cannabinoid agonists may be linked to poor social and behavioral outcomes later in life as well as neurocognitive deficits yet to be determined. The research is lacking, urgently needed, and findings likely subtle and difficult to quantify. The nature of adolescence and young adulthood is experimentation and risk taking but the involvement of the eCB system may now be unlocked during critical periods of neurodevelopment. Exogenous cannabinoid agonists may lead to exaggerated psychoactive effects that could result in the formation of permanent and irreversible neural networks posing issues later in life. Future vulnerabilities may include cannabis use disorder and withdrawal issues in the short term and psychosis, schizophrenia, and addiction in the long term.
Much appreciation to Renee Lamoureux and the librarian staff at Essentiahealth, St. Mary’s Hospital, Duluth, Minnesota, USA for their tremendous assistance in completing this manuscript.
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Unlike males, adult female mosquitoes are evolved with unique ability to take blood meals from a vertebrate host for reproductive success which eventually makes them a potential vector. Processing and integration of chemical information in the neuro-olfactory system followed by salivary actions facilitate blood meal uptake process. Thus, deciphering the underlying molecular mechanism of odor sensing through the detection machinery (olfactory system), odor processing and decision-making by decision machinery (brain), and regulation of saliva secretion by the action machinery (salivary gland) is likely to reveal molecular pathways which can be targeted to disrupt mosquitoes’ feeding behavior. Here we summarize how smart actions of highly specialized neurosensory systems guide and manage feeding behavior associated complex events of (i) successful navigation to find a suitable host, (ii) making food choice decisions, and (iii) regulation of the salivary gland actions in mosquitoes.",book:{id:"8732",slug:"sino-nasal-and-olfactory-system-disorders",title:"Sino-Nasal and Olfactory System Disorders",fullTitle:"Sino-Nasal and Olfactory System Disorders"},signatures:"Tanwee Das De and Rajnikant Dixit",authors:[{id:"309585",title:"Dr.",name:"Tanwee",middleName:null,surname:"Das De",slug:"tanwee-das-de",fullName:"Tanwee Das De"}]},{id:"68352",doi:"10.5772/intechopen.88341",title:"Swallowing Disorders in Patients with Stroke",slug:"swallowing-disorders-in-patients-with-stroke",totalDownloads:1108,totalCrossrefCites:0,totalDimensionsCites:2,abstract:"Swallowing disturbance often causes by stroke and may predispose patients to malnutrition and dehydration, as well as increases the risk of such complications as suffocation and aspiration pneumonia. As an initial evaluation, the water swallowing test can be easily carried out, but not all of the aspiration can be excluded. Therefore, videofluorography (VF) and videoendoscopic examination (VE) of swallowing should be performed to find a safety method of oral intake for providing visualization of the pharynx and larynx dysfunction. Clinical severity scale is important because once the severity is determined, the treatment strategy is also known. Swallowing training can be divided into indirect training without food (basic training) and direct training with food (eating training). In general, it is important to select conditions and training diets that are easy to swallow and have a low risk of aspiration while using indirect training and direct training that aim at gradually improving the level of oral intake.",book:{id:"7844",slug:"voice-and-swallowing-disorders",title:"Voice and Swallowing Disorders",fullTitle:"Voice and Swallowing Disorders"},signatures:"Aiko Osawa and Shinichiro Maeshima",authors:null},{id:"68687",doi:"10.5772/intechopen.88735",title:"Pathology of Nonneoplastic Lesions of the Vocal Folds",slug:"pathology-of-nonneoplastic-lesions-of-the-vocal-folds",totalDownloads:1111,totalCrossrefCites:0,totalDimensionsCites:2,abstract:"Nonneoplastic vocal fold lesions are common that can cause hoarseness and voice change. Reactive lesions of Reinke’s space can be observed in all ages and genders and comprise the majority of the benign nonneoplastic vocal fold lesions. Although clinically different terms are used to define reactive lesions of Reinke’s space, they share the same histopathologic features. In order to differentiate vocal fold polyp and nodule and Reinke’s edema, clinical findings should be considered. Epithelial changes such as pseudoepitheliomatous and verrucous hyperplasia may cause diagnostic challenge due to resemblance of squamous cell carcinoma. Evaluation of the invasion border and cellular atypia may aid in correct diagnosis.",book:{id:"7844",slug:"voice-and-swallowing-disorders",title:"Voice and Swallowing Disorders",fullTitle:"Voice and Swallowing Disorders"},signatures:"Nil Çomunoğlu, Şebnem Batur and Ayşe Mine Önenerk",authors:null},{id:"37027",doi:"10.5772/37764",title:"Endoscopic Dacryocystorhinostomy",slug:"endoscopic-dacryocystorhinostomy",totalDownloads:5396,totalCrossrefCites:0,totalDimensionsCites:2,abstract:null,book:{id:"1758",slug:"otolaryngology",title:"Otolaryngology",fullTitle:"Otolaryngology"},signatures:"Farhad Farahani",authors:[{id:"114231",title:"Prof.",name:"Farhad",middleName:null,surname:"Farahani",slug:"farhad-farahani",fullName:"Farhad Farahani"}]}],mostDownloadedChaptersLast30Days:[{id:"70060",title:"Maxillofacial and Oral Aspects of Dysphagia",slug:"maxillofacial-and-oral-aspects-of-dysphagia",totalDownloads:1013,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Oral cavity/mouth is first recipient of food. Food is broken down and prepared for initial phases of digestion. The oral preparatory phase is voluntary. In this phase, food is manipulated by the tongue and teeth. A bolus which is ready to swallow is prepared. Any disruption of oral cavity functions commonly due to oral infections, space infections, facial trauma, congenital-cleft lip and palate, temporo-mandibular joint disorders, salivary gland pathology, oral cancers, radiation therapy, etc., can cause dysphagia. In this chapter, we would explain the maxillofacial and oral aspects of dysphagia along with diagnosis and treatment aspects.",book:{id:"7844",slug:"voice-and-swallowing-disorders",title:"Voice and Swallowing Disorders",fullTitle:"Voice and Swallowing Disorders"},signatures:"Mohammed Basha",authors:null},{id:"70716",title:"Imaging in Sinonasal Disorders",slug:"imaging-in-sinonasal-disorders",totalDownloads:925,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Computed tomography (CT) is the “working horse” in sinonasal imaging and should always be the first choice. Magnetic resonance imaging (MRI) is complementary to CT when complications to rhinosinusitis or neoplasm are suspected. Imaging of the paranasal sinuses is common due to stuffy nose. In order to correct interpretation, proper imaging technique as well as knowledge of bony anatomy and variants and mucosal incidental findings are of outmost importance. Acute rhinosinusitis is very common and does not need imaging unless complications are suspected. In chronic rhinosinusitis, a CT examination is needed to find the cause and site of the mucociliary obstruction and to rule out other causes as odontogenic and fungal sinusitis and neoplasms.",book:{id:"8732",slug:"sino-nasal-and-olfactory-system-disorders",title:"Sino-Nasal and Olfactory System Disorders",fullTitle:"Sino-Nasal and Olfactory System Disorders"},signatures:"Heidi Beate Eggesbø",authors:[{id:"65505",title:"Dr.",name:"Heidi Beate",middleName:null,surname:"Eggesbø",slug:"heidi-beate-eggesbo",fullName:"Heidi Beate Eggesbø"}]},{id:"70261",title:"Sinusitis, Asthma and Headache",slug:"sinusitis-asthma-and-headache",totalDownloads:660,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Sinusitis is the infection of sinuses. Sinuses are four hollow cavities in face which are connected to nasal pathways to help moisten, warm and filter the air which we breathe in. Sinuses get irritated due to bacteria, virus and allergens. It is often associated with asthma and headache. Pressure in the sinuses is built by over production of mucous and leads to sinus headache. Asthma gets severe with the sinusitis as both are related to sino-nasal pathway. Treatment includes steroids, nasal decongestants, antibiotics and to avoid allergens which not only reduce the symptoms of asthma but also sinusitis. Acute sinusitis may turn into chronic sinusitis including narrowing of nasal passages, deviated septum and lumps in the nose (polyp). It can be treated with surgical procedures. The only way to prevent sinusitis is by precaution and medication. Post nasal drip may also associate with asthma causing bronchial constriction.",book:{id:"8732",slug:"sino-nasal-and-olfactory-system-disorders",title:"Sino-Nasal and Olfactory System Disorders",fullTitle:"Sino-Nasal and Olfactory System Disorders"},signatures:"Fozia Masood",authors:[{id:"302764",title:"Dr.",name:"Fozia",middleName:null,surname:"Masood",slug:"fozia-masood",fullName:"Fozia Masood"}]},{id:"71245",title:"Septoplasty: Endoscopic and Open Techniques",slug:"septoplasty-endoscopic-and-open-techniques",totalDownloads:1040,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Septoplasty is one of the most commonly performed procedures by rhinologists. This article will provide a brief review of the surgical anatomy and the operative techniques of this procedure. Both endoscopic and open septoplasty procedures will be addressed. However, more than 15% of patients undergoing septoplasty fail to achieve symptomatic relief. Incomplete separation of the bony-cartilaginous junction and inadequate correction of the caudal septal deviation are the main reasons for persistent septal deviation after primary septoplasty. In revised septoplasty, correction of the caudal septal deviation can be done by proper correction of the cartilaginous curvature and strengthening of the structure using a batten graft.",book:{id:"8732",slug:"sino-nasal-and-olfactory-system-disorders",title:"Sino-Nasal and Olfactory System Disorders",fullTitle:"Sino-Nasal and Olfactory System Disorders"},signatures:"Yi-Tsen Lin",authors:[{id:"311313",title:"Dr.",name:"Yi-Tsen",middleName:null,surname:"Lin",slug:"yi-tsen-lin",fullName:"Yi-Tsen Lin"}]},{id:"70540",title:"Swallowing Disorders in Cervical Facial Tumors",slug:"swallowing-disorders-in-cervical-facial-tumors",totalDownloads:755,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"We review current state of the art protocols on swallowing disorders associated to cervical facial tumors. The clinician needs to translate physiology notions to bedside diagnosis. Facing such a case the ENT surgeon must follow several key steps: thorough history taking, barium transit, endoscopy evaluation of swallowing, high resolution diagnosis imaging. Afterwards surgical treatment plan should take into consideration the need to careful dissection of vascular and nervous structures. Dysphagia may present from initial diagnosis or after surgical resection of the tumor or during radiation and chemotherapy. We discuss the use of various staging scales or questionnaires for assessing quality of life. We illustrate the importance of swallowing disorders management with various cases of tumors at the level of skull base, pharynx, salivary glands, larynx, esophagus, etc. There are various solutions for dysphagia ranging from nasogastric feeding tube placement to percutaneous endoscopic gastrostomy to specially designed exercises. Sometimes the surgeon neglects these disorders and focuses on airway management. However, the rule should be to encourage swallowing as soon as possible after surgery. A good nutritional status is necessary for a positive prognosis in swallowing disorders. Team effort in tertiary oncology units is the key in supporting such complex cases.",book:{id:"7844",slug:"voice-and-swallowing-disorders",title:"Voice and Swallowing Disorders",fullTitle:"Voice and Swallowing Disorders"},signatures:"Daniela Vrinceanu and Mihai Dumitru",authors:null}],onlineFirstChaptersFilter:{topicId:"1098",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:11,numberOfPublishedChapters:91,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:108,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:332,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:11,numberOfPublishedChapters:142,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:124,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:12,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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",coverUrl:"https://cdn.intechopen.com/series/covers/23.jpg",latestPublicationDate:"August 17th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:0,editor:{id:"280770",title:"Dr.",name:"Katherine K.M.",middleName:null,surname:"Stavropoulos",slug:"katherine-k.m.-stavropoulos",fullName:"Katherine K.M. Stavropoulos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRdFuQAK/Profile_Picture_2022-05-24T09:03:48.jpg",biography:"Katherine Stavropoulos received her BA in Psychology from Trinity College, in Connecticut, USA and her Ph.D. in Experimental Psychology from the University of California, San Diego. She completed her postdoctoral work at the Yale Child Study Center with Dr. James McPartland. Dr. Stavropoulos’ doctoral dissertation explored neural correlates of reward anticipation to social versus nonsocial stimuli in children with and without autism spectrum disorders (ASD). She has been a faculty member at the University of California, Riverside in the School of Education since 2016. Her research focuses on translational studies to explore the reward system in ASD, as well as how anxiety contributes to social challenges in ASD. She also investigates how behavioral interventions affect neural activity, behavior, and school performance in children with ASD. She is also involved in the diagnosis of children with ASD and is a licensed clinical psychologist in California. 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He graduated from the Physics Department of the University of Crete and continued his post-graduate studies at the University Paris 7-Denis Diderot (D.E.A. in Didactic of Physics), University Paris 5-René Descartes-Sorbonne (D.E.A. in Science Education) and received his Ph.D. degree at the University Paris 5-René Descartes-Sorbonne (PhD in Science Education). His research interests include science education in early childhood, science teaching and learning, e-learning, the use of ICT in science education, games simulations, and mobile learning. He has published over 120 articles in international conferences and journals and has served on the program committees of numerous international conferences.",institutionString:"University of Crete",institution:{name:"University of Crete",institutionURL:null,country:{name:"Greece"}}},editorTwo:{id:"422488",title:"Dr.",name:"Maria",middleName:null,surname:"Ampartzaki",slug:"maria-ampartzaki",fullName:"Maria Ampartzaki",profilePictureURL:"https://mts.intechopen.com/storage/users/422488/images/system/422488.jpg",biography:"Dr Maria Ampartzaki is an Assistant Professor in Early Childhood Education in the Department of Preschool Education at the University of Crete. Her research interests include ICT in education, science education in the early years, inquiry-based and art-based learning, teachers’ professional development, action research, and the Pedagogy of Multiliteracies, among others. She has run and participated in several funded and non-funded projects on the teaching of Science, Social Sciences, and ICT in education. She also has the experience of participating in five Erasmus+ projects.",institutionString:"University of Crete",institution:{name:"University of Crete",institutionURL:null,country:{name:"Greece"}}},editorThree:null},{id:"90",title:"Human Development",coverUrl:"https://cdn.intechopen.com/series_topics/covers/90.jpg",isOpenForSubmission:!0,editor:{id:"191040",title:"Dr.",name:"Tal",middleName:null,surname:"Dotan Ben-Soussan",slug:"tal-dotan-ben-soussan",fullName:"Tal Dotan Ben-Soussan",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSBf1QAG/Profile_Picture_2022-03-18T07:56:11.jpg",biography:"Tal Dotan Ben-Soussan, Ph.D., is the director of the Research Institute for Neuroscience, Education and Didactics (RINED) – Paoletti Foundation. Ben-Soussan leads international studies on training and neuroplasticity from neurophysiological and psychobiological perspectives. As a neuroscientist and bio-psychologist, she has published numerous articles on neuroplasticity, movement and meditation. She acts as an editor and reviewer in several renowned journals and coordinates international conferences integrating theoretical, methodological and practical approaches on various topics, such as silence, logics and neuro-education. She lives in Assisi, Italy.",institutionString:"Research Institute for Neuroscience, Education and Didactics, Patrizio Paoletti Foundation",institution:null},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:12,paginationItems:[{id:"83113",title:"Agoraphobic Dispositions towards Action Research: Teacher Education Students’ Perceptions and Experiences",doi:"10.5772/intechopen.106188",signatures:"Davison Zireva",slug:"agoraphobic-dispositions-towards-action-research-teacher-education-students-perceptions-and-experien",totalDownloads:1,totalCrossrefCites:null,totalDimensionsCites:0,authors:[{name:"Davison",surname:"Zireva"}],book:{title:"Active Learning - Research and Practice for STEAM and social sciences education",coverURL:"https://cdn.intechopen.com/books/images_new/11481.jpg",subseries:{id:"89",title:"Education"}}},{id:"83053",title:"Apologies in L2 French in Canadian Context",doi:"10.5772/intechopen.106557",signatures:"Bernard Mulo Farenkia",slug:"apologies-in-l2-french-in-canadian-context",totalDownloads:0,totalCrossrefCites:0,totalDimensionsCites:0,authors:[{name:"Bernard",surname:"Mulo Farenkia"}],book:{title:"Second Language Acquisition - Learning Theories and Recent Approaches",coverURL:"https://cdn.intechopen.com/books/images_new/11480.jpg",subseries:{id:"89",title:"Education"}}},{id:"82903",title:"Walking Accessibility to Primary Healthcare Services: An Inequity Factor for Olders in the Lisbon Metropolitan Area (Portugal)",doi:"10.5772/intechopen.106265",signatures:"Eduarda Marques da Costa, Ana Louro, Nuno Marques da Costa, Mariana Dias and Marcela Barata",slug:"walking-accessibility-to-primary-healthcare-services-an-inequity-factor-for-olders-in-the-lisbon-met",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Social Aspects of Ageing - Selected Challenges, Analyses, and Solutions",coverURL:"https://cdn.intechopen.com/books/images_new/11479.jpg",subseries:{id:"90",title:"Human Development"}}},{id:"82622",title:"Contemporary Geographical Gerontology: Reconciling Space and Place in Population Ageing",doi:"10.5772/intechopen.105863",signatures:"Hamish Robertson",slug:"contemporary-geographical-gerontology-reconciling-space-and-place-in-population-ageing",totalDownloads:13,totalCrossrefCites:0,totalDimensionsCites:0,authors:[{name:"Hamish",surname:"Robertson"}],book:{title:"Social Aspects of Ageing - Selected Challenges, Analyses, and Solutions",coverURL:"https://cdn.intechopen.com/books/images_new/11479.jpg",subseries:{id:"90",title:"Human Development"}}}]},overviewPagePublishedBooks:{paginationCount:0,paginationItems:[]},openForSubmissionBooks:{paginationCount:1,paginationItems:[{id:"11568",title:"Staphylococcal Infections - Recent Advances and Perspectives",coverURL:"https://cdn.intechopen.com/books/images_new/11568.jpg",hash:"92c881664d1921c7f2d0fee34b78cd08",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"July 8th 2022",isOpenForSubmission:!0,editors:[{id:"59719",title:"Dr.",name:"Jaime",surname:"Bustos-Martínez",slug:"jaime-bustos-martinez",fullName:"Jaime Bustos-Martínez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},onlineFirstChapters:{paginationCount:21,paginationItems:[{id:"83000",title:"Purine and Pyrimidine Pathways as Antimalarial Targets",doi:"10.5772/intechopen.106468",signatures:"Yacoba V.T. 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He previously worked as a post-doctoral fellow at the Ben-Gurion University of Negev, Israel; University of the Free State, South Africa; and Central University of Technology Bloemfontein, South Africa. He obtained his Ph.D. in Organic Chemistry from Nagaoka University of Technology, Japan. He has published more than seventy-four journal articles and attended several national and international conferences as speaker and chair. Dr. Kendrekar has received many international awards. He has several funded projects, namely, anti-malaria drug development, MRSA, and SARS-CoV-2 activity of curcumin and its formulations. He has filed four patents in collaboration with the University of Central Lancashire and Mayo Clinic Infectious Diseases. His present research includes organic synthesis, drug discovery and development, biochemistry, nanoscience, and nanotechnology.",institutionString:"Visiting Scientist at Lipid Nanostructures Laboratory, Centre for Smart Materials, School of Natural Sciences, University of Central Lancashire",institution:null},{id:"428125",title:"Dr.",name:"Vinayak",middleName:null,surname:"Adimule",slug:"vinayak-adimule",fullName:"Vinayak Adimule",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/428125/images/system/428125.jpg",biography:"Dr. Vinayak Adimule, MSc, Ph.D., is a professor and dean of R&D, Angadi Institute of Technology and Management, India. He has 15 years of research experience as a senior research scientist and associate research scientist in R&D organizations. He has published more than fifty research articles as well as several book chapters. He has two Indian patents and two international patents to his credit. Dr. Adimule has attended, chaired, and presented papers at national and international conferences. He is a guest editor for Topics in Catalysis and other journals. He is also an editorial board member, life member, and associate member for many international societies and research institutions. His research interests include nanoelectronics, material chemistry, artificial intelligence, sensors and actuators, bio-nanomaterials, and medicinal chemistry.",institutionString:"Angadi Institute of Technology and Management",institution:null},{id:"284317",title:"Prof.",name:"Kantharaju",middleName:null,surname:"Kamanna",slug:"kantharaju-kamanna",fullName:"Kantharaju Kamanna",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284317/images/21050_n.jpg",biography:"Prof. K. Kantharaju has received Bachelor of science (PCM), master of science (Organic Chemistry) and Doctor of Philosophy in Chemistry from Bangalore University. He worked as a Executive Research & Development @ Cadila Pharmaceuticals Ltd, Ahmedabad. He received DBT-postdoc fellow @ Molecular Biophysics Unit, Indian Institute of Science, Bangalore under the supervision of Prof. P. Balaram, later he moved to NIH-postdoc researcher at Drexel University College of Medicine, Philadelphia, USA, after his return from postdoc joined NITK-Surthakal as a Adhoc faculty at department of chemistry. Since from August 2013 working as a Associate Professor, and in 2016 promoted to Profeesor in the School of Basic Sciences: Department of Chemistry and having 20 years of teaching and research experiences.",institutionString:null,institution:{name:"Rani Channamma University, Belagavi",country:{name:"India"}}},{id:"158492",title:"Prof.",name:"Yusuf",middleName:null,surname:"Tutar",slug:"yusuf-tutar",fullName:"Yusuf Tutar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/158492/images/system/158492.jpeg",biography:"Prof. Dr. Yusuf Tutar conducts his research at the Hamidiye Faculty of Pharmacy, Department of Basic Pharmaceutical Sciences, Division of Biochemistry, University of Health Sciences, Turkey. He is also a faculty member in the Molecular Oncology Program. He obtained his MSc and Ph.D. at Oregon State University and Texas Tech University, respectively. He pursued his postdoctoral studies at Rutgers University Medical School and the National Institutes of Health (NIH/NIDDK), USA. His research focuses on biochemistry, biophysics, genetics, molecular biology, and molecular medicine with specialization in the fields of drug design, protein structure-function, protein folding, prions, microRNA, pseudogenes, molecular cancer, epigenetics, metabolites, proteomics, genomics, protein expression, and characterization by spectroscopic and calorimetric methods.",institutionString:"University of Health Sciences",institution:null},{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",biography:"Hiroyuki Kagechika received his bachelor’s degree and Ph.D. in Pharmaceutical Sciences from the University of Tokyo, Japan, where he served as an associate professor until 2004. He is currently a professor at the Institute of Biomaterials and Bioengineering (IBB), Tokyo Medical and Dental University (TMDU). From 2010 to 2012, he was the dean of the Graduate School of Biomedical Science. Since 2012, he has served as the vice dean of the Graduate School of Medical and Dental Sciences. He has been the director of the IBB since 2020. Dr. Kagechika’s major research interests are the medicinal chemistry of retinoids, vitamins D/K, and nuclear receptors. He has developed various compounds including a drug for acute promyelocytic leukemia.",institutionString:"Tokyo Medical and Dental University",institution:{name:"Tokyo Medical and Dental University",country:{name:"Japan"}}},{id:"94311",title:"Prof.",name:"Martins",middleName:"Ochubiojo",surname:"Ochubiojo Emeje",slug:"martins-ochubiojo-emeje",fullName:"Martins Ochubiojo Emeje",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94311/images/system/94311.jpeg",biography:"Martins Emeje obtained a BPharm with distinction from Ahmadu Bello University, Nigeria, and an MPharm and Ph.D. from the University of Nigeria (UNN), where he received the best Ph.D. award and was enlisted as UNN’s “Face of Research.” He established the first nanomedicine center in Nigeria and was the pioneer head of the intellectual property and technology transfer as well as the technology innovation and support center. Prof. Emeje’s several international fellowships include the prestigious Raman fellowship. He has published more than 150 articles and patents. He is also the head of R&D at NIPRD and holds a visiting professor position at Nnamdi Azikiwe University, Nigeria. He has a postgraduate certificate in Project Management from Walden University, Minnesota, as well as a professional teaching certificate and a World Bank certification in Public Procurement. Prof. Emeje was a national chairman of academic pharmacists in Nigeria and the 2021 winner of the May & Baker Nigeria Plc–sponsored prize for professional service in research and innovation.",institutionString:"National Institute for Pharmaceutical Research and Development",institution:{name:"National Institute for Pharmaceutical Research and Development",country:{name:"Nigeria"}}},{id:"436430",title:"Associate Prof.",name:"Mesut",middleName:null,surname:"Işık",slug:"mesut-isik",fullName:"Mesut Işık",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/436430/images/19686_n.jpg",biography:null,institutionString:null,institution:{name:"Bilecik University",country:{name:"Turkey"}}},{id:"268659",title:"Ms.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/268659/images/8143_n.jpg",biography:"Dr. Zhan received his undergraduate and graduate training in the fields of preventive medicine and epidemiology and statistics at the West China University of Medical Sciences in China during 1989 to 1999. He received his post-doctoral training in oncology and cancer proteomics for two years at the Cancer Research Institute of Human Medical University in China. In 2001, he went to the University of Tennessee Health Science Center (UTHSC) in USA, where he was a post-doctoral researcher and focused on mass spectrometry and cancer proteomics. Then, he was appointed as an Assistant Professor of Neurology, UTHSC in 2005. He moved to the Cleveland Clinic in USA as a Project Scientist/Staff in 2006 where he focused on the studies of eye disease proteomics and biomarkers. He returned to UTHSC as an Assistant Professor of Neurology in the end of 2007, engaging in proteomics and biomarker studies of lung diseases and brain tumors, and initiating the studies of predictive, preventive, and personalized medicine (PPPM) in cancer. In 2010, he was promoted to Associate Professor of Neurology, UTHSC. Currently, he is a Professor at Xiangya Hospital of Central South University in China, Fellow of Royal Society of Medicine (FRSM), the European EPMA National Representative in China, Regular Member of American Association for the Advancement of Science (AAAS), European Cooperation of Science and Technology (e-COST) grant evaluator, Associate Editors of BMC Genomics, BMC Medical Genomics, EPMA Journal, and Frontiers in Endocrinology, Executive Editor-in-Chief of Med One. He has\npublished 116 peer-reviewed research articles, 16 book chapters, 2 books, and 2 US patents. His current main research interest focuses on the studies of cancer proteomics and biomarkers, and the use of modern omics techniques and systems biology for PPPM in cancer, and on the development and use of 2DE-LC/MS for the large-scale study of human proteoforms.",institutionString:null,institution:{name:"Xiangya Hospital Central South University",country:{name:"China"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a scientist and Principal Investigator at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering the lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via artificial intelligence-based analyses of exosomal Raman signatures. Dr. Paul also works on spatial multiplex immunofluorescence-based tissue mapping to understand the immune repertoire in lung cancer. Dr. Paul has published in more than sixty-five peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award and the 2022 AAISCR-R Vijayalaxmi Award for Innovative Cancer Research. He is a senior member of the Institute of Electrical and Electronics Engineers (IEEE) and an editorial board member for several international journals.",institutionString:"University of California Los Angeles",institution:{name:"University of California Los Angeles",country:{name:"United States of America"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals. He is currently working on the protective activity of phenolic compounds in disorders associated with oxidative stress and inflammation.",institutionString:null,institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Dr.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329248",title:"Dr.",name:"Md. Faheem",middleName:null,surname:"Haider",slug:"md.-faheem-haider",fullName:"Md. Faheem Haider",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329248/images/system/329248.jpg",biography:"Dr. Md. Faheem Haider completed his BPharm in 2012 at Integral University, Lucknow, India. In 2014, he completed his MPharm with specialization in Pharmaceutics at Babasaheb Bhimrao Ambedkar University, Lucknow, India. He received his Ph.D. degree from Jamia Hamdard University, New Delhi, India, in 2018. He was selected for the GPAT six times and his best All India Rank was 34. Currently, he is an assistant professor at Integral University. Previously he was an assistant professor at IIMT University, Meerut, India. He has experience teaching DPharm, Pharm.D, BPharm, and MPharm students. He has more than five publications in reputed journals to his credit. Dr. Faheem’s research area is the development and characterization of nanoformulation for the delivery of drugs to various organs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/system/329795.png",biography:"Dr. Mohd Aftab Siddiqui is an assistant professor in the Faculty of Pharmacy, Integral University, Lucknow, India, where he obtained a Ph.D. in Pharmacology in 2020. He also obtained a BPharm and MPharm from the same university in 2013 and 2015, respectively. His area of research is the pharmacological screening of herbal drugs/natural products in liver cancer and cardiac diseases. He is a member of many professional bodies and has guided many MPharm and PharmD research projects. Dr. Siddiqui has many national and international publications and one German patent to his credit.",institutionString:"Integral University",institution:null}]}},subseries:{item:{id:"1",type:"subseries",title:"Oral Health",keywords:"Oral Health, Dental Care, Diagnosis, Diagnostic Imaging, Early Diagnosis, Oral Cancer, Conservative Treatment, Epidemiology, Comprehensive Dental Care, Complementary Therapies, Holistic Health",scope:"\r\n\tThis topic aims to provide a comprehensive overview of the latest trends in Oral Health based on recent scientific evidence. Subjects will include an overview of oral diseases and infections, systemic diseases affecting the oral cavity, prevention, diagnosis, treatment, epidemiology, as well as current clinical recommendations for the management of oral, dental, and periodontal diseases.
",coverUrl:"https://cdn.intechopen.com/series_topics/covers/1.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11397,editor:{id:"173955",title:"Prof.",name:"Sandra",middleName:null,surname:"Marinho",slug:"sandra-marinho",fullName:"Sandra Marinho",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRGYMQA4/Profile_Picture_2022-06-01T13:22:41.png",biography:"Dr. Sandra A. Marinho is an Associate Professor and Brazilian researcher at the State University of Paraíba (Universidade Estadual da Paraíba- UEPB), Campus VIII, located in Araruna, state of Paraíba since 2011. She holds a degree in Dentistry from the Federal University of Alfenas (UNIFAL), while her specialization and professional improvement in Stomatology took place at Hospital Heliopolis (São Paulo, SP). Her qualifications are: a specialist in Dental Imaging and Radiology, Master in Dentistry (Periodontics) from the University of São Paulo (FORP-USP, Ribeirão Preto, SP), and Doctor (Ph.D.) in Dentistry (Stomatology Clinic) from Hospital São Lucas of the Pontifical Catholic University of Rio Grande do Sul (HSL-PUCRS, Porto Alegre, RS). She held a postdoctoral internship at the Federal University from Jequitinhonha and Mucuri Valleys (UFVJM, Diamantina, MG). She is currently a member of the Brazilian Society for Dental Research (SBPqO) and the Brazilian Society of Stomatology and Pathology (SOBEP). 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