Results of multivariate analyses examining risk factors for mortality associated with bacteraemia due to
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He has research training experience as a JSPS Research Fellow at Neurorehabilitation Research Center, Kio University, Japan, and Queensland Brain Institute, University of Queensland, Australia. Dr. Nakano has received 13 awards from academic organizations, has authored more than 120 journal papers and 10 book chapters, and was the editor member of 7 academic journals.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"196461",title:"Prof.",name:"Hideki",middleName:null,surname:"Nakano",slug:"hideki-nakano",fullName:"Hideki Nakano",profilePictureURL:"https://mts.intechopen.com/storage/users/196461/images/system/196461.jpg",biography:"Dr. Hideki Nakano is a physical therapist and associate professor at the Neurorehabilitation Laboratory, Graduate School of Health Sciences, Kyoto Tachibana University, Japan. He received his Ph.D. in Health Science from Kio University, Japan, and has accepted research training experience as a JSPS Research Fellow at Neurorehabilitation Research Center, Kio University, Japan, and Queensland Brain Institute, University of Queensland, Australia. He specializes in neuroscience, neurophysiology, and rehabilitation science and conducts research using non-invasive brain function measurement and brain stimulation methods such as electroencephalography, transcranial magnetic stimulation, and transcranial electrical stimulation. 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At present efforts are being made to identify several stress factors in the abiotic stress tolerance and to develop rice varieties with a tolerable stress through biotechnology, molecular breeding, genomics, transcriptomics, proteomics and metabolomics [15, 16, 17, 18]. Abiotic stresses such as drought, salinity, and heat affect the productivity of many agriculturally important crops. Therefore, to meet the food requirements of a growing world population, it is necessary to develop sustainable high-yielding varieties that can persist under abiotic stress [19]. This chapter highlights abiotic stresses such as drought, high temperatures, salinity as well as abiotic stress tolerance techniques in rice plants with emphasis on increased rice yields.
Rice is the world’s most significant food crop, providing calories to more than half of the world’s population of 7 billion people. In most cultivable rice habitats, it has become increasingly vulnerable to losses induced by abiotic factors such as drought, floods, salt, heat, and cold. Drought or water shortages are the most damaging abiotic challenges for rice farming in rainfed habitats. Another important limitation affecting the rainfed lowlands is the submergence of rice plants for one to two weeks owing to flash floods. Long-duration cultivars are frequently affected by floods in the early phases of development, followed by drought during blooming, resulting in significant yield deficits [20]. Meanwhile, salinity, which is determined by a heavy concentration of soluble salts in the soil, is the second most common soil issue after drought, and it is a major constraint for rice production across the world. As a result of global climate change, heat stress is becoming a severe hazard to rice production. Heat stress hinders plant development, disrupts metabolic processes, and reduces output. Rice growing in temperate locations, as well as high-altitude conditions in tropical and subtropical zones, is hampered by low temperatures. Cold stress has a negative impact on rice crops throughout the germination, vegetative development, and reproductive phases, resulting in considerable production losses. Rice crops are sometimes subjected to numerous stressors (such as salt and drought, or drought followed by submergence), resulting in massive crop losses. Rice productivity would be significantly increased while water resources and soil quality were preserved if combined tolerance to several forms of abiotic stress was improved [21].
Drought is a severe abiotic stress that disrupts rice Morphological, Physiological, biochemical and molecular responces (Figure 1), resulting in considerable crop losses [22]. Drought stress has been linked to changes in plant length, biomass, and leaf area are associated with leaf senescence in a variety of crops, [23, 24] including rice (
Drought stress induces various morphological, physiological, biochemical, and molecular responses in rice.
By the end of 2050, the world’s population will have risen to about nine billion people. On the other hand, due to the accumulation of high salt content in the soil, worldwide agricultural production would almost probably remain static, resulting in crop growth inhibition and eventual crop mortality. Salt stress is a worrisome phenomenon because it diminishes soil agricultural productivity, leading to lower crop yields [36]. Salinity is becoming a critical threat because of diminishing irrigation water quality. (Flowers [37]. Salinity and water logging afflict 23% and 37% of worldwide cultivated land, respectively, and it is estimated that about 20% of all cultivated land and nearly half of irrigated land is salt-affected, greatly reducing yield well below the genetic potential [38]. The problem of salinity is particularly intense to agriculture in South and Southeast Asia, which produces about 90% of the world’s rice [39]. By the middle of the twenty-first century, it is estimated that half of the cultivable land would be salt-affected [40]. It is suspected that the rise in soil salinity is due to poor irrigation water, its quality, and the use of brackish. Rice is a salinity-sensitive crop that performs poorly in soils with electrical conductivity (EC) as low as 3 dSm-1, however salty soil is commonly defined as EC >4 dSm-1 [41]. High-salt stress affects plants in several ways, such as ion toxicity, oxidative stress, alteration of metabolic processes, nutritional disorders, genotoxicity, membrane disorganization, reduction of cell division and expansion as well as water stress. In order to cope with the antagonistic effects of soil salinity some new strategies like remediation of salinized soils, to increase the salt tolerance of crop plants through traditional as well as molecular marker-assisted breeding techniques, and biotechnology should be adopted [37, 42, 43]. Khatun and Flowers [44] observed that salt toxicity adversely affect panicle length, spikelets per panicle, and 1000-grain weight in rice crop. Salinity also delays flowering and ripening and reduces the number of tillers, biomass, and leaf area in rice crops. According to Asch and Wopereis [45], irrespective of seasons and growth stages, salt toxicity reduces rice yield, the number of panicles, and grains and causes sterility in all rice cultivars.
Heat stress, characterized by prevalence of high temperature is one of the major abiotic constraints for rice production, next only to drought and salinity [46]. Vastly increased greenhouse gases in the air are predicted to significantly affect the climate and worldwide average air temperature guesstimated to significantly raise by 1.4–5.8°C between 1990 and 2100 [47, 48]. Increasing temperature with this magnitude and severity reduced global rice production [49]. The reduction in rice yield is mainly attributable to changes in critical temperature at each specific phase of growth, namely, germination, seedling, rooting, leaf elongation, tillering, panicle initiation, primordia, panicle differentiation, anthesis and maturing [50]. One of the most sensitive phenological phases to extreme temperatures is pollination that leads to poor seed set and low grain quality [51, 52]. Rice is particularly vulnerable to heat stress during the reproductive and ripening stages, as simply a few hours of heat stress causes flowering plants to become sterile. High temperatures during ripening, on the other hand, might result in a decrease in milling quality and grain filling, resulting in reduced crop yield [53].
Increase in temperature, that leads to higher humidity, can cause spikelet sterility. Consequently, amid heat stress, the floral buds are unable to mobilize carbohydrates [53]. Low temperature stress is another similar environmental stress that can cause the plant’s development and growth to be slowed. Embrane structure and function, protein synthesis, and cellular cytoskeleton structure can all be severely affected by low temperature stress. Low temperatures also impede photosynthesis in both light and dark reactions; further, electron routes are disrupted, resulting in the formation of free radical species that can be harmful to rice crops, causing membrane deterioration. Japonica genotypes are more adaptable than indicas to cold temperatures and so are prevailing in high-altitude and latitude ecologies [54]. The respiratory rate of plants increase or decrease in accordance with the temperature, short-term low temperature stress leads to high respiration rate but in the case of long-term stress the cell gets damaged and eventually dies due to the reduced respiration rate.
The signals of abiotic stress are a multi-faceted phenomenon due to a wide range of environmental abuses. Plants can produce appropriate responses that cause a particular change in conjunction with a specific stress condition, whereas there is significant overlap between abiotic signals. Typically, one sort of stress happens with or is followed by other stresses. The loss of water which is due to heat stress causes drought stress and in this way, both stresses are linked to each other. Signal perception is the first phase in a signal transduction pathway which is tracked by the production of secondary signals. Secondary signals can trigger a protein phosphorylation cascade, which can then control the activation of specific transcription factors (TFs) or target genes. Additionally, these signals can modify the quantity of secondary signals; as a result, more signaling molecules are produced, providing an extra checkpoint for signals to flow in a given direction. Till date, many signaling pathways have been reported [55].
Oxygen is a two-edged sword for plants, since it is a necessary element to be able to develop normal growth, but unavoidably promotes the formation of of ROS like hydrogen peroxide (H2O2), superoxide radical, hydroxyl radical, singlet oxygen, etc. as a result of aerobic metabolic activities, such as photosynthesis and respiration. During stress circumstances in a plant, organelles such as mitochondria, peroxisomes, and chloroplast generate enormous amounts of ROS, which become highly corrosive and reactionary to nucleic acids, proteins, and lipids, inevitably leading to apoptosis or cellular damage [56].
Catalase (CAT),monodehydroascorbate reductase (MDHAR), superoxide dismutase (SOD), glutathione peroxidase (GPX), glutathione reductase (GR), dehydroascorbate reductase (DHAR), peroxiredoxin, and glutathione S transferase are all ROS foraging enzymes in plants (GST) [57]. These antioxidants work in the plant cells where they are present in different locations in order to detoxify ROS. The ROS homeostasis in plants must also be accompanied by non-enzymatic antioxidants, including tocophherols, Carotenoids, GSH, flavonoids and AsA [56]. Many other mechanisms, such as photosynthetic apparatus rearrangement, leaf movement, and leaf curling, can balance a plant’s energy absorption with CO2 supply, preventing ROS overproduction [57].
Phytohormones, a diverse set of signaling chemicals found in minute amounts inside cells, influence the responses. Plant growth, development, and nutrient allocation are all regulated by them. Responses to abiotic stress are triggered by a variety of stimuli, but phytohormones are responsible for the majority of them. Plants, which are sessile organisms, require phytohormones for survival [58]. They can carry out their function in their synthesis site or they can go to their action location [59]. Their family consist of cytokinin (CK), Indole acetic acid (IAA), salicylic acid (SA), ethylene, ABA, gibberellins (GAs), jasmonates, and brassinosteroids. The relatively newly discovered phytohormones are strigolactones. In regulating stress responses through interactions with some other hormones, ABA plays a major role. In order to regulate climate stress, it is the most exciting and indispensable hormone of the plant. In various phases of plant development, it plays a major role especially in opening and closing stomata, drought stress, seed germination and dormancy. PYR/PYL/RCAR-PP2C-SnRK2 is regarded as an ABA-generated signaling cascade, which effectively monitors seed dormancy even in occurrence of drought. ABA buildup amid drought stress restricts stomatal disclosure and modulates transpiration [60]. ABA signaling cascade consisted of 3 units, SnRK2/OST1 (Protein kinase), PP2C (protein phosphatases) and PYR/PYL/RCAR proteins have been investigated recently and their mechanism of operation was elucidated [61].
Ethylene is another major component of phytohormone. Ethylene is supposed to be the signaling path between plant growth and weather changes. Salinity, water logging, high temperature, frost, heavy metal interaction, nutritional inadequacy, and drought are examples of abiotic stressors that influence ethylene production [62]. Ethylene response factors (ERFs) in plants are members of a large family of transcription factors (TFs) that are activated in response to a variety of physiological and environmental stress.
Salinity is the most important abiotic stress that diminishes rice crop productivity. Plants suffer from severe osmotic pressure and a scarcity of water as a result of salinity, which causes ions to accumulate in their tissues. Different rice varieties have different levels of tolerance [63]. IR29, for example, is a salt-sensitive species that accumulates 5–10 times more Na1 in the leaves than Pokkali or BK [64] . Salt tolerance in rice is achieved by limiting Na1 translocation. The gene SKC1/ HKT8 is responsible for salt tolerance and a strong K1/Na1 balance in the shoots, as well as decoding a HKT family Na1 selective transporter that regulates Na1 transport over vast distances [65]. HKT1 is a similar gene that is ubiquitously expressed in the roots and leaves and seems to be involved in the long-distance trafficking of Na1. The Na1/H1 counter transporter salt overly sensitive (SOS)1 can facilitate the outflow of Na1 across the plasma membrane [66]. Plants lacking SOS1 become particularly salt sensitive and their transfer of Na1 over long distances is hampered. The root tip epidermis and xylem parenchyma cells are the primary sites of SOS1 expression. At the root-soil interface, it extrudes too much Na1 from the root epidermal cells. SOS1 seems engaged in the Na1 translocation in the roots and shoots. It’s also responsible for providing ions from the xylem to the shoots in a manageable way. The SOS2/SOS3 kinase complex utilizes SOS1 as a substrate. Plants lacking SOS2 or SOS3 have the same salt sensitivity phenotype as SOS1 plants [64]. Ion homeostasis could be maintained as a result of this.
Calcium plays a role in a variety of abiotic stress symptoms, with varied degrees of directivity. Many of the functions in plants are governed by changes in intracellular calcium levels. Calcium is a harmful ion whose concentration in eukaryotic cells is controlled. Calcium ions travel through specific calcium ion channels, the cell membrane, or organelles into the cytosol after activation. Calcium ions have therefore been progressively increased to provide a number of final preparations for calcium-dependent proteins such as calmodulin, CDPCs and calmodulin-dependent phosphatases. Local calcium increases may also occur in specific organelles, such as chloroplasts, and can easily govern specific actions in organelles [67]. The expanded accurate determination of calcium as a result of abiotic stress, their association with downstream end progressions, and the use of calcium ion homeostasis inhibitors, however, highlight its importance.
The biotechnological approach is an appealing complement to traditional strategies for improving rice genotypes because it allows for the stacking of more genes into the genome without disrupting their genetic background [68]. Drought resistance was greatly improved by overexpressing SNAC1 (STRESS RESPONSIVE NAC 1) in rice, with 22–34 percent higher seed setting than control conditions in the field under acute drought stress during the reproductive stage, with no yield penalty or phenotypic alterations [36]. Similarly, under extreme field drought circumstances, overexpression of AP37 under the control of the OsCc1 promoter enhanced drought, salinity, and cold tolerance at the vegetative stage and also gave a 16–57 percent yield advantage over the control at the reproductive stage [69]. At the vegetative stage, overexpression of OsNAC10 with the GOS2 and RCc3 (root-specific) promoters improved drought tolerance, as well as high salinity and cold tolerance. RCc3:OsNAC10 transgenic rice cultivar showed yield advantages of 25–42 percent in the field under drought conditions [70]. OsPYL/RCAR5 (cytosolic ABA receptor) in rice plants functions as a positive inducer of abiotic stress-responsive genes [17, 18]. In contrast, rice plants exhibited a quick accumulation of soluble sugars, which act as interoperable solutes/osmoprotectants, lead to delays leaf drying and rolling [71]. Heat stress-induced gene expression and metabolite synthesis boost crop plant tolerance markedly [72]. HSFs function as molecular sensors to directly sense ROS such as H2O2 and control the expression of oxidative stress response genes during oxidative stress [73]. Binding of HSFs with heat shock elements (nGAAn) present in the heat responsive genes, including HSPs is critical for transcription induction of HSGs otherwise called heat shock response [74, 75, 76]. The enhanced expression of HSP70 assists in the translocation, proteolysis, translation, folding, aggregation, and refolding of denatured proteins [77]. HSP70 chaperones interact with a wide spectrum of proteins, particularly unfolded proteins generated in stressful situations [78]. Rice has 25 HSFs on 10 chromosomes other than chromosomes 11 and 12. Of these, 13 genes are class A, 8 are class B, and the remaining 4 are class C type HSFs [79]. Two HSBPs, namely OsHSBP1 and OsHSBP2, existing in rice plants and are abundantly expressed in all tissues under ordinary conditions, involved with HSR regulation, seed growth and found in considerably greater amount after heat shock recovery [80]. While considerable progress has been made in clarifying thermotolerance molecular systems, how plants perceive and translate heat stress signals is still not easy.
Abiotic stress tolerance alleles were genetically eroded as a result of domestication and breeding for high yield. As a result, efforts are currently being conducted to restore allelic diversity for abiotic stress tolerance in modern high yielding varieties using locally adapted cultivars and germplasm. Stress sensitive genotypes/parents have contributed many advantageous alleles for abiotic stress tolerance, indicating the impact of a genotype’s genetic background on its performance under stress [81]. A comprehensive screening and evaluation process, gene genetic background interaction, and gene environment interaction are all important factors in the utilization of QTLs in abiotic stress tolerance. The combination of whole genome expression data, QTL information, and meta-QTL analysis has proven to be a useful approach for narrowing down the search for abiotic stress tolerance candidate genes [82]. There are many success stories of introgression of QTLs for abiotic stress tolerance, and many varieties are in the advanced field trails stage [83] for tolerance to drought, salinity, and heat separately or in combination.
IRRI revealed the first important and persistent QTLs for grain yield under extreme drought stress [84]. Vikram et al [85] studied three populations: N22/IR64, N22/MTU1010, and N22/Swarna, and discovered a major consistent grain yield QTL, qDTY1.1, on chromosome 1 that can be used for marker-assisted breeding (MAB). Furthermore, in Vandana/IR64 populations, qDTY1.1 and the locus for plant height (sd1) were shown to be connected [86], suggesting that in large segregating populations, recombinant alleles with unlinked qDTY1.1 and sd1 could create drought-tolerant plants with shorter stature [87]. In Apo/Swarna, Apo/IR72, and Vandana/IR72 genetic backgrounds, another large QTL “qDTY6.1” [88] was found on chromosome 6, explaining 40–66 per cent of the genetic variation for grain yield in aerobic conditions. Swarna and IR72, both drought-prone, performed better in aerobic conditions when this QTL was present. This was also the first report of a significant QTL that increases yield and yield potential in aerobic circumstances. Nevertheless, this QTL had no effect on lowland drought stress conditions. Three grain yield QTLs under drought stress namely qDTY2.2, qDTY3.1, and qDTY12.1 were introgressed into high quality Malaysian rice cultivar MRQ74 by MAB [89]. An Indian project in collaboration with IRRI: “From QTL to variety: marker assisted breeding of abiotic stress tolerant rice varieties with major QTLs for drought, submergence and salt tolerance” has introgressed seven consistent QTLs for grain yield under drought into high yielding, submergence-tolerant elite backgrounds of Swarna-Sub1, Samba Mahsuri-Sub1, and IR64-Sub1 [83].
Saltol QTL is a key salt-tolerant QTL that has been widely exploited to create excellent rice cultivars around the world Lin et al. [90] used an F2 population resulting from a hybrid between “Nona Bokra” and “Koshihikari” to find multiple QTLs for Na1 and K1 absorption in shoots and roots, including a significant QTL responsible for SKC1 on chromosome 1. Ren et al. [63] cloned the SKC1 QTL, which maintains K1 homeostasis in salt-tolerant cultivars under salt stress, and the SKC1 gene, which is a member of the HKT-type transporters and corresponds to the OsHKT8/Os01g0307500 locus. Using F2 mapping populations, Zhou et al. [91] and Deng et al. [92] mapped QTLs qSKC-1 and qSNC-1 for SKC and SNC, respectively, between SSR markers RM283 and RM312. Deng et al. [93] used rice salt-tolerant 1 (rst1) mutant and showed that rst1 was controlled by a single recessive gene and QTL mapping between rst13Peiai 64 revealed the QTL loci on chromosome 6. Bizimana et al. [94] identified QTLs using RILs derived from IR29 (a salt-sensitive line) and Hasawi (a salt-tolerant line) and could not find Saltol or QTLs nearby this position indicating that tolerance in Hasawi is due to novel QTLs other than Saltol/SKC1. Emon et al. [95] and Kumar et al. [96] used association panel following a genome-wide association study approach to find marker-trait associations for salt stress tolerance. Kumar et al. [96] discovered 20 SNPs (loci) that were strongly related with Na1/K1 ratio at the reproductive stage, as well as the Saltol region, which is known to affect salt tolerance at the seedling stage. Many notable examples of transferring the Saltol QTL into elite rice varieties by MABC include PB1121 and PB6 [97], AS996 [98, 99], Bac Thom 7 [100, 101], Binadhan-7 [102], BRRI Dhan [103].
Technological advancement in the omics area, the intrinsic genes for complicated abiotic stress in plants might be elucidated [14, 104]. Since high-strength omics approaches produced huge numbers of data, requiring both computer tools and storage resources, and data analysis, several online databases, servers and platforms were developed [105]. Proteomics and metabolomics have been shown to grow rapidly, allowing researchers to get extensive and accurate information on plant cell produced proteins and metabolites in response to environmental concerns [14, 106]. Both these emerging areas are highly expected to improve cereal crops. Similarly, profiling transcriptomics is extremely useful in ensuring a thorough understanding of regulatory molecules and their networks that are important to the communication of stress tolerance [106]. For illustrate, in order to learn more about regulatory processes and identify stress-responsive transcripts, researchers compared transcripts from tolerant and sensitive rice cultivars [107]. Despite significant improvements in high-throughput genotyping, phenotyping of complex abiotic stress responses (sometimes multigenic) remains a difficult task for molecular breeders [108]. Plants’ epigenetic regulators have emerged as important regulatory mechanisms for responding to and inducing tolerance to abiotic stressors [109]. Epigenetic modulation of plant abiotic stress responses has been revealed thanks to breakthroughs in epigenomics. Short non-coding RNAs, such as miRNA, have emerged as critical epigenetic regulators of plant responses to stress [109]. However, more research is needed into how key crops, including rice, respond to abiotic stress, particularly at the epigenetic level. Overall, multiple omics techniques provide good platforms for understanding insights into plant responses and adaptation mechanisms, as well as developing abiotic stress tolerant, smart crops.
Considering the massive losses of crop production due to severe environmental stresses, the development of crop varieties with increased tolerance or resistance to multiple stresses is presently indispensable. To date, relatively few genes reported to react to abiotic stress because agronomic characteristics of these stress tolerances have been controlled by many QTL, which show low inheritance and substantial interactions between the G/E systems. The discovery of possible genes for sustaining high pollen viability, effective gamete fertilization, and seed development in harsh conditions is not far off. With the progress of high-throughput techniques, many genes which are involved in stress regulation have been identified [110]. Plants that are subjected to several abiotic challenges at the same time must be investigated in order to comprehend the impact of various stresses. Every new combination of stresses has been suggested as a special type of stress, because it generates a totally new appropriate response. Enhanced and implementing tolerance mechanisms with the use of available low-cost sequencing and genotyping platforms, genetic and genomic resources and transgenic approaches provide huge opportunities for better rice cultivars in the near-coming future. Breeding and marker assistant selection, as well as modifying stress responses via plant hormones, are all ways that can be used to manage abiotic stress responses. Plant functional genomics perspectives which including proteomics, transcriptomic, and metabolomic analysis, as well as other high-throughput approaches and technologies, have yielded a number of drought-regulated genes, transcription factors, and cellular signaling components whose functions are crucial in rice stress tolerance.
Despite being commensal microorganisms, they are the Gram-negatives which are most often a cause of human infections, having pathogenic strains that cause a wide variety of intestinal or extra-intestinal infections, such as urinary tract, intra-abdominal and soft tissue, sepsis, neonatal meningitis, gastrointestinal infection, and pneumonia, often leading to bacteremia [3, 7]. Although Gram-positive microorganisms have been increasing as a cause of sepsis due to the instrumentation of medical care—understood as the use of invasive devices or tools for the treatment or diagnosis of patients, and to infections associated with health care—
They are classified as Gram-negative bacteria and divided into 3 main groups: commensal lines, intestinal pathogenic lines (enteric or diarrhea) and extra-intestinal pathogenic lines [10].
Furthermore, Gram-negative bacteria produce large molecules consisting of a lipid and a polysaccharide, known as lipopolysaccharides (LPS), lipoglycans and endotoxin, which increases their pathogenicity in relation to Gram-positive bacteria [11].
Studies have shown an increasing incidence of
Very low birth weight newborns remained the group with higher incidence (10.4 cases per 1000 live births) and mortality (35.3%). Systematic use of PCR increased
Several hospital-based studies have suggested that a number of comorbid illnesses, including diabetes, malignancy, chronic lung disease, cirrhosis and heart disease, may increase the risk of
Dialysis, solid organ transplantation and neoplastic disease were important risk factors for acquiring
Mortality risk factor | OR (95% CI) | |
---|---|---|
Age | 0.03 | 1.04 (1–1.08) |
Severe sepsis or shock | <0.0001 | 14.64 (6.14–30.86) |
Non-urinary origin | 0.013 | 2.78 (1.24–6.2) |
Charlson index | 0.006 | 1.31 (1.08–1.59) |
Inadequate empirical treatment | 0.006 | 2.98 (1.25–7.11) |
Results of multivariate analyses examining risk factors for mortality associated with bacteraemia due to
The human gastrointestinal tract is normally inhabited by
Typical enteropathogenic
The small intestine is the most likely place for EPEC infection to occur. For the onset of diseases, tEPEC obeys the following steps:
Initial localized adhesion of organisms to enterocyte via BFP.
Induction of signal transduction in the enterocyte by secretion of protein toxins.
Development of intimin-mediated intimate adhesion to the enterocyte.
Around 20 protein toxins are injected directly into the target epithelial cell, made, together with the intimin, by the chromosomal island LEE and expressed by both tEPEC and aEPEC [29]. The complex nanomachine called type III secretion injector is the one that injects protein toxins. It is assumed that some modifications happen to the epithelial stem cells, which is physiologically absorbent, and through a pathological process, it becomes a secretory dynamo [30].
What is believed is that type III ejection toxins are responsible for binding to protein elements of the cell’s signal transduction apparatus. This event is accompanied by the mobilization of calcium from the intracellular compartment, activation of protein kinase C, kinase light chain myosin and induction of protein phosphorylation by tyrosine. The rearrangement of cytoskeletal proteins is induced by effectors, which results in the classic lesion "attaching and erasing," changes in the secretion of water and electrolytes and increased permeability of the tight intestinal junctions [31].
Enterotoxigenic
After colonization, ETEC produces two classes of secretory toxins encoded by plasmids: heat-labile toxin (LT) and heat-stable toxin (ST). To be classified as ETEC,
LT toxin is related to Vibrio cholera toxins in terms of structure, function and mechanism. It works by stimulating adenylate cyclase and increasing adenosine intracellular cyclic monophosphate (AMP), a fact that stimulates chloride secretion from intestinal crypt cells and inhibits the absorption of sodium chloride at the ends of the villi. After that, the water secretion is free in the intestinal lumen, clinically developing watery diarrhea [35].
STa toxin, the only ST variant that causes disease in humans, activates cyclic GMP of enterocytes, leading to increased chloride secretion and decreased sodium chloride absorption. As a final result, the secretion of free water in the intestinal lumen clinically appears as watery diarrhea [36].
Among the pathotypes that cause the most severe conditions, the strains classified as enterohemorrhagic (EHEC) stand out, which are the most common to cause disease in developed countries [29].
They are bacteria responsible for food infections and represent a risk to the health of the population, so they must be monitored frequently. Thus, good hygiene practices, as well as the use of quality tools, are extremely important to help reduce the risk of cross-contamination and human infection.
EHEC has the ability to attach itself to the host and to produce shiga-toxins, which gives the strain pathogenicity. The toxins produced by EHEC cause damage to the mucosa of the large intestine, where they are absorbed by reaching the bloodstream, which makes it possible to affect other organs, such as the kidneys [37]. An average of 5–10% of patients confirmed with EHEC infection develop potentially fatal complications, such as hemolytic uremic syndrome (HUS), which leads to sudden renal failure and hemolytic anemia [38].
Outbreaks are related to the ingestion of contaminated food and water, causing watery diarrhea and hemorrhagic colitis to those infected. The disease has a sudden onset with severe abdominal cramps and watery diarrhea that progresses to bloody, on average after 24 hours, lasting between 1 to 8 days.
The treatment consists of supportive therapy for fluid replacement, since the use of antibiotics is not indicated, as there is no proven efficacy. In fact, it could increase the risk of developing HUS, since the death of the bacteria would increase the release of toxins, predisposing to the syndrome [39].
Enteroinvasive
To differentiate Shigella from EIEC it is necessary to analyze the strains, those from EIEC ferment glucose and xylose, this differentiates them. Nucleic acid tests, including multiplexed panels, are used to detect organisms [41].
Diffusely adherent
The pattern of diffuse adhesion in HEp-2 or HeLa cells is a characteristic that differentiates this pathotype from the others, although DAEC strains are quite heterogeneous. This adhesion is mediated by fimbrial and afimbrial adhesins, which can cause damage to microvilli due to the disorganization of the cytoskeleton. However, some strains produce an adhesin involved in diffuse adhesion (AIDA-I), instead of encoding the diffuse adhesion pattern, which is why they are called atypical DAEC [42].
In addition, DAEC can also provide a pro-inflammatory effect [43].
The type of
Thereto, the ExPEC strains were isolated from food products, in particular raw meat and poultry, indicating that these organisms potentially represent a new class of foodborne pathogens [45].
Almost 25% of sepsis cases originate from the urogenital tract. [46, 47, 48]. Considering this percentage, the most common pathogen that causes urinary tract infection (and, consequently, urosepsis) is
In addition to early antibiotics, there are some important parts of the management of sepsis. Initial fluid resuscitation with crystalloid is still recommended at a minimum of 30 mL/kg. Consider early administration of vasopressor support to maintain a mean arterial pressure greater than 65 mm Hg. The first choice for vasopressor support in sepsis is norepinephrine (with epinephrine and vasopressin 2 and 3). Tight glucose control is also recommended, with corticosteroids and blood products being more controversial in the literature [52].
Although
Agent or phenotype [n (%)] | 1997 | 1998 | 1999 | 2000 | 2001 | 2002 | 2003 | 2004 | 2005 (January–June) | Total | |
---|---|---|---|---|---|---|---|---|---|---|---|
Ampicillin | 27 (46.6) | 24 (49) | 24 (46.2) | 50 (60.2) | 54 (62.8) | 46 (65.7) | 55 (63.2) | 70 (57.9) | 35 (62.5) | 385 (58.2) | 0.02 |
Trimethoprim/sulfamethoxazole | 14 (24.1) | 11 (22.4) | 13 (25.0) | 28 (33.7) | 21 (24.4) | 28 (40) | 32 (36.8) | 41 (33.6) | 20 (35.7) | 208 (31.4) | 0.02 |
Ciprofloxacin | 9 (15.5) | 7 (14.3) | 10 (19.2) | 7 (8.4) | 14 (16.3) | 16 (22.9) | 22 (25.3) | 27 (22.1) | 13 (23.2) | 125 (18.9) | 0.02 |
Amoxicillin/clavulanate | 9 (15.5) | 4 (8.2) | 9 (17.3) | 16 (19.3) | 8 (9.3) | 7 (10) | 11 (12.6) | 15 (12.3) | 20 (35.7) | 99 (14.9) | 0.1 |
Gentamicin | 4 (6.9) | 6 (12.2) | 5 (9.6) | 5 (6.0) | 8 (9.3) | 6 (8.6) | 7 (8.0) | 8 (6.6) | 8 (14.3) | 57 (8.6) | 0.8 |
Piperacillin/tazobactam | 1 (1.7) | 4 (8.2) | 1 (1.9) | 8 (9.6) | 6 (7.0) | 4 (5.7) | 5 (5.7) | 2 (1.6) | 2 (3.6) | 33 (5) | 0.4 |
Cefotaxime | 11 | 2 (4.1) | 0 | 2 (2.4) | 3 (3.5) | 5 (7.1) | 3 (3.4) | 12 (9.8) | 4 (7.1) | 31 (4.7) | 0.001 |
ESBL production | 0 | 0 | 0 | 2 (2.4) | 3 (3.5) | 3 (4.3) | 2 (2.3) | 9 (7.4) | 3 (5.4) | 22 (3.3) | 0.002 |
MDR | 4 (6.9) | 4 (8.2) | 5 (9.6) | 9 (10.8) | 9 (10.5) | 12 (17.1) | 15 (17.2) | 17 (13.9) | 12 (21.4) | 87 (13.1) | 0.006 |
Number, yearly percentages, and
The sepsis’ diagnosis confirmation is done from the evaluation of the clinical status of the patient, analyzing some criteria. For adult patients, it is confirmed or a diagnosis of sepsis is made when two criteria are present: hyperthermia>38.3 °C or hypothermia <36°C, tachycardia>90 bpm, leukocytosis (>12,000 μL-1) or leukopenia (<4000 μL-1) or >10% bands, acutely altered mental status, tachypnea > 20 bpm, hyperglycemia (>120 mg/dl) in the absence of diabetes [56].
Collect a careful history from patient, addressing information such as previous illnesses, surgeries, how long ago the symptoms started, if there are comorbidities, if it have traveled to a place recently and other details, added to a complete physical examination, which provides very relevant information and leads to a line of rationality, it is extremely important to start the development of a preliminary differential diagnosis of the patient’s complaints.
All this information collected is recorded and saved in medical records, more recently, electronics, which are more organized, more readable and allows a better comparison, in relation to written records [57].
Some of the most frequent reasons that lead patients to go to a medical consultation are dyspnea, cough with or without hemoptysis and chest pain, as these symptoms can be indications of serious illnesses, it shows the importance of asking questions and exams in a way attentive and careful [58].
Ventilator-associated pneumonia (VAP) is the most common fatal hospital infection [59]. One of the bacteria most involved in the clinical picture in question is Enterobacteriaceae
Studies show that these
Due to the severity of the disease, early diagnosis, adequate antibiotic treatment and hemodynamic control are essential [68].
Although the process is unknown, it is known that, for the onset of the disease, it is necessary to have an invasion of the blood–brain barrier by
With the complete discovery of this mechanism, it is likely that new targets for the prevention and therapy of
Regarding treatment, it is currently known only that antimicrobial chemotherapy has limited efficacy [79, 80, 81].
Intra-abdominal infections (IAI) are invasive and bacterial multiplications in the hollow organ walls and beyond. Usually, it is located in the abdominal cavity, in the retroperitoneum and in the abdominal organs, being a common complication in the post-surgical period [82]. In addition, they have a wide variety of pathological conditions, from appendicitis to fecal peritonitis, which makes IAI generally have a poor prognosis (especially in high-risk patients) and is an important cause of morbidity [83]. Mostly, the most common source of this infection is the appendix, followed by gastroduodenal perforations. The Gram-negative bacteria
Although
Although there are many etiological agents responsible for diarrhea, pathogenic
Outbreaks are common all over the world, with fatal consequences mainly in children under 5 years of age living in underdeveloped countries, where diarrheal diseases can lead to death more frequently [89].
The transmission of enteric
Among the most common types of bacterial infections that occur both in the community and in hospitals, urinary tract infections (UTI) stand out. Urinary tract infections can be associated with the hospital (HAUTIs) and the community (CAUTIs). In the case of CAUTIs, it is known whether women are the predominant group of patients.
Although the UTI is multifactorial, the main bacteria related to the diagnosis is
Co-trimoxazole (trimethoprim/sulfamethoxazole), nitrofurantoin, ciprofloxacin and ampicillin are the antibiotics commonly recommended for the treatment of UTIs. However, there is an overall increase in antibiotic resistance among pathogens in the urinary tract, which is a limitation on treatment options [94, 95].
Since the evidence suggests a significant relationship between the extensive use of antibiotics and antimicrobial resistance, it is necessary to prescribe and use antibiotics in order to reduce their complications and costs [96].
For this reason, in order to guide the selection of empirical therapy, surveillance of antibiotic resistance is crucial for determining the pattern of antimicrobial resistance [97].
It aims to check the presence of fungi and bacteria in the urine, being carried out from a urine sample, which was placed in Petri dishes. The urine culture is placed in an incubator (1–2 days) and if there is any microorganism in the tested material, colonies grow and are visible on the plate. When the result is positive for some bacteria, a test antibiogram is performed, which determines the type of antibiotic needed to act against the pathogen [98].
The culture of urine is important precisely because it allows the precise recognition of the bacteria and, consequently, the best antibiotic to be used [99].
As urine culture is most frequently requested when UTI is suspected, the most common bacteria found are
Blood culture is part of the routine assessment of patients with suspected bloodstream infection, and is crucial to guide therapeutic intervention. The ideal method for collecting blood culture is venepuncture, since it increases diagnostic yield, and has lower rates of contamination, according to some studies [102].
Since the timing of blood culture collection does not influence the detection of clinically relevant microorganisms, most authorities recommend collecting several sets simultaneously or for a short period of time, with the exception of patients with endovascular infection who need documented continuous bacteremia [103, 104].
Two to four sets of blood samples should be collected, whenever possible, at independent locations [103, 104, 105, 106]. For adults, the volume required for the examination varies between 40 and 160 mL of blood, and for babies and children, the volume is age-based and does not exceed 1% of the patient’s total blood volume [103, 107].
The importance of blood culture, as well as urine, is related to the determination of the bacteria and the antibiogram, which directs the treatment to the best antibiotic to be used [108].
In some cases, it is possible to suspect a complicated urinary tract infection/urosepsis without being serious urological abnormalities. In such cases, there are some screening options that can be performed to assist in the management of the patient. Thus, simple abdominal radiography, intravenous urography, ultrasound, computed tomography and magnetic resonance imaging are cited [109].
The anatomical identification of most areas of infection has become common with the development of high resolution cross-sectional images, which allow visualization of bacterial and viral metabolism, early diagnosis and treatment. Thus, the cross-sectional image was included as part of the routine investigation of unidentified infection sites and sources of sepsis. The trend is that the use of these images will become increasingly widespread and become part of standard clinical care in the near future [110].
When abdominal sepsis is suspected, ultrasound is a valuable tool. As it is a portable scanning technique, it is ideal for clinically unstable patients who cannot be transported to an examination room [110].
Ideal for the diagnosis of liver sepsis and gallbladder, ultrasound identifies and indicates the presence and location of intra-abdominal fluids (subphrenic space, in pericological calculations or pelvis) [110, 111, 112, 113]. Intrahepatic fluids are also well visualized, and can even be drained percutaneously with ultrasound guidance [110].
The main obstacle for ultrasound responses is air interference, highlighted in loop regions of the intestine with intraluminal gas, since the USG image is darkened and makes it difficult to visualize interloop abscesses or peri-pancreatic collections. The intestine in patients with disease due to sepsis or recent intra-abdominal surgery is also capable of compromising the quality of the ultrasound [114].
The availability of CT scanners with multiple detectors allows rapid acquisition of images, making this method the most common in the diagnosis and detection of intra-abdominal abscesses [114, 115]. It is an interesting option especially for sick patients who have difficulty holding their breath, obese or with abdominal or chest bandages.
In addition, CT is essential in the diagnosis of interloop and retroperitoneal pathologies (including retroperitoneal abscesses or pancreatitis or intra-biliary stones), in addition to being highly sensitive in the detection of chest pathologies (pneumonia, pleural effusion and localized collections) [113, 115, 116, 117]. For intra-abdominal fluids and abscesses, CT showed a sensitivity of 90–100%, while ultrasound showed sensitivity between 80% and 85% [115, 118, 119].
Due to the contemporary contrast protocols available, it is possible to identify by CT even small infected collections [110].
With the development of hybrid cameras, the combination of PET and magnetic resonance imaging was introduced, which despite having interesting advantages and clinical applications, is still such an expensive tool.
The simultaneous acquisition of PET and magnetic resonance imaging can provide quantitative molecular functional information about the inflammatory lesion and precise location, in addition to anatomical changes with movement correction, improving the differential diagnosis and guiding anti-inflammatory treatment strategies.
Since MRI cannot visualize all parts of the body at once, the new hybrid technique may require collaboration between radiologists and nuclear medicine doctors to interpret the image and can be more expensive than PET/CT (capital and operational costs).
The functional image of inflammation and infection was mainly restricted to the flat image and SPECT, however, with the increasing development of PET radiopharmaceuticals, the detection and quantification of specific aspects of inflammatory processes became more sensitive. Precisely for this reason, there is an interesting potential in the application of hybrid whole body PET/MRI in the context of the investigation of infectious and inflammatory diseases [120].
Imaging technique that uses biological radionuclides to track hidden infections and improve the specificity of the infection diagnosis that allows the detection of early pathophysiological changes even when there are no apparent anatomical changes. When compared to ex vivo techniques (blood culture), in vivo biological screening is preferred since it is accurate, does not require a sterile environment and does not expose the health team to the risk of contamination by blood-borne pathogens.
This type of tool is used mainly in patients suspected of infection or abscess, but who have had negative results for the cross-sectional image. Thus, the use of marked leukocyte traffic allows a response to hidden sites, based on the recognition of white blood cells marked with radionuclides. The marked leukocytes travel to the infection sites and allow noninvasive images in areas of hidden infection, such as osteomyelitis, orthopedic prosthesis, endocarditis or inflammation and intestinal disease [110].
Adequate organ perfusion must be ensured. Hypotension should be managed initially with intravenous fluid administration and the goal should be maintenance of pulmonary capillary wedge pressure at 12–16 mm Hg or central venous pressure at 8–12 cm H2O. Urine output rate should be kept at greater than 0.5 mL/kg/hr. A mean arterial blood pressure of greater than 65 mmHg (systolic blood pressure greater than 90 mmHg) and a cardiac index of greater than or equal to 4 L/min/m2 should be maintained. Vasopressor therapy should be initiated in the event of failure to achieve these goals with iv fluids alone. These include dopamine, dobutamine and norepinephrine [109].
Ventilatory support should be provided for patients with progressive hypoxemia, hypercapnia, altered sensorium or respiratory muscle fatigue. A study of “early goal directed therapy” (EGDT) found that prompt resuscitation to maintain SvO2 > 70% was associated with improved survival in patients of severe sepsis [121]. In this study, failure to maintain saturation after fluids and vasopressors was followed by erythrocyte infusion to raise hematocrit to 30%. Patients requiring mechanical ventilation should be adequately sedated and stress ulcer prophylaxis should be administered.
Blood glucose levels should be maintained at less than 150 mg/dL during initial few days of severe sepsis and normoglycemic range could be targeted later. Frequent blood glucose monitoring should be done to avoid hypoglycemia in patients on intensive insulin therapy. Multi-organ dysfunction, if any should be managed. Disseminated intravascular coagulation, if accompanied by major bleeding, should be treated with fresh-frozen plasma and platelet transfusion. Hypercatabolic individuals with acute renal failure benefit substantially from hemodialysis or hemofiltration. Prophylaxis for deep vein thrombosis and nutritional supplementation should be undertaken [109].
Considering the limited knowledge about the combination of antibiotics, the susceptibility of these pathogens to drugs and the lack of evidence to support the routine use of combined antimicrobial therapy, the decision regarding the ideal therapy is the responsibility of medical professionals [122]. Regarding the most appropriate approach, it is prioritized in the literature that the optimization of antimicrobial therapy includes adaptation of the appropriate antibiotics in terms of class, dose, frequency, route and duration [123].
The combination of different antibiotics has been widely used by large centers when it comes to invasive infections by multi-resistant Gram-negative bacteria [122].
The various positive and negative aspects of combination therapy are depicted in Table 3.
Positive aspects of combination therapy for treatment | Negative aspects of combination therapy for treatment |
---|---|
1. Greater probability of choosing an effective agent and well-founded theoretical reasons to support its use 2. Considering the increase in mortality related to the delay in the establishment of treatment and delays in appropriate and effective antimicrobial treatment, it is prudent to initiate empirical broad-spectrum antimicrobial treatment in the first suspected infection in critically ill patients 3. Indicated for patients with compromised immune systems, previous ICU admissions or who have recently received broad-spectrum antibiotics [124] | 1. Increased toxicity in treatment by combining antibiotics (nephrotoxicity and ototoxicity). In such cases, it is suggested to discontinue the old therapy and introduce a new one, based on the clinical evolution of the patient and the results of the culture and susceptibility profile 2. This type of therapy has not been shown to be effective by clinical data (meta-analyses performed with the evaluation of randomized clinical trials demonstrate that there was no difference in clinical results between the two strategies for definitive treatment of Gram-negative bacteria infections) [124] |
Comparison of positive and negative aspects of combination therapy.
Antibiotics such as colistin are the last resort to deal with infections by carbapenem-resistant Enterobacteriaceae (CREB), and when the pathogen does not respond to colistin, therapeutic options are severely restricted. Thus, it becomes necessary to restore the sensitivity of the pathogen to the drug [125].
The combination of colistin + salicylate + potent efflux pump inhibitor (BC1) has been documented with highly positive results, providing a connection between colistin and the efflux pump inhibitor (BC1), which prevents extrusion of colistin [126].
The reduction in affinity between the drug and Gram-negative bacteria is due to the modification of lipid A, linked to the appearance of the gene that confers resistance to bacteria, which is present in animals that receive colistin and are part of human food. Despite this, there is still no complete explanation of the mutation and resistance of Gram-negative bacteria (especially Enterobacteriaceae) in patients who received administered colistin [127].
Due to the increased resistance of bacteria to cephalosporin (and aminopenicillins), the use of narrow-spectrum β-lactamases, especially carbapenems, has increased considerably, being the only β-lactamase antibiotics with proven effectiveness in serious infections due to ESBL-producing bacteria [128, 129, 130].
With the discovery of
These enzymes are able to confer resistance to drugs of the class b-lactamases, and in relation to
Tigecycline is a new expanded-spectrum antimicrobial agent in the glycylcycline class. Developed with the objective of overcoming the most common processes of bacterial resistance, the drug has emerged as a great therapeutic option in the treatment of serious infections, which endanger the patient’s life, and which no longer respond to traditional antibiotics. The use of tigecycline is mainly interesting for the initial therapy of major infections, and is largely effective in the action against multi-resistant Gram-negative bacteria [132].
Aminoglycosides are natural or semi-synthetic drugs obtained from actinomycetes, used as an antibiotic since the beginning of bacterial treatment. As it was replaced in the 1980s by cephalosporins, carbapenems and fluoroquinolones, aminoglycosides had little use.
With the increase in the number of cases of multidrug-resistant bacteria, aminoglycosides were again considered for their ability to synergize with a variety of other classes of antibacterials, improving the safety and effectiveness of the class through optimized dosing regimens, being broad-spectrum and quickly bactericidal.
Enzymatic modification by acetylation of an amino group, impaired uptake and phosphorylation of aminoglycosides are the most commonly reported processes that confer resistance to bacteria in relation to aminoglycosides [133].
Fosfomycin is an antibiotic from the 1969s, prescribed mainly in its oral form for the treatment of uncomplicated urinary tract infections (UTI), and considered as an option in the treatment of bacteria with advanced resistance, causing serious infections [134].
For
The best pharmacological approach to
The duration of treatment for infection caused by
Condition | General | Perinephric abscesses | Prostatitis | Intra-abdominal infections | Pneumonia |
---|---|---|---|---|---|
Duration | 14–21 days | 42 days | 42 days | 14–21 days | 14 days |
Recommended duration of antibiotic therapy depending upon the type of infection.
In general, infectious diseases occur more frequently and cause greater concern when dealing with diabetic patients. This occurs because the environment offered by the organism is rich in glucose, which favors immune dysfunction, including decreasing the antibacterial activity of the urine and its motility [138].
Moreover, when comparing
Hence, to treat the disease, the most commonly prescribed antimicrobials are used—amoxicillin, nitrofurantoin, trimethoprim/sulfamethoxazole (TMP/SMX) and ciprofloxacin. It is understood that the same treatment choice used by nondiabetic patients can be made, depending only on the local resistance patterns of the commonly found uropathogens [140, 141].
Generally, most uropathogens have a high resistance to TMP/SMX, in addition, this antimicrobial can cause hypoglycemia, which makes it not a good first choice of treatment for this portion of patients [142].
As for the treatment, it is recommended to consider the urinary tract infection complicated, it is advisable to keep the treatment for a period of 7 to 14 days [143].
Acute pyelonephritis is an infection located in the upper urinary tract, which accommodates either parenchyma and renal pelvis, with
Approximately 250,000 cases of this disease are reported each year, with more than 100,000 eventually requiring hospitalization [146].
In order to confirm the diagnosis of the disease, the patient’s urine culture is performed before the start of antibiotic therapy [147]. In addition, it is recommended to perform a microbial susceptibility test in order to select the most appropriate antimicrobial regimen [148, 149].
If the diagnosis is uncertain or the patient is immunocompromised and suspected of having a hematogenic infection, blood culture analysis is requested [150, 151].
In the last few decades, there has been an increasing rate of resistance of
On the other hand, in cases of complicated infections, sepsis or failed outpatient treatment, hospital treatment is best indicated [154]. After antibiotic therapy, urine culture should be performed again after 1–2 weeks to conclude whether the treatment was successful or not [155].
Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the renal parenchyma and its surrounding tissues—resulting in the presence of gas in the renal parenchyma, collecting system or perinephric tissue—and is caused in 70% of cases by
The clinical evolution of EPN when not recognized and treated immediately can be serious and pose a risk to the patient’s life. Another fact that should be mentioned is that up to 95% of the cases of EPN are underlyingly associated with uncontrolled diabetes mellitus [157, 158].
In addition to the risk of developing EPN primarily, the risk of developing secondary to an obstruction of the urinary tract is considerably relevant, about 25–40% can be considered as positive findings in EPN [159, 160].
The combination of percutaneous drainage (PCD) and medical management (MM) revealed a significant reduction in mortality rates [161, 162]. Thus, it is recommended that PCD be performed in patients with localized areas of gas and the presence of functional renal tissue. Another approach that can be used in association with treatment is emergency nephrectomy, classified as simple, radical or laparoscopic [163].
Being caused by kidney stones, structural abnormality, history of urological surgery, trauma or any other cause of obstruction, renal abscess can also be related to pathogens [164]. The predominant organisms causing renal abscesses are Gram-negative organisms, and the most common is
Among the various intra-abdominal abscesses, renal abscess is a rare entity, especially in children and accounts for a number of cases of “missed diagnoses” [166, 168].
With regard to the symptoms of pediatric patients, the presentation of fever, flank pain, with or without a palpable mass, has been established in the literature; increased leukocyte count and increased erythrocyte sedimentation rate [169].
Early diagnosis is a key factor in the management of these patients, which can be aided by Ultrasound (USG). Drainage of pus and appropriate antibiotic therapy is the gold standard for treatment, being able to treat a great amount of cases. Thereby, the most successful combination of antibiotics was ceftriaxone, being associated with amikacin. Cases that cannot be resolved by the conventional approach can be treated with surgery, such as nephrectomy. Thus, complications such as extension of the peritoneal cavity, skin or chest can be avoided [166, 167].
Perinephric abscess results from perirenal fatty necrosis, usually a complication of urological infection (more than 75%) [170]. Most of these abscesses have
Renal papillary necrosis (NPN) is a condition defined as ischemic necrobiosis of the papilla in the kidney medulla. Among several etiological factors important for the involvement of papillary necrosis, pyelonephritis due to bacterial uropathogens such as
In order to improve the prognosis of the disease and reduce morbidity, the ideal is that the diagnosis of the disease is as early as possible. In this sense, it is clear that the radiological image is able to offer an early diagnosis and guidance in relation to the immediate treatment of papillary necrosis, thus minimizing the decline in renal function [174].
Failure to respond to standard therapy for acute bacterial prostatitis can lead to complications, such as prostate abscess or fistula [175].
Acute bacterial prostatitis is a common and clinically important genitourinary disorder that has a higher incidence in patients with diabetes, cirrhosis and suppressed immune system. Usually caused by an ascending infection, it can also be triggered by organisms that cause other common genitourinary infections that may also be responsible for acute bacterial prostatitis. Being introduced during transrectal prostate biopsy, the clinical presentation ranges from mild symptoms of the lower urinary tract to total sepsis, and
Regarding the therapeutic approach, oral or intravenous antibiotics are most effective in curing the infection. In this sense, the progression to chronic bacterial prostatitis is uncommon. It should be noted that special attention is needed in relation to immunosuppressed patients, whereas bacterial prostatitis in these patients may be caused by atypical infecting organisms and, therefore, may require additional therapies [176].
It is already known that iron is an essential micronutrient for most bacteria and hosts, in this thought line, it is also known that there are relatively rare classical siderophilic pathogens that cause an increase in hepcidin in the body, responsible for the sequestration of iron for macrophages and enterocytes and, consequently hypoferremia [177, 178, 179, 180]. So, current studies investigate if this mechanism used by the body against rare siderophilic bacteria, it also works for a wider set of bacteria. Results of these studies are shown to be positive, by demonstrating that excess iron allows rapid bacterial replication and spread, which means a susceptibility to infection caused by
With regard to urinary tract infection, an effective preventive measure is the characterization and correction of the underlying genitourinary abnormalities that promote the infection. Another alternative mentioned in the literature is the future development of catheters whose material limits the growth of biofilm [109].
Early symptom recognition, followed by appropriate investigations, accurate diagnosis and early goal-directed therapy, is essential to improve results. Patient management includes an interprofessional team approach, with microbiologists, radiologists, surgeons and intensive care physicians [109].
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His research interest focuses on computational chemistry and molecular modeling of diverse systems of pharmacological, food, and alternative energy interests by resorting to DFT and Conceptual DFT. He has authored a coauthored more than 255 peer-reviewed papers, 32 book chapters, and 2 edited books. He has delivered speeches at many international and domestic conferences. He serves as a reviewer for more than eighty international journals, books, and research proposals as well as an editor for special issues of renowned scientific journals.",institutionString:"Centro de Investigación en Materiales Avanzados",institution:{name:"Centro de Investigación en Materiales Avanzados",country:{name:"Mexico"}}},{id:"76477",title:"Prof.",name:"Mirza",middleName:null,surname:"Hasanuzzaman",slug:"mirza-hasanuzzaman",fullName:"Mirza Hasanuzzaman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/76477/images/system/76477.png",biography:"Dr. Mirza Hasanuzzaman is a Professor of Agronomy at Sher-e-Bangla Agricultural University, Bangladesh. He received his Ph.D. in Plant Stress Physiology and Antioxidant Metabolism from Ehime University, Japan, with a scholarship from the Japanese Government (MEXT). Later, he completed his postdoctoral research at the Center of Molecular Biosciences, University of the Ryukyus, Japan, as a recipient of the Japan Society for the Promotion of Science (JSPS) postdoctoral fellowship. He was also the recipient of the Australian Government Endeavour Research Fellowship for postdoctoral research as an adjunct senior researcher at the University of Tasmania, Australia. Dr. Hasanuzzaman’s current work is focused on the physiological and molecular mechanisms of environmental stress tolerance. Dr. Hasanuzzaman has published more than 150 articles in peer-reviewed journals. He has edited ten books and written more than forty book chapters on important aspects of plant physiology, plant stress tolerance, and crop production. According to Scopus, Dr. Hasanuzzaman’s publications have received more than 10,500 citations with an h-index of 53. He has been named a Highly Cited Researcher by Clarivate. He is an editor and reviewer for more than fifty peer-reviewed international journals and was a recipient of the “Publons Peer Review Award” in 2017, 2018, and 2019. He has been honored by different authorities for his outstanding performance in various fields like research and education, and he has received the World Academy of Science Young Scientist Award (2014) and the University Grants Commission (UGC) Award 2018. He is a fellow of the Bangladesh Academy of Sciences (BAS) and the Royal Society of Biology.",institutionString:"Sher-e-Bangla Agricultural University",institution:{name:"Sher-e-Bangla Agricultural University",country:{name:"Bangladesh"}}},{id:"187859",title:"Prof.",name:"Kusal",middleName:"K.",surname:"Das",slug:"kusal-das",fullName:"Kusal Das",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSBDeQAO/Profile_Picture_1623411145568",biography:"Kusal K. Das is a Distinguished Chair Professor of Physiology, Shri B. M. Patil Medical College and Director, Centre for Advanced Medical Research (CAMR), BLDE (Deemed to be University), Vijayapur, Karnataka, India. Dr. Das did his M.S. and Ph.D. in Human Physiology from the University of Calcutta, Kolkata. His area of research is focused on understanding of molecular mechanisms of heavy metal activated low oxygen sensing pathways in vascular pathophysiology. He has invented a new method of estimation of serum vitamin E. His expertise in critical experimental protocols on vascular functions in experimental animals was well documented by his quality of publications. He was a Visiting Professor of Medicine at University of Leeds, United Kingdom (2014-2016) and Tulane University, New Orleans, USA (2017). For his immense contribution in medical research Ministry of Science and Technology, Government of India conferred him 'G.P. Chatterjee Memorial Research Prize-2019” and he is also the recipient of 'Dr.Raja Ramanna State Scientist Award 2015” by Government of Karnataka. He is a Fellow of the Royal Society of Biology (FRSB), London and Honorary Fellow of Karnataka Science and Technology Academy, Department of Science and Technology, Government of Karnataka.",institutionString:"BLDE (Deemed to be University), India",institution:null},{id:"243660",title:"Dr.",name:"Mallanagouda Shivanagouda",middleName:null,surname:"Biradar",slug:"mallanagouda-shivanagouda-biradar",fullName:"Mallanagouda Shivanagouda Biradar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243660/images/system/243660.jpeg",biography:"M. S. Biradar is Vice Chancellor and Professor of Medicine of\nBLDE (Deemed to be University), Vijayapura, Karnataka, India.\nHe obtained his MD with a gold medal in General Medicine and\nhas devoted himself to medical teaching, research, and administrations. He has also immensely contributed to medical research\non vascular medicine, which is reflected by his numerous publications including books and book chapters. Professor Biradar was\nalso Visiting Professor at Tulane University School of Medicine, New Orleans, USA.",institutionString:"BLDE (Deemed to be University)",institution:{name:"BLDE University",country:{name:"India"}}},{id:"289796",title:"Dr.",name:"Swastika",middleName:null,surname:"Das",slug:"swastika-das",fullName:"Swastika Das",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/289796/images/system/289796.jpeg",biography:"Swastika N. Das is Professor of Chemistry at the V. P. Dr. P. G.\nHalakatti College of Engineering and Technology, BLDE (Deemed\nto be University), Vijayapura, Karnataka, India. She obtained an\nMSc, MPhil, and PhD in Chemistry from Sambalpur University,\nOdisha, India. Her areas of research interest are medicinal chemistry, chemical kinetics, and free radical chemistry. She is a member\nof the investigators who invented a new modified method of estimation of serum vitamin E. She has authored numerous publications including book\nchapters and is a mentor of doctoral curriculum at her university.",institutionString:"BLDEA’s V.P.Dr.P.G.Halakatti College of Engineering & Technology",institution:{name:"BLDE University",country:{name:"India"}}},{id:"248459",title:"Dr.",name:"Akikazu",middleName:null,surname:"Takada",slug:"akikazu-takada",fullName:"Akikazu Takada",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248459/images/system/248459.png",biography:"Akikazu Takada was born in Japan, 1935. After graduation from\nKeio University School of Medicine and finishing his post-graduate studies, he worked at Roswell Park Memorial Institute NY,\nUSA. He then took a professorship at Hamamatsu University\nSchool of Medicine. In thrombosis studies, he found the SK\npotentiator that enhances plasminogen activation by streptokinase. He is very much interested in simultaneous measurements\nof fatty acids, amino acids, and tryptophan degradation products. By using fatty\nacid analyses, he indicated that plasma levels of trans-fatty acids of old men were\nfar higher in the US than Japanese men. . He also showed that eicosapentaenoic acid\n(EPA) and docosahexaenoic acid (DHA) levels are higher, and arachidonic acid\nlevels are lower in Japanese than US people. By using simultaneous LC/MS analyses\nof plasma levels of tryptophan metabolites, he recently found that plasma levels of\nserotonin, kynurenine, or 5-HIAA were higher in patients of mono- and bipolar\ndepression, which are significantly different from observations reported before. In\nview of recent reports that plasma tryptophan metabolites are mainly produced by\nmicrobiota. He is now working on the relationships between microbiota and depression or autism.",institutionString:"Hamamatsu University School of Medicine",institution:{name:"Hamamatsu University School of Medicine",country:{name:"Japan"}}},{id:"137240",title:"Prof.",name:"Mohammed",middleName:null,surname:"Khalid",slug:"mohammed-khalid",fullName:"Mohammed Khalid",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/137240/images/system/137240.png",biography:"Mohammed Khalid received his B.S. degree in chemistry in 2000 and Ph.D. degree in physical chemistry in 2007 from the University of Khartoum, Sudan. He moved to School of Chemistry, Faculty of Science, University of Sydney, Australia in 2009 and joined Dr. Ron Clarke as a postdoctoral fellow where he worked on the interaction of ATP with the phosphoenzyme of the Na+/K+-ATPase and dual mechanisms of allosteric acceleration of the Na+/K+-ATPase by ATP; then he went back to Department of Chemistry, University of Khartoum as an assistant professor, and in 2014 he was promoted as an associate professor. In 2011, he joined the staff of Department of Chemistry at Taif University, Saudi Arabia, where he is currently an assistant professor. His research interests include the following: P-Type ATPase enzyme kinetics and mechanisms, kinetics and mechanisms of redox reactions, autocatalytic reactions, computational enzyme kinetics, allosteric acceleration of P-type ATPases by ATP, exploring of allosteric sites of ATPases, and interaction of ATP with ATPases located in cell membranes.",institutionString:"Taif University",institution:{name:"Taif University",country:{name:"Saudi Arabia"}}},{id:"63810",title:"Prof.",name:"Jorge",middleName:null,surname:"Morales-Montor",slug:"jorge-morales-montor",fullName:"Jorge Morales-Montor",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/63810/images/system/63810.png",biography:"Dr. Jorge Morales-Montor was recognized with the Lola and Igo Flisser PUIS Award for best graduate thesis at the national level in the field of parasitology. He received a fellowship from the Fogarty Foundation to perform postdoctoral research stay at the University of Georgia. He has 153 journal articles to his credit. He has also edited several books and published more than fifty-five book chapters. He is a member of the Mexican Academy of Sciences, Latin American Academy of Sciences, and the National Academy of Medicine. He has received more than thirty-five awards and has supervised numerous bachelor’s, master’s, and Ph.D. students. Dr. Morales-Montor is the past president of the Mexican Society of Parasitology.",institutionString:"National Autonomous University of Mexico",institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}},{id:"217215",title:"Dr.",name:"Palash",middleName:null,surname:"Mandal",slug:"palash-mandal",fullName:"Palash Mandal",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/217215/images/system/217215.jpeg",biography:null,institutionString:"Charusat University",institution:null},{id:"49739",title:"Dr.",name:"Leszek",middleName:null,surname:"Szablewski",slug:"leszek-szablewski",fullName:"Leszek Szablewski",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49739/images/system/49739.jpg",biography:"Leszek Szablewski is a professor of medical sciences. He received his M.S. in the Faculty of Biology from the University of Warsaw and his PhD degree from the Institute of Experimental Biology Polish Academy of Sciences. He habilitated in the Medical University of Warsaw, and he obtained his degree of Professor from the President of Poland. Professor Szablewski is the Head of Chair and Department of General Biology and Parasitology, Medical University of Warsaw. Professor Szablewski has published over 80 peer-reviewed papers in journals such as Journal of Alzheimer’s Disease, Biochim. Biophys. Acta Reviews of Cancer, Biol. Chem., J. Biomed. Sci., and Diabetes/Metabol. Res. Rev, Endocrine. He is the author of two books and four book chapters. He has edited four books, written 15 scripts for students, is the ad hoc reviewer of over 30 peer-reviewed journals, and editorial member of peer-reviewed journals. Prof. Szablewski’s research focuses on cell physiology, genetics, and pathophysiology. He works on the damage caused by lack of glucose homeostasis and changes in the expression and/or function of glucose transporters due to various diseases. He has given lectures, seminars, and exercises for students at the Medical University.",institutionString:"Medical University of Warsaw",institution:{name:"Medical University of Warsaw",country:{name:"Poland"}}},{id:"173123",title:"Dr.",name:"Maitham",middleName:null,surname:"Khajah",slug:"maitham-khajah",fullName:"Maitham Khajah",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/173123/images/system/173123.jpeg",biography:"Dr. Maitham A. Khajah received his degree in Pharmacy from Faculty of Pharmacy, Kuwait University, in 2003 and obtained his PhD degree in December 2009 from the University of Calgary, Canada (Gastrointestinal Science and Immunology). Since January 2010 he has been assistant professor in Kuwait University, Faculty of Pharmacy, Department of Pharmacology and Therapeutics. His research interest are molecular targets for the treatment of inflammatory bowel disease (IBD) and the mechanisms responsible for immune cell chemotaxis. He cosupervised many students for the MSc Molecular Biology Program, College of Graduate Studies, Kuwait University. Ever since joining Kuwait University in 2010, he got various grants as PI and Co-I. He was awarded the Best Young Researcher Award by Kuwait University, Research Sector, for the Year 2013–2014. He was a member in the organizing committee for three conferences organized by Kuwait University, Faculty of Pharmacy, as cochair and a member in the scientific committee (the 3rd, 4th, and 5th Kuwait International Pharmacy Conference).",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"195136",title:"Dr.",name:"Aya",middleName:null,surname:"Adel",slug:"aya-adel",fullName:"Aya Adel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/195136/images/system/195136.jpg",biography:"Dr. Adel works as an Assistant Lecturer in the unit of Phoniatrics, Department of Otolaryngology, Ain Shams University in Cairo, Egypt. Dr. Adel is especially interested in joint attention and its impairment in autism spectrum disorder",institutionString:"Ain Shams University",institution:{name:"Ain Shams University",country:{name:"Egypt"}}},{id:"94911",title:"Dr.",name:"Boulenouar",middleName:null,surname:"Mesraoua",slug:"boulenouar-mesraoua",fullName:"Boulenouar Mesraoua",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94911/images/system/94911.png",biography:"Dr Boulenouar Mesraoua is the Associate Professor of Clinical Neurology at Weill Cornell Medical College-Qatar and a Consultant Neurologist at Hamad Medical Corporation at the Neuroscience Department; He graduated as a Medical Doctor from the University of Oran, Algeria; he then moved to Belgium, the City of Liege, for a Residency in Internal Medicine and Neurology at Liege University; after getting the Belgian Board of Neurology (with high marks), he went to the National Hospital for Nervous Diseases, Queen Square, London, United Kingdom for a fellowship in Clinical Neurophysiology, under Pr Willison ; Dr Mesraoua had also further training in Epilepsy and Continuous EEG Monitoring for two years (from 2001-2003) in the Neurophysiology department of Zurich University, Switzerland, under late Pr Hans Gregor Wieser ,an internationally known epileptologist expert. \n\nDr B. Mesraoua is the Director of the Neurology Fellowship Program at the Neurology Section and an active member of the newly created Comprehensive Epilepsy Program at Hamad General Hospital, Doha, Qatar; he is also Assistant Director of the Residency Program at the Qatar Medical School. \nDr B. Mesraoua's main interests are Epilepsy, Multiple Sclerosis, and Clinical Neurology; He is the Chairman and the Organizer of the well known Qatar Epilepsy Symposium, he is running yearly for the past 14 years and which is considered a landmark in the Gulf region; He has also started last year , together with other epileptologists from Qatar, the region and elsewhere, a yearly International Epilepsy School Course, which was attended by many neurologists from the Area.\n\nInternationally, Dr Mesraoua is an active and elected member of the Commission on Eastern Mediterranean Region (EMR ) , a regional branch of the International League Against Epilepsy (ILAE), where he represents the Middle East and North Africa(MENA ) and where he holds the position of chief of the Epilepsy Epidemiology Section; Dr Mesraoua is a member of the American Academy of Neurology, the Europeen Academy of Neurology and the American Epilepsy Society.\n\nDr Mesraoua's main objectives are to encourage frequent gathering of the epileptologists/neurologists from the MENA region and the rest of the world, promote Epilepsy Teaching in the MENA Region, and encourage multicenter studies involving neurologists and epileptologists in the MENA region, particularly epilepsy epidemiological studies. \n\nDr. Mesraoua is the recipient of two research Grants, as the Lead Principal Investigator (750.000 USD and 250.000 USD) from the Qatar National Research Fund (QNRF) and the Hamad Hospital Internal Research Grant (IRGC), on the following topics : “Continuous EEG Monitoring in the ICU “ and on “Alpha-lactoalbumin , proof of concept in the treatment of epilepsy” .Dr Mesraoua is a reviewer for the journal \"seizures\" (Europeen Epilepsy Journal ) as well as dove journals ; Dr Mesraoua is the author and co-author of many peer reviewed publications and four book chapters in the field of Epilepsy and Clinical Neurology",institutionString:"Weill Cornell Medical College in Qatar",institution:{name:"Weill Cornell Medical College in Qatar",country:{name:"Qatar"}}},{id:"282429",title:"Prof.",name:"Covanis",middleName:null,surname:"Athanasios",slug:"covanis-athanasios",fullName:"Covanis Athanasios",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/282429/images/system/282429.jpg",biography:null,institutionString:"Neurology-Neurophysiology Department of the Children Hospital Agia Sophia",institution:null},{id:"190980",title:"Prof.",name:"Marwa",middleName:null,surname:"Mahmoud Saleh",slug:"marwa-mahmoud-saleh",fullName:"Marwa Mahmoud Saleh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/190980/images/system/190980.jpg",biography:"Professor Marwa Mahmoud Saleh is a doctor of medicine and currently works in the unit of Phoniatrics, Department of Otolaryngology, Ain Shams University in Cairo, Egypt. She got her doctoral degree in 1991 and her doctoral thesis was accomplished in the University of Iowa, United States. Her publications covered a multitude of topics as videokymography, cochlear implants, stuttering, and dysphagia. She has lectured Egyptian phonology for many years. Her recent research interest is joint attention in autism.",institutionString:"Ain Shams University",institution:{name:"Ain Shams University",country:{name:"Egypt"}}},{id:"259190",title:"Dr.",name:"Syed Ali Raza",middleName:null,surname:"Naqvi",slug:"syed-ali-raza-naqvi",fullName:"Syed Ali Raza Naqvi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259190/images/system/259190.png",biography:"Dr. Naqvi is a radioanalytical chemist and is working as an associate professor of analytical chemistry in the Department of Chemistry, Government College University, Faisalabad, Pakistan. Advance separation techniques, nuclear analytical techniques and radiopharmaceutical analysis are the main courses that he is teaching to graduate and post-graduate students. In the research area, he is focusing on the development of organic- and biomolecule-based radiopharmaceuticals for diagnosis and therapy of infectious and cancerous diseases. Under the supervision of Dr. Naqvi, three students have completed their Ph.D. degrees and 41 students have completed their MS degrees. He has completed three research projects and is currently working on 2 projects entitled “Radiolabeling of fluoroquinolone derivatives for the diagnosis of deep-seated bacterial infections” and “Radiolabeled minigastrin peptides for diagnosis and therapy of NETs”. He has published about 100 research articles in international reputed journals and 7 book chapters. Pakistan Institute of Nuclear Science & Technology (PINSTECH) Islamabad, Punjab Institute of Nuclear Medicine (PINM), Faisalabad and Institute of Nuclear Medicine and Radiology (INOR) Abbottabad are the main collaborating institutes.",institutionString:"Government College University",institution:{name:"Government College University, Faisalabad",country:{name:"Pakistan"}}},{id:"58390",title:"Dr.",name:"Gyula",middleName:null,surname:"Mozsik",slug:"gyula-mozsik",fullName:"Gyula Mozsik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/58390/images/system/58390.png",biography:"Gyula Mózsik MD, Ph.D., ScD (med), is an emeritus professor of Medicine at the First Department of Medicine, Univesity of Pécs, Hungary. He was head of this department from 1993 to 2003. His specializations are medicine, gastroenterology, clinical pharmacology, clinical nutrition, and dietetics. His research fields are biochemical pharmacological examinations in the human gastrointestinal (GI) mucosa, mechanisms of retinoids, drugs, capsaicin-sensitive afferent nerves, and innovative pharmacological, pharmaceutical, and nutritional (dietary) research in humans. He has published about 360 peer-reviewed papers, 197 book chapters, 692 abstracts, 19 monographs, and has edited 37 books. He has given about 1120 regular and review lectures. He has organized thirty-eight national and international congresses and symposia. He is the founder of the International Conference on Ulcer Research (ICUR); International Union of Pharmacology, Gastrointestinal Section (IUPHAR-GI); Brain-Gut Society symposiums, and gastrointestinal cytoprotective symposiums. He received the Andre Robert Award from IUPHAR-GI in 2014. Fifteen of his students have been appointed as full professors in Egypt, Cuba, and Hungary.",institutionString:"University of Pécs",institution:{name:"University of Pecs",country:{name:"Hungary"}}},{id:"277367",title:"M.Sc.",name:"Daniel",middleName:"Martin",surname:"Márquez López",slug:"daniel-marquez-lopez",fullName:"Daniel Márquez López",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/277367/images/7909_n.jpg",biography:"Msc Daniel Martin Márquez López has a bachelor degree in Industrial Chemical Engineering, a Master of science degree in the same área and he is a PhD candidate for the Instituto Politécnico Nacional. His Works are realted to the Green chemistry field, biolubricants, biodiesel, transesterification reactions for biodiesel production and the manipulation of oils for therapeutic purposes.",institutionString:null,institution:{name:"Instituto Politécnico Nacional",country:{name:"Mexico"}}},{id:"196544",title:"Prof.",name:"Angel",middleName:null,surname:"Catala",slug:"angel-catala",fullName:"Angel Catala",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/196544/images/system/196544.jpg",biography:"Angel Catalá studied chemistry at Universidad Nacional de La Plata, Argentina, where he received a Ph.D. in Chemistry (Biological Branch) in 1965. From 1964 to 1974, he worked as an Assistant in Biochemistry at the School of Medicine at the same university. From 1974 to 1976, he was a fellow of the National Institutes of Health (NIH) at the University of Connecticut, Health Center, USA. From 1985 to 2004, he served as a Full Professor of Biochemistry at the Universidad Nacional de La Plata. He is a member of the National Research Council (CONICET), Argentina, and the Argentine Society for Biochemistry and Molecular Biology (SAIB). His laboratory has been interested for many years in the lipid peroxidation of biological membranes from various tissues and different species. Dr. Catalá has directed twelve doctoral theses, published more than 100 papers in peer-reviewed journals, several chapters in books, and edited twelve books. He received awards at the 40th International Conference Biochemistry of Lipids 1999 in Dijon, France. He is the winner of the Bimbo Pan-American Nutrition, Food Science and Technology Award 2006 and 2012, South America, Human Nutrition, Professional Category. In 2006, he won the Bernardo Houssay award in pharmacology, in recognition of his meritorious works of research. Dr. Catalá belongs to the editorial board of several journals including Journal of Lipids; International Review of Biophysical Chemistry; Frontiers in Membrane Physiology and Biophysics; World Journal of Experimental Medicine and Biochemistry Research International; World Journal of Biological Chemistry, Diabetes, and the Pancreas; International Journal of Chronic Diseases & Therapy; and International Journal of Nutrition. He is the co-editor of The Open Biology Journal and associate editor for Oxidative Medicine and Cellular Longevity.",institutionString:"Universidad Nacional de La Plata",institution:{name:"National University of La Plata",country:{name:"Argentina"}}},{id:"186585",title:"Dr.",name:"Francisco Javier",middleName:null,surname:"Martin-Romero",slug:"francisco-javier-martin-romero",fullName:"Francisco Javier Martin-Romero",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSB3HQAW/Profile_Picture_1631258137641",biography:"Francisco Javier Martín-Romero (Javier) is a Professor of Biochemistry and Molecular Biology at the University of Extremadura, Spain. He is also a group leader at the Biomarkers Institute of Molecular Pathology. Javier received his Ph.D. in 1998 in Biochemistry and Biophysics. At the National Cancer Institute (National Institute of Health, Bethesda, MD) he worked as a research associate on the molecular biology of selenium and its role in health and disease. After postdoctoral collaborations with Carlos Gutierrez-Merino (University of Extremadura, Spain) and Dario Alessi (University of Dundee, UK), he established his own laboratory in 2008. The interest of Javier's lab is the study of cell signaling with a special focus on Ca2+ signaling, and how Ca2+ transport modulates the cytoskeleton, migration, differentiation, cell death, etc. He is especially interested in the study of Ca2+ channels, and the role of STIM1 in the initiation of pathological events.",institutionString:null,institution:{name:"University of Extremadura",country:{name:"Spain"}}},{id:"217323",title:"Prof.",name:"Guang-Jer",middleName:null,surname:"Wu",slug:"guang-jer-wu",fullName:"Guang-Jer Wu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/217323/images/8027_n.jpg",biography:null,institutionString:null,institution:null},{id:"148546",title:"Dr.",name:"Norma Francenia",middleName:null,surname:"Santos-Sánchez",slug:"norma-francenia-santos-sanchez",fullName:"Norma Francenia Santos-Sánchez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/148546/images/4640_n.jpg",biography:null,institutionString:null,institution:null},{id:"272889",title:"Dr.",name:"Narendra",middleName:null,surname:"Maddu",slug:"narendra-maddu",fullName:"Narendra Maddu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272889/images/10758_n.jpg",biography:null,institutionString:null,institution:null},{id:"242491",title:"Prof.",name:"Angelica",middleName:null,surname:"Rueda",slug:"angelica-rueda",fullName:"Angelica Rueda",position:"Investigador Cinvestav 3B",profilePictureURL:"https://mts.intechopen.com/storage/users/242491/images/6765_n.jpg",biography:null,institutionString:null,institution:null},{id:"88631",title:"Dr.",name:"Ivan",middleName:null,surname:"Petyaev",slug:"ivan-petyaev",fullName:"Ivan Petyaev",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Lycotec (United Kingdom)",country:{name:"United Kingdom"}}},{id:"423869",title:"Ms.",name:"Smita",middleName:null,surname:"Rai",slug:"smita-rai",fullName:"Smita Rai",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Integral University",country:{name:"India"}}},{id:"424024",title:"Prof.",name:"Swati",middleName:null,surname:"Sharma",slug:"swati-sharma",fullName:"Swati Sharma",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Integral University",country:{name:"India"}}},{id:"439112",title:"MSc.",name:"Touseef",middleName:null,surname:"Fatima",slug:"touseef-fatima",fullName:"Touseef Fatima",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Integral University",country:{name:"India"}}},{id:"424836",title:"Dr.",name:"Orsolya",middleName:null,surname:"Borsai",slug:"orsolya-borsai",fullName:"Orsolya Borsai",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca",country:{name:"Romania"}}},{id:"422262",title:"Ph.D.",name:"Paola Andrea",middleName:null,surname:"Palmeros-Suárez",slug:"paola-andrea-palmeros-suarez",fullName:"Paola Andrea Palmeros-Suárez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Guadalajara",country:{name:"Mexico"}}}]}},subseries:{item:{id:"12",type:"subseries",title:"Human Physiology",keywords:"Anatomy, Cells, Organs, Systems, Homeostasis, Functions",scope:"Human physiology is the scientific exploration of the various functions (physical, biochemical, and mechanical properties) of humans, their organs, and their constituent cells. 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