Types of LMIS data items.
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IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"1811",leadTitle:null,fullTitle:"Public Health - Social and Behavioral Health",title:"Public Health",subtitle:"Social and Behavioral Health",reviewType:"peer-reviewed",abstract:"Human behavior accounts for the majority of morbidity and premature mortality throughout the world. This book explores several areas of human behavior including physical activity, nutrition and food, addictive substances, gun violence, sexual transmitted diseases and more. Several cutting edge methods are also examined including empowering nurses, community based participatory research and nature therapy. Less well known public health topics including human trafficking, tuberculosis control in prisons and public health issues in the deaf community are also covered. The authors come from around the world to describe issues that are both of local and worldwide importance to protect and preserve the health of populations. This book demonstrates the scope and some of the solutions to addressing today's most pressing public health issues.",isbn:null,printIsbn:"978-953-51-0620-3",pdfIsbn:"978-953-51-4295-9",doi:"10.5772/2242",price:159,priceEur:175,priceUsd:205,slug:"public-health-social-and-behavioral-health",numberOfPages:584,isOpenForSubmission:!1,isInWos:1,isInBkci:!0,hash:"93597bfaec819d81d8764fde5784fc02",bookSignature:"Jay Maddock",publishedDate:"May 16th 2012",coverURL:"https://cdn.intechopen.com/books/images_new/1811.jpg",numberOfDownloads:104333,numberOfWosCitations:200,numberOfCrossrefCitations:79,numberOfCrossrefCitationsByBook:3,numberOfDimensionsCitations:251,numberOfDimensionsCitationsByBook:3,hasAltmetrics:1,numberOfTotalCitations:530,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"May 18th 2011",dateEndSecondStepPublish:"June 15th 2011",dateEndThirdStepPublish:"October 20th 2011",dateEndFourthStepPublish:"November 19th 2011",dateEndFifthStepPublish:"March 18th 2012",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,8",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"67153",title:"Prof.",name:"Jay",middleName:null,surname:"Maddock",slug:"jay-maddock",fullName:"Jay Maddock",profilePictureURL:"https://mts.intechopen.com/storage/users/67153/images/system/67153.jpg",biography:"Jay Maddock, Ph.D., FAAHB is Professor and Director of the Office of Public Health Studies at the University of Hawai‘i at Mānoa and Luojia Chair Professor at Wuhan University. Professor Maddock has extensive experience in system, environmental and policy research to improve population level risk factors for chronic disease. Dr. Maddock chaired the state board of health and was a charter member of the NIH study section on Community-Level Health Promotion. He is an author of over 75 scientific articles. He is the Honorary Secretary for the Asia-Pacific Academic Consortium for Public Health. 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The aim of this study is to present the emerging trends in the
However, the logistics process of pharmaceutical products in the healthcare sector accuses a relevant gap compared to other sectors: hospital companies tend to behave like “individual agents” with their own purchasing offices, a pharmacy and an internal distribution system based on order-delivery process. Additionally, they have to manage very different kinds of goods, taking care of the impact in the process of patients care. Consequently, a large number of transactions sent to different vendors and purchases of large quantities of drugs from individual departments with the resulting generation of high inventory and storage costs. As a natural consequence of this diversity of assets to manage, the organizational responsibility of the logistics function is often fragmented and dispersed across multiple organizational units, with clear coordination and integration problems.
In order to optimize the inventory control and reduce the material handling costs of pharmaceutical products, it is necessary to manage the Supply Chain following an integrated perspective, capable to overcome boundaries between professional specializations and organizations involved in the materials flow from warehouses to wards. This appears to be even more important for the Italian National Health Service, where all the discussions are concentrated in the fact that the hospitals’ costs should be decreased, even if the materials managers’ duties are still not defined. The state of the art shows that Italian hospital companies are in a condition of delay from the point of view of materials management, from which only recently they have been trying to get out, analyzing and rationalizing their Supply Chain processes [1].
Due to the critical role Supply Chain play in the healthcare sector, cost control and the optimization of material flows of drugs have been the subject of numerous studies, and different approaches and methods have been suggested in the literature [2-10]. They indicate that, starting from the traditional healthcare Supply Chain Management, some organizations are applying innovative transformations in the way of
According to these premises, in this chapter we explore the possibilities of Supply Chain and Logistics flows optimization and innovation in the Italian healthcare sector, through a process reengineering project. The literature review and an in-depth analysis of an Italian Local Healthcare Company help us to explain how changes in the pharmaceutical logistics flow can improve efficiency and reduce costs.
The
The
In particular, the healthcare SC in the Italian context generally consists of four main actors: 1) producers (pharmaceutical companies); 2) purchasers (dealers/depositaries and wholesalers); 3) providers (healthcare organizations and pharmacies); 4) patients (Figure 1).
Healthcare Supply Chain
Due to the growing influence of patient-associations and to the necessity to deliver health services in a more efficient and effective way, many healthcare organisations have started projects in the area of patient logistics, clinical pathways, data interchange [20]. Moreover, the redesign of hospital services and the implementation of integrated care programmes are frequently addressed as being critical strategies to decrease resource utilization and improve healthcare quality. During the last ten years an impressive number of studies, originated in different disciplines like economics, organisational behaviour and logistics, have drastically enlarged our knowledge regarding the healthcare sector [16, 21-23].
Although many healthcare organizations have recognized the importance of adopting SCM practices, the application of techniques, methods and best practices originally developed in the industrial setting is often problematic. Their implementation has proven to be more complex primarily because it handles a diversity of items in widely varying quantities, in response to the large number of diagnosis types and procedures. Secondly, it requires the participation of many
In healthcare the term logistics encompasses the set of techniques, methodologies, tools and infrastructure used in the management of the physicals flows (such as drugs and surgical medical products) and the associated information flows, from the acquisition in the market to the distribution to wards (Figure 2). The proposed definition allows us to make some important specifications as regards to
With reference to the first aspect, the
The pharmaceutical logistics process
As some authors point out [28], the mains objectives of a good logistics include:
improve information systems for accurate collects and reports data when and where needed;
improve forecasting/procurement;
improve distribution activities;
obtain clean, secure, organized storage;
implement a good transportation system.
The increased complexity that characterizes the management of logistics flows within the healthcare companies is linked to different aspects (Figure 3):
Healthcare companies manage at least
Healthcare companies treat
Last but not less important point, logistics has an important impact on the processes of care, that is on the quality and safety of care provided to patients. When healthcare actors communicate and share information, they are more likely to improve the quality in terms of patient safety, cycle time reduction and operational efficiency [29-32]. The safety of patients is the top priority in healthcare, and pharmaceutical managers play a crucial role in protecting their interest: their biggest responsibility is to ensure that the products purchased for clinical use are good quality ones. This can be achieved by developing a product evaluation system, consisting of well-defined parameters, to guarantee that only approved products can enter a hospital’s stockroom. Additionally, timely placement factor is probably not as crucial in any other field as it is in healthcare delivery, where delay of a few seconds can cost a life.
Factors of complexity in the pharmaceutical logistics process.
Managers operating in the pharmaceutical logistics process face many problems related to
Optimization of information storage and use requires that the organization and storage of data throughout the SC is consistent, so that all the data are accessible to multiple entities at different levels. The results are well coordinated movements of inventories, products that are delivered quickly and reliably when and where they are needed, as well as high responsiveness to short lead times [34]. A solution is given by implementing a
tracking the storage and movement of goods at every level within the supply system in order to obtain stocks ready for use in healthcare structures;
ensuring proper stock rotation so that items of earliest expiry dates are used first;
enabling managers to know the total amounts of commodities that are within the supply and where they are located.
The purpose of LMIS is to collect, organise, and report the logistics data in order to improve the customer service by improving the quality of management decisions. A well-functioning LMIS provides decision makers with
There are four essential
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\tAn average of stock dispensed to users during a particular period of time. | \n\t\t
\n\t\t\t\t | \n\t\t\tInclude the quantity of stock removed for any reason other than consumption. | \n\t\t
\n\t\t\t\t | \n\t\t\tThey are created when quantities are issued to or received from other facilities at the same level. | \n\t\t
Types of LMIS data items.
These data must be available for every product, at every level, and in all times. The additional data item is known as
At the end of a certain period, particularly monthly or quarterly, reports should be prepared and sent to the higher levels in the logistics systems for decision making, policy making, and planning. Reports are used to move the essential data to the logistics decision makers and the data should be available to the managers in a form suitable for decision making. For this reason, literature suggests six “rights” for LMIS data: the managers must receive the
Additionally, the
The Italian National Health Service (NHS) is the institution through which the State guarantees its citizens the constitutional right to health (article 32 of the Italian Constitution), in conditions of equality throughout the national territory. The NHS is a public system with universal nature, that is to say that it guarantees healthcare to all citizens (all citizens are equal and enjoy equal rights); it is funded through general taxation, direct incomes (health tickets) and fees. The NHS is organized according to the
The public healthcare service considers different levels of responsibility and government at central, and regional level. In particular, at the
The need for change the management of public healthcare structures is due to some fundamental reasons: 1) the process of
All these has contributed to the continuous improvement of the healthcare organizational and management
In the healthcare sector there is a growing awareness of the significant weight that investment in consumables and the cost of managing them have on the corporate balance sheet. Therefore, in order to increase the efficiency it is necessary to operate in the direction of simplifying the flows of materials and replace the current high level of stocks with a greater amount of accurate information available in real time about the various stages of the SC.
Unlike what happened in manufacturing companies, in which the SCM is a strategic element of management, in the world of healthcare it is still anchored, in most cases, to a distribution with the
the high value of departments fixed deposits;
the difficult drug consume control at the ward level;
the high risk of product obsolescence;
the staff time devoted to administrative and medical medication management;
the wards stocks location;
unpredictability of requests for wards and frequency of urgent requests;
the risk of failure in the early stages of association and patient care, preparation, administration and manual transcription of prescriptions from paper medical records to the nursing register paper.
Traditional system of drugs management.
However, starting from this traditional healthcare SCM [7-9], some healthcare realities are testing the
The
In order to complete the process of SC redesign and pharmaceutical logistics reorganization, among the ASL has been set up the experimentation of the
Ensure the organization and operation of activities and processes aimed at the government of pharmaceutical care; | \n\t\t
Ensure the quality of service delivery, at both hospital and community level; | \n\t\t
Promote the development of integrated actions for the clinical management of drugs and medical devices; | \n\t\t
Support the human resources training process for the improvement of professional qualification; | \n\t\t
Identify guidelines for carrying out the activities of clinical pharmacy and patient care at hospital, outpatient, home and residential level; | \n\t\t
Act within the criteria of effectiveness, efficiency, appropriateness and transparency. | \n\t\t
Pharmaceutical Department functions.
The organizational structure has been defined according to the functions of pharmaceutical care, attributing coordination and management specialist of the main tasks to specific operating units. This reorganization also took into account the problems related to the government of pharmaceuticals expenditure and the information derived from the ministerial projects relating to drugs policies. For this reason, in order to facilitate the reorganization and rationalization of processes, the Department consists of six operational units (Table 3):
\n\t\t\t\t | \n\t\t
Pharmaceutical Assistance in Agreement | \n\t\t
Hospital Parmaceutical Assistance | \n\t\t
Direct Distribution | \n\t\t
Pharmacovigilance and Pharmacoeconomics | \n\t\t
Pharmaceutical Warehouse | \n\t\t
Central Pharmaceutical Unit | \n\t\t
The Pharmaceutical Department structure.
With this configuration, skills are reconfigured and redistributed in order to provide greater support to corporate governance to all the units of the network. In particular:
The
The
The
The
The
The
The current logistics organization of the ASL presents strengths but especially criticalities. In particular, the presence of six pharmaceutical warehouses located in six different hospitals guarantees some
a reduction of the time for the procurement of health goods by Cost Centers;
the optimization of emergencies management;
a cost reduction for the transport of goods from the pharmacy to the user centers.
Conversely,
the replication of the same activities in the six hospitals, such as order management, receiving and distribution to Cost Centers;
inefficient management of stocks, as each pharmacy define their own needs independently from the others, with a resulting disproportionate total data compared to the real needs of the company;
ineffective management of stocks, because each pharmacy is completely independent from the other, whereby in case of drug stock breaking in a pharmaceutical warehouse the pharmacy purchase it even if it is present in sufficient quantity. In fact, the exchange from one warehouse to another is activated only in case of emergency;
the need for a large number of operators resulting from the localization of stocks in the different six warehouses and from the replication of the same activities;
a difficult inventory management with the multiplication of activities and different timings for each pharmaceutical warehouse;
inadequate places with inappropriate surfaces and volumes, architectural barriers that make it inadequate the storage and handling of goods;
high risk of consistent stocks in the wards.
The aim of the project is the outsourcing of logistics services and the unification and standardization of all the logistics procedures related to the supply, storage and distribution of health and non-health goods in the ASL, by improving the effectiveness, efficiency and safety of all logistics processes. The main objective is the rationalization of pharmaceuticals management, in order to contain risks associated with clinical processes for medication management, and to improve efficiency and effectiveness of supply logistics management, storage and distribution/administration of pharmaceuticals and medical devices. The overall project involves the concentration of existing warehouses in one site, and the structuring of stocking points of proximity, coinciding with the current hospital pharmacies and local pharmaceutical services, together with the centralized management and unified inventory of materials through an integrated information system (Figure 5).
The project involves the reengineering of the main logistics processes (order management, procurement, inventory management, distribution) through the centralization of the commons activities, in order to contain the pharmaceutical expenditure.
The reorganized pharmaceutical management with the Centralized Warehouse.
This centralization will cause an effect even in the organization of the drugs and medical devices procurement requests process to Cost Centers, which will be managed exclusively by computerized means (Figure 6).
As already pointed out, the reengineering includes the transition from an empirical management of inventories to a
Inventory management in case of centralized warehouse
Actually, the predominant activity of the pharmacists is represented by the orders issuance, which requires the 20% of their time/work; the control of healthcare goods entering and leaving the ASL requires approximately the 60% of the time/work available; the remaining 10% of the workload is dedicated to procurement practices, and only the 10% of the time is dedicated to give information in the wards. Therefore, it is clear that the management processes related to logistics absorb almost all the work of the pharmacist, which is mainly spent in
With regard to the orders management, the phase of issuance actually entails that each hospital pharmacy produce supply orders for the same supplier, the same drug and the same day, with a useless
Conversely, with the centralized warehouse, the under-stock and reorder point will be indicated and orders will be created on the basis of computerized data, assembling goods for the same supplier with a reduction in the number of orders: it will be generated only one order, and not six different orders for the same supplier. Additionally, the order will be prepared on the basis of a date processed electronically and not according to an empirical verification. In the centralized warehouse there will be an area dedicated to the acceptance of drugs and medical devices in stock, followed by a qualitative and quantitative control, with the loading of transport documents in the computer system, followed by the print of the position in the central warehouse and the storage of medicines and medical devices.
As regards to medical devices in transit, after the qualitative and quantitative control and the loading of the document in the computer system, the delivery of the material will take place. The expected result is a significant reduction of supply orders and a consequent reduction in the number of bills that will affect positively the timing of their settlement. In addition, the replication of activities in the various hospital pharmacies by pharmacists will be avoided, allowing a reduction in the time/effort devoted to the orders issuance management, and consequently prescription appropriateness increase.
The reorganized procurement process to Cost Centers
As regards the procurement process managed, the Figure 7 shows how the process will change with the exclusive use of the computerized procedure. The figure describes the new drugs and medical devices procurement requests process to Cost Centers. It will start with the “coarse profile” preparation, on the basis of historical consumption by Cost Centers, to be followed by a custom profiling managed by the pharmacist. The next phase will involve the preparation of the computerized request of the Cost Center and the subsequent electronic transmission to the pharmacy. At this point, the pharmacist performs qualitative and quantitative computerized assessment of health goods required, and prints the request that is then delivered to warehouse personnel, who will provide for the preparation of pharmaceuticals and medical devices. If a discrepancy turns out during the preparation, it will be reported and the appropriate changes in the information technology will take place. At this point, the administrative operator closes the request, and the computerized unloading to Cost Centers will take place. The final demand of drugs and medical devices will be printed and delivered to Cost Centers. The expected result of this innovation is a constantly updated inventory and a full Cost Centers expenditure monitoring, as well as the possibility of providing an annual program of supply on the basis of consumption data.
The motivation for this research field is driven by the need to lower healthcare costs and to improve patient care quality by identyfing opportunities for healthcare organizations to improve their logistics processes, considering that hospitals represent the largest cost component of the national healthcare expenditures in most of the countries.
In the first part of the chapter we have provided general definitions and charactersitics of Healthcare Supply Chain and pharmaceutical logistics. We have emphasized the importance of both concepts in relation to emerging trends in healthcare system. Healthcare Supply Chain has become an important research topic in the past decade and its popularity is still increasing. This has resulted in the need to reenginering the Healthcare Supply Chian and, in particular, the pharmaceutical management, the importance of which is fundamental to the delivery of quality services to patients and reduction of costs.
There are two opportunities in this work where reenginering is applied: a) centralized supply system, and b) material management. In the redisigned system, several benefits have been achieved, in terms of:
The transformation of the SCM model requires three mains conditions:
At last, automating and integrating IT systems will allow hospitals to seamlessly link their logistics processes. The centralized management requires that hospitals in the network dialogue continuously with the warehouse, together with a flow of information that travels in both directions (from the hospital to the Central Warehouse and vice versa).
Fabiana Marras gratefully acknowledges Sardinia Regional Government for the financial support of her PhD scholarship (P.O.R. Sardegna F.S.E. Operational Programme of the Autonomous Region of Sardinia, European Social Fund 2007-2013-Axis IV Human Resources, Objective l.3, Line of Activity l.3.1.).
Dehydration is the main clinical manifestation and the most frequent complication in pediatric patients with AGE. It remains to be a common reason for ED visits, and it can lead to significant morbidity and mortality rates [1]. Management of gastroenteritis is based mainly on the proper assessment of dehydration severity and correction of dehydration.
In newborn babies, 75–80% of the total body weight constitutes the total body water (TBW) (varies with the gestational age), which decreases to 67% of body weight (2/3) after the neonatal period. There is a further decrease that reaches 60% by the end of the first year, and this percentage remains the same during the rest of life. After puberty and in adulthood, TBW is 60% in males and 55% in females. The TBW is divided into two components throughout the body: intracellular fluid compartment (ICF), which constitutes 40% of TBW, and extracellular fluid (ECF), which forms the remaining 20%. The ECF comprises interstitial fluid (IF) (15% of the TBW), and the remaining 5% of the TBW comprises intravascular plasma (Figures 1 and 2) [2, 3, 4]. This distribution of body fluids can have an impact on the management of pediatric gastroenteritis, as most of the fluid loss in AGE comes from the ECF. This matters because ECF contains a lot of sodium (135–145 mEq), and ICF contains a lot of potassium (150 mEq). In a brief duration of illness (<3 days), 80% of the deficit is typically from the ECF. After more than 3 days of illness, the deficit from the ECF decreases to 60%. Fluid losses for longer than 7 days are equally lost from ECF (50%) and ICF (50%) [5].
The percentage distribution of body fluids in the various compartments in a 1-year-old infant [
Body water compartments in relation to age [
Accurate and quick assessment of the degree of dehydration is important for proper treatment and disposition of infants and children with AGE [6]. The percentage of weight loss is the best measure to assess the degree of dehydration, as shown in Eq. (1). However, this method is impractical because in most patients the pre-illness weight is not known [7].
Current validated dehydration scales may help in assessing the versatile presentations of dehydration more objectively. Most of them illustrate clinical signs that can be assessed easily and rapidly, which can facilitate stratification of patients into dehydration categories. There are three clinical scales designed to estimate dehydration severity in children below 5 years of age: the World Health Organization (WHO) scale (Table 1), the Gorelick scale (Table 2), and the Clinical Dehydration Scale (CDS) (Table 3) [8, 9, 10].
Characteristics | No dehydration | Some dehydration (>1 sign) | Severe dehydration (>1 sign) |
---|---|---|---|
Alertness | Well, alert | Irritable or drowsy | Lethargic or poorly responsive |
Eyes | Normal | Sunken | Sunken |
Thirst | Drinks normally | Drinks eagerly | Poor or weak drinking |
Skin turgor | Goes back quickly | Goes back slowly (<2 s) | Return very slowly (>2 s) |
WHO scale for dehydration in children aged 1 month–5 years old.
Characteristics | No or minimal dehydration | Moderate-to-severe dehydration |
---|---|---|
General appearance | Alert | Restless, lethargic, unconscious |
Capillary refill | Normal | Prolonged or minimal |
Tears | Present | Absent |
Mucous membranes | Moist | Dry, very dry |
Gorelick (4-item) scale for dehydration in children aged 1 month–5 years. Scoring: ≥2 clinical signs indicates ≥ 5% loss of body weight from baseline (moderate dehydration), and ≥3 clinical signs indicates ≥ 10% loss of body weight from baseline (severe dehydration). The presence of two or more of these signs had a sensitivity of 79% and a specificity of 87% in predicting 5% dehydration.
Characteristics | Score of 0 | Score of 1 | Score of 2 |
---|---|---|---|
General appearance | Normal | Thirsty, restless, or lethargic but irritable when touched | Drowsy, limp, cold, sweaty ± comatose |
Eyes | Normal | Slightly sunken | Very sunken |
Mouth and tongue | Moist | Sticky | Dry |
Tears | Present | Decreased | Absent |
Clinical dehydration scale (CDS) for children aged 1 month–3 years. Scoring: ≥2 clinical signs indicates ≥ 5% loss of body weight from baseline (moderate dehydration), and ≥3 clinical signs indicates ≥ 10% loss of body weight from baseline (severe dehydration). The presence of two or more of these signs had a sensitivity of 79% and a specificity of 87% in predicting 5% dehydration.
Using common tools to evaluate and assess dehydration would be more helpful in day-to-day practice. Consistent evidence supports the CDS which is more useful and easy to use in assessing dehydration. This scale in combination with other criteria should be used to guide the proper medical interventions in individual cases [11]. Clinical dehydration scales are imprecise and of limited diagnostic value in children with gastroenteritis [12]. As a screening test of dehydration, historical points are moderately sensitive. Classification of dehydration into NO, SOME, and SEVERE are recommended by WHO and other groups [1, 8].
Prolonged capillary refill time, abnormal skin turgor, and abnormal respiratory pattern still remain the best three individual examination signs for assessment of dehydration. Increased capillary refill time was the strongest individual sign as an isolated finding to predict dehydration, and the poor predictor of dehydration was reduced urine output. Combinations of signs perform much better than individual signs. History taking and laboratory tests show limited utility [13].
Blood biochemistry is generally not accurate and not routinely required for assessment of dehydration. Commonly done laboratory tests such as blood urea nitrogen (BUN) and bicarbonate concentrations are generally helpful only when the results are markedly abnormal. A normal serum bicarbonate concentration of more than 15 or 17 mEq/L appears to be valuable in reducing the likelihood of dehydration. These laboratory tests done for assessing dehydration should not be considered definitive, which could be reserved for children requiring IV fluids and suffering from severe dehydration, altered conscious state or convulsions, suspected hypernatremia, suspicion of hemolytic uremic syndrome and children with pre-existing medical conditions that predispose to electrolyte abnormalities [14, 15]. Historical points and laboratory tests only have limited utility for assessing dehydration [10]. Laboratory investigations should be performed if the results will influence the management and outcome of a specific patient.
Oral rehydration should be the first line of treatment for pediatric gastroenteritis with intravenous (IV) fluid therapy being used if the oral route fails [16, 17].
Oral rehydration is the preferred method for replacing fluid and electrolyte deficits resulting from dehydration secondary to acute gastroenteritis. ORT is a safe, easy-to-use, efficacious, and cost-effective alternative to intravenous rehydration for uncomplicated gastroenteritis in children [18].
The use of ORT is based on the principle of glucose-facilitated sodium transport across the intestinal mucosa. The ORT facilitates the absorption of water and sodium for the compensation of fluid losses. Additionally, the absorption can be adequate for the replacement of significant fluid loss, such as in cholera. The absorption of potassium and bicarbonate is maintained by the osmotic gradient in the intercellular space. Metabolic acidosis, usually associated with dehydration, can be safely corrected by this mechanism. The currently available ORT contains an appropriate amount of sodium, glucose, and other electrolytes and is of appropriate osmolality to maximize clinical efficacy [19].
The WHO, Centers for Disease Control (CDC), and the American Academy of Pediatrics (AAP) all support the use of ORT for some (mild–moderate) dehydration [8, 20, 21]. Rapid ORT in mild dehydration is done by giving 50 ml/kg over 4 hours. For moderate dehydration, 100 ml/kg can be given over the same duration. Generally, children being enterally rehydrated do not require blood tests.
Children who received oral ondansetron initially were less likely to be administered IV rehydration compared with those given placebo. In addition, both oral and IV ondansetron administration are associated with reduced rate of hospitalization [17]. Ondansetron is contraindicated in children with long QT syndrome, concomitant drugs that prolong QT, and to be used cautiously in children with heart disease.
Children can be discharged home when the following levels of recovery are achieved: satisfactory rehydration status as shown by clinical improvement, IV or NG fluids not required, and no significant losses. Adequate family education, proper instructions, and medical follow-up should be provided.
Inform about the expected natural course of the illness, prevention of transmission and looking at signs of dehydration. Encourage breastfeeding continuation in small babies, early refeeding, and the correct method of preparing ORS. Educate about the importance of giving anti-rotavirus vaccination and of course not to use unnecessary medication in simple AGE.
Nasogastric route is a safe rehydration technique with minimal adverse effects which has been adequately studied. Many clinical trials showed this method to have similar efficacy compared to IV therapy. Rapid NG rehydration using gastrolyte, 50 ml/kg for fluid deficit replacement over 4 hours, appears to be appropriate for children with mild-to-moderate dehydration [22]. If nasogastric rehydration is required beyond 4 hours, check urea and electrolyte concentration (UEC) and blood glucose level (BGL), and reassess the patient for hydration status.
Intravenous rehydration should be reserved for patients with severe dehydration or shock and for those with some (mild-to-moderate) dehydration who fail ORT. Fluid containing not less than 0.9% sodium chloride is preferred for rehydration [23, 24]. Using hypotonic fluids predisposes for dilutional hyponatremia due to excess antidiuretic hormone (ADH) secretion in children with AGE. Serum electrolytes and BGL are required in children with severe dehydration and/or requiring IV fluid therapy for correction of dehydration.
The WHO recommends IV rehydration to be rapidly completed over 3–4 hours [8]. Rapid replacement of ECF improves gastrointestinal and renal perfusion, allowing earlier oral intake and a faster correction of electrolyte and acid-base abnormalities, which results in excellent recovery rate and decreased length of stay in ED [25].
Resuscitate shock/near shock with a prompt intravenous infusion of 20 ml/kg of 0.9% sodium chloride solution or Ringer’s lactate solution as fast as possible. Reassessing and repeating boluses given, as necessary, are required until the patient is recovered from shock and then followed by maintenance IV fluids [26].
The clinical standard is to administer 20 mL/kg/h of isotonic crystalloid fluid, such as 0.9% normal saline or lactated Ringer’s solution. Reassess the patient after each bolus, and if the patient is still dehydrated, a total of 2–4 fluid boluses may allow rapid restoration of intravascular volume which can bring rapid recovery. Rapid IV rehydration followed by oral fluids is adequate for initial rehydration for most patients requiring IV fluid therapy. For those refusing oral intake, continuous infusion of maintenance IV fluids are to be given until oral fluids are tolerated [27]. Glucose solution should be added once ECF volume has been restored and addition of potassium considered once the child passes urine and serum electrolytes are known [28].
Refer to the correction of dehydration using a large volume of fluids over a relatively shorter time (50–60 ml/kg/hour). Ultra-rapid IV rehydration may be associated with electrolyte abnormalities and longer hospital stay or delayed discharge and therefore is not recommended [29, 30].
Children with acute watery diarrhea and severe dehydration, such as cholera, who fail ORT, can benefit from large-volume IV rehydration (100 ml/kg) of Ringer’s lactate solution or normal saline over 3–6 hours. Frequent reassessment is required, and if hydration status is not improving, IV fluids should be given more rapidly [31]. Further research investigations are needed to justify the use of rapid large-volume IV rehydration in pediatric gastroenteritis.
Dyselectrolytemia is a serious complication of AGE with dehydration. The majority of electrolyte disorders associated with AGE in children can be adequately treated using ORT.
Hypernatremia leads to hypertonicity that can be potentially dangerous as there is a greater likelihood of neurological manifestations. Most frequently, it is due to water deficit from increased water losses in diarrhea and due to reduced water intake during the illness.
As in any type of dehydration, the primary aim should be restoration of hemodynamic stability by administration of isotonic fluids. The gradual replacement of water deficit remains the gold standard treatment for hypernatremic dehydration [32]. The recent advance in management of hypernatremia is to give isotonic (0.9% sodium chloride + 5% glucose) than hypotonic solution to correct the calculated fluid deficit slowly. The more the solution contains free water, the higher the risk of developing hyponatremia during rehydration [23, 33].
It represents an excess of water in relation to sodium in ECF [34]. Hyponatremia is seldom symptomatic unless the serum Na is <120 or if the hyponatremia occurs quickly [35]. Hyponatremia may be presented with nausea, vomiting, headache, irritability, lethargy, confusion, muscle cramps, convulsions, disorientation, and reduced consciousness and places the patient at risk of neurologic impairment [36].
The initial goal in treating hyponatremia is the restoration of intravascular volume with isotonic saline and to be followed by a slower correction using 0.9% sodium chloride + 5% glucose. In severe hyponatremia or symptomatic children, the goal is to raise the serum sodium to 120–125 mmol/L or until the seizure stops [35]. As a rule of thumb, IV infusion of 3% NaCl, 3–5 ml/kg over 15–30 min, will raise serum Na by 5 mEq/L.
See Figure 3.
Flow chart for the management of pediatric gastroenteritis with dehydration.
The management of a child with a dehydrating gastroenteritis requires careful initial assessment and reassessment of hydration status. The majority of gastroenteritis in infants and children are simple and can be treated by ORT. In children who presented with severe dehydration or those with some dehydration and fail ORT, IV rehydration is required. Rapid IV rehydration using standard boluses of isotonic fluids followed by oral fluid intake or maintenance IV fluids for those refusing oral intake appears sufficient for most patients requiring IV fluids. Patients achieving satisfactory hydration status and tolerating oral intake can be discharge home with proper instructions.
The authors thank physicians and nurses staff who are working at the Pediatric Emergency center (PEC) Alsadd, Hamad Medical Corporation (HMC), Qatar, for their help and support.
The authors declare no conflict of interest.
AGE | acute gastroenteritis |
TBW | total body water |
ECF | extracellular fluid |
ICF | intracellular fluid |
UEC | urea electrolyte concentration |
BGL | blood glucose level |
ORT | oral rehydration therapy |
IV | intravenous |
ADH | antidiuretic hormone |
NICE | National Institute for Health and Care Excellence |
ED | emergency department |
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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. 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Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. 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Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. 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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. 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