Overview of available studies on nonpharmacological interventions in patients with systemic sclerosis.
\\n\\n
IntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\\n\\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\\n\\nLaunching 2021
\\n\\nArtificial Intelligence, ISSN 2633-1403
\\n\\nVeterinary Medicine and Science, ISSN 2632-0517
\\n\\nBiochemistry, ISSN 2632-0983
\\n\\nBiomedical Engineering, ISSN 2631-5343
\\n\\nInfectious Diseases, ISSN 2631-6188
\\n\\nPhysiology (Coming Soon)
\\n\\nDentistry (Coming Soon)
\\n\\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\\n\\nNote: Edited in October 2021
\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/132"}},components:[{type:"htmlEditorComponent",content:'With the desire to make book publishing more relevant for the digital age and offer innovative Open Access publishing options, we are thrilled to announce the launch of our new publishing format: IntechOpen Book Series.
\n\nDesigned to cover fast-moving research fields in rapidly expanding areas, our Book Series feature a Topic structure allowing us to present the most relevant sub-disciplines. Book Series are headed by Series Editors, and a team of Topic Editors supported by international Editorial Board members. Topics are always open for submissions, with an Annual Volume published each calendar year.
\n\nAfter a robust peer-review process, accepted works are published quickly, thanks to Online First, ensuring research is made available to the scientific community without delay.
\n\nOur innovative Book Series format brings you:
\n\nIntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\n\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\n\nLaunching 2021
\n\nArtificial Intelligence, ISSN 2633-1403
\n\nVeterinary Medicine and Science, ISSN 2632-0517
\n\nBiochemistry, ISSN 2632-0983
\n\nBiomedical Engineering, ISSN 2631-5343
\n\nInfectious Diseases, ISSN 2631-6188
\n\nPhysiology (Coming Soon)
\n\nDentistry (Coming Soon)
\n\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\n\nNote: Edited in October 2021
\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:"6896",leadTitle:null,fullTitle:"Diversity and Ecology of Invasive Plants",title:"Diversity and Ecology of Invasive Plants",subtitle:null,reviewType:"peer-reviewed",abstract:"This book, Diversity and Ecology of Invasive Plants, is a collection of reviewed and relevant research chapters, offering a comprehensive overview of recent developments in the field of invasive species biology. The book comprises chapters authored by various researchers and edited by experts active in the field of conservation of biodiversity. All chapters are complete in itself but united under a common topic. This publication aims at providing a thorough overview of the latest research efforts by international authors on diversity, distribution, and ecological consequences of invasive species and opens new possible research paths for further developments.",isbn:"978-1-83968-352-7",printIsbn:"978-1-83968-351-0",pdfIsbn:"978-1-83968-353-4",doi:"10.5772/intechopen.73424",price:119,priceEur:129,priceUsd:155,slug:"diversity-and-ecology-of-invasive-plants",numberOfPages:112,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"fedc1666d43e1a79529b7d5dd8604892",bookSignature:"Sudam Charan Sahu and Sanjeet Kumar",publishedDate:"December 18th 2019",coverURL:"https://cdn.intechopen.com/books/images_new/6896.jpg",numberOfDownloads:5334,numberOfWosCitations:1,numberOfCrossrefCitations:0,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:4,numberOfDimensionsCitationsByBook:0,hasAltmetrics:0,numberOfTotalCitations:5,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"May 15th 2018",dateEndSecondStepPublish:"August 28th 2018",dateEndThirdStepPublish:"October 27th 2018",dateEndFourthStepPublish:"January 15th 2019",dateEndFifthStepPublish:"March 16th 2019",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"89118",title:"Dr.",name:"Sudam Charan",middleName:null,surname:"Sahu",slug:"sudam-charan-sahu",fullName:"Sudam Charan Sahu",profilePictureURL:"https://mts.intechopen.com/storage/users/89118/images/system/89118.jpeg",biography:"Sudam Charan Sahu, M.Sc., Ph. D, F.I.A.T. is working as an Assistant Professor at the Department of Botany, North Orissa University, Baripada (Odisha), India. He has done his Ph. D from CSIR-IMMT, Bhubaneswar (Under Utkal University, Bhubaneswar), India and Post-Doctorate from Indian Institute of Science, Bangalore (India). His specialization and research fields include plant taxonomy, ethnobotany, forest ecology, climate change and biodiversity conservation. He published more than 34 papers in various national and international journals, 4 book chapters and edited 2 books to his credit. He is recognized as Fellow of Indian Association for Angiosperm Taxonomy. He was also awarded with DST-Young Scientist from Science & Engineering Research Board (SERB), DST, Government of India. He was also the editor of the book entitled “Plant Science” (Intech publisher). He is a well-recognized reviewer of many SCI and Non-SCI journals.",institutionString:"North Orissa University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"North Orissa University",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"258148",title:"Dr.",name:"Sanjeet",middleName:null,surname:"Kumar",slug:"sanjeet-kumar",fullName:"Sanjeet Kumar",profilePictureURL:"https://mts.intechopen.com/storage/users/258148/images/system/258148.png",biography:"Dr. Sanjeet Kumar, DELF, is the founder and CEO of Ambika Prasad Research Foundation, India. His current research is focused on status, taxonomy, diversity, phytochemistry, and antimicrobial activity of medicinal and nutraceutical plants; population analysis and restoration of threatened taxa; wetland ecosystems and their bio-wealth; various management practices in protected areas; and giving training to the researchers, biologists, and academicians on medicinal plants and threatened taxa. He is also Chief Editor, Journal of Biodiversity and Conservation. He is documenting the floral and faunal wealth, ecological importance of different landscapes and giving training to undergraduate and postgraduate students in these areas. Dr. Kumar has thirteen years of research experience and published twenty books and 115 research and review articles in journals of national and international repute.",institutionString:"Ambika Prasad Research Foundation",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"1",institution:null},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"356",title:"Biogeography",slug:"agricultural-and-biological-sciences-plant-biology-biogeography"}],chapters:[{id:"68780",title:"Invasive Alien Flora in and around an Urban Area of India",doi:"10.5772/intechopen.88725",slug:"invasive-alien-flora-in-and-around-an-urban-area-of-india",totalDownloads:905,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Invasive alien species are non-native exotic organisms which can disperse and destroy the biodiversity and change the ecosystem. The present study deals with the comprehensive list of invasive alien plants (IAPs) of Rourkela Steel City, Sundargarh, Odisha, with background information on family, habit, and nativity. A total of 165 invasive alien species under 132 genera and 59 families have been recorded. From the nativity study, among 25 geographic regions, the majority of invasive plants reported from American continent (62%) with 103 species. While in life form analysis, the herbs (114 species) are dominant, followed by trees (23 species), shrubs (22 species), climber (5 species), and undershrub (1 species). Ageratum conyzoides, Blumea lacera, Cassia alata, Lantana camara, Cassia tora, Parthenium hysterophorus, Xanthium sp., Datura sp., Cardamine scutata, Argemone mexicana, Grangea maderaspatana, Hyptis suaveolens, and Gnaphalium polycaulon are some noxious species found during the study. Parthenium hysterophorus is the highly noxious plant which is grown everywhere after Ageratum conyzoides and Lantana camara. Most of the invasive species are locally used for medicinal purposes as well as for food, fuel, and fodder purposes. A better planning and reporting of the spread of new plants in the area are needed for early identification and control of the invasive alien plant species in different seasons. Since the flora of Sundargarh districts has not been beneficially explored, this study will help in the compilation of flora of Sundargarh district and Rourkela in particular. Further studies will reveal the allelopathic effects on different agricultural crops as well as the different ethnobotanical values.",signatures:"Samarendra Narayan Mallick, Nirius Xenan Ekka, Sanjeet Kumar and Sudam C. Sahu",downloadPdfUrl:"/chapter/pdf-download/68780",previewPdfUrl:"/chapter/pdf-preview/68780",authors:[{id:"89118",title:"Dr.",name:"Sudam Charan",surname:"Sahu",slug:"sudam-charan-sahu",fullName:"Sudam Charan Sahu"}],corrections:null},{id:"65904",title:"Invasive Species in the Amazon",doi:"10.5772/intechopen.84720",slug:"invasive-species-in-the-amazon",totalDownloads:1006,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"One of the main reasons for environmental disturbances such as declination in pasture productivity and biodiversity losses is the high infestation of herbaceous weeds, generally referred to as “Juquira” in the Amazon region. If they are not adequately controlled, such infestation might lead to degradation of pasture, resulting in complete loss of productivity and subsequent abandonment of the area. In this sense, this chapter aims to describe the main invasive species present in the Amazon region, as well as to characterize both the old and innovative techniques of use in agriculture, in large and small scale, for the control of agricultural pests.",signatures:"Wanessa Almeida da Costa, Cinthya Elen Pereira de Lima, Sérgio Henrique Brabo de Sousa, Mozaniel Santana de Oliveira, Fernanda Wariss Figueiredo Bezerra, Jorddy Neves da Cruz, Sebastião Gomes Silva, Renato Macedo Cordeiro, Cintya Cordovil Rodrigues, Antônio Robson Batista de Carvalho, Priscila do Nascimento Bezerra, Pedro Alam de Araújo Sarges, Daniel Santiago Pereira, Antônio Pedro Silva de Souza Filho and Raul Nunes de Carvalho Junior",downloadPdfUrl:"/chapter/pdf-download/65904",previewPdfUrl:"/chapter/pdf-preview/65904",authors:[{id:"192844",title:"Dr.",name:"Raul",surname:"Nunes de Carvalho Jr",slug:"raul-nunes-de-carvalho-jr",fullName:"Raul Nunes de Carvalho Jr"},{id:"195289",title:"MSc.",name:"Wanessa",surname:"Almeida Da Costa",slug:"wanessa-almeida-da-costa",fullName:"Wanessa Almeida Da Costa"},{id:"195290",title:"Ph.D.",name:"Mozaniel",surname:"Santana De Oliveira",slug:"mozaniel-santana-de-oliveira",fullName:"Mozaniel Santana De Oliveira"},{id:"195295",title:"Dr.",name:"Fernanda",surname:"Wariss Figueiredo Bezerra",slug:"fernanda-wariss-figueiredo-bezerra",fullName:"Fernanda Wariss Figueiredo Bezerra"},{id:"241344",title:"MSc.",name:"Priscila do Nascimento",surname:"Bezerra",slug:"priscila-do-nascimento-bezerra",fullName:"Priscila do Nascimento Bezerra"},{id:"241345",title:"Dr.",name:"Antonio Pedro Da Silva",surname:"Souza Filho",slug:"antonio-pedro-da-silva-souza-filho",fullName:"Antonio Pedro Da Silva Souza Filho"},{id:"242603",title:"MSc.",name:"Renato Macedo",surname:"Cordeiro",slug:"renato-macedo-cordeiro",fullName:"Renato Macedo Cordeiro"},{id:"282408",title:"MSc.",name:"Sérgio Henrique Brabo De",surname:"Sousa",slug:"sergio-henrique-brabo-de-sousa",fullName:"Sérgio Henrique Brabo De Sousa"},{id:"282409",title:"Mr.",name:"Jorddy Neves Da",surname:"Cruz",slug:"jorddy-neves-da-cruz",fullName:"Jorddy Neves Da Cruz"},{id:"282410",title:"Dr.",name:"Sebastião",surname:"Silva",slug:"sebastiao-silva",fullName:"Sebastião Silva"},{id:"282411",title:"MSc.",name:"Cintya Cordovil",surname:"Rodrigues",slug:"cintya-cordovil-rodrigues",fullName:"Cintya Cordovil Rodrigues"},{id:"282412",title:"BSc.",name:"Antônio Robson Batista De",surname:"Carvalho",slug:"antonio-robson-batista-de-carvalho",fullName:"Antônio Robson Batista De Carvalho"},{id:"282414",title:"Dr.",name:"Daniel Santiago",surname:"Pereira",slug:"daniel-santiago-pereira",fullName:"Daniel Santiago Pereira"},{id:"290710",title:"Dr.",name:"Cinthya Elen",surname:"Pereira de Lima",slug:"cinthya-elen-pereira-de-lima",fullName:"Cinthya Elen Pereira de Lima"},{id:"290711",title:"Dr.",name:"Pedro",surname:"Alam de Araújo Sarges",slug:"pedro-alam-de-araujo-sarges",fullName:"Pedro Alam de Araújo Sarges"}],corrections:null},{id:"64861",title:"Impacts of Invasive Plants on Soil Fungi and Implications for Restoration",doi:"10.5772/intechopen.82108",slug:"impacts-of-invasive-plants-on-soil-fungi-and-implications-for-restoration",totalDownloads:1320,totalCrossrefCites:0,totalDimensionsCites:3,hasAltmetrics:0,abstract:"Biological plant invasions impact the function and biodiversity of ecosystems across the globe by displacing native plant species and altering the physical and chemical soil environment. While much is known about direct competition between invasive and native plants, ecologists have just begun to uncover the less obvious impact of plant invasion: changes to the soil fungal community. Fungi are important to the survival of many plant species and an integral part of a healthy soil system. Arbuscular mycorrhizal fungi are plant mutualistic symbionts that associate with many species and provide necessary services, such as increasing surface area for root water absorption and resistance to pathogens, while ectomycorrhizal fungi play an equally important role and are critical for plant nutrient acquisition in boreal and temperate forests. Invasive plants are altering the soil fungal community in ways that indirectly impact the structure of native plant communities, sometimes for years after the invasive plant has been removed from an area (i.e., legacy effects). These changes make restoration especially difficult in areas from which long-term plant invasions have been eradicated; in some cases these changes can be so severe that even with active management, they take months or decades to reverse.",signatures:"Brooke Pickett, Mia Maltz and Emma Aronson",downloadPdfUrl:"/chapter/pdf-download/64861",previewPdfUrl:"/chapter/pdf-preview/64861",authors:[{id:"260303",title:"Dr.",name:"Mia",surname:"Maltz",slug:"mia-maltz",fullName:"Mia Maltz"},{id:"260913",title:"Ms.",name:"Brooke",surname:"Pickett",slug:"brooke-pickett",fullName:"Brooke Pickett"},{id:"270380",title:"Dr.",name:"Emma",surname:"Aronson",slug:"emma-aronson",fullName:"Emma Aronson"}],corrections:null},{id:"64613",title:"Relationship between Exotic Plant Species Richness, Native Vegetation and Climate in Forest Ecosystems of Chile",doi:"10.5772/intechopen.82233",slug:"relationship-between-exotic-plant-species-richness-native-vegetation-and-climate-in-forest-ecosystem",totalDownloads:881,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"In this chapter, we evaluated how native species cover, native species richness, and foliage periodicity of forests are related to exotic species richness in different forest ecosystems distributed through the Mediterranean-type and temperate climate regions of Chile. We compiled published and unpublished data on Chilean vegetation (mainly phytosociological studies) located between 30º and 41º S in which plant species composition and abundance (percentage of cover) per plot was evaluated and published. When all forests were analysed together, we found that exotic species richness was not significantly related to native species richness; it was negatively related to native species cover in both Mediterranean and temperate climatic regions and was greater in deciduous than evergreen forests, although only in the temperate region. In an analysis considering separately every forest type, we observed that only in 50% of these communities, exotic species richness was negatively related to native species cover. Furthermore, in 25% of forest types, exotic species richness was negatively related to native species richness, and in only one forest type, this relationship was positive. Our results suggest that native species produce some resistance against invasion of exotic plants, but this effect may depend on climate and forest type.",signatures:"Pablo I. Becerra and Ramiro O. Bustamante",downloadPdfUrl:"/chapter/pdf-download/64613",previewPdfUrl:"/chapter/pdf-preview/64613",authors:[{id:"276850",title:"Dr.",name:"Pablo",surname:"Becerra",slug:"pablo-becerra",fullName:"Pablo Becerra"},{id:"279513",title:"Dr.",name:"Ramiro",surname:"Bustamante",slug:"ramiro-bustamante",fullName:"Ramiro Bustamante"}],corrections:null},{id:"65049",title:"Game of Clones: Students Model the Dispersal and Fighting of Japanese Knotweed (Fallopia japonica)",doi:"10.5772/intechopen.82873",slug:"game-of-clones-students-model-the-dispersal-and-fighting-of-japanese-knotweed-em-fallopia-japonica-e",totalDownloads:1222,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Fallopia japonica as an invasive alien species in Europe and North America presents a significant problem to the existing flora as well as to infrastructures and agricultural land. That is why measures and attempts to control the plant are increasing rapidly. However, conservationists are not yet able to agree on the most suitable method. In the research project ‘Game of Clones’, a team of scientists together with the help of high school students is spatially modeling the spreading behavior of knotweed under different circumstances and is creating and providing a board game as well as a computer simulation as an experimental platform. To develop sustainable assumptions to be able to model the responses of knotweed to each control measure, a vast understanding of the plant is necessary. The chapter covers the results of research activities and experiments within the project and gives a comprehensive review about Japanese knotweed.",signatures:"Anneliese Fuchs, Christina Pichler-Koban, Wilfried Elmenreich and Michael Jungmeier",downloadPdfUrl:"/chapter/pdf-download/65049",previewPdfUrl:"/chapter/pdf-preview/65049",authors:[{id:"50644",title:"Dr.",name:"Michael",surname:"Jungmeier",slug:"michael-jungmeier",fullName:"Michael Jungmeier"},{id:"163771",title:"Dr.",name:"Wilfried",surname:"Elmenreich",slug:"wilfried-elmenreich",fullName:"Wilfried Elmenreich"},{id:"278865",title:"MSc.",name:"Anneliese",surname:"Fuchs",slug:"anneliese-fuchs",fullName:"Anneliese Fuchs"},{id:"279217",title:"Dr.",name:"Christina",surname:"Pichler-Koban",slug:"christina-pichler-koban",fullName:"Christina Pichler-Koban"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"2984",title:"The Species Problem",subtitle:"Ongoing Issues",isOpenForSubmission:!1,hash:"412f4d7e90c7760651420c3fa397f600",slug:"the-species-problem-ongoing-issues",bookSignature:"Igor Ya. 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\r\n\tWith the discovery of more unconventional heavier crude and alternative hydrocarbon sources, primary upgrading or cracking of the oil into lighter liquid fuel is critical. With increasing concern for environmental sustainability, the regulations on fuel specifications are becoming more stringent. Processing and treating crude oil into a cleaner oil with better quality is equally important. Hence, there has been a relentless and continuous effort to develop new crude upgrading and treating technologies, such as various catalytic systems for more economical and better system performance, as well as cleaner and higher-quality oil.
\r\n\tThis edited book aims to provide the reader with an overview of the state-of-the-art technologies of crude oil downstream processing which include the primary and secondary upgrading or treating processes covering desulfurization, denitrogenation, demetallation, and evidence-based developments in this area.
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However, there is still an unmet need to ensure medical awareness of the importance of physical therapy among patients, health professionals, rheumatologists, and other specialists to implement these nonpharmacological interventions into the daily care of patients with SSc.
Currently, physical therapy is considered a process by which patients try to restore and maintain their optimal physical, mental, social, occupational, and emotional state. It is therefore a comprehensive approach to the patient, which includes physical activity, as well as the principles of secondary prevention and healthy lifestyles, which are based on the patient’s collaboration, activity, and compliance. It is beyond doubt that physical inactivity is a major risk factor for both cardiovascular and respiratory systems, but also for functional limitations and reduced quality of life.
To acknowledge the importance of prevention and adherence to healthy lifestyle even before the onset of the disease, we can draw inspiration from the results of a recently published study on another, less rare, rheumatic disease, rheumatoid arthritis (RA): about the influence of environmental factors (e.g., the intensity and frequency of physical activity, of smoking, and different exposures) showing that patients with regular physical activity before the onset of RA suffer from a milder form of the disease and that obesity reduces the chance of achieving a good response to standard pharmacological approaches in RA [1, 2].
Tissue fibrosis is the dominant feature of SSc and affects both the skin and internal organs—especially the lungs, heart, and gastrointestinal tract [3]. While visceral involvement is responsible for increased mortality, musculoskeletal involvement (e.g., arthralgia/arthritis, flection contractures, and muscle weakness) and skin involvement (skin thickening and tethering) pose a significant burden for the patient in terms of reduction of functionality, quality of life, and ability to work or perform activities of daily living [4].
Current recommendations for the treatment of SSc include symptomatic therapy of individual organ manifestations and complications of SSc. However, to date, we have no effective treatment of tissue fibrosis, for example, skin, lung, heart, and gastrointestinal tract. Nonpharmacological management of patients with SSc with the main focus on the musculoskeletal system and the affected skin may be useful to reduce disability and improve quality of life and contribute to reducing the burden of disease on the organism. Nevertheless, the major limitations of most of the small number of existing publications focused on physical interventions in patients with SSc include the diversity of interventions, small cohorts of patients, the absence of a control group, randomization and/or a follow-up, and a short duration of intervention [3].
The most frequently investigated nonpharmacological interventions include commonly used methods such as paraffin, manual lymphatic drainage, soft tissue techniques, stretching exercises for hands and face, massage, exercises to maintain range of motion in joints, mobilization, aerobic exercise, and strength training. Other studies focus on occupational therapy, physical therapy, sleep disturbances, sexual function, and depression.
The following paragraphs will provide an overview of the results of the available publications, which are divided according to the nature of the intervention.
One of the methods frequently used in physiotherapy of rheumatic diseases is paraffin treatment. Paraffin solidifies at a temperature of 52–62°C and yet gives latent heat. In order to utilize this heat, paraffin must be applied to the body in a fluid state and allowed to solidify in the course of application. There are a few studies of paraffin in SSc patients: two randomized controlled studies (RCTs), one nonrandomized controlled trial and a series of three individual case studies.
The RCT by Sandqvist et al. evaluated the difference in intervention outcomes in 17 patients with SSc who underwent therapy with paraffin in combination with exercise on one hand chosen by random, and on the other hand received only exercise. Interventions continued daily for 1 month. Hand function was assessed at the beginning of the intervention and after the first month according to hand mobility and strength, the perception of pain, stiffness and elasticity of the skin. The authors demonstrated a significant improvement in flexion and extension of the fingers, thumb abduction, plantar flexion, perceived stiffness, and elasticity of the skin in patients who underwent paraffin intervention in combination with exercise compared to baseline levels. Furthermore, significant improvement in hand function (specifically in extension deficit, perception of stiffness, and elasticity of skin) was significantly greater in the hand that was treated with paraffin in combination with exercise than in the hand treated with exercise only [5].
In another RCT study [6], 16 patients with SSc underwent 12 times paraffin wrap therapy and then were randomly assigned to the intervention and control groups. The intervention group continued with paraffin therapy for 3 months, and the control group did not. Skin thickness decreased in all patients after 12 sessions of paraffin treatment. However, at the end of 3 months therapy in the intervention group, there was no significant difference between the intervention and control group [6].
One of the first studies, a nonrandomized controlled trial by Askew et al., recruited 10 patients with SSc and examined the effectiveness of once performed interventions including paraffin, friction massage, and exercise maintaining range of motion in the joints of the wrist and hand. Compared with seven patients with SSc, who did not attend any sessions, the interventions lead to significant improvements in the articular range of motion, skin elasticity, and overall function of the hand [7].
In a series of three individual case studies [8], respondents conducted active exercises with their hands after paraffin wrap 5 times per week for 8 weeks. The authors detected clinically significant improvements in both body function/structure measurements of hand function and in their ability to participate in activities in all participants [8].
Orofacial region has many functions. Primarily, it ensures food intake and contributes to breathing. Coordinated interplay of activity of facial muscles allows for expression of verbal, articulate speech. In the orofacial region, we find more than fifty facial muscles that enable people to communicate nonverbally, to express their feelings. No other part of the human body possesses such a social function as the orofacial region. Through this region we communicate, we speak to others, express our feelings, and create new relationships. In patients with SSc, tightening of the skin and muscle atrophy in orofacial region lead to loss of facial expressions and an appearance of a mask-like face. The affected orofacial region with skin thickening often contribute to inability of mechanical mouth opening, microstomia, which along with other symptoms, such as dry mouth, can lead to dental and mouth hygiene issues, and hampered alimentation.
In the RCT by Yuen Hon et al., the authors studied the effect of orofacial home exercise program to increase the orifice in adults with SSc. The study included 48 adult patients with SSc who were randomly divided into two groups and examined for oral aperture at baseline, 3-month, and 6-month intervals. The intervention group underwent a multifaceted oral health intervention including adaptive oral hygiene devices, instruction and demonstration on the use of the devices, brushing teeth for 2 min and flossing twice a day for 6 months. The control group received the usual dental care. Participants with orifices <40 mm in the intervention group underwent orofacial exercise program, which included manual mouth-stretching and oral augmentation exercises with a wooden stick, twice a day with a total of 6 minutes for 6 months. The results showed a significant increase in oral orifice in patients of the intervention group at 3 months, but not after 6 months evaluation. However, compliance with the program was low (48.9%), which could distort the results of this study [9].
An RCT by Maddali-Bongi et al. evaluated the effectiveness of an intervention program based on a combination of the Kabat’s technique (proprioceptive neuromuscular facilitation, PNF), connective tissue massage, and kinesiotherapy specially developed for the face of SSc patients. Out of the 40 recruited SSc patients, 20 patients were randomly selected into the intervention group and underwent the intervention program for 9 weeks, 2 times a week for 1 h with a home exercise program. Twenty patients were randomly assigned into the control group, which underwent home exercise program only. Patients of both groups were evaluated at baseline, after 9 weeks and after 9 weeks of follow-up in terms of quality of life and health, stiffness of the facial area, opening of the mouth, and oral handicap. At the end of treatment, both groups showed improved orifice. However, in the follow-up period, improvement persisted only in the intervention group. The facial score in the intervention group improved both at the end of therapy and follow-up period, whereas in the control group, there were no changes. According to the results of quality of life and health status, no effect of therapy was detected in any group. A significant improvement was also found in oral handicap at the end of therapy in the intervention group, whereas in the control group, no changes were observed [10].
In an observational study by Poole et al., the authors investigated the improvement in oral hygiene in SSc patients who underwent a program involving structured oral hygiene and exercises for the face and hands. The authors recruited 17 patients with SSc who previously underwent basic dental checkup, including examination for decayed or missing teeth, calculus, sites that bleed upon probing, measures of oral aperture, and the patient hygiene performance index. The study also evaluated upper limb function involving strength, joint range and maneuverability. Participants underwent a structured exercise program including education on brushing and flossing techniques used, hand exercise of three series with five repetitions, once daily stretching, once daily facial exercise of five times stretching 3–5 seconds, individually adjusted dental equipment, and a 6-month supply of dental products. This program was performed one or two times a day for 6 months. At the end of the 6-month intervention, there were a significant improvement in oral hygiene and a significant decline in the number of teeth with calculus and a reduction in bleeding gums. There were no differences in any of the upper extremity measures or oral aperture [11].
Another observational study by Pizzo et al. examined the effects of nonsurgical exercise program in 10 patients with severe SSc-associated microstomia (maximal mouth opening ≤ 30 mm). Patients were instructed to perform an exercise program, which included mouth stretching exercises for at least 15 minutes, twice a day, and oral augmentation exercise with a stick of soft wood daily during 18 weeks. After 18 weeks, the effect of exercise was evaluated measuring the maximal mouth opening. The exercise program improved mouth opening of all subjects. At the end of the period of 18 weeks, all patients noted that eating, speaking, and oral hygiene were easier [12].
In 2009, Maddali-Bongi et al. performed two other RCTs that examined the effect of specialized intervention programs and pointed out their safety and improvements in the hands and mouth (facial). These studies will be discussed in the following sections of this chapter.
At this point, it is worth to mention a study that can be useful for dentists treating this area in such a rare disease as SSc. Alantar et al. reviewed the literature and collected expert opinion for the design of preventive and curative treatment of oral and dental disability in patients with SSc. The authors point out that prevention of oral and dental complications is a major issue in patients with SSc. Dental treatment should be tailored to limitations in mouth opening, disease severity, and on-going treatments [13].
Physiotherapy is a vital part of nonpharmacological approaches, which deals with the prevention and treatment of disorders of the musculoskeletal system. Based on a comprehensive approach, physiotherapy pays special attention to the life situations, in which the person is. The aim of comprehensive physiotherapy is to find the best way to mitigate or eliminate health problems and to maintain the current effect in a long term. There are several studies available in this area of research.
In 2009, Maddali-Bongi et al. performed two RCTs that examined the effect of a specialized intervention program in the area of hands and mouth (face). The first study aimed to evaluate the effectiveness of the intervention program based on a combination of connective tissue massage and joint manipulation according to Mc Mennell specially designed for the hands of SSc patients. Of the 40 recruited SSc patients, 20 patients were randomly assigned to intervention and underwent the exercise program for 9 weeks, twice a week for one hour, and a home exercise program. Twenty patients were randomly assigned to the control group which underwent only the home exercise program. Patients of both groups were evaluated at baseline, after 9 weeks and after 9 weeks of follow-up in terms of quality of life, hand involvement, hand functional disability, and the measurements of range of motion. The intervention group demonstrated a significant improvement in all measured parameters, whereas the home exercise program in the control group improved just closing the hand into a fist at the end of therapy [14].
The aim of the second study was to evaluate the efficacy of a specific and comprehensive rehabilitation program tailored for patients with SSc. Hand involvement was treated with a combination of connective tissue massage and Mc Mennell joint manipulation. Manual lymph drainage was applied if patients had edematous hands. Face involvement was treated with a combination of Kabat’s method, connective tissue massage, and kinesiotherapy. Other techniques used in the study included hydrokinesiotherapy (for patients without ulcers), land-based rehabilitation (for patients with ulcers), and respiratory rehabilitation exercises. The authors recruited twenty patients with SSc, who were randomly divided into two groups and evaluated at baseline and after 9 weeks in terms of quality of life, health, hand function, range of motion, water volumetric test, orifice, Duruoz scale, and purpose-built-questionnaire for hand and face Involvement. The intervention group was evaluated also after 9 weeks of follow-up. The intervention group 10 patients underwent a specific rehabilitation program, one or two times per week for 9 weeks. The control group underwent only educational advice and medical information for patients with SSc. At the end of treatment, patients in the intervention group improved in all measured parameters. In follow-up, orofacial function and mobility as well as general health condition were partially lost, whereas only the mobility and function of the hand were preserved. No changes in the examined parameters were observed in the control group [15].
In a controlled clinical study by Antonioli et al., the authors evaluated the effect of a specialized individual rehabilitation program that consisted of warm-up and cool-down exercises, training of motor functions, diaphragmatic breathing, controlled coughing exercises, treadmill, freewalking, finger stretching, and occupational therapy for 2 weeks of daily 30-minute sessions (10 sessions in total). Physical therapy was also prescribed to 13 patients with joint-related problems. At-home exercise program was prescribed on days when the intervention program was terminated. Patients were reevaluated after 2 and 4 months. The control group consisted of 17 patients who did not receive any form of rehabilitation. The authors evaluated aerobic capacity, hand function, limitations in activities of daily living, quality of life, and skin-related problems. At the end of the 4-month period, the examiners observed an improvement in the perception of quality of life, better exercise tolerance, and better mobility of hand in a significant number of patients with SSc [16].
Since patients with SSc reported great need to receive support and education regarding their disease, Kwakkenbos et al. developed a short, group-based psychoeducational program, and evaluated it in an observational study using pre- and posttest design. Participants filled out a questionnaire assessing their physical and mental condition. Subsequently, patients were asked to evaluate the program content using a questionnaire. Completely filled questionnaires were available for data analysis from 41 patients. The authors detected a high satisfaction of patients with the program, smaller helplessness after the intervention, and a higher acceptance of patients’ limitations. However, no differences were observed in depressed mood or in physical function. Thus, this psychoeducational program contributed to meeting the reported needs of patients and to improving the care of patients with SSc [17].
In an RCT by Schouffoer et al., the authors compared the effectiveness of a 12-week multidisciplinary nursing program with usual outpatient care for SSc patients. The multidisciplinary nursing program included individual treatment goals once a week for 12 weeks, general exercises, hand/mouth exercises, educational sessions under supervision of a local physical therapist, and a home-based exercise program at least 6 days a week for 12 weeks. Twenty-eight patients with SSc were randomly selected into the intervention group (twenty-five of them completed the treatment), and twenty-five patients were randomly assigned to the control group. The examiners evaluated the hand function, grip strength, maximal mouth opening, aerobic capacity, gait, quality of life, and health status at baseline, at the end of treatment (12 weeks), and at the end of follow up (after 24 weeks). Results showed that the 12-week daily multidisciplinary care program was more effective than regular outpatient care with regard to significant improvement in grip strength, mouth opening, gait, and quality of life after 12 weeks, whereas the results in other followed parameters showed no difference between the intervention and control group. At the end of the follow-up period, after 24 weeks, only improvement in grip strength was maintained [18].
Our own preliminary results (unpublished data) from an ongoing single-center controlled study further support the role of intensive physiotherapy in patients with SSc. Our project aimed to address some limitations of existing studies and to assess the efficacy of a long-term (24-week intervention, 24-week follow-up), intensive (1 h physiotherapy + 0.5 h occupational therapy twice weekly, and home-exercise for 0.5 h five times a week), tailored physiotherapy program on function and impairment of the hands and face, and quality of life and disability in patients with SSc. We recruited 27 SSc patients into the intervention group, which underwent the 24-week intervention, and 29 SSc patients into the control group, which received an education and textbook on home exercise at baseline only. The intervention program unit comprised several physiotherapy/occupational therapy techniques, such as warm-up with infrared lamp, manual lymphatic drainage, skin wrinkling, fascial techniques, postisometric muscle relaxation, joint mobilization, passive/active muscle stretching and exaggerated facial mimicry training, soft ball facilitation techniques, senosoric stimulation with terabeans and therapeutic plasticine. Our program not only prevented the natural course of progressive deterioration of function of hands/mouth (observed in the control group) but also led to a significant improvement in monitored parameters (e.g., delta finger to palm, hand/finger grip strength, HAMIS-Hand Mobility in Scleroderma, interincisor/lip distance), which was clinically meaningful in a substantial proportion of patients.
Stretching includes special exercises leading to increased mobility of the body that can address a variety of health-related issues. It is a method, which can gently prepare your muscles to increased physical stress, but also to very ordinary functioning of our body during daily life activities. Stretching increases performance, maintains the elasticity of muscles and tendons, prevents muscle imbalance, improves joint mobility, and helps to maintain correct posture, proper breathing, and efficient and economical movement. Furthermore, stretching reduces muscle tone and brings overall relaxation, provides prevention from muscle- and joint-related injuries, improves response and readiness, and increases resistance to fatigue. To sum up the benefits of stretching, this technique maintains overall good physical and mental condition. For patients, most of all, it is a method/technique that maintains the elasticity of tendons, muscles, and improves joint mobility. Therefore, not only in healthy individuals but also in patients with SSc, it is the only way to recover, or aim to restore physiologic length of shortened muscles.
Mugii et al., in their observational study, compared the effect of autostretching of individual fingers in patients with SSc. Forty-five patients with SSc were instructed how to autostretch their fingers. The individual fingers were held with the other hand in the stretched position for 10 s, and this was repeated 3–10 times a day. To evaluate the effect of autostretching intervention, passive range of motion of the fingers was evaluated using a goniometer during the first visit, after 1 month and 1 year of the autostretching program. Quality of life was also assessed at the first visit and after a year using the Health Assessment Questionnaire (HAQ). The authors demonstrated a significant improvement in the overall range of passive joint motion of each finger after 1 month of autostretching, which was further improved or maintained even after 1 year. Although the range of motion of the fingers was lower in patients with diffuse cutaneous (dc) SSc than in patients with limited cutaneous (lc) SSc during the first visit, the examiners detected a significant improvement regardless of the disease duration or severity of skin sclerosis. The study team noted that stretching your fingers can improve the function of fingers, because HAQ score assessing the hand function activities, such as eating and grasping, decreased significantly [19].
An RCT by Vannajak et al. recruited 28 patients with SSc who were divided into two groups of 14 patients. Both groups received the same daily home treatment with one difference: one group with gloves and the other group without gloves. The 2-week daily home intervention included a Thai massage, stretching exercises and heating. The authors assessed the function of the hand using Hand Mobility in Scleroderma (HAMIS). Both groups showed a significant improvement in the function of the hand. Wearing gloves, however, lead to greater thumb mobility [20].
The rehabilitation of patients with impaired cardiovascular system is based on endurance, aerobic training, that is, a prolonged dynamic loading at or below the anaerobic threshold. Regular aerobic exercise improves the efficiency of the cardiovascular system (lungs, heart, and circulatory system), and regular endurance and strength training induce characteristic changes that lead to improved physical condition. These changes represent the training effect and help to achieve greater physical load with lower heart-rate responses.
Pinto et al. in their observational study focused on the effects of 12 weeks of combined resistance and aerobic training program (concurrent training) in 11 SSc patients. Supervised concurrent training session consisted of treadmill warm-up (5 min) followed by resistance training (30 min), treadmill aerobic training (20 min), and stretching exercises (5 min). Resistance training included five exercises for the main muscle groups: bench press, leg press, latissimus pull down, leg extension, and seated row. The concurrent training program was performed in one hour sessions, twice per week for 12 weeks. The study showed that concurrent 12-week training program was safe and significantly improved muscle strength, function and aerobic capacity in SSc patients [21].
The aim of a pilot study by Alexanderson et al. was to determine the effect of 8-week intense aerobic and endurance training program in four patients (three women and one man) with SSc with 50–100% of forced vital capacity (FVC). The authors detected significantly improved muscular endurance in three participants and significantly or clinically significantly improved aerobic capacity in two participants [22].
Oliveira et al., in their prospective nonrandomized controlled trial, examined whether patients with SSc have reduced exercise capacity compared to healthy individuals, and whether aerobic exercise is safe for patients with SSc and improves their aerobic capacity. In this study, 7 patients with SSc (without interstitial lung disease) and 7 healthy controls underwent an 8-week aerobic exercise program of moderate intensity. Participants were evaluated by cardiopulmonary stress test before and after 8 weeks of training, and examined for blood lactate concentration and oxygen saturation at each visit and at rest, and quality of life. Patients with SSc and healthy controls underwent 40-min training twice weekly. The first five minutes of the exercise program were reserved for the warm-up, when the speed was gradually increased until a target heart rate. The last five minutes of exercise were represented by the cool-down with slowing down the speed to a standstill. In the first session of the program, the participants underwent 15 min of aerobic exercise at their respective target heart rate. In the second session, aerobic training was increased to 20 min, in the third session to 25 min, and in all subsequent sessions to 30 min. Both groups showed a significant improvement in peak VO2 but with no significant difference between the study groups. Furthermore, both groups improved in exercise intensity which was documented by significantly increased peak lactate concentration in blood. No significant changes in SSc skin score or quality of life were detected [23].
In SSc commonly affected area of the body is the lower limbs, especially their muscular strength and function, the loss of which has an impact on quality of life of patients with SSc. Therefore, Lima et al. in their cross-sectional study assessed peripheral and respiratory muscle strength in patients with SSc and examined their correlation with the 6-minute walk test and quality of life. Secondary aim of this study was to characterize the nutritional status, lung function, functional ability and quality of life of SSc patients compared with healthy controls. The study included 20 patients with SSc and 20 healthy control subjects. Results showed that patients with SSc have significantly reduced respiratory muscle strength, decreased strength in m. quadriceps femoris, and increased fatigability compared to healthy controls [24].
Poole et al., in 2013 and 2014, assessed their two self-management programs and their impact on self-management for patients with SSc. The first program (2013) consisted of a workbook and a DVD (sent by postmail) that provided information on medical aspects of the disease, dysphagia, fatigue management, advocacy, activities of daily living, oral hygiene, skin and wound care, psychosocial changes, exercises, and other features of the condition. Forty-nine participants evaluated the effect of the program providing feedback through series of questions, filling out the protocol on health condition, and through their participation in the evaluation interview. The results of the study showed a decrease in depression, fatigue and pain, and an improvement in the hand function, self-efficacy for controlling pain, and self-efficacy “other.” However, the only statistically significant change was in self-sufficient pain control. Moreover, the study showed that the program was easy to use and should help individuals with SSc in self-sufficiency [25].
In another pilot study (2014), Poole et al. assessed the effectiveness of internet-based self-management program for patients with SSc. Participants logged on to a password-protected web site and completed the program, which consisted of 10 modules (e.g., coping and body image/appearance, fatigue and energy conservation, self-advocacy), an exercise video, learning activities, worksheets, and resources. Participants proceeded through the modules at their own pace over 10 weeks. Participants were encouraged to log on to the discussion board, participate in an interactive component of the web site, and respond to questions posted for each module. Participants completed pre- and postintervention questionnaires on perceived self-efficacy, health efficacy, ability to manage care, functional disability, depression, pain, and fatigue. They also completed an eight-question evaluation form regarding satisfaction with the web site, program content, discussion boards, and learning activities. Sixteen participants completed the study and postintervention measures. The authors demonstrated significant improvements in mean scores for ability to manage health care and efficacy, and significant decreases in fatigue and depression. Self-efficacy was improved as well, but not significantly [26].
Functional impairment of the hand in SSc patients is one of the major problems encountered in rehabilitation practice. Research in this area also includes splinting interventions of the hand and wrist, which aim to facilitate restoration of the lost function. In a 2-month study by Seeger et al., the authors investigated splinting effect on the secondary contractures in 19 patients with SSc. Specifically, whether dynamic splinting can improve flexion contractures in the proximal interphalangeal joints (PIP). Of the eight patients who completed the study, only one had significant improvement in range of motion as a result of PIP joint splinting, which shows that the study failed to demonstrate the use of splints as a suitable method to maintain PIP extension compared with the control hand [27].
In addition to the abovementioned list of interventions, there are few studies that evaluate the effectiveness of some other nonpharmacological approaches in SSc including the use of physical therapy, which is the practical application of physical treatments procedures and methods on living organism.
Manual lymphatic drainage (MLD) stimulates the lymphatic system and reduces swelling. It is one of the main components of a combined physical therapy, which is used for the treatment of lymphedema [28]. It is a technique that applies a force to the interstitial fluid and proteins within the initial lymphatics, thereby shifting toward collaterals and/or normally functioning lymphatics [29]. This technique not only directly softens the tissues, but perhaps also removes excessive local fluid. Therefore, it is speculated that the MLD technique should modify the mechanical properties, such as strain, of the skin and subcutaneous tissue. Strain is defined as deformation of a solid due to stress and is considered to be one of the measures representing tissue hardness [30].
The effect of manual lymphatic drainage to reduce swelling, improve the functionality of the hand and the perceived quality of life (QoL) in patients with SSc in edematous stage of disease was assessed in an RCT by Bongi et al. The study recruited 35 patients with SSc who were in the edematous disease stage (swelling of the hands), 20 of which were randomly assigned to the intervention group, and underwent MLD 1h once a week for 5 weeks according to the Vodder procedures, and 15 of which served as a control group. The study demonstrated a reduction in the hand volume, improved hand function, and perceived swelling and pain. Reduction in the volume and improvement in hand function were also maintained at follow-up. Furthermore, the authors detected an improvement in overall disability and quality of life in patients who received therapy. In the control group, no improvement was observed. The authors concluded that the application of MLD is effective in the treatment of the hand in edematous SSc by reducing hand volume, edema, and pain, and improving hand function and perceived quality of life. A study on a larger cohort of patients and with a longer follow-up is needed to assess the effect of MLD on different disease subsets as well, and to verify whether the technique could be of help in preventing the transition from hand edema to fibrosis [31].
Beyond examining the effects of MLD, researchers also investigated the effects of other types of physical therapy in the rehabilitation of patients with SSc.
Sallam et al. evaluated the impact of 14-day transcutaneous electrical nerve stimulation (TENS) of gastrointestinal (GI) acupoints on GI symptoms and quality of life in 17 SSc patients. This treatment significantly increased sympathetic and vagal activity in comparison with the basal value, lead to normalization of sympathovagal balance, and increased physical function score, which is closely related to the change in the sympathovagal balance. This provides the potential to treat the upper GI tract symptoms; however, further studies are needed to support these results [32].
In a pilot study by Tinazzi et al., the authors investigated the effect of extracorporeal shock wave therapy on the skin of 30 patients with SSc. This study was based on a hypothesis that the treatment effect of extracorporeal shock wave may decrease damage to the endothelial cells and skin fibrosis in patients with SSc. The authors demonstrated rapid and sustained reduction in Rodnan skin scores and a reduction in visual analog scale. Furthermore, an improvement in skin structure and vascularization was recorded 90 days after treatment. The number of endothelial progenitor cells and circulating endothelial cells increased 60 and 90 days after treatment, whereas serological biomarkers showed no differences before and after treatment [33].
Results of a prospective RCT by Sporbeck et al. point out the beneficial impact of biofeedback and deep oscillation (three times a week for 4 weeks) on Raynaud’s phenomenon in patients with SSc [34].
In an observational study by Uhlemann et al., the authors evaluated the effect of ultrasound applied to the hands with an intensity of 0.6 W/cm2, for 6 minutes, 3 times a day for 6 days on the hand function and strength. Pain decreased in 18 of 24 patients. At the end of therapy, no increase in pain was observed, and the hand strength significantly improved in all patients [35].
Milačić et al. examined the change in volume of orifice before and after combined hyperbaric oxygen (HBO) therapy with facial physical therapy. Patients received HBO therapy ten times (2.0 ATA) and infrared phototherapy using Solux lamp 15 min before kinesiotherapy in front of mirrors daily for 10 days. This treatment targeted facial muscles. The results showed a statistically highly significant difference in improvement before and after treatment, and that use of HBO in the treatment of these patients has a significant role [36].
Chronic rheumatic diseases have a significant impact on the function, quality of life, and ability to work and represent a significant clinical and economic burden on healthcare systems. It is generally known that adequate physical activity is considered one of the adequate means to maintain or improve the quality of life, both physically and mentally. Nonpharmacological therapy plays a key role in the treatment of most rheumatic diseases. However, its effect for some of them has not been adequately studied or been little researched. A limitation of most of the small number of existing works aimed at nonpharmacological treatment for patients with SSc is low methodological quality, low number of patients, lack of a control group or monitoring (follow-up), and short-term intervention. The purpose of this chapter was to introduce the few studies that have examined this issue (Table 1) and to show that nonpharmacological therapies for diseases such as systemic sclerosis have been the focus of some research teams in recent years, the studies of which have demonstrated safety and benefits of these approaches.
Name of study | Author, year | Study design | Type of intervention | Description of intervention in intervention group | Description of intervention in control group | Number of individuals in intervention group | Number of individuals in control group | Duration of the intervention | Postintervention assessment | Results |
---|---|---|---|---|---|---|---|---|---|---|
Evaluation of paraffin bath treatment in patients with systemic sclerosis [5] | SANDQVIST, 2004 | RCT | Paraffin | Paraffin in combination with exercise | Only exercise | 17 SSc patients | 17 SSc patients | 1 month daily | After 1 month | The results showed that hand exercise in combination with paraffin bath seemed to be a suitable form of treatment in the effort to improve mobility and perceived hand stiffness |
Paraffin hand bath for scleroderma [6] | PILS, 1991 | RCT | Paraffin | 12 times paraffin wrap therapy which continued for next 3 months | 12 times paraffin wrap therapy | 8 SSc patients | 8 SSc patients | 3 months | After 3 months | Skin thickness decreased in all patients after 12 sessions of paraffin treatment. However, at the end of 3 months therapy in the intervention group, there was no significant difference between the intervention and control group |
Objective evaluation of hand function in scleroderma patients to assess effectiveness of physical therapy [7] | ASKEW, 1983 | CCT | Paraffin | Paraffin, friction massage and exercise maintaining ROM in the joints of the wrist and hand | – | 10 SSc patients | 7 SSc patients | Once performed interventions | After 2 hours | Significant improvement in the articular ROM, skin elasticity and overall function of the hand |
The effect of paraffin and exercise on hand function in persons with scleroderma: a series of single case studies [8] | MANCUSO and POOLE, 2009 | 3x single case study | Paraffin | Active exercises with hands after paraffin wrap | - | 3 SSc patients | - | 5 times per week for 8 weeks | 1 month and at 2 months after intervention | The results of this study suggest clinical efficacy of paraffin and exercises to improve activity/participation involving the use of the hands |
Effect of orofacial exercises on oral aperture in adults with systemic sclerosis [9] | YUEN, 2012 | RCT | Orofacial treatment | Multifaceted oral health intervention | Usual dental care | 26 SSc patients | 22 SSc patients | Twice a day with a total of 6 minutes for 6 months | After 3 months, and 6 months | A significantly larger increase in oral aperture for participants receiving the orofacial exercise program was found when compared to those in the usual care at 3 months, but not at 6 months evaluation. Participants’ adherence rate to the exercise program was low (48.9%) |
The rehabilitation of facial involvement in systemic sclerosis: efficacy of the combination of connective tissue massage, Kabat’s technique and kinesitherapy [10] | MADDALI-BONGI, 2011 | RCT | Orofacial treatment | Combination of the Kabat’s technique, connective tissue massage, and kinesiotherapy specially developed for the face of SSc patients with a home exercise program | Only home exercise program | 20 SSc patients | 20 SSc patients | 9 weeks, 2 times a week for 1 hour | After 9 weeks and after 9 weeks of follow-up | The combination of connective tissue massage, Kabat’s technique, kinesiotherapy, and home-based exercises was more effective than a home exercise program alone in the rehabilitative treatment of SSc facial involvement |
Oral hygiene in scleroderma: the effectiveness of a multidisciplinary intervention program [11] | POOLE, 2010 | OD | Orofacial treatment | Structured oral hygiene and exercises for the face and hands | – | 17 SSc patients | – | 6 months daily | After 6 month intervention | There was a significant improvement in oral hygiene and a significant decrease in the number of teeth that bled on probing and in subgingival calculus |
Effects of a nonsurgical exercise program on the decreased mouth opening in patients with systemic scleroderma [12] | PIZZO, 2003 | OD | Orofacial treatment | Mouth stretching exercises for at least 15 minutes, twice a day, and oral augmentation exercise with a stick of soft wood daily | – | 10 SSc patients | – | 18 weeks | After 18 weeks | The exercise program improved the mouth opening of all subjects. At the end of the 18 week period, all patients commented that eating, speaking and oral hygiene measures were easier |
Efficacy of connective tissue massage and Mc Mennell joint manipulation in the rehabilitative treatment of the hands in systemic sclerosis [14] | BONGI, 2009 | RCT | Comprehensive physical therapy for physical and/or psychological functioning | Combination of connective tissue massage and joint manipulation according to Mc Mennell specially designed for the hands, and a home exercise program | Only home exercise program | 20 SSc patients | 20 SSc patients | 9 weeks twice a week, 1 h per session | After 9 weeks, and after 9 weeks of follow-up | The combination of connective tissue massage, Mc Mennell joint manipulation and home exercise program was effective in the rehabilitative treatment of SSc hands. This combined treatment may lead to an improvement in hand function and QoL |
Efficacy of a tailored rehabilitation program for systemic sclerosis [15] | BONGI, 2009 | RCT | Comprehensive physical therapy for physical and/or psychological functioning | Combination of connective tissue massage and Mc Mennell joint manipulation (MLD if patients had edematous hands. Face involvement was treated with a combination of Kabat’s method, connective tissue massage, and kinesiotherapy. Hydrokinesiotherapy (for patients without ulcers) or land-based rehabilitation (for patients with ulcers), and respiratory rehabilitation exercises) | Educational advices and medical information | 10 SSc patients | 10 SSc patients | One or two times per week for 9 weeks | After 9 weeks and after 9 weeks of follow-up | The association of disease-specific and global rehabilitative techniques designed and tailored for SSc patients improved disability, HRQoL, hand and face disability and functionality, with its effects partially maintained at the follow-up |
An individualized rehabilitation program in patients with systemic sclerosis may improve quality of life and hand mobility [16] | ANTONIOLI, 2009 | CCT | Comprehensive physical therapy for physical and/or psychological functioning | Rehabilitation program that consisted of warm-up and cool-down exercises, training of motor functions, diaphragmatic breathing, controlled coughing exercises, treadmill, freewalking, finger stretching, and occupational therapy (physical therapy was also prescribed to 13 patients with articular problems) and home exercise program | – | 16 SSc patients | 17 SSc patients | 2 weeks daily 30-minute sessions (10 sessions in total) | After 2 and 4 months | This study suggests that a significant proportion of patients with SSc experience an improvement in their perception of QoL, a better exercise tolerance, and a better hand mobility after a rehabilitation program consisting of a 2-week period of daily individual 30-min sessions of outpatient care, followed by at-home exercise program |
Addressing patient health care demands in systemic sclerosis: pre- and postassessment of a psychoeducational group programme [17] | KWAKKENBOS, 2011 | OD | Comprehensive physical therapy for physical and/or psychological functioning | A short, group-based psychoeducational program | – | 41 SSc patients | – | The intervention was scheduled over 3 weekends | 6 weeks after the intervention and 6 months postintervention | Patients reported less helplessness after the intervention, and higher acceptance of their limitations. However, no difference in depressed mood and physical functioning was observed. Patients reported high satisfaction with the content of the program |
Randomized comparison of a multidisciplinary team care program with usual care in patients with systemic sclerosis [18] | SCHOUFFOER, 2011 | RCT | Comprehensive physical therapy for physical and/or psychological functioning | Multidisciplinary team care program (1 day per week; individual treatments, group exercises, and group education) | Regular outpatient care | 25 SSc patients | 25 SSc patients | 12 weeks | 0, 12, and 24 weeks | In patients with SSc, a 12-week multidisciplinary day patient treatment program was more effective than regular outpatient care |
The efficacy of self-administered stretching for finger joint motion in Japanese patients with systemic sclerosis [19] | MUGII, 2006 | OD | Stretching | Autostretching (individual fingers were maintained in a stretched position using the opposite hand for 10 seconds and this was repeated 3–10 times) | - | 45 SSc patients | - | 1 year | After 1 month and 1 year | The total passive ROM was significantly improved in each finger after 1 month of finger stretching and 1 year after the first visit. Eating and gripping was also significantly improved |
The short-term effect of gloving in combination with traditional Thai massage, heat, and stretching exercise to improve hand mobility in scleroderma patients [20] | VANNAJAK, 2014 | RCT | Stretching | The home program combined traditional Thai massage with stretching exercises and heat with gloves | Same program without gloves | 14 SSc patients | 14 SSc patients | 2 weeks daily | After intervention | Both groups showed a significant improvement in hand mobility after 2 weeks of daily home exercise program. Wearing the glove, however, resulted in better thumb mobility |
Efficacy and safety of concurrent training in systemic sclerosis [21] | PINTO, 2011 | OD | Aerobic training and combined endurance/resistance training | Combined resistance and aerobic training program (concurrent training) | – | 11 SSc patients | – | 12 weeks | After intervention | This study demonstrates that a 12-week concurrent training program is safe and substantially improves muscle strength, function, and aerobic capacity in SSc patients |
Intensive aerobic and muscle endurance exercise in patients with systemic sclerosis: a pilot study [22] | ALEXANDERSON, 2014 | Pilot study | Aerobic training and combined endurance/resistance training | Intense aerobic and endurance training program | – | 4 SSc patients | – | 6 weeks (noninterventional baseline period) and 8 weeks (exercise intervention period 3× a week) | Every other week throughout the 14-week study | Three participants improved significantly in muscular endurance, and two participants improved significantly or clinically relevantly in aerobic capacity. All other variables remained unchanged, except for a trend toward reduced fatigue |
Aerobic exercise is safe and effective in systemic sclerosis [23] | OLIVEIRA, 2009 | CCT | Aerobic training and combined endurance/resistance training | Aerobic exercise program of moderate intensity | Aerobic exercise program of moderate intensity | 7 SSc patients | 7 healthy volunteers | 8 weeks | Pre- and posttest | Both groups showed a significant improvement in peak VO2 but with no significant difference between the study groups. Furthermore, both groups improved in exercise intensity which was documented by significantly increased peak lactate concentration in blood. No significant changes in SSc skin score or QoL were detected |
Lower limb muscle strength is associated with functional performance and quality of life in patients with systemic sclerosis [24] | LIMA, 2015 | Cross-sectional study | Lower extremities treatment | Study assesses the peripheral and respiratory muscle strength in individuals with SSc and investigates their correlation with the 6MWD and QoL measurements | 20 SSc patients | 20 healthy volunteers | April 2013 and January 2014 | Patients with SSc exhibited reduced respiratory muscle and quadriceps strength and an increase in its fatigability. In these individuals, there was a relationship between quadriceps strength, functional capacity, and QoL | ||
Evaluation of a mail-delivered, print-format, self-management program for persons with systemic sclerosis [25] | POOLE, 2013 | Pilot study | Self-management program | The program consisted of a workbook and exercise DVD that provided information on medical aspects of the disease, dysphagia, fatigue management, advocacy, activities of daily living, oral hygiene, skin and wound care, psychosocial changes, exercises, and other features of the condition | – | 49 SSc patients | – | 4–6 weeks | – | Participants consistently reported that the program was easy to use. Depression, fatigue, and pain decreased, and hand function, self-efficacy for controlling pain, and self-efficacy “other” improved; however, the only statistically significant change was in self-efficacy for pain |
Taking charge of systemic sclerosis: a pilot study to assess the effectiveness of an internet self‐management program [26] | POOLE, 2014 | Pilot study | Self-management program | The program consisted of 10 modules (e.g. coping and body image/appearance, fatigue and energy conservation, self-advocacy), an exercise video, learning activities, worksheets, and resources | – | 16 SSc patients | – | Over 10 weeks | – | There were significant improvements in mean scores for ability to manage care and health, and significant decreases in fatigue and depression. Self-efficacy improved, but not significantly |
Effects of splinting in the treatment of hand contractures in progressive systemic sclerosis [27] | SEEGER, 1987 | Pilot study | Splinting interventions | Dynamic splinting of the hand daily for 8 hours (could decrease proximal interphalangeal (PIP) flexion contractures?) | The nonsplinted hand | 8 SSc patients | 8 SSc patients | 2 months | After 1 and 2 months | Just one of eight patients experienced a statistically significant improvement in PIP range of motion as a result of the splinting. There was no evidence that the use of the splints served to maintain PIP extension when compared with the control hand |
Manual lymph drainage improving upper extremity edema and hand function in patients with systemic sclerosis in edematous phase [31] | BONGI, 2011 | RCT | Physical therapy | MLD 1 session a week (lasting 1 hour) | – | 20 SSc patients | 15 SSc patients | 14 weeks: 5 weeks of rehabilitation and 9 weeks of follow-up | At the end of the treatment, and after a follow-up of 9 weeks | The application of MLD is effective in the treatment of the hand in edematous SSc by reducing hand volume, edema, and pain, and improving hand function and perceived QoL |
Transcutaneous electrical nerve stimulation (TENS) improves upper GI symptoms and balances the sympathovagal activity in scleroderma patients [32] | SALLAM, 2007 | CCT | Physical therapy | Home use TENS application at two GI acupoints on GI symptoms and QoL | 17 SSc patients | 9 healthy controls | 14 days | The electrocardiogram was recorded for two intervals: baseline and TENS application | Prolonged TENS application improved GI symptoms and restored the sympathovagal balance, with an impressive correlation with improved physical functioning scores | |
Effects of shock wave therapy in the skin of patients with progressive systemic sclerosis: a pilot study [33] | TINAZZI, 2011 | CCT | Physical therapy | ESWT of the arm and the hand of one arm | Second arm was without intervention | 30 SSc patients | 30 SSc patients | Three sittings | Before and immediately after ESWT and at 7, 30, 60, and 90 days after the treatment | The results of this study suggest that ESWT is a novel and efficacious treatment that can be added to the pharmacological therapy in order to decrease endothelial cell damage and skin fibrosis in patients with SSc. This treatment is well tolerated and can be repeated without side effects; in the majority of cases it determines a rapid improvement in skin elasticity and skin wellness, even if the effects tend to reduce during the time |
Effect of biofeedback and deep oscillation on Raynaud’s phenomenon secondary to systemic sclerosis: results of a controlled prospective randomized clinical trial [34] | SPORBECK, 2012 | RCT | Physical therapy | The effect of deep oscillation and biofeedback on RP secondary to SSc | No intervention or therapies with an expected effect | 8 SSc patients biofeedback and 10 SSc patients—deep oscillation | 10 SSc patients | 3 times per week for 4 weeks | After 4 and 12 weeks | Biofeedback resulted in an improvement in RP as determined by score reduction of visual analogue scale compared with patients of the control group, whereas deep oscillation revealed a tendency for improvement. The study underlines the beneficial role of physiotherapy for the treatment of SSc-related RP |
Multiple daily ultrasound treatment of patients with progressive systemic scleroderma [35] | UHLEMANN, 1990 | OD | Physical therapy | Ultrasound therapy of the hands with an intensity of 0.6W/cm2, 6 minutes per region | – | 24 SSc patients | – | 3 times a day during 6 days | After 6 days | Pain decreased in 18 of 24 patients. At the end of therapy, no increase in pain was observed, and the hand strength significantly improved in all patients |
Mouth opening scope in the patients with systemic sclerosis: Simultaneous application of a hyperbaric oxygenation and physical therapy [36] | MILAČIĆ, 2014 | Prospective study | Physical therapy | Combined HBO therapy with facial physical therapy | – | 13 SSc patients | – | Daily 10 days | After intervention | The therapy showed a statistically significant difference and proved that the combination of HBO therapy and physical therapy has its place in treating these patients |
Overview of available studies on nonpharmacological interventions in patients with systemic sclerosis.
Nonpharmacological therapy in patients with SSc includes, in particular, methods commonly used, for example, paraffin, manual lymphatic drainage, massage, stretching exercises to maintain range of motion in joints, mobilization, aerobic exercises, specially developed programs for the face and hands, self-management programs, splinting, and physical therapy. Other studies also investigated occupational therapy, sexual dysfunction, education, psychosocial status, and nutrition in patients with SSc.
Quality of treatment depends on the cooperation of a multidisciplinary team. A physician should properly choose the right medical treatment. A physiotherapist must select an adequate therapy to be individually tailored for a specific patient. An exercise program should be feasible even in the home environment, and patient’s family or partner should get involved. Modifications to the home and work environments should be consulted with an occupational therapist. A psychologist or a psychosomatic medicine specialist can help not only the patient but also the family or a partner to solve the psychological problems that could be associated with the establishment of the diagnosis.
It is clear from the systematic literature search of available studies that nonpharmacological treatment for these patients has its positive results and has been investigated worldwide. However, since it is a rare disease, the strength of evidence of efficacy of nonpharmacological treatment is limited. The aforementioned limitations suggest that there is an unmet need for international multicentric cooperation, teamwork, and unified projects with a solid design in order to explore this area to arrive at definite conclusions and treatment recommendations. Thus, even nonpharmacological approaches could offer specific techniques that could be implemented and would effectively contribute to greater self-sufficiency, and easier self-management of patients with SSc.
It is also important to carry out further studies to assess other neglected areas such as psychosocial status, depression or sexual dysfunction in order to provide a complex therapy by a team of specialist offering a versatile assistance to patients with SSc.
This chapter was supported by grant projects AZV 16-33542A, AZV 16-33574A, SVV for FTVS UK 2017, UNCE, PRVOUK P38, GAUK 214615, and the Ministry of Health of the Czech Republic [Research Project No. 00023728].
The world populations of 2.3 billion small ruminants (goat and sheep) which comprise 1.09 billion goats [1] provide vital milk, meat and fiber. Goats (and sheep) are particularly important in Asia and Africa where they account for more than 90% and nearly 70% respectively of the world stocks [2]. Coccidian parasites of the genus
Studies in some countries such as Sri Lanka [6], Iraq [7], Jordan [8], Austria [9], Turkey [10], Saudi Arabia [11], China [12], Brazil [13] and Iran [14, 15] have shown that coccidiosis in goats is an important clinical and subclinical disease that may be linked to serious economic losses, especially under intensive breeding conditions with high animal density and high productivity [16]. Of the 16
Organism | Distribution | Remark | Reference |
---|---|---|---|
USA, European countries | Pathogenic | [3, 21] | |
USA, Australia, Asia | Pathogenic | [3, 21] | |
USA, Spain, Africa | Pathogenic | [3, 21] | |
US, Africa, Asia, Australia | Pathogenic | [3, 21] | |
Africa, Asia | Benign | [3, 21] | |
Africa, Asia, Australia | Benign | [3, 21] | |
Australia | Benign | [3, 21] | |
Africa | Benign | [3, 21] | |
Asia | Benign | [3, 21] | |
Africa | Benign | [3, 21] | |
- | - | [21] | |
- | - | [21] | |
- | - | [21] | |
- | - | [21] | |
- | - | [21] |
Common species of
In temperate areas including Europe,
When the unsporulated oocysts pass through the feces, after 2–7 days they become infected depends on
After ingestion by the host, the walls of the oocyst break down, releasing sporozoites from the sporocysts. The sporozoites penetrate the small intestine through an epithelial cell and develop into schizont of the first generation. The schizonts release motile merozoites, which may either initiate a second generation of schizonts or develop into gamont, gametes and then non-sporulated oocysts, which are released with the feces. The schizogony of second generation in the large intestines usually occurs with another generation of merozoites invades epithelial cells and develops the sexual stages, the gametocytes, male (microgametocytes) and female (macrogametocytes). Second-generation schizogony and fertilization of the gametocytes (gametogony) cause functional and systemic lesions of the large intestine [16]. In general, prepatent period for
Life cycle of
The pathological and clinical outcomes are influenced by a number of factors such as the present
In early infections with
Most affected goats show diarrhea, poor growth rate, weakness and rough hair coat [12]. The feces are soft, watery and have clumps of mucus and color shifts from brown to yellow or dark tarry [18]. Loss of weight and dehydration are noted. Because the appetite is decreased, the animals’ general condition is worsened. In some cases, sudden deaths occur in young animals between 2 and 4 months old without preceding digestive signs [3]. Diarrhea with or without mucus or blood, dehydration, emaciation, fatigue, and death are common clinical signs. But in fact, some goats are constipated and die acutely without diarrhea.
Impairment of growth is the major sign in subclinical form of coccidiosis. Early signs in acute cases include decreased appetite, listlessness, fatigue and abdominal pain which can be manifested by crying and repeated rising up and lying down. First, the feces may be unpelleted, then pasty, and eventually watery yellowish-green or brown diarrhea. The typical characteristics associated with coccidiosis are diarrhea that may be mucoid or bloody, abdominal pain, tenesmus, loss of appetite, fatigue, weight loss, rough hair coat, dehydration and anemia. Fever, ocular and nasal discharges can occur in the acute disease. Clinical coccidiosis is common in lambs 4–6 weeks old. Acute, bloody diarrhea can occur in severe cases, as a result of extensive damage to the intestinal epithelium [39].
While coccidiosis is self-limiting, the clinical presentation can be exacerbated further by other enteric pathogens. Exposure to low-grade challenges results in development of a strong immunity against to the disease. Successive infections in young animals might lead to the excretion of a large numbers of oocysts in animals, which leads to heavy contamination of houses, pastures or watering places [34].
The present chapter intends to give a comprehensive approach of the importance of
Some assumed parameters for estimation of economic losses are summarized in Table 2. There are not well documented economic impacts of coccidiosis in small ruminants and no published data for economic losses due to subclinical or clinical disease in tropical regions are available. While subclinical coccidiosis might not be of great importance, it cannot be compared to other infections [5]. Where the high density of animals with high productivity can cause coccidiosis to become an infection of great economic significance in small ruminants [16]. In the case of a mild infection, these losses can be attributed to reduce productivity with no clinical signs.
No. | Parameters | Possible impact | Reference |
---|---|---|---|
1. | Poor feed conversion rate | Poor weight gain | [3, 41] |
2. | Poor body weight gain | Poor weight gain | [3, 41] |
3. | Weight loss | Poor weight gain | [3, 41] |
4. | Intercurrent or concurrent diseases | Secondary infections, the cost of treatment | [16] |
5. | Reduced productions (milk, wool, hair) | Reduced income | [3] |
6. | Losses due to mortality | Production loss | [16] |
7 | Reduced carcass quality | Reduced income | [3] |
8 | Reduced fertility | Production loss | [41] |
Assumed parameters for estimation of economic losses due to coccidiosis in goats.
Global sheep and goats production was being estimated to lose up to $140 million per year [40]. Losses result from mortality, treatment costs for animals with diarrhea, enhanced sensitivity to secondary infections in infected animals, and reduced production efficiency. Beside the acute impacts, a prolonged effect was suggested as regards a lower feed efficiency, less final growth performance, and a reduced reproductive performance for life [41]. Subclinical coccidiosis is believed to cause higher production losses than clinical coccidiosis, since animals are infected and are affected for long-term [42].
There are different diagnostic methods available for specific identification of
Oocysts of
However, the morphological approach is not entirely accurate due to the prevalence of intraspecies heterogeneity, as natural
Coccidiosis in ruminant is usually controlled by a combination of good management and treatment with anticoccidial drugs or prophylactics [42]. In general, effective control of coccidiosis is not based on the complete removal of
Prevention is mainly based on the management of herds, including hygienic measures, since no vaccine is available. Coccidiosis outbreaks are a herd-level problem that is driven by stress. Infected animals need a responsive immune system to prevent severe disease. Therefore, minimizing or eliminating stressors like diet changes, harsh climate conditions, crowding, frequent shipping, animal grouping and exposure to other disease pathogens is a crucial part in preventing disease [16]. It is important to ensure adequate nutrition and appropriate uses of anticoccidial drugs. Colostrum uptake is important for newborn ruminants as it protects them from pathogens. Although the protection against
Proper hygiene and minimizing predisposing factors in the environment are important for the control strategies of coccidiosis [53]. Pens for lambing and kidding should be kept clean, and bedding should be disposed when old or infested with oocysts. The washing and disinfecting of the buildings must be done with boiling water under pressure and gaseous ammonia [54].
All steps that minimize the amount of fecal contamination on hair coats should be routinely applied. Feed and water troughs should be high sufficient to prevent heavy fecal contamination. Feeding animals on the ground should be avoided, particularly when overcrowding. The regular rotation of pastures for parasite control will also assist in the controls of coccidial infection [53].
With respect to available anticoccidials, they are usually supplied as feed additives, in drinking water, or in feed supplements such as salt. As a result, their use is often most feasible in weaned animals. However, anticoccidial prevention may need to start in the first weeks of life depending on the procedure [3]. In general, coccidiostats and coccidiocidal drugs are available. The development of internal coccidia stages is inhibited by coccidiostats, while coccidiocidal drugs kill the parasites. Drugs of both modes of action are currently available on the market. The best time to administer a prophylactic treatment would allow for the infection to develop but not for full parasite development. An appropriate treatment given following or prior to infection by the onset of oocyst release and appearance of symptoms is known as metaphylaxis. Anticoccidial therapy would therefore be optimally applied after infection, for the most important ruminant
Anticoccidial drugs belong to one of two categories [55, 56, 63]:
Polyether antibiotics or ionophores produced by the
Monovalent ionophores (monensin, narasin, salinomycin)
Monovalent glycosidic ionophores (maduramicin, semduramicin)
Divalent ionophore (lasalocid)
Synthetic compounds produced by chemical synthesis with a particular mode of action, which are often referred to as “chemicals”:
Inhibition of parasite mitochondrial respiration (decoquinate, clopidol)
Inhibition of the folic acid pathway (sulfonamides)
Competitive inhibition of thiamine uptake (amprolium)
Inhibition of respiratory chain enzymes and nuclear division of protozoan (e.g., diclazuril, halofuginone, nicarbazin, robenidine)
Polyether ionophores inhibit the growth of sporozoites by increasing the concentration of intracellular Na+ ions. They also accelerate the activity of Na+/K+/ATPase [57] and affect merozoites by inducing the breakup of the cell membrane [58]. Monensin was the first antibiotic to show an anticoccidial effect at reasonable concentrations, allowing it to be used in feed [59]. It can act as an effective anticoccidial agent for coccidiosis caused by
Monensin fed prophylactically at 20 g per ton of feed for 28 days decreases shedding of oocysts and improves feed conversion. However, high monensin levels make the feed unpalatable and toxic [53, 60]. It is believed that toxic effects in the horse, cattle, dogs, cats, rats, avian species and goat are mediated by interference with cell membranes ion gradients, inducing mitochondrial disruption and thus depleting of cellular energy [61, 62]. The documented toxic effects include heart toxicity, muscle degeneration and neuropathy, the latter is shown by myelin and ataxia [62].
Quinolones, pyridones, alkaloids, guanidines, thiamine analogues, and triazine derivatives are examples of synthetic anticoccidial drugs. Triazines inhibit nuclear division of protozoan thus interfere with the development of schizonts and gametocytes [63]. Decoquinate (0.5 mg/kg BW) and lasalocid at a dose of 25-100 mg/kg feed can be used to treat coccidiosis from weaning to market [53]. Sulfonamides at dosage rates of 25 to 35 mg/kg BW for at least 15 days are effective against coccidiosis in small ruminants. The combination of chlortetracycline and sulfonamide has provided protection in lambs. Other drugs include monensin (20 and 16 g/ton of feed for sheep and goats, respectively), toltrazuril (20 mg/kg BW as a single oral dose) and diclazuril (2 mg/kg BW as a double oral dose) [34, 53, 64].
Amprolium in feed is also used to treat the disease in goats (100 mg/kg BW for 21 days) and sheep (50 mg/kg BW for 21 days) [53]. Amprolium is structurally related to thiamine, and it is believed to be associated with a competitive inhibition of successful transportation of thiamine into parasite [65]. The production of oocyst in lambs has proved to be decreased when given as an in-feed medicine and clinical coccidiosis outbreaks have been successfully controlled by single drenching [66]. Young
Diclazuril and toltrazuril have shown in several studies to decrease production of oocysts in natural and artificial
Resistant problems have been reported for some anticoccidial drugs, such as arprinocid and quinolone buquinolate [74]. In the field trials, toltrazuril resistance did not exist in at least five consecutive drug exposures [75]. The polyether ionophores became the drug of choice in 1972 and, as of today, are now the most commonly used drugs in poultry. Although ionophores resistance is likely to develop slowly due to their specific mode of action, resistance development in synthetic drugs with a specific mode of action appears to be faster, involving genetic mechanisms [76].
In this review, we highlight the management and control of
The authors declare no conflict of interest.
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The task-focused leadership style is explored under the headings of transactional and autocratic leadership, laissez-faire leadership, and instrumental leadership.",book:{id:"9047",slug:"nursing-new-perspectives",title:"Nursing",fullTitle:"Nursing - New Perspectives"},signatures:"Serpil Çelik Durmuş and Kamile Kırca",authors:null},{id:"58916",title:"Factors Affecting the Attitudes of Women toward Family Planning",slug:"factors-affecting-the-attitudes-of-women-toward-family-planning",totalDownloads:8485,totalCrossrefCites:9,totalDimensionsCites:18,abstract:"Everyone has the right to decide on the number and timing of children without discrimination, violence and oppression, to have the necessary information and facilities for it, to access sexual and reproductive health services at the highest standard. 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",coverUrl:"https://cdn.intechopen.com/series/covers/22.jpg",latestPublicationDate:"June 27th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:1,editor:{id:"356540",title:"Prof.",name:"Taufiq",middleName:null,surname:"Choudhry",slug:"taufiq-choudhry",fullName:"Taufiq Choudhry",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000036X2hvQAC/Profile_Picture_2022-03-14T08:58:03.jpg",biography:"Prof. Choudhry holds a BSc degree in Economics from the University of Iowa, as well as a Masters and Ph.D. in Applied Economics from Clemson University, USA. In January 2006, he became a Professor of Finance at the University of Southampton Business School. He was previously a Professor of Finance at the University of Bradford Management School. He has over 80 articles published in international finance and economics journals. 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Prof. Emeje was a national chairman of academic pharmacists in Nigeria and the 2021 winner of the May & Baker Nigeria Plc–sponsored prize for professional service in research and innovation.",institutionString:"National Institute for Pharmaceutical Research and Development",institution:{name:"National Institute for Pharmaceutical Research and Development",country:{name:"Nigeria"}}},{id:"268659",title:"Ms.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/268659/images/8143_n.jpg",biography:"Dr. Zhan received his undergraduate and graduate training in the fields of preventive medicine and epidemiology and statistics at the West China University of Medical Sciences in China during 1989 to 1999. He received his post-doctoral training in oncology and cancer proteomics for two years at the Cancer Research Institute of Human Medical University in China. In 2001, he went to the University of Tennessee Health Science Center (UTHSC) in USA, where he was a post-doctoral researcher and focused on mass spectrometry and cancer proteomics. Then, he was appointed as an Assistant Professor of Neurology, UTHSC in 2005. He moved to the Cleveland Clinic in USA as a Project Scientist/Staff in 2006 where he focused on the studies of eye disease proteomics and biomarkers. He returned to UTHSC as an Assistant Professor of Neurology in the end of 2007, engaging in proteomics and biomarker studies of lung diseases and brain tumors, and initiating the studies of predictive, preventive, and personalized medicine (PPPM) in cancer. In 2010, he was promoted to Associate Professor of Neurology, UTHSC. Currently, he is a Professor at Xiangya Hospital of Central South University in China, Fellow of Royal Society of Medicine (FRSM), the European EPMA National Representative in China, Regular Member of American Association for the Advancement of Science (AAAS), European Cooperation of Science and Technology (e-COST) grant evaluator, Associate Editors of BMC Genomics, BMC Medical Genomics, EPMA Journal, and Frontiers in Endocrinology, Executive Editor-in-Chief of Med One. He has\npublished 116 peer-reviewed research articles, 16 book chapters, 2 books, and 2 US patents. His current main research interest focuses on the studies of cancer proteomics and biomarkers, and the use of modern omics techniques and systems biology for PPPM in cancer, and on the development and use of 2DE-LC/MS for the large-scale study of human proteoforms.",institutionString:null,institution:{name:"Xiangya Hospital Central South University",country:{name:"China"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a Principal Investigator and Scientist at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via machine-learning-based analyses of exosomal signatures. Dr. Paul has published in more than fifty peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award, a senior member of the Institute of Electrical and Electronics Engineers (IEEE), and an editorial board member for several international journals.",institutionString:"University of California Los Angeles",institution:{name:"University of California Los Angeles",country:{name:"United States of America"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals. He is currently working on the protective activity of phenolic compounds in disorders associated with oxidative stress and inflammation.",institutionString:null,institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Dr.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329248",title:"Dr.",name:"Md. Faheem",middleName:null,surname:"Haider",slug:"md.-faheem-haider",fullName:"Md. Faheem Haider",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329248/images/system/329248.jpg",biography:"Dr. Md. Faheem Haider completed his BPharm in 2012 at Integral University, Lucknow, India. In 2014, he completed his MPharm with specialization in Pharmaceutics at Babasaheb Bhimrao Ambedkar University, Lucknow, India. He received his Ph.D. degree from Jamia Hamdard University, New Delhi, India, in 2018. He was selected for the GPAT six times and his best All India Rank was 34. Currently, he is an assistant professor at Integral University. Previously he was an assistant professor at IIMT University, Meerut, India. He has experience teaching DPharm, Pharm.D, BPharm, and MPharm students. He has more than five publications in reputed journals to his credit. Dr. Faheem’s research area is the development and characterization of nanoformulation for the delivery of drugs to various organs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/system/329795.png",biography:"Dr. Mohd Aftab Siddiqui is an assistant professor in the Faculty of Pharmacy, Integral University, Lucknow, India, where he obtained a Ph.D. in Pharmacology in 2020. He also obtained a BPharm and MPharm from the same university in 2013 and 2015, respectively. His area of research is the pharmacological screening of herbal drugs/natural products in liver cancer and cardiac diseases. He is a member of many professional bodies and has guided many MPharm and PharmD research projects. Dr. Siddiqui has many national and international publications and one German patent to his credit.",institutionString:"Integral University",institution:null},{id:"255360",title:"Dr.",name:"Usama",middleName:null,surname:"Ahmad",slug:"usama-ahmad",fullName:"Usama Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255360/images/system/255360.png",biography:"Dr. Usama Ahmad holds a specialization in Pharmaceutics from Amity University, Lucknow, India. He received his Ph.D. from Integral University, Lucknow, India, with his work titled ‘Development and evaluation of silymarin nanoformulation for hepatic carcinoma’. Currently, he is an Assistant Professor of Pharmaceutics, at the Faculty of Pharmacy, Integral University. He has been teaching PharmD, BPharm, and MPharm students and conducting research in the novel drug delivery domain. From 2013 to 2014 he worked on a research project funded by SERB-DST, Government of India. He has a rich publication record with more than twenty-four original journal articles, two edited books, four book chapters, and several scientific articles to his credit. He is a member of the American Association for Cancer Research, the International Association for the Study of Lung Cancer, and the British Society for Nanomedicine. Dr. Ahmad’s research focus is on the development of nanoformulations to facilitate the delivery of drugs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"333824",title:"Dr.",name:"Ahmad Farouk",middleName:null,surname:"Musa",slug:"ahmad-farouk-musa",fullName:"Ahmad Farouk Musa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333824/images/22684_n.jpg",biography:"Dato’ Dr Ahmad Farouk Musa\nMD, MMED (Surgery) (Mal), Fellowship in Cardiothoracic Surgery (Monash Health, Aust), Graduate Certificate in Higher Education (Aust), Academy of Medicine (Mal)\n\n\n\nDato’ Dr Ahmad Farouk Musa obtained his Doctor of Medicine from USM in 1992. He then obtained his Master of Medicine in Surgery from the same university in the year 2000 before subspecialising in Cardiothoracic Surgery at Institut Jantung Negara (IJN), Kuala Lumpur from 2002 until 2005. He then completed his Fellowship in Cardiothoracic Surgery at Monash Health, Melbourne, Australia in 2008. He has served in the Malaysian army as a Medical Officer with the rank of Captain upon completing his Internship before joining USM as a trainee lecturer. He is now serving as an academic and researcher at Monash University Malaysia. He is a life-member of the Malaysian Association of Thoracic & Cardiovascular Surgery (MATCVS) and a committee member of the MATCVS Database. He is also a life-member of the College of Surgeons, Academy of Medicine of Malaysia; a life-member of Malaysian Medical Association (MMA), and a life-member of Islamic Medical Association of Malaysia (IMAM). Recently he was appointed as an Interim Chairperson of Examination & Assessment Subcommittee of the UiTM-IJN Cardiothoracic Surgery Postgraduate Program. As an academic, he has published numerous research papers and book chapters. He has also been appointed to review many scientific manuscripts by established journals such as the British Medical Journal (BMJ). He has presented his research works at numerous local and international conferences such as the European Association for Cardiothoracic Surgery (EACTS) and the European Society of Cardiovascular Surgery (ESCVS), to name a few. He has also won many awards for his research presentations at meetings and conferences like the prestigious International Invention, Innovation & Technology Exhibition (ITEX); Design, Research and Innovation Exhibition, the National Conference on Medical Sciences and the Annual Scientific Meetings of the Malaysian Association for Thoracic and Cardiovascular Surgery. He was awarded the Darjah Setia Pangkuan Negeri (DSPN) by the Governor of Penang in July, 2015.",institutionString:null,institution:{name:"Monash University Malaysia",country:{name:"Malaysia"}}},{id:"30568",title:"Prof.",name:"Madhu",middleName:null,surname:"Khullar",slug:"madhu-khullar",fullName:"Madhu Khullar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/30568/images/system/30568.jpg",biography:"Dr. Madhu Khullar is a Professor of Experimental Medicine and Biotechnology at the Post Graduate Institute of Medical Education and Research, Chandigarh, India. She completed her Post Doctorate in hypertension research at the Henry Ford Hospital, Detroit, USA in 1985. She is an editor and reviewer of several international journals, and a fellow and member of several cardiovascular research societies. 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Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. 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She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. 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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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