Physico-chemical characteristics of water observed in commercial bullfrog tadpole (Lithobates catesbeianus) farms in Brazil.
\r\n\tWe must not forget that farming requires quite different approaches and animal feeding conditions in different farming systems. It is not the same having a larger number of animals or small herds just for family needs.
\r\n\r\n\tHowever, one thing should be common and most important: animal “well-being”, knowledge of the health status of animals, continuous monitoring and, if necessary, healing and treatment of animals. Without this knowledge, infectious diseases, feed-borne diseases and resistance to individual drugs cannot be traced, which can lead to very serious problems and, in some cases, tragedies.
",isbn:"978-1-78984-709-3",printIsbn:"978-1-78984-708-6",pdfIsbn:"978-1-78985-193-9",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,hash:"7e5d45badb49806d949ad1475e3a0ef0",bookSignature:"Prof. Sándor Kukovics",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/9706.jpg",keywords:"Goats and Environment, Stress Factors, Goats Feed, Goats and Society, Economy, Meat, Skin, Fibre, Milk, Human Health Benefits, Goat Health, Goat Management",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"November 2nd 2020",dateEndSecondStepPublish:"December 3rd 2020",dateEndThirdStepPublish:"February 1st 2021",dateEndFourthStepPublish:"April 22nd 2021",dateEndFifthStepPublish:"June 21st 2021",remainingDaysToSecondStep:"2 months",secondStepPassed:!0,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"Dr. Kukovics is the President of the Hungarian Sheep and Goat Dairying Public Utility Association. He has been the Executive Manager of Sheep and Goat Products’ Board and Inter-professional Organisation since 2010. Between 2015 and 2019 he served as Vice President of the EU COPA-COGECA Working Party on Sheep and Goats and he has been a member of the Board of Directors of the International Goat Association since 2016.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"25894",title:"Prof.",name:"Sándor",middleName:null,surname:"Kukovics",slug:"sandor-kukovics",fullName:"Sándor Kukovics",profilePictureURL:"https://mts.intechopen.com/storage/users/25894/images/system/25894.jpeg",biography:"Prof. Dr. Sándor Kukovics spent 40 years at the Research Institute\nfor Animal Breeding and Nutrition (Herceghalom, Hungary)\nbeing responsible for the small ruminants sector. He also edited\n30 books, published more than 1,000 articles and has licences\nfor 4 products. Besides research work, he has been taking part in\nundergraduate and further education from various universities (in\nDebrecen, Mosonmagyaróvár, Gödöllő, Kaposvár). Since 1996 he\nhas been the President of the Hungarian Sheep and Goat Dairying Public Utility Association. He has been the Executive Manager of Sheep and Goat Products’ Board and\nInter-professional Organisation since 2010. Between 2015 and 2019 he served as Vice\nPresident of the EU COPA-COGECA Working Party on Sheep and Goats and he has\nbeen a member of the Board of Directors of the International Goat Association since\n2016. As an expert he has been taking part in the activities of several special groups in\nthe EU working with small ruminants since 2004.",institutionString:"Hungarian Sheep and Goat Dairying Public Utility Association",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"2",institution:null}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"5",title:"Agricultural and Biological Sciences",slug:"agricultural-and-biological-sciences"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"184402",firstName:"Romina",lastName:"Rovan",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/184402/images/4747_n.jpg",email:"romina.r@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. 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Graphene",subtitle:"Experiments",isOpenForSubmission:!1,hash:"0e6622a71cf4f02f45bfdd5691e1189a",slug:"physics-and-applications-of-graphene-experiments",bookSignature:"Sergey Mikhailov",coverURL:"https://cdn.intechopen.com/books/images_new/57.jpg",editedByType:"Edited by",editors:[{id:"16042",title:"Dr.",name:"Sergey",surname:"Mikhailov",slug:"sergey-mikhailov",fullName:"Sergey Mikhailov"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"64836",title:"Importance of Optimum Water Quality Indices in Successful Frog Culture Practices",doi:"10.5772/intechopen.81747",slug:"importance-of-optimum-water-quality-indices-in-successful-frog-culture-practices",body:'\nFrog culture consists of small- and medium-scale producers and is gaining the attention since several years. The improvements in production systems and research have contributed a lot to make it more viable and profitable for producers. Brazil is considered as the country that has the best technologies in the production of bullfrog, that is, the entire production cycle is completed under controlled conditions. However, the sector encounters some limitations such as fewer improvements in the areas of nutrition, reproduction and genetics, mismanagement of the sector, and little investment and actions by the public sector [1].
\nThe frog’s production has different markets including the domestic and foreign markets. The main product is fresh meat, represented mostly by the trade of frogs’ thighs [2]. More than 90% of internationally traded frog meat comes from extractive hunting, but there is enormous pressure from environment protection agencies that are claiming the finishing of such practice. Data published by FAO [3] on world ranching showed Brazil as the second largest producer, the first being Taiwan.
\nIn Brazil and China, raniculture is exclusively based on the production and rearing of bullfrog (Lithobates catesbeianus), an exotic species from North America that was introduced for captive breeding. When compared to native species, it presents higher productive performance in commercial productions [4]. The species presents extremely favorable zoo-technical characteristics for high-scale breeding, such as precocity, prolificacy, and rusticity, which greatly facilitate management [2].
\nAs among all amphibian species, frogs are ectothermic animals, that is, the temperature of water and environment directly influences the animal’s metabolism [5]. The temperature of water between 22 and 28°C is considered ideal for the excellent development of tadpoles [6] and may result in achieving better zoo-technical indices in the rearing phase [7].
\nAmphibians like bullfrog need water of specific physical and chemical quality. For producers, before starting a rearing system, it is extremely important to know and has a good knowledge about different water quality parameters and their role in successful frog culture. They should measure the pH, electrical conductivity, total alkalinity, total hardness, ammonia, nitrite, nitrate, phosphorus, chlorides, iron, and especially oxygen properly before starting breeding. These parameters are the most important indices that indicate the water quality.
\nAquaculture has shown great development in the last decades and is competing with production systems of other aquatic animals due to water resource. Its development, however, presents risks of deteriorating the quality and quantity of water and in contributing declining the environmental, social, and economic quality. Technical, scientific, and representative links of Brazilian aquaculture have stated that frog culture does not consume but rather uses water, and this characteristic of nonconductivity could change approaches and strategies related to the management of water resources directed to aquatic productions, taking in consideration different from the industries [8].
\nThe granting and charging due to the use of water resources by aquaculture become more relevant when it highlights the aspects of water quality used and release the water source at the expense of aspects that basically involve the use of large volumes of water. The usage of aquaculture water depends greatly on water quality [9].
\nAquaculture uses water resources intensively, competing for water available to the population and other productive systems. However, unlike other production systems, aquaculture can collaborate with water quality control systems by constant monitoring while keeping in view its role in producing food for humans especially protein food [8].
\nAn objective and consistent model of granting and charging due to the use of water for aquaculture refers to methods focused on quality differentials, which are possibly based on measurements of biochemical oxygen demand (BOD) and levels of nitrogen (N) and phosphorus (P) in the water collected and returned to its source or original course. Other factors, such as water surface area, chosen design, or management techniques, may interfere with higher actual water consumption and may also be taken into account in the models of granting and charging the use of water resources for aquaculture [8].
\nEvaluating water use in the last 100 years, Telles [10] stated that globally about 70% of the available water is destined for agricultural usage. According to the author, approximately 20% of the water is destined to the industry and less than 10% to population (hygiene and direct consumption). In response to increasing food demands, aquaculture has also advanced its production. In the last decade, world production has increased by 200% mainly searching for a healthy product and the next step is the search for an ecologically correct product.
\nFor any production system to continue its growth, it must be economically and environmentally correct [11, 12]. In addition, it should be based on the concepts of food security and socioeconomic development [13]. According to Valenti et al. [13], modern aquaculture is based on three pillars: profitable production, social development, and preservation of the environment, having an intrinsic and interdependent relationship for a perpetual production.
\nAlthough aquaculture provides a number of social and economic benefits, it must seek new technologies to reduce impacts such as deforestation, diversion of watercourses, introduction of exotic species into the natural environment, and effluent emission into aquifers. Environmental pollution can be defined as any action or omission of man, which has a direct impact on water, soil, and air and causes a harmful imbalance on the environment as well [14]. The impacts caused by aquaculture result in reduced production, disease outbreaks in cultivated and wild populations, and in some cases may restrict aquaculture operations [15].
\nEnvironmental factors such as soil quality, water quality, risks of introducing exotic species/ biodiversity, chemical and organic discharge in the natural environment, recycling and interaction with other neighboring fish farms have a great impact on fish farming [16]. Another type of impact is that which is caused by aquaculture on water quality is related to the accumulation of nutrients and organic residues at the bottom of tanks and nurseries and such impact is time dependent. This time is related to unused food, fertilizer usage, and the nutrients present in the sediment, which precipitate and then release into the water column [17].
\nThe nurseries have high concentrations of nutrients, plankton, organic, and inorganic matter due to the food provided and the morphometry of the systems. The input and output of constant water with short residence time and uncontrolled management of feed and water are some of the important factors that directly act on nutrient dynamics, accelerating or allowing greater availability in the water column [18].
\nThe water inflow and outflow due to its great intensity remove excess nutrients and other material from the nursery, controlling the phosphorus dynamics in the medium in relation to its absorption in the sediment [19]. In times of high fish production, from November to April (increased water temperature), the addition of feed is more intense and climatic factors such as temperature and precipitation influence the dynamics of these systems [18].
\nThe impacts of aquaculture can be classified as internal, local, and/or regional. Internal impacts refer to those that interfere with the breeding system itself, such as the depletion of dissolved oxygen in a fish farm. In general, local impacts extend 1 km downstream of the effluent discharge. Effects on aquatic environments with a spatial scale of several kilometers are considered regional impacts [20].
\nThe effluents from aquaculture ponds have a high volume and low nutrient concentrations when compared to domestic effluents, which present little volume and high concentration of nitrogen and phosphorus [21]. Although the dilution value of these effluent discharges from aquaculture is considered high, its direct launch in the limnic environments can result in a chronic bioaccumulation and eutrophication, which can lead to an excessive increase of phytoplankton, causing dissolved oxygen deficit at night and possible death of local organisms [22]. Thus, the advancements in aquaculture simultaneously increase the concern of environmental agencies and societies with the environmental impact generated by it.
\nThe main negative impact of effluents from aquaculture activities on aquatic ecosystems is the increase of nitrogen and phosphorus concentrations in the water column and accumulation of organic matter in the sediments [22]. In addition to effluent produced by natural processes, nutrient enrichment, feces, and unconsumed feed, chemical residues are also released, which are used in disinfection, pest and predator controls, disease treatments, hormones to induce reproduction, and sexual reversal beyond anesthetics for transport [23].
\nNot all breeding techniques have negative environmental consequences, since many of them are beneficial when environmental management is effective and socioeconomically sustainable [24]. As a positive impact of aquaculture, there are related consortiums between aquaculture and agriculture (irrigation and farming), rearing of tadpoles along with ornamental fish [25] or integrated systems of multiple uses such as recreation, gastronomy and rural tourism.
\nAnother positive aspect is the maintenance of fish stocks in the sea and rivers, protecting and conserving endangered species, the use of industrial and domestic (treated) effluents in the enrichment of fish farms, or the coupling of a hydroponics system together with the residues of fish farming itself. It is also important to highlight the opportunities for new economic and working sources in the river basin [23] as a positive social and economic aspect.
\nThe increasing growth of the animal industry has forced the reduction in the effects of intensive production systems on the environment. The concern with amino acids up to recent animal response considerations was restricted for maximizing production efficiency but little or no attention was given for reducing nitrogen excretion [26]. But now, there is a great concern about modern aquaculture’s response to intensive production systems—the sustainability and environmental impact or pollution caused by them. In these systems, the density of fish per volume of water is very high, needing high rations and large amount of feed consisting of ingredients of high digestibility and palatability in order to produce minimum residue from feed wastage and stop high excretion of phosphorus and nitrogen [27].
\nThe development of nutritious and environmentally and economically viable rations depends on the knowledge regarding the alimentary habits and nutritional requirements of the species reared [27]. Being an alternative production in the agriculture sector, frog culture can be placed among aquaculture activities that are gaining importance in the natural scenario [28], as the natural populations of frogs in Asia are decreasing due to environmental contamination and uncontrolled capture [29].
\nThe quality and cleanliness of water used in production of aquatic organisms are essential factors for the success of these programs. The frogs leave their excreta, and skin remains in water due to constant changes. It is imperative to constantly renew the water and clean the tanks and bays, and such care is necessary to prevent diseases and mortalities.
\nAmphibians such as bullfrog need water with specific physical and chemical quality. Parameters such as pH, electrical conductivity, total alkalinity, total hardness, ammonia, nitrite, nitrate, phosphorus, chlorides, iron, and especially oxygen must be measured before starting a breeding. These parameters are the most important indexes that characterize the quality of water. For breeders who are starting the activity, it is of the utmost importance to understand these variables.
\nAll animal or vegetable life forms breathe in inhaling oxygen and exhaling carbon dioxide. When an aquatic environment is polluted with organic matter, the consumption of O2 (respiration) exceeds beyond the acceptable levels and a decrease occurs in its available concentration. If the imbalance persists under anaerobic conditions (without oxygen), fish and most other animals will be unable to exist and will die. Oxygen allows aerobic (oxygen-using) bacteria to be more efficient decomposers than anaerobic (non-oxygen) bacteria, reducing decomposing organic matter in the water without leaving harmful odors.
\nWhen large quantities of organic material are discharged into rivers, for example, a population explosion of decomposing bacteria occurs. By “breathing,” oxygen depletion occurs and the water becomes anaerobic or septic. The aerobic bacteria then facilitate the anaerobic bacteria, which produce hydrogen sulfide gas that has an extremely unpleasant smell and affect the aquatic life.
\nAquatic ecosystems are dynamic, and even in tanks with small volumes of water, the physical and chemical parameters interrelate and are dependent on one another. The level of dissolved oxygen in water varies with temperature and atmospheric pressure. The dissolved oxygen content is about 9.08 mg L−1 at sea level and a temperature of 20°C, while this concentration rises up to 10.07 mg L−1 of oxygen, if the temperature drops to 15°C, indicating them the two closely interrelated factors.
\nThe behavior of several other parameters occurs in the same way. Thus, it is not enough to know only one parameter or strictly follow the literature. The physical and chemical evaluation of water must be analyzed together, taking into account all factors.
\npH (hydrogenation potential): It is the ratio between concentrations of hydrogen ions (H+) and hydroxyl ions (OH−), that is, acidity or alkalinity. It has a scale of 0–14, with pH 7 being neutral, where H+ and OH concentrations are the same. Below 7, the pH indicates acidity, and above 7, it indicates alkalinity. The most responsible for its variation is the carbonic acid, which is originating from the carbon dioxide produced by phytoplankton during photosynthesis, where in excess, it renders the pH acidic and vice versa.
\nElectric conductivity: It is determined by the presence of dissolved substances that dissociate into anions and cations. It is the ability of water to transmit electric current. Practically for aquatic organisms, the higher the conductivity the more charged the system will be.
\nTotal alkalinity: It indicates the concentration of carbonate and bicarbonate salts in water. It has a function of water buffering, that is, it maintains the pH stable, besides participating in the carapace formation of some species of plankton. Carbonates and other salts react with carbonic acid, neutralizing their action.
\nTotal hardness: It indicates the concentration of metallic ions mainly the ions of calcium (Ca2+) and magnesium (Mg2+) present in water. It is expressed in CaCO3 equivalents. The values of total hardness are practically associated with alkalinity. It also potentiates the toxicity of various chemicals.
\nAmmonia, nitrite, and nitrate: Ammonia produced due to the excretions of aquatic organisms and bacterial decomposition of the organic material in water is divided into toxic ammonia (NH3) and ammonium ion (NH4). Through bacterial oxidation (nitrosomonas), the ammonia is transformed into nitrite. Then, nitrite is oxidized by bacteria of the genus Nitrobacter to nitrate. The denitrifying bacteria transform nitrate into nitrogen by completing the cycle. Generally, ammonia and nitrite are the toxic forms (depending on pH and temperature). Nitrate is not toxic.
\nPhosphorus: It is a nutrient with low concentration in water but is one with the highest concentration factor in phytoplankton, followed by nitrogen and carbon. Its compounds constitute an important component of the living cell, especially nucleoproteins, essential for cellular reproduction. It is also associated with respiratory and photosynthetic metabolism. They occur mainly in the form of soluble phosphates and phosphate rock. Organic wastes, especially domestic sewage, contribute to the enrichment of water with this element.
\nIron: Among the physical and chemical parameters of water, iron is the one that most frequently makes impossible the implantation of a commercial raniculture. This metal when in high concentration causes tadpoles mortality due to its chemical toxicity. It is sometimes possible to remove the iron from water through its oxidation (Fe3—colloidal), in other words, introducing oxygen in the medium and aeration.
\nThe excretion of the animals (feces and urine) results in ammonia-based compounds. Ammonia is extremely toxic when in large quantities and is converted into nitrite and nitrate by the action of nitrifying bacteria. Nitrite is also a toxic compound. It can oxidize hemoglobin in animals’ blood; thus, converting it into methaemoglobin, a molecule incapable of carrying oxygen. This transformation process of ammonia (NH3—toxic) in nitrite (NO2—toxic) and then in nitrate (NO3—toxic only in high quantities) is called denitrification and occurs depending on the temperature, pH, and oxygen of water. This reaction is one of the most common causes of mortality in tadpole tanks but it can also be easily avoided by taking basic precautions such as controlling the amount of food offered, constant and efficient oxygenation, water renewal, and regular cleaning.
\nThe changes in water are related to values that allow classifying water by its degree of contamination, origin or nature of the main pollutants, and their effects to characterize cases of loads or peaks of concentration of toxic substances and to evaluate the biochemical balance necessary for maintenance of aquatic life. In other words, the farmer observing the water of his tanks daily can infer and/or perceive its state. However, not even the experience gained over the years will spare the farmer from regular observing/monitoring the water of his tanks.
\nIn the literature, we find little information available on the ideal water quality for raniculture. Many concepts and values come from other types of aquaculture animals. Thus, a gap occurs when the farmers apply this information in commercial ranks, which is a more practical activity. Another way to aid in the elucidation of this process is to conduct aquatic research regarding the impact of water quality on frog culture on large-scale laboratory tests in order to provide more accurate and practical information to the frog culturists.
\nFollowing are some data collected in the field from observations made in commercial ranks in Brazil (Table 1), which are demonstrated.
\nParameters | \nDesirable values | \nValues observed | \n
---|---|---|
pH | \n6.5–7.0 | \n6.0–8.0 | \n
Oxygen | \n0.7–6.0 mg L−1 | \n2.0–6.0 mg L−1 | \n
Ammonia (NH3) | \nUp to 0.5 mg L−1 | \nUp to 0.7 mg L−1 | \n
Nitrite (NO2) | \nUp to 0.5 mg L−1 | \nUp to 1.0 mg L−1 | \n
Nitrate (NO3) | \nUp to 1.0 mg L−1 | \n— | \n
Hardness | \nUp to 40 mg L−1 | \n10–80 mg L−1 CaCO3 (most frequent) | \n
Alkalinity | \nUp to 40 mg L−1 | \n10–80 mg L−1 CaCO3 (most frequent) | \n
Chloride (Cl2) | \nUp to 7 mg L−1 | \n— | \n
Chlorine (Cl) | \n0.02 mg L−1 | \nUp to 1 mg L−1 | \n
Fluoride (F2) | \nLess than 1 mg L−1 | \n— | \n
Iron | \nUp to 0.3 mg L−1 | \nUp to 1 mg L−1 | \n
Orthophosphate (PO4) | \nLess than 0.3 mg L−1 | \n\n |
Electrical conductivity | \n— | \nLess than 150 μS cm−1 | \n
Analyzing the above mentioned variables, it is verified that there is a very great similarity between fish and amphibians with respect to the physical and chemical parameters of the water. It has been noted that bullfrog tadpoles require less oxygen than fish. This is one of the reasons why many amphibians are known as “homebodies,” that is, animals do not migrate from their place of origin when environmental conditions become adverse.
\nNormally, higher production of tadpoles is carried out in hot periods due to better adaptation and development of animals at an average temperature of 26°C [32]. The pH values did not show large changes among the frog farms, normally presenting average values of 7.0 for water supply and effluent, respectively. Thus, it remains within the standards recommended by the Brazilian resolution (pH between 6.0 and 9.0 for breeding waters of this species).
\nIt is common to observe decrease in the dissolved oxygen content in the effluent than the water supply, but ideally, it is above the minimum required by the legislation (5.0 mg L−1). As far as the ideal flow rate for spinning water is concerned, it is ideal that the total tank volume is renewed at least once a day in small tanks. Some authors have already described some flow rates found in frogs: Borges et al. [33] found 0.11 L s−1 and for the exit water, 0.08 L s−1; and Pereira et al. [34] found the value of 0.064 L s−1.
\nFor electrical conductivity, there is no established standard for tadpoles. We find literature that demonstrates values of 30 to 200 μS cm−1 for incoming water and runoff water [35, 36, 37]. Mercante et al. [38] working with sequential nurseries of semi-intensive fish production observed a mean variation between 46 and 113 μS cm−1 in the nurseries (Table 1). The same author states that when the values are high, they indicate a high degree of decomposition and the inverse (reduced values) is intense primary production (phytoplankton).
\nThe maximum limit for turbidity in effluents, according to Brazilian legislation, is 100 NTU (nephelometric turbidity units). According to Borges et al. [33], in a study with tadpoles, the maximum value obtained for incoming water was 20 NTU and for output was 26 NTU, thus remaining within the allowed range. Sipaúba-Tavares [39] argues that high levels of turbidity may be related to the presence of clays and dissolved or colloidal organic matter. In the same study by Borges et al. [33], ammonia and nitrate remained well below the limit established by legislation during the experimental period. However, from collection 2 (31 days of experiment), the concentrations were higher in the outlet water, with mean values of 0.40 and 0.49 mg L−1, respectively, evidencing the organic matter decomposition and the rapid nitrification process due to the good oxygenation of the tanks.
\nThe main problem observed in raniculture as already observed in aquaculture is water enrichment (eutrophication) caused mainly by inadequate food management, which raises nutrient concentrations and modifies the environmental conditions of the farm [40]. The eutrophication process is a frequently observed problem and suggests the need for effluent studies and management techniques focused on ecological and specific aspects of these systems, favoring a lower impact of the effluents in the receiving water bodies [41].
\nIn raniculture, commercial feed is usually used for carnivorous fish with average levels of 45% crude protein [42]. In addition to the increase in the amount of feed offered according to the growth of the animals, there is also a change in the use of this feed in each developmental stage of the animal [43]. The bullfrog produced in “anfigranja system” presents low protein efficiency of the commercial diet elaborated based on the requirements of carnivorous fish, which is used for feeding in most Brazilian ranicultures [44]. In addition, there is a significant loss of feed nutrients to the environment, resulting in the degradation of water quality [45].
\nA compound resulting from the catabolism of proteins is ammonia; therefore, the control of food quantity and quality, as well as adequate flow of water, is of fundamental importance for the maintenance of a good artificial breeding system [46]. In breeding systems for aquatic organisms, food introduced into the water and ammoniacal nitrogen fertilizers, such as ammonium sulfate, ammonium nitrate, phosphates, and urea, contribute to the increase of ammonia concentration in water [47]. The diet formulation should eliminate high levels of phosphorus and nondigestible components, testing the minimum necessity to grow a certain species [48]. Thus, the quality and quantity of food should be controlled for the sustainability of the harvesting system [49], since a relationship has been observed between commercial feed utilization and the water eutrophication process [50]. If the aquatic system is in imbalance, it becomes propitious to the development of diseases, compromising the sanitary sanity of that place.
\nEctothermal animals such as bullfrog often serve as carriers for etiological agents by contact or as carriers when agents are ingested. When they are infected, it may result in an imbalance in the population of the pathogenic microorganisms in the environment, changes in the physical, chemical, and biological quality of water, immunological deficiency of these organisms, and unnecessary stresses [51].
\nThe “Biological Institute of São Paulo, Brazil” has identified the presence of Escherichia coli bacteria in a very high load in diseased frogs (secondary and opportunistic infection) in a breeding system where the frogs fed larvae, and in the examination of feces of pigs used as substrate of larvae, an extremely high amount of this enterobacterium was reported [52].
\nE. coli is found in sewage, effluent, natural waters, and soils that have received recent fecal discharge, being inactivated. When ingested, it becomes active and pathogenic, but it is most used as indicator of fecal pollution in the environment and food, appearing in fresh and poor fish, frogs, mollusks, and shrimp [51].
\nBacteria from the coliform group are also found in soil and vegetables, some with a certain ability to remain and even multiply in humid environments with high levels of organic and inorganic nutrients. Organisms in the coliform group may be introduced into water and food from nonfecal sources, such as plants and individual transporters, already polluted (lack of hygiene or sanity), such as contact with other animals or humans, even without release or direct contact with their excreta [51]. Gray et al. [53] suggest that frogs in metamorphosis or infected “froglets” may continue to release this pathogen, infecting other breeding members and eventually contaminating water sources. In addition, they can transport terrestrial pathogens to adjacent aquatic systems. It is possible that bullfrog adults may serve as suitable hosts for E. coli in stagnant aquatic systems. Another care that must be taken in raniculture is during the process of metamorphosis that is directly related to the reduced immunocompetence.
\nIt has been reported that this microorganism can survive in fluvial waters for up to 27 days. Thus, persistence of E. coli in aquatic environments should be maintained through periodic contributions from primary reservoirs (homeothermic animals) or excreta contamination of wild host animals. The results of Borges et al. [33] suggest that bullfrogs can function as spill-over reservoirs of E. coli and thus contribute to its persistence in aquatic environments. In addition, since tadpoles in metamorphosis are capable of dispersion, they may play a role in the pathogen epidemiology [53]. Table 2 shows the values of the biotic and abiotic variables of different types of aquatic cultures.
\nVariables | \nPisciculture Macedo and Sipaúba-Tavares [54]1 Sipaúba-Tavares et al. [55]2 Macedo et al. [56]3 | \nCarciniculture Henry-Silva and Camargo [57]1 Pistori et al. [58]2 Keppeler [59]3 | \nTadpole Borges et al. [45] | \n
---|---|---|---|
EC (μS cm) | \n962 | \n702 | \n74 | \n
DO (mg L−1) | \n8.402 | \n4.632 | \n6.15 | \n
P-total (mg L−1) | \n0.252 | \n0.291 | \n1.88 | \n
Nitrate (mg L−1) | \n0.132 | \n0.623 | \n0.68 | \n
Ammonia (mg L−1) | \n0.102 | \n0.133 | \n0.82 | \n
BOD (mg L−1) | \n71 | \n73 | \n12 | \n
COD (mg L−1) | \n181 | \n— | \n51 | \n
Escherichia coli (MLN/100 ml) | \n4 × 10^63 | \n— | \n1.3 × 103 | \n
Comparison between the values of biotic and abiotic variables found in effluents from different aquaculture activities.
DO, dissolved oxygen; EC, electrical conductivity; BOD, biochemical oxygen demand; COD, chemical oxygen demand; MLN, most likely number.
\nFrogs are water-dependent organisms, thus, for the elimination of excreta, controlling their body posture, respiration, reproduction, protection and safety makes the quality of water extremely important in breeding times [60]. The quality of water used in the production of aquatic organisms is one of the essential factors for the success of these enterprises. In raniculture, postmetamorphic animals leave their excreta and skin remains from constant changes in water. Therefore, it is important to constantly renew the water and clean the tanks and bays. Such care is essential for the prevention and prophylaxis of diseases, because when a disease sets in, mortality is certain [30].
\nThe water for use in commercial frog farms should be of good quality, without fecal coliforms, heavy metals, and iron, with neutral pH, being preferably of spring or artesian well. It is recommended to select places with higher ambient temperatures for its rearing, since the frogs are ectothermic animals, presenting a more accelerated growth in higher temperatures. To maintain the quality of the breeding place, the water used in the farm must come from its own source and protected, do not receive polluting load of any kind, and have its reservoirs protected and cleaned regularly [61].
\nRaniculture projects should include knowledge of local hydrography and concern for the rational use of water, mainly to reduce impacts on water resources. Particular attention should be paid to the construction of projects in ecologically sensitive areas of importance to environmental preservation, such as permanent preservation areas. According to the Brazilian Institute of Fisheries, the flow necessary for the installation of commercial frog farms of 500 m2 is 0.5 L s−1 ABRAPOA [62], resulting in an amount of 43,200 liters per day. However, this volume should not be discarded in the receiving water body without prior treatment.
\nThe quality of the effluents must be periodically monitored, and the projects must provide for the installation of a treatment system for these effluents. Efforts should be made to increase the feed efficiency of the animals in order to ensure the reduction of the waste loads generated by the activity. The adoption of measures to reduce and eliminate the chances of diseases with preventive actions (sanitary management) and the maintenance of efficient and sustainable population densities is also important.
\nThe main negative environmental impact observed is related to the degradation of the unconsumed feed, releasing to the water the nutrients and increasing the concentration of nitrogen and phosphorus. The excretion of animals (urea) is also released into the water and results in increased ammonia concentration. Remains of skin contribute to increase the amount of organic matter (total solids). Due to the nitrification processes that take place inside the bays, the amount of dissolved oxygen decreases drastically and reaches the anoxic levels.
\nThe quality of the breeding place is based on the application of good animal breeding practices, in which the factors such as the technical knowledge about raniculture, ideal soil qualities (space), water in quality and quantity, constant, trained, and responsible workforce and projects that contemplate an economic planning should be properly addressed. The frog culture presents higher levels of dissolved nutrients, mainly concentrations of phosphorus, ammonia, and conductivity, as compared to other aquaculture activities, such as fish and shrimp cultures (Table 3).
\nLimnological variables | \nBullfrog culture Borges et al. [45] | \nShrimp culture Henry-Silva and Camargo [57] | \nFish culture Sipaúba-Tavares et al. [55]1 Henry-Silva and Camargo [63]2 | \n
---|---|---|---|
Temperature (°C) | \n28.2 | \n26.5 | \n25.71 | \n
pH | \n7.2 | \n8.1 | \n7.21 | \n
Dissolved oxygen (mg L−1) | \n1.23 | \n5.10 | \n5.401 | \n
Conductivity (μS cm−1) | \n249 | \n68 | \n621 | \n
Turbidity (NTU) | \n66 | \n62 | \n262 | \n
Total phosphorus (mg L−1) | \n6.09 | \n0.23 | \n0.201 | \n
Ammonia (mg L−1) | \n6.94 | \n0.02 | \n0.071 | \n
Nitrate (mg L−1) | \n2.37 | \n0.16 | \n0.161 | \n
Comparison of the limnological characteristics of effluent from frog, shrimp, and fish cultures.
Borges et al. [45] (2012) concluded that the management adopted in ponds of frog growth positively changed the quality of water. In contrast to other cultures of aquatic organisms (fish and shrimp), effluent from frog culture has a greater potential to cause eutrophication in receiving bodies of water. Best aquaculture practices (BAPs) should also be recommended for frog culture in order to avoid water pollution and contamination of animals (food biosecurity).
\nMercante et al. [38] evaluated the mean concentrations of total phosphorus (TP) and flow in the water (inlet and outlet) and the load produced per day for bullfrogs and compare their results with other aquatic production systems (Table 4).
\n\n | Inlet | \nOutlet | \n\n | ||||
---|---|---|---|---|---|---|---|
\n | Concentration | \nFlow | \nLoad | \nConcentration | \nFlow | \nLoad | \n\n |
\n | (mg L−1) | \n(L s−1) | \n(g day−1) | \n(mgL−1) | \n(L s−1) | \n(g day−1) | \n\n |
Bullfrog farming | \n0.03 | \n0.06 | \n0.21 | \n0.19 | \n0.06 | \n14.3 | \nMercante et al. [38] | \n
Bullfrog farming | \n0.07 | \n0.03 | \n0.18 | \n6.09 | \n0.02 | \n11.57 | \nBorges et al. [45] | \n
Tilapia farming | \n0.42 | \n2.76 | \n9.7 | \n2.45 | \n2.76 | \n49.1 | \nPereira et al. [64] | \n
Trout farming | \n72.26 | \n40.61 | \n233.33 | \n99.69 | \n40.61 | \n343.67 | \nMoraes et al. [65] | \n
Mean concentrations of total phosphorus (TP) and flow in water (inlet and outlet) and the load produced per day in different systems of animal production.
Mercante et al. [38] concluded that a constant renewal of water in the breeding bay is necessary to avoid the toxic effects in bullfrogs. However, it can promote higher nutrient loads. In order to improve the effluent quality and to reduce the nutrient load, in addition to effluent treatment, management options such as (a) flow maintenance and density reduction of animals and (b) maintain flow and density storage with better control of food supply, quality, and digestibility are proposed.
\nEffluent treatment systems generated in aquaculture farms can be deployed using wetlands constructed to remove nutrients and improve water quality [66]. The aquatic macrophytes that are used in biological treatment systems, such as constructed wetlands, function as a bio-filter, improving the environmental conditions of production nurseries [67].
\nThe constructed wetlands are tools used for the treatment of waste in aquaculture whose physical, chemical, and biological processes together with the local climatic conditions can improve the effluent quality [57, 68]. The importance of the implementation of these systems for the treatment of fish farming effluents in Brazil is due to the fact that many producers release water directly into natural streams and rivers [69], and the organic load exceeds its capacity of support and resilience [70].
\nThe disposal of the effluent in the soil together with the presence of microorganisms, aquatic macrophytes, and solar energy results in the production of biomass and chemical energy, removing the polluting load. This is a system artificially designed to use aquatic plants (macrophytes) on substrates (such as sand, soil, or gravel), where the occurrence of biofilms with diverse populations of microorganisms treats wastewater through biological, chemical, and physical processes [71].
\nThe conversion of ammoniacal nitrogen into wetlands is mainly due to two basic factors: the assimilatory process of microorganisms and macrophytes present in the systems and nitrification due to the transfer of oxygen from atmospheric air through the leaves of the macrophytes that through the aerenchyma permits the distribution of oxygen to the rhizomes and roots of plants [72].
\nThe phosphorus present in the wastewater is generally phosphate and its removal in wetlands is controlled by the biotic and abiotic processes. The removal occurs due to the use of phosphorus by plants, periphyton and microorganisms, sedimentation, adsorption, precipitation, and exchange processes between the substrate and the water layer that remain in the system [73].
\nAccording to Travaini-Lima and Sipaúba-Tavares [68], the removal of phosphate compounds is associated to the hydraulic flow of the system, retention time, and the macrophyte species used, and species such as Cyperus giganteus, Typha domingensis, and Eichhornia crassipes are resistant and highly effective plants for subtropical regions. Sipaúba-Tavares and Boyd [74] verified that the wetland installed in an aquaculture farm containing only the aquatic plant E. crassipes presented efficiency in the removal of nitrogenous and phosphate compounds, improving the water quality of the effluent and also confirming that the system of biofiltration can be applied in shallow water channels.
\nThe reduction of thermotolerant and total coliforms occurs due to the combination of physical, chemical, and biological factors. Physical factors include filtration through the plants, biofilm fixation on the substrate and on the macrophytes, and sedimentation. The chemical factors involve oxidation, biocidal effect resulting from the material excreted by some macrophytes, and adsorption of the organic matter. The biological mechanism includes production and effusion of chemical substances in the environment, which prevent the development of other organisms (antibiosis) and predation by nematodes and parasites, bacterial lysis, and inactivation [75].
\nEffluent treatment in aquaculture is one of the main factors in systems for breeding aquatic organisms that improve the water quality, avoiding or minimizing eutrophication in the receiving body. In addition, it is important to note that the use of nitrogen and phosphorus as a source of nitrogen and phosphorus in the aquatic ecosystem is a very important factor.
\nThe importance of using biofiltration in aquaculture in different locations around the world is to ensure the development of this enterprise. The production of aquatic organisms varies from country to country, directly influenced by climatic and edaphic factors, as well as the population habit of each site. The incorporation of effluent treatment mechanisms of aquatic organism breeding systems depends on the economic conditions of the enterprise, the degree of pollution of the effluent, the cultivated species, and the ecological management employed [76].
\nTechnology transfer should be stimulated toward the use of water or even in the treatment systems for the production of aquatic organisms, as a way of minimizing the impacts caused by aquaculture, being located and identifiable as possibilities of techniques for the mitigation of waste [77].
\nIntegrated management of the system for the establishment of built wetlands and organisms results in significant productive and environmental gains. The cost of constructing the wetland system is similar to the cost of building stabilization ponds. The advantage of using wetland is the quality of the effluent, which can be used in crop irrigation, and the macrophytes can be used as material for green fertilization in agriculture, since they contain the nutrients withdrawn from the water stored in their biomass [78].
\nRaniculture or frog culture, as well as any other aquaculture practice, requires a large volume of water and produces effluent with high organic load and can be a significant source of local environmental impact. The main characteristics of this type of effluent are the high concentrations of dissolved nutrients, mainly ammonia and phosphorus, high electrical conductivity, and low dissolved oxygen concentration, as compared to effluents from other aquaculture practices [45].
\nDue to the need to treat the effluent from aquaculture practices, the use of “wetlands” constructed in a growing way in the country has been studied to minimize the impacts produced by these aquatic organisms [63, 66, 68, 69]. The aquatic plants extract or take out nutrients and other substances from the surrounding water which are necessary for their development, besides requiring low capital, low operating cost and versatility in the removal mechanism than conventional treatments. Sipaúba-Tavares and Braga [69] are also important in the removal of nitrogen, phosphorus, biochemical oxygen demand, thermotolerant solids, and coliforms [79].
\nStudies on the treatment of raniculture effluents are still scarce, and however, the aim of the wetlands is to avoid the degradation of the water quality of receiving reservoirs. Keeping this in view, Borges and Sipaúba-Tavares [80] constructed a wetland for the treatment of effluent from bullfrog breeding and evaluated the efficiency of removal of nutrients and thermotolerant coliforms in two phases of the fattening period (post metamorphosis). The total area and volume of the “wetland” were 14.2 m2 and 2.2 m3, respectively. It was 23 m long and composed of three boxes, the first with 0.51 m3, the second 0.72 m3, and the third 0.93 m3, connected by channels with surface water flow, according to Figure 1. The first box was used only for sedimentation of solid residues, the second one filled with Eichhornia crassipes, and the third with Typha domingensis and Cyperus giganteus planted at the density of 5 m2 plants (Figure 1).
\nLayout of the wetland constructed in the frog breeding sector of the aquaculture center located at the State University of São Paulo (UNESP), Jaboticabal, SP, Brazil. I = entry point where the wastewater of the bullfrog production system entered the built marsh; O = the exit point where treated wastewater left the constructed wetland entering directly into a fish pond, adapted of Borges and Sipaúba-Tavares [80].
In the study by Borges and Sipaúba-Tavares [80], water harvesting occurred in two distinct phases, phase I corresponded to the period of highest stock biomass (IF) between July and October 2012, when the animals weighed on average 276 g and the other in phase II (FII) between December 2012 and March 2013, where the animals weighed on average 29 g. The total biomass of animals in the bays in phase I was 351 kg and in phase II 218 kg.
\nBorges and Sipaúba-Tavares [80] found the following values for phase I: limnological variables such as pH and dissolved oxygen (DO) were higher (p < 0.05) at the exit and turbidity, and NO3, NO2, total suspend solids (TSS), and thermotolerant coliforms (TC) were higher (p < 0.05) at the entrance to the wetland (Table 1). In phase II, the values of the limnological variables such as turbidity, NO2, NO3, SST, and TC were higher (p < 0.05) at the entrance and DO and NH3 were higher (p < 0.05) at the wetland exit (Table 1). In both phases, it was possible to observe an increase of DO in the water leaving the wetland in relation to the input water (Table 5).
\nVariables | \nPhase I | \nPhase II | \n||
---|---|---|---|---|
Entrance | \nExit | \nEntrance | \nExit | \n|
Temperature (°C) | \n28.0 ± 1.0 | \n27.3 ± 1.0 | \n27.9 ± 0.9 | \n26.4 ± 0.9 | \n
pH | \n7.1 ± 0 | \n7.3 ± 0.1 | \n6.7 ± 0.3 | \n6.9 ± 0.3 | \n
EC (μS cm−1) | \n182.9 ± 22.0 | \n181.7 ± 19.9 | \n162.6 ± 3.6 | \n169.0 ± 5.4 | \n
Turbidity (NTU) | \n5.8 ± 1.6 | \n2.9 ± 2.4 | \n8.2 ± 3.4 | \n2.3 ± 0.9 | \n
Alkalinity (mg L−1) | \n104.0 ± 2.3 | \n108.4 ± 2.9 | \n103.5 ± 1.6 | \n104.9 ± 2.8 | \n
DO (mg L−1) | \n1.9 ± 0.3 | \n2.6 ± 0.2 | \n1.6 ± 0.4 | \n2.9 ± 0.6 | \n
NO3 (μg L−1) | \n82.7 ± 45.7 | \n37.2 ± 14.4 | \n81.8 ± 12.6 | \n22.9 ± 18.5 | \n
NO2 (μg L−1) | \n9.4 ± 3.6 | \n5.3 ± 1.0 | \n19.7 ± 3.1 | \n11.6 ± 5.0 | \n
NH3 (μg L−1) | \n2.785 ± 1.219.6 | \n3.590 ± 955.9 | \n1.388 ± 217.2 | \n1.863 ± 164.9 | \n
PO4 (μg L−1) | \n271.1 ± 132.6 | \n309.9 ± 94.9 | \n242.1 ± 52.2 | \n265.4 ± 24.6 | \n
TP (μg L−1) | \n570.5 ± 285.5 | \n480.4 ± 192.9 | \n361.5 ± 102.2 | \n283.4 ± 61.3 | \n
TSS (mg L−1) | \n21.0 ± 12.3 | \n7.6 ± 6.8 | \n9.0 ± 7.0 | \n1.0 ± 0.8 | \n
STD (mg L−1) | \n135.7 ± 23.1 | \n153.2 ± 31.7 | \n194.5 ± 70.4 | \n111.4 ± 9.5 | \n
BOD (mg L−1) | \n76.5 ± 13.6 | \n71.6 ± 18.7 | \n93.0 ± 3.8 | \n85.6 ± 7.8 | \n
TC (NMP.100 m L−1) | \n50.750 ± 32.623 | \n3.475 ± 2.284 | \n25.250 ± 16.257 | \n3.325 ± 1.362 | \n
Chlorophyll a (μg L−1) | \n4.5 ± 3.7 | \n6.0 ± 4.8 | \n7.2 ± 5.2 | \n5.1 ± 3.4 | \n
Mean, minimum, maximum, and standard deviation for the limnological variables of the water entering and exiting the wetland in phases I and II.
EC, Electrical conductivity; DO, Dissolved oxygen; NO3, Nitrate; NH3, Nitrite; PO4, Orthophosphate; TP, Total phosphorus; TSS, Total suspended solids; TSD, Total solids dissolved; BOD, Biochemical oxygen demand; TC, Thermotolerant coliforms.
In phase I, the highest values of NH3, PT, SST, and TC occurred at the entrance of the wetland, and in phase II, the highest values of NO2, total solids dissolved (TSD), biochemical oxygen demand (BOD), and chlorophyll occurred. NO2 was approximately twice as high at the water inlet in the wetland of stage II, and NH3 and STS were also higher at the entrance in phase I (Table 5).
\nThe authors concluded that there was a significant improvement in the quality of waste water of the bullfrog production system. Therefore, the treatment used was adequate and could be used in commercial farms, with only a few adjustments being made to improve the efficiency of nutrient removal.
\nRaniculture like other aquaculture practices is facing problems that affect the water regime, impacting natural water sources and directly water quality, which are responsible for the successful breeding and production systems. Although there are few studies on water quality in raniculture, aquaculture has already a number of studies but still there is a lack of understanding of how these ecosystems actually function and interact with biotic and abiotic factors. Any sudden disturbance rapidly changes the water quality and consequently causing certain damages to the commercially important species. Thus, future studies should focus on the point to explain how different aquaculture systems function and how they interact with biotic and abiotic factors. These practices may provide excellent information to establish successful aquaculture systems with favorable environmental influences.
\nWe thank the Brazil University (Univ. Brasil) for financial support.
\nRegarding addictions of psychoactive substances, there are multiple definitions since it is a multifactorial phenomenon ranging from the moment of the vital development in which the subject is, in which the gender influences the process of addition, both physically and socially, up to the pattern of consumption, the type of substance ingested, the route of administration, among others. However, one of the main characteristics of addiction is that it generates changes at a functional level in the brain by altering the reward and self-control systems [1]. According to the World Health Organization the addiction is a physical and psycho-emotional disease, related to a set of signs and symptoms, in which biological, genetic, psychological and social factors are compromised [2]. Considering that over the years new substances producing greater damage to consumers’ health [3] have emerged, the WHO has made changes to the classification of substance abuse disorders, in order to improve the prevention and treatment of these problems, these modifications will be reflected in the CIE-11, which is expected to take effect in January 2022. So far, one of the effective models to follow in the intervention of addictions is the Harm Reduction to improve the quality of life of the substance abusers, with or without achieving abstinence, but improving physical and mental health [4].
\nInequality at a global level represents a social problem that influenced the phenomenon of drug abuse, which has experienced a serious growth, since only in a decade the number of people abusing drugs increased by 30% worldwide, from 2009 with 210 million people to 2019 with 271 million consumers of psychoactive substances, representing 5.5% of the population between 15 and 64 years of age, of which 17 million abusers suffer from infectious diseases such as HIV/AIDS, Tuberculosis and Hepatitis C; in the latter, the main cause was the increase of “opioids” consumers, with approximately 53.4 million people consuming it worldwide, being the main responsible for the majority of the 585,000 deaths; in addition of the lost years of healthy life due to disabilities entitled to drug abuse, with about 42 million years of healthy life [5] (Cited [6]). Besides, an alarming fact are respiratory diseases, cardiovascular pathologies, as well as cancer associated with drug abuse, without undermining of deaths due to injected drugs overdose, with a higher risk of suicide, in addition to psychiatric comorbidities; being a focus of attention for health systems in the world since only 1 in 6 drug abusers receives medical treatment [7].
\nIn America, the consumption of abused substances is not less alarming, considering that the start of the consumption of any psychoactive substance, including alcohol and tobacco, starts during high school and it is decreasing even further. An important fact in the continent is the systematic decrease shown by the use of tobacco over time, probably due to the creation of the WHO Framework Convention on Tobacco Control arising from the need to combat this pandemic in 2003 [8] and having a positive impact on the legislation of its use worldwide. In the America continent, tobacco shows decreases in its use in most of the countries monitoring it, as is the case in Chile, even with the highest level, going from 44 to 33.4% from 2000 to 2016 in the consumption of the last month; but in terms of alcohol consumption, there is a decrease in consumers but those that exist are taking more and more [9]; in the case of illegal drugs, trends in use are increasing, especially cannabis and cocaine. These increases in consumption have also been identified in other substances, such as new psychoactive substances (NPS), opioids and benzodiazepines, which produce new challenges for the treatment of patients with dependency, for public health and drug policies in general [10].
\nIn Mexico, poppy cultivation had a 21% increase from 2016 to 2017, keeping the country in third place worldwide in its production [6], mainly in the “Golden Triangle” formed by Sonora, Durango and Chihuahua, north of Nayarit and the state of Guerrero, which responds to the socioeconomic situation of poverty in the population [7]. Our country has become the main distributor of the United States of America with 86% of the total of this drug [11].
\nAccording to the National Survey of Drug, Alcohol and Tobacco Consumption (ENCODAT) 2016–2017 [12], alcohol is the most consumed and 1.8 million people in the country already have dependence; while in the population from 12 to 65 years old, the excessive consumption of alcohol increased from 12.3% in 2011 to 19.8% in 2016.
\nTobacco is the second most consumed psychoactive substance; its prevalence in the population from 12 to 65 years old remained stable between 2011 and 2016 with 17 and 17.6%, respectively [12].
\nThe consumption of any illegal drug increased from 7.2% in 2011 to 9.9% in 2016, the preferred drugs abused at some time in life continue to be marijuana (8.6%) and cocaine (3.5%) [12]. The use of illicit drugs (marijuana, cocaine, heroin), substances of abuse (solvents and inhalants) and non-prescription drugs (stimulants, depressants), as well as new psychoactive substances, show a lower prevalence compared to tobacco and alcohol statistics. However, the seriousness of the matter is the severe damage they generate in the individual health, with implications for family members, the community and society in general, as it is associated with greater emphasis on insecurity and violence problems [13].
\nRegarding medical care, in the Report on the situation of drug abuse in Mexico and its comprehensive care 2019, from 2010 to 2017 of the 22,856 deaths directly related to drug abuse, the largest number with 21,920 are caused by the consumption of alcohol, this is the reason why it continues to be the main drug for which attention is requested in medical emergencies, followed by the consumption of cocaine, volatile solvents and marijuana. Among the diseases prior to admission due to medical emergency under the influence of a drug, the appearance of the following were mainly reported: musculoskeletal condition, alcoholic/substance psychosis, diabetes mellitus, gastritis, cirrhosis and hypertension. As relevant data in the last deaths register of 2017, in our country 2597 people died, of which the highest percentage of deaths were between 30 and 49 years of age [14] which are one of the most productive stages in the lives of human beings, reflecting the lack of effective educational activities and campaigns for the prevention and early and timely detection of conditions to guide consumers regarding these chronic degenerative non-communicable diseases (NCDs) that represent a serious problem for public health in Mexico. Only in 2016, two of the main health care institutions in our country, Instituto Mexicano del Seguro Social (IMSS) and Instituto de Servicio y Seguro Social de los Trabajadores del Estado (ISSSTE), together allocated 31.4% of their budget for the attention of diseases such as: diabetes, hypertension, renal impairment and cancer [15], being mainly those of greater demand, combined with the low budget that the Mexican health system has received and the lack of specialized coverage that prevents it from reaching poorer populations.
\nThe coverage in universal health is a worldwide problem. The burden of a disease is observed in disadvantaged groups resulting in disability at a very young age. The dynamics in the social hierarchy and the social flow of the disease are the bases on which the Social Determinants of Health (SDH) model is based, explaining the majority of inequalities in and between countries when directing interventions in the structural determinants and intermediates underlying health inequity: the former includes the political and economic context where social hierarchical patterns originate, modify and maintain within cultural norms and values; these determinants shape the health of the individuals based on their social position, gender, age, employment, race and ethnic group, income, and education; while the intermediate determinants are the means by which the structural determinants operate, allowing the exposure to conditions damaging the health of the subject such as: housing quality, physical work environment, social support networks, healthy lifestyles, genetic factors, social cohesion and the structure of the health system [16, 17].
\nIn Mexico, based on measurements carried out by the “Consejo Nacional de Evaluación de la Política de Desarrollo Social” (CONEVAL), some of the social determinants show that 52.4 million people are in poverty, which represents 41.9% in 2018 compared to 44.4% in 2008. On the other hand there are 9.3 million people in extreme poverty (7.4%) and 37.7 million vulnerable people due to social deprivations, whose main indicators of the total Mexican population include: educational lag (16.9%), access to health services (16.2%) access to social security (57.3%), access to food (20.4%), housing quality and spaces (11.1%) and access to basic housing services (19.8%) [18].
\nTherefore the social determinants describe addictions as a public health problem caused by the lack of a public health policy. The economic and basic education inequality, as structural determinants, hinder the development of all the physical and intellectual potential of people, since these would have to operate as protective factors in society; therefore, their absence affects and impacts directly on the intermediate determinants, which are distorted, when observed without a basic system in the health condition, in the family, culture and nutrition of the population to name the most important [19].
\nConsequently, addressing the risk factors fills the gaps that the traditional medical model has left in the search for the causes related to NCD and that will prevent its progress. The use of this concept has its importance and historical development in medicine with the improvement of techniques in the treatment of infectious diseases based on microbial theory, considering that humanity has gone through an epidemiological transition, in which the increase and appearing of non-communicable diseases, such as cardiovascular, cancer, chronic obstructive pulmonary disease and diabetes, cannot be treated as infectious diseases were treated, where there was a pathogen, because the causes of NCDs are multifactorial, among which the consumption of addictive substances, physical inactivity and deficit in eating behavior stand out [20].
\nConsidering that the causal relationship with the health condition is different for each consumer, it will be difficult to identify a specific factor for each one. However, it has been possible to find functional relationships in which the consumption pattern will be characterized in the one hand by the type of substance abused, and in the other hand in the chain of functional background in the case of structural determinants, understood as “those circumstances in which people are born, grow, live, work and grow old as a result of the distribution of money, power and resources that will depend on the public policies adopted” [21] will play an important role.
\nWithin each functional analysis of the behavior of drug abusers, they report in the background that the psychosocial determinants of addictions are in a cultural context that molds and shapes values in people, structuring their personality [22], which makes them more vulnerable to drug abuse in the short, medium or long term. The abuse of psychoactive substances operates as a positive reinforcement before situations that, after their consumption, are gratifying because allow avoiding such a displeasing situation for a moment [23], a feeling of relaxation due to excessive work hours, the attachment to consumers receiving support from the same when there is no affection in the family or the ease of consumption in recreational spaces such as bars, allows consumers to maintain unhealthy lifestyles [24].
\nThe use of addictive substances is a complex behavior. To begin understanding the different variables related, it is necessary to comprehend that people are acquiring different behaviors based on learning, whether they are transmitted verbally, or if the person observes the behavior and then executes it [25].
\nAs already mentioned, the etiology of the use of addictive substances is classified as multifactorial, because there is not only one factor determining an addictive behavior. But it can be confirmed that the main factors related to a substance abuse problem are usually environmental, psychological and genetic [7, 26]. Since the interaction between genes and the environment can cause the expression of genes to undergo some modification, i.e., the individual experience of consumers produces changes in genes, which in turn influence memory, cognition, emotions and behavior, it can lead to a psychiatric disorder [27]. Sometimes, these genetic changes are not reversible and, unfortunately, not only influence the person who uses addictive substances, but also can be inherited. Consequently, substance abuse decreases the quality of life of the current and future generations. Among the environmental factors that lead to epigenetic changes, the following stand out: prenatal and postnatal factors, such as malnutrition, drug abuse of the parents during pregnancy, abuse or stress [28]. To address the problem of substance abuse, the traditional medical model is insufficient to achieve adherence to treatment, because it only contemplates the biological factor. For that reason, it is relevant to focus the intervention towards a flexible treatment which adapts to the different factors influencing substance abuse. Interdisciplinary treatments have been reported to produce benefits to maintain or improve the quality of life of people with chronic degenerative diseases [29]. This style of treatment is characterized by relying on different areas of knowledge to improve or maintain effectively the health of people who consume addictive substances.
\nIt is important to note that addictions treatment, although predominantly of a psychological type, must be duly complemented by medical specialists who focus their action not only on the pharmacological treatment of the addiction, while also emphasizing the timely diagnosis of conditions as well as the reference - counter-reference of patients with conditions, associated with consumption, as this action will be decisive in the adherence that drug abusers will have to the medical treatment and which, in turn, will promote their decision of abstinence [30] (Figure 1).
\nMexico presents inequality between its population and the social determinants allow us to understand the consumption of psychoactive substances in the country [18, 19].
The definition based on the above, in which the strong relationship of the psychosocial determinants in addictions is observed, as well as some of the risk factors for medical and psychiatric comorbidities due to the use of addictive substances, becomes the implementation of treatments in the three levels of health care emergent; considering that entering in the topic of addictions is relatively new for health professionals, in addition to the fact that this interventions are not so simple, since treating an individual with addictions is carried out with marked parameters of preventive medicine and not only from the cure of the medical and psychiatric comorbidities that these consumptions cause. The treatment needs to be transdisciplinary and must include health protection, promotion and maintenance parameters, as well as the abstinence from substance abuse, since the user and abuse are committed in a multifactorial way.
\nDifferent treatments have been implemented in patients who have problems with the use of addictive substances. In the 60s, they were treated with psychological therapies with the aim of modifying behavior based on punishment. These patients have a high rate of remission that over time presented a relapse [31]. Interventions via telephone, online and self-help manuals are also effective but over the months the relapse rate was significant [32].
\nWith the advance of research and the development of psychology, programs were created that tried to improve treatments to increase adherence to treatment. To be able to work with the problem of additions it was done from the multidisciplinary, involving different areas of knowledge in such a way that adequate treatments will be provided to maintain or improve the quality of life of patients. The results are positive and supported by different investigations.
\nA Meta-analysis conducted by Schwartz [33] to a total of 416 clinical trials of different treatments for smokers and complemented by Becoña [34] recognizes the relevance of multimodal or multidisciplinary treatments to achieve abstinence, placing them as the most effective treatment. These results are supported by the work of Sanz et al. [35] who provided interdisciplinary treatment for people who use tobacco, granted psychological treatment, supported by nicotine replacement therapies, bupropion and other medical alternatives according to the patient’s characteristics. At the end of the treatment approximately 70% of the participants were in withdrawal.
\nIt is suggested that integrated care may provide long-term benefits in terms of medical and wellness outcomes 6 months after treatment, for example Sterling [36] reports that in several studies conducted by Drug and Alcohol Research Team (DART) integrated care in the treatment of people with consumption of alcohol and other drugs and with medical or psychiatric conditions have 69% withdrawal compared to 55%. In a systematic review by Savic [37], it indicates that one of the objectives of comprehensive care is to improve the quality of life, incorporating the harm reduction strategy to achieve success. On the other hand, within the important strategies for comprehensive care, staff training, training on alcohol and other drugs to doctors who have no attention to consumers is relevant, the reference to other instances for medical care is also indicated as An important strategy.
\nIf we examine the increase in the use of legal and illegal psychoactive substances during the last five decades, they have led us to the search for the best clinical practices, in which their user will benefit from treatment and rehabilitation schemes to find the “cure”; that it is not only when consumption is abandoned in hospitalizations since, sadly for our health institutions, all the efforts made in these schemes do not contemplate the approaches for medical and psychiatric comorbidities derived from consumption, reducing the effectiveness from the discharge of the substance abusers, believing that the clinical setting that led them to this will not be repeated. Most of the time, when users are facing their daily life associated with consumption they restart the intake of psychoactive substances, discarding that all professional efforts in clinical treatments are extinguished with their relapse.
\nThe World Drug Report [7] mentions the urgent need to redouble efforts in order to facilitate access to effective medical services, based on scientific evidence, in terms of prevention, treatment and care for people who consume psychoactive substances and desperately need them.
\nAn example of these measures can be identified in the need to accelerate the accessibility to Hepatitis C treatment, a disease whose harmful health consequences for “drug” users are much greater than those of HIV/AIDS. It is very important to frame that in the latter, the transmission of the virus was one of the main diseases that emerged as an epidemic in the early 1980s through injected drugs (opiates) and at the end there will be the exchange of syringes in consumers of heroin in Liverpool or the decriminalization of the personal dose (amount without being lethal or illegal) in Holland in 1976 [38]. When total abstinence is not met, it is important to considered that one of the fundamental basis is to reduce or avoid further damage [39] by decreasing morbidity-mortality and achieving family stability and the possibility of obtaining and keeping a job, family, besides to health, which is a priority [40].
\nMexico has also implemented projects for harm reduction, such as the Syringe Program, as well as Methadone substitution therapy in Ciudad Juárez and Tijuana, managed by Non Governmental Organizations [41], which support people with physiological dependencies to prevent them from sharing the same syringe and avoid more complications.
\nIn the context of demonstrating the benefits that can be obtained through multidisciplinary treatments, in which the aim is to achieve comprehensive health and improve the quality of life of the patients who consume any substance harmful to their health, which leads to non-communicable and infectious diseases also by the relationship of unhealthy behaviors. Harm Reduction is one element where it has been proven that it is not only about abstinence of substance abuse, it is also reducing the risks and damages associated to it.
\nDue to the relevance of the application of this strategy, we will now discern its meaning and scope in the current medicine. Reduction comes from the Latin reductio and means “action of returning something where or how it was.” Its lexical components are: the prefix re- (backwards); the word Damage (discomfort, pain, deterioration or injure) comes from the Latin damnum (condemnation, punishment) [42]. For purposes of having an understanding updated and focused on the objective of finding a definition expressing the subject under study regarding the chore of health professionals’ work within the intervention, we find that reduction is everything that implies reducing the measure of a factor with actions leading to the original state or closest to it.
\nIt should be mentioned that Harm Reduction differs from Risk Reduction, since the first is to avoid as much as possible the negative effects due to the use of substances, i.e., it pretends to reduce the harmful aspects that such practice may cause, promoting healthy and hygienic habits, so that the drug abusers will have an active participation in the event of consumption and their habits regarding such consumption. While the second term becomes an educational-health activity involving the problem regarding the consequences of drug abuse and the main population targeted is the one with no treatment related with its consumption [43].
\nThe program for the patient with alcohol consumption started in 1974 at the Hospital General de México and in 1982 with the first Anti-Smoking Clinic (CCT), the latter program, ahead of their age, carried out multidisciplinary protocols addressed to the prevention, early and timely detection of diseases consequence of tobacco consumption, where therapeutic adherence played a very important role for the rehabilitation of the patient, as well as health education programs that will allow users know from their addiction to nicotine to their physical illness, in addition to a whole range of activities that will allow them modify their thoughts, behaviors and emotions that surround the consumption of the substance, achieving through this model the reduction of the damages [30]. The research carried out at the General Hospital of Mexico in which it compares two therapeutic techniques: cognitive restructuring and health education; the cessation obtained with the first was 52% while the second was 56%, important results because they indicate that by only applying health education the person can reach the cessation of the use of psychoactive substances [44].
\nIn 2015 the treatment focused on all psychoactive substances, since the changes of the time were observed in the lifestyles of the population attending the anti-smoking clinic, because of which, from 2000 to 2010, 934 patients were studied demonstrating that 47% of users used more than one drug. Likewise, the inadequate processes were investigated in lifestyles where uncontrolled intake of soda and coffee was found between 64.1 and 68.4% [45] and sedentary life 61.8%. Other studies in this population also showed low level of assertiveness and social skills deficit [46]. Given these findings, the proposal is made through a holistic approach with the sum of the different medical specialties and subspecialties for the comorbidities by apparatus and system, as well as the psychological intervention, to abandon the different consumptions of psychoactive substances, widening their field of attention, monitoring the medical guidelines with therapeutic adherence, with a psychoeducational and active orientation in which it is intended to generate, strengthen and use the protective factors of each individual with therapies based on learning theories for the recovery of their physical and mental health and creating an intervention where the priority is still to reduce harm.
\nIn the anti-smoking and other addictive substances clinics, the objective is for medical personnel to resume their activity in adherence to treatment as a fundamental tool for their work versus psychologists who are involved in the recovery and compliance of the treatment of medical or psychiatric comorbidities and not only work with cessation. Since we can observe that intrinsically the most important were bad habits in lifestyles, the discipline in self-care is responsible for playing a good role in their health and their execution is responsible for not consuming substances. Thus, within Harm Reduction Intervention proposed in a comprehensive care model, adherence to treatment has an important weight in the recovery of the person with substance abuse.
\nAdherence to treatment allows patient to have greater control over chronic degenerative diseases. Commitment of patients, along with their motivation, is essential to continue such treatment, since it is relatively complex, prolonged and requires discipline, planning and adaptation to change. Chronic complications related to the use of psychoactive substances or drugs can be avoided or delayed if the person follows the instructions given by health specialists. The treatment that patients with dependence receive focuses on the modification of addictive behaviors but unfortunately poor adherence is a very common situation and the high dropout rate is one of the factors that generate the greatest concern in the consumption of drugs [47].
\nThe World Health Organization conducted an investigation to determine the level of adherence to treatment of people with chronic diseases living in developed countries. The results indicated that about only 50% of the people followed the indications and assumed that this deficiency would be greater in developing countries (such as Mexico) due to the scarcity of resources and inequities in access to medical care a fact still present nowadays [48].
\nThe WHO [48] considers the lack of adherence to treatments and its negative clinical and economic consequences a priority public health issue. It also considers that compliance with treatments will result in a reduction of the overall health budget, due to the reduction in the need for expensive interventions, such as frequent and prolonged hospitalizations, the unnecessary use of emergency services and costly intensive care services. If patients fail to have a good adherence, they will have great losses at a personal (physical and psychological), family and social level. In the United States, for example, poor adherence to taking the medication is related to 33–69% of hospitalizations [49]. An important point is that once again, the social determinants of health play an important role in allowing patients to adhere to their treatment, as well as on their socioeconomic status, public policies regarding social protection or the structure of the health system where they belong.
\nThere are different definitions of adherence to treatment, one of the definitions that has been most widely accepted and which the WHO resumed in 2003 is the one proposed by Haynes [50] who defines it as “the degree to which a patient’s behavior in relation to taking medications, following a diet or changing lifestyle habits, coincides with the instructions provided by the doctor or healthcare staff.” It can be said that there is adherence when patients collaborate and participate proactively and voluntarily with their treatment, promoting better health conditions, which go beyond passive compliance with the indications [51].
\nAdherence is influenced by several psychosocial factors, such as beliefs, attitudes, attributions, mental representation of the disease and social support [52, 53]. Adherence as a health behavior will be closely related to the general health values or motivation for health, it will also be modulated by the experimentation of risk or perceived vulnerability, the consideration of the severity of the disease and self-efficacy [54] (Figure 2).
\nThe treatment is directed towards the prevention of physical and psychiatric risk factors through a multidisciplinary intervention with the intervention of psychology, psychiatry and the different medical specialties [47].
For the consumers to change their lifestyle, they first need to modify their belief system, since this is an important modulating factor in compliance with medical and/or health recommendations. The person follows the indications based on the considerations of his/her personal beliefs and on the perception of the origin of his/her illness or the way he/she thinks he/she should face his/her health condition [55]. Patients have a representation of what a threat to their health means, their fears are concepts based on social learning in their relationships with others [56]. There are several sources that influence beliefs about their health: friends, family, media and information from other health professionals [57]. Patient beliefs regarding the treatment produce and maintain healthy behaviors. The specialist has to establish realistic expectations about the benefits patients will get when changing their lifestyle but take into consideration the time and effort required.
\nA strategic source of adherence to treatment is assertive communication, which occurs between the patient with addiction and the specialist. During the communication exercise presented during the first approaches, especially during the first interview, it is essential to identify the level of predisposition that the person has to modify his/her addictive behavior. This level is directly related to the degree of motivation of a patient, since it predicts whether consumption will remain the same or will change favorably [58]. To recognize and work on the motivation to change, the Transteoric Change Model and the Motivational Interview formulated by Prochaska and DiClemente [59] stand out in order to identify different levels of predisposition that a person can show -stages of change- when it is proposed to modify his/her addictive behavior [60]. Thus, favoring respect for the patient, his/her beliefs and scale of values, trying to stimulate his/her motivation and favor his/her positioning towards healthy habits, emphasizing his/her own point of view and his/her freedom to choose. Progressively increasing the willingness to change, becoming aware of the problem and developing the necessary strategies to overcome it, including the skills to overcome contingencies and relapse. To go through the process of motivation to change in a stable and constant way, promoting his/her level of self-efficacy and allowing him/her to have greater adherence. Besides, by emphasizing the discovery of his/her risk factors we will also work on protective factors, since both have a relevant role during the onset, development, maintenance and treatment of addictions [59].
\nIn order to globally address the consumption of psychoactive substances, the clinical history is the indispensable information tool that will establish the meeting point with precision and the scientific, ethical, technological criteria that will be included in it, through their participation in its preparation between the different health professionals [61]. The integration will generate a unique file resulting in comprehensive management and attention, which serves as an effective communication meeting point for the treatment and evolution of the disciplines that converge, as well as the homogenization of decision-making subsequent to the diagnosis established by the consumption of legal and illegal substances, and will influence with good practices on the diagnosis, treatment, rehabilitation, of the “drug” abusers and achieve healthy lifestyles, with the priority of enriching his/her quality of life, decreasing the risks, as well as motivating the user as far as possible to eradicate substance abuse through techniques for restructuring his/her beliefs, behaviors and emotions. Besides, the health professional will accept, in a more committed way, that the consumer may feel worried about his/her health even if he/she does not succeed or does not want to stop its consumption.
\nFinally, the first thing to conceive in the field of health, what we have been working on for decades, is to state that the harm reduction intervention focuses on the tertiary prevention framework, which is carried out once the problem has appeared and its objective is to avoid complications, reducing risks [62], transcending in the general improvement of patients (adherence to treatment/self-efficacy, self-care) and increasing their physical and psychological recovery by encouraging abstinence and preventing relapses; reaching an approach that achieves the integral health of the users with interdisciplinary interventions, reducing the cost and increasing the benefit for the hospital users and their families, as well as for the psychological institution, reducing the cost and increasing the benefit for the hospital users and their families as well as for the institution.
\nIntechOpen implements a robust policy to minimize and deal with instances of fraud or misconduct. As part of our general commitment to transparency and openness, and in order to maintain high scientific standards, we have a well-defined editorial policy regarding Retractions and Corrections.
",metaTitle:"Retraction and Correction Policy",metaDescription:"Retraction and Correction Policy",metaKeywords:null,canonicalURL:"/page/retraction-and-correction-policy",contentRaw:'[{"type":"htmlEditorComponent","content":"IntechOpen’s Retraction and Correction Policy has been developed in accordance with the Committee on Publication Ethics (COPE) publication guidelines relating to scientific misconduct and research ethics:
\\n\\n1. RETRACTIONS
\\n\\nA Retraction of a Chapter will be issued by the Academic Editor, either following an Author’s request to do so or when there is a 3rd party report of scientific misconduct. Upon receipt of a report by a 3rd party, the Academic Editor will investigate any allegations of scientific misconduct, working in cooperation with the Author(s) and their institution(s).
\\n\\nA formal Retraction will be issued when there is clear and conclusive evidence of any of the following:
\\n\\nPublishing of a Retraction Notice will adhere to the following guidelines:
\\n\\n1.2. REMOVALS AND CANCELLATIONS
\\n\\n2. STATEMENTS OF CONCERN
\\n\\nA Statement of Concern detailing alleged misconduct will be issued by the Academic Editor or publisher following a 3rd party report of scientific misconduct when:
\\n\\nIntechOpen believes that the number of occasions on which a Statement of Concern is issued will be very few in number. In all cases when such a decision has been taken by the Academic Editor the decision will be reviewed by another editor to whom the author can make representations.
\\n\\n3. CORRECTIONS
\\n\\nA Correction will be issued by the Academic Editor when:
\\n\\n3.1. ERRATUM
\\n\\nAn Erratum will be issued by the Academic Editor when it is determined that a mistake in a Chapter originates from the production process handled by the publisher.
\\n\\nA published Erratum will adhere to the Retraction Notice publishing guidelines outlined above.
\\n\\n3.2. CORRIGENDUM
\\n\\nA Corrigendum will be issued by the Academic Editor when it is determined that a mistake in a Chapter is a result of an Author’s miscalculation or oversight. A published Corrigendum will adhere to the Retraction Notice publishing guidelines outlined above.
\\n\\n4. FINAL REMARKS
\\n\\nIntechOpen wishes to emphasize that the final decision on whether a Retraction, Statement of Concern, or a Correction will be issued rests with the Academic Editor. The publisher is obliged to act upon any reports of scientific misconduct in its publications and to make a reasonable effort to facilitate any subsequent investigation of such claims.
\\n\\nIn the case of Retraction or removal of the Work, the publisher will be under no obligation to refund the APC.
\\n\\nThe general principles set out above apply to Retractions and Corrections issued in all IntechOpen publications.
\\n\\nAny suggestions or comments on this Policy are welcome and may be sent to permissions@intechopen.com.
\\n\\nPolicy last updated: 2017-09-11
\\n"}]'},components:[{type:"htmlEditorComponent",content:'IntechOpen’s Retraction and Correction Policy has been developed in accordance with the Committee on Publication Ethics (COPE) publication guidelines relating to scientific misconduct and research ethics:
\n\n1. RETRACTIONS
\n\nA Retraction of a Chapter will be issued by the Academic Editor, either following an Author’s request to do so or when there is a 3rd party report of scientific misconduct. Upon receipt of a report by a 3rd party, the Academic Editor will investigate any allegations of scientific misconduct, working in cooperation with the Author(s) and their institution(s).
\n\nA formal Retraction will be issued when there is clear and conclusive evidence of any of the following:
\n\nPublishing of a Retraction Notice will adhere to the following guidelines:
\n\n1.2. REMOVALS AND CANCELLATIONS
\n\n2. STATEMENTS OF CONCERN
\n\nA Statement of Concern detailing alleged misconduct will be issued by the Academic Editor or publisher following a 3rd party report of scientific misconduct when:
\n\nIntechOpen believes that the number of occasions on which a Statement of Concern is issued will be very few in number. In all cases when such a decision has been taken by the Academic Editor the decision will be reviewed by another editor to whom the author can make representations.
\n\n3. CORRECTIONS
\n\nA Correction will be issued by the Academic Editor when:
\n\n3.1. ERRATUM
\n\nAn Erratum will be issued by the Academic Editor when it is determined that a mistake in a Chapter originates from the production process handled by the publisher.
\n\nA published Erratum will adhere to the Retraction Notice publishing guidelines outlined above.
\n\n3.2. CORRIGENDUM
\n\nA Corrigendum will be issued by the Academic Editor when it is determined that a mistake in a Chapter is a result of an Author’s miscalculation or oversight. A published Corrigendum will adhere to the Retraction Notice publishing guidelines outlined above.
\n\n4. FINAL REMARKS
\n\nIntechOpen wishes to emphasize that the final decision on whether a Retraction, Statement of Concern, or a Correction will be issued rests with the Academic Editor. The publisher is obliged to act upon any reports of scientific misconduct in its publications and to make a reasonable effort to facilitate any subsequent investigation of such claims.
\n\nIn the case of Retraction or removal of the Work, the publisher will be under no obligation to refund the APC.
\n\nThe general principles set out above apply to Retractions and Corrections issued in all IntechOpen publications.
\n\nAny suggestions or comments on this Policy are welcome and may be sent to permissions@intechopen.com.
\n\nPolicy last updated: 2017-09-11
\n'}]},successStories:{items:[]},authorsAndEditors:{filterParams:{sort:"featured,name"},profiles:[{id:"105746",title:"Dr.",name:"A.W.M.M.",middleName:null,surname:"Koopman-van Gemert",slug:"a.w.m.m.-koopman-van-gemert",fullName:"A.W.M.M. Koopman-van Gemert",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/105746/images/5803_n.jpg",biography:"Dr. Anna Wilhelmina Margaretha Maria Koopman-van Gemert MD, PhD, became anaesthesiologist-intensivist from the Radboud University Nijmegen (the Netherlands) in 1987. She worked for a couple of years also as a blood bank director in Nijmegen and introduced in the Netherlands the Cell Saver and blood transfusion alternatives. She performed research in perioperative autotransfusion and obtained the degree of PhD in 1993 publishing Peri-operative autotransfusion by means of a blood cell separator.\nBlood transfusion had her special interest being the president of the Haemovigilance Chamber TRIP and performing several tasks in local and national blood bank and anticoagulant-blood transfusion guidelines committees. Currently, she is working as an associate professor and up till recently was the dean at the Albert Schweitzer Hospital Dordrecht. She performed (inter)national tasks as vice-president of the Concilium Anaesthesia and related committees. \nShe performed research in several fields, with over 100 publications in (inter)national journals and numerous papers on scientific conferences. \nShe received several awards and is a member of Honour of the Dutch Society of Anaesthesia.",institutionString:null,institution:{name:"Albert Schweitzer Hospital",country:{name:"Gabon"}}},{id:"83089",title:"Prof.",name:"Aaron",middleName:null,surname:"Ojule",slug:"aaron-ojule",fullName:"Aaron Ojule",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Port Harcourt",country:{name:"Nigeria"}}},{id:"295748",title:"Mr.",name:"Abayomi",middleName:null,surname:"Modupe",slug:"abayomi-modupe",fullName:"Abayomi Modupe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/no_image.jpg",biography:null,institutionString:null,institution:{name:"Landmark University",country:{name:"Nigeria"}}},{id:"94191",title:"Prof.",name:"Abbas",middleName:null,surname:"Moustafa",slug:"abbas-moustafa",fullName:"Abbas Moustafa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94191/images/96_n.jpg",biography:"Prof. Moustafa got his doctoral degree in earthquake engineering and structural safety from Indian Institute of Science in 2002. He is currently an associate professor at Department of Civil Engineering, Minia University, Egypt and the chairman of Department of Civil Engineering, High Institute of Engineering and Technology, Giza, Egypt. He is also a consultant engineer and head of structural group at Hamza Associates, Giza, Egypt. Dr. Moustafa was a senior research associate at Vanderbilt University and a JSPS fellow at Kyoto and Nagasaki Universities. He has more than 40 research papers published in international journals and conferences. He acts as an editorial board member and a reviewer for several regional and international journals. His research interest includes earthquake engineering, seismic design, nonlinear dynamics, random vibration, structural reliability, structural health monitoring and uncertainty modeling.",institutionString:null,institution:{name:"Minia University",country:{name:"Egypt"}}},{id:"84562",title:"Dr.",name:"Abbyssinia",middleName:null,surname:"Mushunje",slug:"abbyssinia-mushunje",fullName:"Abbyssinia Mushunje",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Fort Hare",country:{name:"South Africa"}}},{id:"202206",title:"Associate Prof.",name:"Abd Elmoniem",middleName:"Ahmed",surname:"Elzain",slug:"abd-elmoniem-elzain",fullName:"Abd Elmoniem Elzain",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Kassala University",country:{name:"Sudan"}}},{id:"98127",title:"Dr.",name:"Abdallah",middleName:null,surname:"Handoura",slug:"abdallah-handoura",fullName:"Abdallah Handoura",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"École Supérieure des Télécommunications",country:{name:"Morocco"}}},{id:"91404",title:"Prof.",name:"Abdecharif",middleName:null,surname:"Boumaza",slug:"abdecharif-boumaza",fullName:"Abdecharif Boumaza",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Abbès Laghrour University of Khenchela",country:{name:"Algeria"}}},{id:"105795",title:"Prof.",name:"Abdel Ghani",middleName:null,surname:"Aissaoui",slug:"abdel-ghani-aissaoui",fullName:"Abdel Ghani Aissaoui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/105795/images/system/105795.jpeg",biography:"Abdel Ghani AISSAOUI is a Full Professor of electrical engineering at University of Bechar (ALGERIA). He was born in 1969 in Naama, Algeria. He received his BS degree in 1993, the MS degree in 1997, the PhD degree in 2007 from the Electrical Engineering Institute of Djilali Liabes University of Sidi Bel Abbes (ALGERIA). He is an active member of IRECOM (Interaction Réseaux Electriques - COnvertisseurs Machines) Laboratory and IEEE senior member. He is an editor member for many international journals (IJET, RSE, MER, IJECE, etc.), he serves as a reviewer in international journals (IJAC, ECPS, COMPEL, etc.). He serves as member in technical committee (TPC) and reviewer in international conferences (CHUSER 2011, SHUSER 2012, PECON 2012, SAI 2013, SCSE2013, SDM2014, SEB2014, PEMC2014, PEAM2014, SEB (2014, 2015), ICRERA (2015, 2016, 2017, 2018,-2019), etc.). His current research interest includes power electronics, control of electrical machines, artificial intelligence and Renewable energies.",institutionString:"University of Béchar",institution:{name:"University of Béchar",country:{name:"Algeria"}}},{id:"99749",title:"Dr.",name:"Abdel Hafid",middleName:null,surname:"Essadki",slug:"abdel-hafid-essadki",fullName:"Abdel Hafid Essadki",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"École Nationale Supérieure de Technologie",country:{name:"Algeria"}}},{id:"101208",title:"Prof.",name:"Abdel Karim",middleName:"Mohamad",surname:"El Hemaly",slug:"abdel-karim-el-hemaly",fullName:"Abdel Karim El Hemaly",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/101208/images/733_n.jpg",biography:"OBGYN.net Editorial Advisor Urogynecology.\nAbdel Karim M. A. El-Hemaly, MRCOG, FRCS � Egypt.\n \nAbdel Karim M. A. El-Hemaly\nProfessor OB/GYN & Urogynecology\nFaculty of medicine, Al-Azhar University \nPersonal Information: \nMarried with two children\nWife: Professor Laila A. Moussa MD.\nSons: Mohamad A. M. El-Hemaly Jr. MD. Died March 25-2007\nMostafa A. M. El-Hemaly, Computer Scientist working at Microsoft Seatle, USA. \nQualifications: \n1.\tM.B.-Bch Cairo Univ. June 1963. \n2.\tDiploma Ob./Gyn. Cairo Univ. April 1966. \n3.\tDiploma Surgery Cairo Univ. Oct. 1966. \n4.\tMRCOG London Feb. 1975. \n5.\tF.R.C.S. Glasgow June 1976. \n6.\tPopulation Study Johns Hopkins 1981. \n7.\tGyn. Oncology Johns Hopkins 1983. \n8.\tAdvanced Laparoscopic Surgery, with Prof. Paulson, Alexandria, Virginia USA 1993. \nSocieties & Associations: \n1.\t Member of the Royal College of Ob./Gyn. London. \n2.\tFellow of the Royal College of Surgeons Glasgow UK. \n3.\tMember of the advisory board on urogyn. FIGO. \n4.\tMember of the New York Academy of Sciences. \n5.\tMember of the American Association for the Advancement of Science. \n6.\tFeatured in �Who is Who in the World� from the 16th edition to the 20th edition. \n7.\tFeatured in �Who is Who in Science and Engineering� in the 7th edition. \n8.\tMember of the Egyptian Fertility & Sterility Society. \n9.\tMember of the Egyptian Society of Ob./Gyn. \n10.\tMember of the Egyptian Society of Urogyn. \n\nScientific Publications & Communications:\n1- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Asim Kurjak, Ahmad G. Serour, Laila A. S. Mousa, Amr M. Zaied, Khalid Z. El Sheikha. \nImaging the Internal Urethral Sphincter and the Vagina in Normal Women and Women Suffering from Stress Urinary Incontinence and Vaginal Prolapse. Gynaecologia Et Perinatologia, Vol18, No 4; 169-286 October-December 2009.\n2- Abdel Karim M. El Hemaly*, Laila A. S. Mousa Ibrahim M. Kandil, Fatma S. El Sokkary, Ahmad G. Serour, Hossam Hussein.\nFecal Incontinence, A Novel Concept: The Role of the internal Anal sphincter (IAS) in defecation and fecal incontinence. Gynaecologia Et Perinatologia, Vol19, No 2; 79-85 April -June 2010.\n3- Abdel Karim M. El Hemaly*, Laila A. S. Mousa Ibrahim M. Kandil, Fatma S. El Sokkary, Ahmad G. Serour, Hossam Hussein.\nSurgical Treatment of Stress Urinary Incontinence, Fecal Incontinence and Vaginal Prolapse By A Novel Operation \n"Urethro-Ano-Vaginoplasty"\n Gynaecologia Et Perinatologia, Vol19, No 3; 129-188 July-September 2010.\n4- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Laila A. S. Mousa and Mohamad A.K.M.El Hemaly.\nUrethro-vaginoplasty, an innovated operation for the treatment of: Stress Urinary Incontinence (SUI), Detursor Overactivity (DO), Mixed Urinary Incontinence and Anterior Vaginal Wall Descent. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/ urethro-vaginoplasty_01\n\n5- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamed M. Radwan.\n Urethro-raphy a new technique for surgical management of Stress Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/\nnew-tech-urethro\n\n6- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamad A. Rizk, Nabil Abdel Maksoud H., Mohamad M. Radwan, Khalid Z. El Shieka, Mohamad A. K. M. El Hemaly, and Ahmad T. El Saban.\nUrethro-raphy The New Operation for the treatment of stress urinary incontinence, SUI, detrusor instability, DI, and mixed-type of urinary incontinence; short and long term results. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=urogyn/articles/\nurethroraphy-09280\n\n7-Abdel Karim M. El Hemaly, Ibrahim M Kandil, and Bahaa E. El Mohamady. Menopause, and Voiding troubles. \nhttp://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly03/el-hemaly03-ss\n\n8-El Hemaly AKMA, Mousa L.A. Micturition and Urinary\tContinence. Int J Gynecol Obstet 1996; 42: 291-2. \n\n9-Abdel Karim M. El Hemaly.\n Urinary incontinence in gynecology, a review article.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/abs-urinary_incotinence_gyn_ehemaly \n\n10-El Hemaly AKMA. Nocturnal Enuresis: Pathogenesis and Treatment. \nInt Urogynecol J Pelvic Floor Dysfunct 1998;9: 129-31.\n \n11-El Hemaly AKMA, Mousa L.A.E. Stress Urinary Incontinence, a New Concept. Eur J Obstet Gynecol Reprod Biol 1996; 68: 129-35. \n\n12- El Hemaly AKMA, Kandil I. M. Stress Urinary Incontinence SUI facts and fiction. Is SUI a puzzle?! http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly/el-hemaly-ss\n\n13-Abdel Karim El Hemaly, Nabil Abdel Maksoud, Laila A. Mousa, Ibrahim M. Kandil, Asem Anwar, M.A.K El Hemaly and Bahaa E. El Mohamady. \nEvidence based Facts on the Pathogenesis and Management of SUI. http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly02/el-hemaly02-ss\n\n14- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Mohamad A. Rizk and Mohamad A.K.M.El Hemaly.\n Urethro-plasty, a Novel Operation based on a New Concept, for the Treatment of Stress Urinary Incontinence, S.U.I., Detrusor Instability, D.I., and Mixed-type of Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/urethro-plasty_01\n\n15-Ibrahim M. Kandil, Abdel Karim M. El Hemaly, Mohamad M. Radwan: Ultrasonic Assessment of the Internal Urethral Sphincter in Stress Urinary Incontinence. The Internet Journal of Gynecology and Obstetrics. 2003. Volume 2 Number 1. \n\n\n16-Abdel Karim M. El Hemaly. Nocturnal Enureses: A Novel Concept on its pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecolgy/?page=articles/nocturnal_enuresis\n\n17- Abdel Karim M. El Hemaly. Nocturnal Enureses: An Update on the pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecology/?page=/ENHLIDH/PUBD/FEATURES/\nPresentations/ Nocturnal_Enuresis/nocturnal_enuresis\n\n18-Maternal Mortality in Egypt, a cry for help and attention. The Second International Conference of the African Society of Organization & Gestosis, 1998, 3rd Annual International Conference of Ob/Gyn Department � Sohag Faculty of Medicine University. Feb. 11-13. Luxor, Egypt. \n19-Postmenopausal Osteprosis. The 2nd annual conference of Health Insurance Organization on Family Planning and its role in primary health care. Zagaziz, Egypt, February 26-27, 1997, Center of Complementary Services for Maternity and childhood care. \n20-Laparoscopic Assisted vaginal hysterectomy. 10th International Annual Congress Modern Trends in Reproductive Techniques 23-24 March 1995. Alexandria, Egypt. \n21-Immunological Studies in Pre-eclamptic Toxaemia. Proceedings of 10th Annual Ain Shams Medical Congress. Cairo, Egypt, March 6-10, 1987. \n22-Socio-demographic factorse affecting acceptability of the long-acting contraceptive injections in a rural Egyptian community. Journal of Biosocial Science 29:305, 1987. \n23-Plasma fibronectin levels hypertension during pregnancy. The Journal of the Egypt. Soc. of Ob./Gyn. 13:1, 17-21, Jan. 1987. \n24-Effect of smoking on pregnancy. Journal of Egypt. Soc. of Ob./Gyn. 12:3, 111-121, Sept 1986. \n25-Socio-demographic aspects of nausea and vomiting in early pregnancy. Journal of the Egypt. Soc. of Ob./Gyn. 12:3, 35-42, Sept. 1986. \n26-Effect of intrapartum oxygen inhalation on maternofetal blood gases and pH. Journal of the Egypt. Soc. of Ob./Gyn. 12:3, 57-64, Sept. 1986. \n27-The effect of severe pre-eclampsia on serum transaminases. The Egypt. J. Med. Sci. 7(2): 479-485, 1986. \n28-A study of placental immunoreceptors in pre-eclampsia. The Egypt. J. Med. Sci. 7(2): 211-216, 1986. \n29-Serum human placental lactogen (hpl) in normal, toxaemic and diabetic pregnant women, during pregnancy and its relation to the outcome of pregnancy. Journal of the Egypt. Soc. of Ob./Gyn. 12:2, 11-23, May 1986. \n30-Pregnancy specific B1 Glycoprotein and free estriol in the serum of normal, toxaemic and diabetic pregnant women during pregnancy and after delivery. Journal of the Egypt. Soc. of Ob./Gyn. 12:1, 63-70, Jan. 1986. Also was accepted and presented at Xith World Congress of Gynecology and Obstetrics, Berlin (West), September 15-20, 1985. \n31-Pregnancy and labor in women over the age of forty years. Accepted and presented at Al-Azhar International Medical Conference, Cairo 28-31 Dec. 1985. \n32-Effect of Copper T intra-uterine device on cervico-vaginal flora. Int. J. Gynaecol. Obstet. 23:2, 153-156, April 1985. \n33-Factors affecting the occurrence of post-Caesarean section febrile morbidity. Population Sciences, 6, 139-149, 1985. \n34-Pre-eclamptic toxaemia and its relation to H.L.A. system. Population Sciences, 6, 131-139, 1985. \n35-The menstrual pattern and occurrence of pregnancy one year after discontinuation of Depo-medroxy progesterone acetate as a postpartum contraceptive. Population Sciences, 6, 105-111, 1985. \n36-The menstrual pattern and side effects of Depo-medroxy progesterone acetate as postpartum contraceptive. Population Sciences, 6, 97-105, 1985. \n37-Actinomyces in the vaginas of women with and without intrauterine contraceptive devices. Population Sciences, 6, 77-85, 1985. \n38-Comparative efficacy of ibuprofen and etamsylate in the treatment of I.U.D. menorrhagia. Population Sciences, 6, 63-77, 1985. \n39-Changes in cervical mucus copper and zinc in women using I.U.D.�s. Population Sciences, 6, 35-41, 1985. \n40-Histochemical study of the endometrium of infertile women. Egypt. J. Histol. 8(1) 63-66, 1985. \n41-Genital flora in pre- and post-menopausal women. Egypt. J. Med. Sci. 4(2), 165-172, 1983. \n42-Evaluation of the vaginal rugae and thickness in 8 different groups. Journal of the Egypt. Soc. of Ob./Gyn. 9:2, 101-114, May 1983. \n43-The effect of menopausal status and conjugated oestrogen therapy on serum cholesterol, triglycerides and electrophoretic lipoprotein patterns. Al-Azhar Medical Journal, 12:2, 113-119, April 1983. \n44-Laparoscopic ventrosuspension: A New Technique. Int. J. Gynaecol. Obstet., 20, 129-31, 1982. \n45-The laparoscope: A useful diagnostic tool in general surgery. Al-Azhar Medical Journal, 11:4, 397-401, Oct. 1982. \n46-The value of the laparoscope in the diagnosis of polycystic ovary. Al-Azhar Medical Journal, 11:2, 153-159, April 1982. \n47-An anaesthetic approach to the management of eclampsia. Ain Shams Medical Journal, accepted for publication 1981. \n48-Laparoscopy on patients with previous lower abdominal surgery. Fertility management edited by E. Osman and M. Wahba 1981. \n49-Heart diseases with pregnancy. Population Sciences, 11, 121-130, 1981. \n50-A study of the biosocial factors affecting perinatal mortality in an Egyptian maternity hospital. Population Sciences, 6, 71-90, 1981. \n51-Pregnancy Wastage. Journal of the Egypt. Soc. of Ob./Gyn. 11:3, 57-67, Sept. 1980. \n52-Analysis of maternal deaths in Egyptian maternity hospitals. Population Sciences, 1, 59-65, 1979. \nArticles published on OBGYN.net: \n1- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Laila A. S. Mousa and Mohamad A.K.M.El Hemaly.\nUrethro-vaginoplasty, an innovated operation for the treatment of: Stress Urinary Incontinence (SUI), Detursor Overactivity (DO), Mixed Urinary Incontinence and Anterior Vaginal Wall Descent. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/ urethro-vaginoplasty_01\n\n2- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamed M. Radwan.\n Urethro-raphy a new technique for surgical management of Stress Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/\nnew-tech-urethro\n\n3- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamad A. Rizk, Nabil Abdel Maksoud H., Mohamad M. Radwan, Khalid Z. El Shieka, Mohamad A. K. M. El Hemaly, and Ahmad T. El Saban.\nUrethro-raphy The New Operation for the treatment of stress urinary incontinence, SUI, detrusor instability, DI, and mixed-type of urinary incontinence; short and long term results. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=urogyn/articles/\nurethroraphy-09280\n\n4-Abdel Karim M. El Hemaly, Ibrahim M Kandil, and Bahaa E. El Mohamady. Menopause, and Voiding troubles. \nhttp://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly03/el-hemaly03-ss\n\n5-El Hemaly AKMA, Mousa L.A. Micturition and Urinary\tContinence. Int J Gynecol Obstet 1996; 42: 291-2. \n\n6-Abdel Karim M. El Hemaly.\n Urinary incontinence in gynecology, a review article.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/abs-urinary_incotinence_gyn_ehemaly \n\n7-El Hemaly AKMA. Nocturnal Enuresis: Pathogenesis and Treatment. \nInt Urogynecol J Pelvic Floor Dysfunct 1998;9: 129-31.\n \n8-El Hemaly AKMA, Mousa L.A.E. Stress Urinary Incontinence, a New Concept. Eur J Obstet Gynecol Reprod Biol 1996; 68: 129-35. \n\n9- El Hemaly AKMA, Kandil I. M. Stress Urinary Incontinence SUI facts and fiction. Is SUI a puzzle?! http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly/el-hemaly-ss\n\n10-Abdel Karim El Hemaly, Nabil Abdel Maksoud, Laila A. Mousa, Ibrahim M. Kandil, Asem Anwar, M.A.K El Hemaly and Bahaa E. El Mohamady. \nEvidence based Facts on the Pathogenesis and Management of SUI. http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly02/el-hemaly02-ss\n\n11- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Mohamad A. Rizk and Mohamad A.K.M.El Hemaly.\n Urethro-plasty, a Novel Operation based on a New Concept, for the Treatment of Stress Urinary Incontinence, S.U.I., Detrusor Instability, D.I., and Mixed-type of Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/urethro-plasty_01\n\n12-Ibrahim M. Kandil, Abdel Karim M. El Hemaly, Mohamad M. Radwan: Ultrasonic Assessment of the Internal Urethral Sphincter in Stress Urinary Incontinence. The Internet Journal of Gynecology and Obstetrics. 2003. Volume 2 Number 1. \n\n13-Abdel Karim M. El Hemaly. Nocturnal Enureses: A Novel Concept on its pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecolgy/?page=articles/nocturnal_enuresis\n\n14- Abdel Karim M. El Hemaly. 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