Differences in hemodynamic characteristics in women and men.
\\n\\n
IntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\\n\\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\\n\\nLaunching 2021
\\n\\nArtificial Intelligence, ISSN 2633-1403
\\n\\nVeterinary Medicine and Science, ISSN 2632-0517
\\n\\nBiochemistry, ISSN 2632-0983
\\n\\nBiomedical Engineering, ISSN 2631-5343
\\n\\nInfectious Diseases, ISSN 2631-6188
\\n\\nPhysiology (Coming Soon)
\\n\\nDentistry (Coming Soon)
\\n\\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\\n\\nNote: Edited in October 2021
\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/132"}},components:[{type:"htmlEditorComponent",content:'With the desire to make book publishing more relevant for the digital age and offer innovative Open Access publishing options, we are thrilled to announce the launch of our new publishing format: IntechOpen Book Series.
\n\nDesigned to cover fast-moving research fields in rapidly expanding areas, our Book Series feature a Topic structure allowing us to present the most relevant sub-disciplines. Book Series are headed by Series Editors, and a team of Topic Editors supported by international Editorial Board members. Topics are always open for submissions, with an Annual Volume published each calendar year.
\n\nAfter a robust peer-review process, accepted works are published quickly, thanks to Online First, ensuring research is made available to the scientific community without delay.
\n\nOur innovative Book Series format brings you:
\n\nIntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\n\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\n\nLaunching 2021
\n\nArtificial Intelligence, ISSN 2633-1403
\n\nVeterinary Medicine and Science, ISSN 2632-0517
\n\nBiochemistry, ISSN 2632-0983
\n\nBiomedical Engineering, ISSN 2631-5343
\n\nInfectious Diseases, ISSN 2631-6188
\n\nPhysiology (Coming Soon)
\n\nDentistry (Coming Soon)
\n\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\n\nNote: Edited in October 2021
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"9651",leadTitle:null,fullTitle:"Cereal Grains - Volume 1",title:"Cereal Grains",subtitle:"Volume 1",reviewType:"peer-reviewed",abstract:"Over the past 50 years, cereals such as maize, rice, wheat, sorghum, and barley have emerged as rapidly evolving crops because of new technologies and advances in agronomy, breeding, biotechnology, genetics, and so on. Population growth and climate change have led to new challenges, among which are feeding the growing global population and mitigating adverse effects on the environment. One way to deal with these issues is through sustainable cereal production. This book discusses ways to achieve sustainable production of cereals via agronomy, breeding, transcriptomics, proteomics, and metabolomics. Chapters review research, examine challenges, and present prospects in the field. This volume is an excellent resource for students, researchers, and scientists interested in and working in the area of sustainable crop production.",isbn:"978-1-83969-164-5",printIsbn:"978-1-83969-163-8",pdfIsbn:"978-1-83969-165-2",doi:"10.5772/intechopen.87454",price:119,priceEur:129,priceUsd:155,slug:"cereal-grains-volume-1",numberOfPages:244,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"918540a77975243ee748770aea1f4af2",bookSignature:"Aakash Kumar Goyal",publishedDate:"December 8th 2021",coverURL:"https://cdn.intechopen.com/books/images_new/9651.jpg",numberOfDownloads:3392,numberOfWosCitations:0,numberOfCrossrefCitations:4,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:13,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:17,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 21st 2020",dateEndSecondStepPublish:"December 4th 2020",dateEndThirdStepPublish:"February 2nd 2021",dateEndFourthStepPublish:"April 23rd 2021",dateEndFifthStepPublish:"June 22nd 2021",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"97604",title:"Dr.",name:"Aakash K.",middleName:null,surname:"Goyal",slug:"aakash-k.-goyal",fullName:"Aakash K. Goyal",profilePictureURL:"https://mts.intechopen.com/storage/users/97604/images/system/97604.jpg",biography:"Aakash Goyal graduated with a degree in Biology from Maharshi Dayanand Saraswati University (MDSU), Ajmer, in 1999. He obtained a master’s in Biotechnology with a specialization in Plant Biotechnology and Molecular Breeding from Guru Jambheshwar University of Science and Technology (GJUS&T), Hissar, in 2002, and a Ph.D. in Genetics and Plant Breeding with a specialization in Wheat Breeding from Chaudhary Charan Singh Universit (CCSU), Meerut, in 2007. After earning his Ph.D., Dr. Goyal completed a visiting fellowship with the Natural Sciences and Engineering Research Council of Canada (NSERC) and joined the wheat and triticale breeding program at Lethbridge Research Center, Agriculture and Agri Food Canada (AAFC), Lethbridge. In 2012, he received an honorable position of Wheat Breeder for Bayer Crop Science, Saskatoon, Canada. In 2014, he took a senior research scientist position with the International Center of Agriculture Research in Dry Areas (ICARDA). In 2017, he moved back to Canada and joined InnoTech Alberta as a Native Plant Research Scientist. Since November 2019 he has been working as an agriculture specialist with Palm Gardens, Inc. In July 2021, he joined RAYN Cultivation Inc., Edmonton, Alberta, Canada as Chief Executive Officer (CEO). Dr. Goyal has published ten books and fifty research papers, review articles, book chapters, and book reviews. He is also an elected fellow member of the International College of Nutrition (FICN) and Society of Applied Biotechnology (FSAB).",institutionString:"RAYN Cltivation Inc.",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"5",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"323",title:"Food and Nutrition",slug:"food-and-nutrition"}],chapters:[{id:"77391",title:"Current Scenario of Breeding Approaches in Rice",doi:"10.5772/intechopen.98744",slug:"current-scenario-of-breeding-approaches-in-rice",totalDownloads:186,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Rice is the predominant crop in India and is the staple food in eastern and southern Indian populations. One of the oldest grown crops is rice. The initial discovery of cytoplasmic male sterile (CMS) three-line system made it possible to produce hybrids that significantly increase rice yields compared to its inbred counterparts. Further genetic and molecular studies help elucidate the mechanisms involved in CMS male sterility. Additional CMS types were also discovered with similar genetic control from wild sources by interspecific hybridization. In India more than 1200 varieties were released for cultivation suitable different ecosystems and out of them 128 varieties have been contributed from NRRI, Cuttack. A list of these varieties are furnished below with their duration, grain type, yield potential, reaction to major disease and insects grain quality and tolerance to different adverse situations. Recent advances in molecular approaches used in modern rice breeding include molecular marker technology and marker-assisted selection (MAS); molecular mapping of genes and QTLs and production of hybrids and alien introgression lines (AILs). Genomic selection (GS) has been projected as alternative to conventional MAS. GS has huge potential to enhance breeding efficiency by increasing gain per selection per unit time. Due to the adaptation of semi dwarf high yielding varieties, combined with intensive input management practices, the country witnessed an impressive rice production growth in the post-independent period. Rice production was increased four times, productivity three times while the area increase was only one and half times during this period. The projected rice requirement by 2025, in order to keep up with increasing population, is about 130 m.t. The challenge of growing rice production is made more difficult by declining trends in HYV’s yields, decreasing and degrading natural resources such as land and water and a severe labour shortage.",signatures:"Suhel Mehandi, Anita Yadav, Ramanuj Maurya, Sudhakar Prasad Mishra, Syed Mohd. Quatadah, Nagmi Praveen and Namrata Dwivedi",downloadPdfUrl:"/chapter/pdf-download/77391",previewPdfUrl:"/chapter/pdf-preview/77391",authors:[{id:"275243",title:"Dr.",name:"Suhel",surname:"Mehandi",slug:"suhel-mehandi",fullName:"Suhel Mehandi"},{id:"275246",title:"Prof.",name:"Sudhakar",surname:"Prasad Mishra",slug:"sudhakar-prasad-mishra",fullName:"Sudhakar Prasad Mishra"},{id:"290295",title:"Dr.",name:"Syed",surname:"Mohd. Quatadah",slug:"syed-mohd.-quatadah",fullName:"Syed Mohd. Quatadah"},{id:"290728",title:"MSc.",name:"Nagmi",surname:"Praveen",slug:"nagmi-praveen",fullName:"Nagmi Praveen"},{id:"290731",title:"Dr.",name:"Namrata",surname:"Dwivedi",slug:"namrata-dwivedi",fullName:"Namrata Dwivedi"},{id:"354321",title:"Dr.",name:"Anita",surname:"Yadav",slug:"anita-yadav",fullName:"Anita Yadav"},{id:"354323",title:"Dr.",name:"Ramanuj",surname:"Maurya",slug:"ramanuj-maurya",fullName:"Ramanuj Maurya"}],corrections:null},{id:"76126",title:"Cereal Grains of Bangladesh – Present Status, Constraints and Prospects",doi:"10.5772/intechopen.97072",slug:"cereal-grains-of-bangladesh-present-status-constraints-and-prospects",totalDownloads:366,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:0,abstract:"The edible seeds or grains of the grass family Poaceae (conserved name Gramineae) is commonly known as cereals and are cultivated for the edible component, grain consisting of the germ (or an embryo), endosperm and bran. Bangladesh, predominantly an agrarian country, has a long tradition of cereal grains cultivation, consumption and conservation. Rice is the staple food for millions (of people) across the globe including Bangladesh. It occupies more than 96% of the land area under “Cereal Agriculture” in Bangladesh. Maize occupies the 2nd position both in acreage and production followed by wheat and other minor cereals viz. barley, sorghum and millets. In this chapter, the historical development and production scenario of different cereal crops and their present status, constraints, challenges and opportunities has been described and discussed. The information presented here would provide a clear inside of the “Cereal Agriculture of Bangladesh” to students, researchers, administrators, policymakers, and the common people as well.",signatures:"Abul Khayer Mohammad Golam Sarwar and Jiban Krishna Biswas",downloadPdfUrl:"/chapter/pdf-download/76126",previewPdfUrl:"/chapter/pdf-preview/76126",authors:[{id:"338439",title:"Prof.",name:"Abul Khayer Mohammad",surname:"Golam Sarwar",slug:"abul-khayer-mohammad-golam-sarwar",fullName:"Abul Khayer Mohammad Golam Sarwar"},{id:"341985",title:"Dr.",name:"Jiban Krishna",surname:"Biswas",slug:"jiban-krishna-biswas",fullName:"Jiban Krishna Biswas"}],corrections:null},{id:"77463",title:"Breeding Maize for Food and Nutritional Security",doi:"10.5772/intechopen.98741",slug:"breeding-maize-for-food-and-nutritional-security",totalDownloads:154,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Maize occupies an important position in the world economy, and serves as an important source of food and feed. Together with rice and wheat, it provides at least 30 percent of the food calories to more than 4.5 billion people in 94 developing countries. Maize production is constrained by a wide range of biotic and abiotic stresses that keep afflicting maize production and productivity causing serious yield losses which bring yield levels below the potential levels. New innovations and trends in the areas of genomics, bioinformatics, and phenomics are enabling breeders with innovative tools, resources and technologies to breed superior resilient cultivars having the ability to resist the vagaries of climate and insect pest attacks. Maize has high nutritional value but is deficient in two amino acids viz. Lysine and Tryptophan. The various micronutrients present in maize are not sufficient to meet the nutritive demands of consumers, however the development of maize hybrids and composites with modifying nutritive value have proven to be good to meet the demands of consumers. Quality protein maize (QPM) developed by breeders have higher concentrations of lysine and tryptophan as compared to normal maize. Genetic level improvement has resulted in significant genetic gain, leading to increase in maize yield mainly on farmer’s fields. Molecular tools when collaborated with conventional and traditional methodologies help in accelerating these improvement programs and are expected to enhance genetic gains and impact on marginal farmer’s field. Genomic tools enable genetic dissections of complex QTL traits and promote an understanding of the physiological basis of key agronomic and stress adaptive and resistance traits. Marker-aided selection and genome-wide selection schemes are being implemented to accelerate genetic gain relating to yield, resilience, and nutritional quality. Efforts are being done worldwide by plant breeders to develop hybrids and composites of maize with high nutritive value to feed the people in future.",signatures:"Ajaz A. Lone, Zahoor A. Dar, Audil Gull, Asima Gazal, Sabina Naseer, Mudasir H. Khan, Ashraf Ahangar and Asif M. Iqbal",downloadPdfUrl:"/chapter/pdf-download/77463",previewPdfUrl:"/chapter/pdf-preview/77463",authors:[{id:"208555",title:"Dr.",name:"Asima",surname:"Gazal",slug:"asima-gazal",fullName:"Asima Gazal"},{id:"208558",title:"Dr.",name:"Zahoor A.",surname:"Dar",slug:"zahoor-a.-dar",fullName:"Zahoor A. Dar"},{id:"208560",title:"Dr.",name:"Ajaz A.",surname:"Lone",slug:"ajaz-a.-lone",fullName:"Ajaz A. Lone"},{id:"306994",title:"Dr.",name:"Mudasir H.",surname:"Khan",slug:"mudasir-h.-khan",fullName:"Mudasir H. Khan"},{id:"345473",title:"Mr.",name:"Audil",surname:"Gul",slug:"audil-gul",fullName:"Audil Gul"},{id:"345485",title:"Dr.",name:"Sabina",surname:"Naseer",slug:"sabina-naseer",fullName:"Sabina Naseer"},{id:"345521",title:"Dr.",name:"Ashraf",surname:"Ahangar",slug:"ashraf-ahangar",fullName:"Ashraf Ahangar"},{id:"345522",title:"Dr.",name:"Asif M.",surname:"Iqbal",slug:"asif-m.-iqbal",fullName:"Asif M. Iqbal"}],corrections:null},{id:"77893",title:"Molecular and Transcriptional Regulation of Seed Development in Cereals: Present Status and Future Prospects",doi:"10.5772/intechopen.99318",slug:"molecular-and-transcriptional-regulation-of-seed-development-in-cereals-present-status-and-future-pr",totalDownloads:249,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Cereals are a rich source of vitamins, minerals, carbohydrates, fats, oils and protein, making them the world’s most important source of nutrition. The influence of rising global population, as well as the emergence and spread of disease, has the major impact on cereal production. To meet the demand, there is a pressing need to increase cereal production. Optimal seed development is a key agronomical trait that contributes to crop yield. The seed development and maturation is a complex process that includes not only embryo and endosperm development, but also accompanied by huge physiological, biochemical, metabolic, molecular and transcriptional changes. This chapter discusses the growth of cereal seed and highlights the novel biological insights, with a focus on transgenic and new molecular breeding, as well as biotechnological intervention strategies that have improved crop yield in two major cereal crops, primarily wheat and rice, over the last 21 years (2000–2021).",signatures:"Anuradha Singh, Jyotirmaya Mathan, Amit Yadav, Aakash K. Goyal and Ashok Chaudhury",downloadPdfUrl:"/chapter/pdf-download/77893",previewPdfUrl:"/chapter/pdf-preview/77893",authors:[{id:"97604",title:"Dr.",name:"Aakash K.",surname:"Goyal",slug:"aakash-k.-goyal",fullName:"Aakash K. Goyal"},{id:"25426",title:"Prof.",name:"Ashok",surname:"Chaudhury",slug:"ashok-chaudhury",fullName:"Ashok Chaudhury"},{id:"355878",title:"Dr.",name:"Anuradha",surname:"Singh",slug:"anuradha-singh",fullName:"Anuradha Singh"},{id:"355880",title:"Dr.",name:"Jyotirmaya",surname:"Mathan",slug:"jyotirmaya-mathan",fullName:"Jyotirmaya Mathan"},{id:"355881",title:"Dr.",name:"Amit",surname:"Yadav",slug:"amit-yadav",fullName:"Amit Yadav"}],corrections:null},{id:"75956",title:"Benefits of Barley Grain in Animal and Human Diets",doi:"10.5772/intechopen.97053",slug:"benefits-of-barley-grain-in-animal-and-human-diets",totalDownloads:412,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Barley (Hordeum vulgare L) is one of the major cereal grains grown in temperate countries and ranked globally as the fourth largest grain crop. Currently, it is produced in more than 100 countries around the world with a global production of approximatively 159 million tonnes and 51 million hectares in 2019. The production and value-added barley products impact breweries, food processors, feed mills, and livestock operations. Barley grain is used primarily as an energy and protein source in beef cattle diets and as a malt source for alcoholic beverages, especially in the beer industry. Also, barley is used in bread, soups, stews, and health products since the barley grain is rich in several health-boosting components. As such, barley is high in protein, fibre, vitamins and natural bioactive antioxidants such as phenolics and lipids. However the studies of bioactive and nutritional properties of barley and the utilization of the crop as a functional food in animal and human diet is still limited. The work herein provides a review covering world production, end-use and processing, nutritional attributes, and will advocate its potential as a functional food for animal and human health and its role in preventing some chronic diseases.",signatures:"Ana Badea and Champa Wijekoon",downloadPdfUrl:"/chapter/pdf-download/75956",previewPdfUrl:"/chapter/pdf-preview/75956",authors:[{id:"339736",title:"Dr.",name:"Ana",surname:"Badea",slug:"ana-badea",fullName:"Ana Badea"},{id:"339739",title:"Dr.",name:"Champa",surname:"Wijekoon",slug:"champa-wijekoon",fullName:"Champa Wijekoon"}],corrections:null},{id:"76657",title:"Cereal Grain: A Vehicle for Improved Healthy Living",doi:"10.5772/intechopen.97078",slug:"cereal-grain-a-vehicle-for-improved-healthy-living",totalDownloads:209,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The increasing population of the world, emergence, and prominence of diseases coupled with side effects of drugs has led to the search of non-toxic, healthy foods products. Cereal grains are a stable food consumed by a large population of the world, containing an array of nutritional and bioactive compounds such as dietary fiber, protein, carbohydrate, vitamins, minerals, β-glucan, lignans, phytosterol, phenolics among others. These compounds proffer beyond basic nutritional needs as they also provide health benefits on consumption such asantioxidants, antidiabetics, antihypertension, antihyperlipidemic/anti-cholesterol, antimicrobial and anticancer with no side effects. Cereal grains canbe processed into divers of food products, singly or as multigrain food products in other to increases the bioavailability of its nutrients or bioactive compounds. Its by-products can further be used to enriched human diets or serve as animal feeds. Hence, this review addresses the needs for more processing, value additions and consumption of cereal grain as a vehicle to improved healthy livings.",signatures:"Timilehin David Oluwajuyitan, Oseni Kadiri, Babawande Adeboye Origbemisoye, Oladapo Fisoye Fagbohun, Ruth Nkemjika Ukejeh, Oyekemi Popoola and Babatunde Olawoye",downloadPdfUrl:"/chapter/pdf-download/76657",previewPdfUrl:"/chapter/pdf-preview/76657",authors:[{id:"315621",title:"Dr.",name:"Oladapo Fisoye",surname:"Fagbohun",slug:"oladapo-fisoye-fagbohun",fullName:"Oladapo Fisoye Fagbohun"},{id:"336690",title:"Dr.",name:"Babatunde",surname:"Olawoye",slug:"babatunde-olawoye",fullName:"Babatunde Olawoye"},{id:"338084",title:"Dr.",name:"Oseni",surname:"Kadiri",slug:"oseni-kadiri",fullName:"Oseni Kadiri"},{id:"344834",title:"MSc.",name:"Timilehin David",surname:"Oluwajuyitan",slug:"timilehin-david-oluwajuyitan",fullName:"Timilehin David Oluwajuyitan"},{id:"346527",title:"Mr.",name:"Babawande",surname:"Origbemisoye",slug:"babawande-origbemisoye",fullName:"Babawande Origbemisoye"},{id:"346528",title:"Ms.",name:"Oyekemi",surname:"Popoola",slug:"oyekemi-popoola",fullName:"Oyekemi Popoola"},{id:"352183",title:"MSc.",name:"Ruth",surname:"Ukejeh",slug:"ruth-ukejeh",fullName:"Ruth Ukejeh"}],corrections:null},{id:"76189",title:"Millets Cereal Grains: Nutritional Composition and Utilisation in Sub-Saharan Africa",doi:"10.5772/intechopen.97272",slug:"millets-cereal-grains-nutritional-composition-and-utilisation-in-sub-saharan-africa",totalDownloads:237,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Millets are small to medium size cereal grain crops that are cultivated throughout the tropics and subtropical region. The grains are used for food and fodder for feeding animals around the globe. Millets have great economic, health importance, gluten-free, have low glycemic index and are known as “nutra–cereals”. The grains are mostly utilised as a food source by population with lower socio-economic factors which are traditional consumers in the farm and village levels. They are rich sources of carbohydrates, protein, crude fibre, phytochemicals, minerals, and vitamins. They are processed by using different traditional processes such as soaking, germination, malting, fermentation, milling or grinding, cooking, roasting and popping. Millet grains/ flours are utilised and consumed as flat breads, biscuits, snacks, beverages, porridges, chapati, dosa, pastas. There is a need to produce new value-added products from millets which is underutilised crop to improve food security and prevent micronutrients deficiencies.",signatures:"Shonisani Eugenia Ramashia, Mpho E. Mashau and Oluwatoyin O. Onipe",downloadPdfUrl:"/chapter/pdf-download/76189",previewPdfUrl:"/chapter/pdf-preview/76189",authors:[{id:"201858",title:"Mr.",name:"Mpho E.",surname:"Mashau",slug:"mpho-e.-mashau",fullName:"Mpho E. Mashau"},{id:"205968",title:"Dr.",name:"Oluwatoyin O.",surname:"Onipe",slug:"oluwatoyin-o.-onipe",fullName:"Oluwatoyin O. Onipe"},{id:"229973",title:"Ms.",name:"Shonisani Eugenia",surname:"Ramashia",slug:"shonisani-eugenia-ramashia",fullName:"Shonisani Eugenia Ramashia"}],corrections:null},{id:"75615",title:"Building Stress Resilience of Cereals under Future Climatic Scenarios: ‘The Case of Maize, Wheat, Rice and Sorghum’",doi:"10.5772/intechopen.96608",slug:"building-stress-resilience-of-cereals-under-future-climatic-scenarios-the-case-of-maize-wheat-rice-a",totalDownloads:356,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"World population is projected to reach 10 billion by 2050 and the phenomenon is expected to cause a surge in demand for food, feed and industrial raw materials. Cereals (i.e., carbohydrate-rich grain crops) are the most widely grown and consumed crops worldwide. All cereals combined provide approximately 56% and 50% of global energy and protein needs, respectively. Maize, wheat, rice, barley and sorghum are the most produced and consumed cereals, globally. These are widely grown across the world from the tropics to the temperate regions. Although efforts are being done by governments, research organizations and academic institutions to increase productivity of these important crops, huge yield deficits still exist. Climate induced biotic (e.g., pests and diseases) as well as abiotic stresses (especially; heat and drought) are widely regarded as the key yield-constraining factors of most cereal crops. Given the contribution of cereals in global food and nutrition security, improvements in productivity of cereal production systems is mandatory if livelihoods are to be guaranteed. This chapter discusses the global production and utilization of four of the major global cereals, limiting factors to their productivity and possible solutions to the production constraints.",signatures:"Clemence Muitire, Casper Kamutando and Martin Moyo",downloadPdfUrl:"/chapter/pdf-download/75615",previewPdfUrl:"/chapter/pdf-preview/75615",authors:[{id:"338393",title:"Dr.",name:"Casper",surname:"Nyaradzai Kamutando",slug:"casper-nyaradzai-kamutando",fullName:"Casper Nyaradzai Kamutando"},{id:"346259",title:"Mr.",name:"Clemence",surname:"Muitire",slug:"clemence-muitire",fullName:"Clemence Muitire"},{id:"346260",title:"Dr.",name:"Martin",surname:"Moyo",slug:"martin-moyo",fullName:"Martin Moyo"}],corrections:null},{id:"76264",title:"Management of False Smut Disease of Rice: A Review",doi:"10.5772/intechopen.97329",slug:"management-of-false-smut-disease-of-rice-a-review",totalDownloads:368,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Rice (Oryza sativa L.) is the most important food crop of the developing world. Among the biotic stresses of false smut is an emerging disease caused by Ustilaginoidea virens. The disease reduces both the quality and quantity of rice. The pathogen produces mycotoxins that are harmful to animals and humans. The disease is severe when favorable environmental conditions like high humidity (more than 80%) and temperature ranging from 25 to 30°C, late sowing and high soil fertility as well as using high amount of nitrogen. It has gained the status of a major disease of rice and causing varying yield loss depending on the weather conditions during the crop-growing period and the genotypes. Therefore, the primary concern of the farmers is the disease management methods, which are effective, simple and practical. Since, there is no single effective management strategy for false smut, we have discussed about the potential management options available depending upon the economic status and adoption capacity of the farmers. In the Plant Pathologists point of view, eco-friendly methods of disease management like cultural, biological and use of resistant variety should be advocated for sustainability of agriculture and human being.",signatures:"Mathew S. Baite, Mukesh K. Khokhar and Ram P. Meena",downloadPdfUrl:"/chapter/pdf-download/76264",previewPdfUrl:"/chapter/pdf-preview/76264",authors:[{id:"291843",title:"Dr.",name:"Mathew S.",surname:"Baite",slug:"mathew-s.-baite",fullName:"Mathew S. Baite"},{id:"304625",title:"Dr.",name:"Mukesh K.",surname:"Khokhar",slug:"mukesh-k.-khokhar",fullName:"Mukesh K. Khokhar"},{id:"356367",title:"Dr.",name:"Ram P.",surname:"Meena",slug:"ram-p.-meena",fullName:"Ram P. Meena"}],corrections:null},{id:"77601",title:"Etiology, Epidemiology and Management of Asian Soybean Rust (ASR) in Brazil and Vulnerability of Chemical Control of Specific without Multisite Fungicides",doi:"10.5772/intechopen.97686",slug:"etiology-epidemiology-and-management-of-asian-soybean-rust-asr-in-brazil-and-vulnerability-of-chemic",totalDownloads:254,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Brazil is the first soybean producer in the world, and the largest exporter. In the 2019/20 harvest, the country produced about 124.85 million tons, representing 30% of world production. Global soy production for 2019/20 reached 337.9 million tons. Asian soybean rust (ASR) is the most pathogen on soybean in Brazil in nowadays. Target spot and Septoria leaf spot plus white mold complete these scenarios. ASR emerged in Brazil in 1979. The use of fungicides in the soybean crop in Brazil intensified after the master of 2002 with the resurgence of soybean rust, where the use of triazoles intensified. The massive sprays to pathogen control reached 3.5 sprays per season. In 2006, the first reports of loss of sensitivity of the fungus to the group appeared, notably for the fungicide flutriafol and tebuconazole used in many situations in a curative way or to eradicate the fungus. From that moment on, the productive system sought to use triazoles and strobilurins. In 2011 came the first reports of loss of sensitivity of the fungus in the group of strobilurins. This fact was due to the use of pyraclostrobin in the vegetative phase of soybeans without protection by multisite. That same year, the introduction of the active ingredients in copper oxychloride, mancozeb and chlorothalonil took place in Brazil. In 2015, the first carboxamides ((benzovindiflupyr) (solatenol and fluxpyroxade) associated in triple mode with triazoles and strobilurins were launched on the Brazilian market. Due to the specific mode of action in the metabolism of the fungus (biosynthesis of ergosterol (triazoles), mitochondrial respiration in the cytochrome oxidase enzyme complex - QOIs (strobilurins) and succin dehydrogenase - SDHIs (carboxamides), the need for their association in the sprayings was seen. To multisite (cuprics, dithiocarbamates and nitriles). For the sustainable management of the disease in Brazil, control strategies are recommended, such as the use of systemic fungicides, with a specific biochemical mechanism of action with the adoption of tank mix with multisite, adoption of cultural practices (sanitary emptiness) and sowing schedule and the use of varieties with quantitative resistance (partial or horizontal resistance). These measures will guarantee the sustainability of the culture and the useful life of systemic fungicides or specific sites.",signatures:"Fernando Cezar Juliatti and Laércio Zambolim",downloadPdfUrl:"/chapter/pdf-download/77601",previewPdfUrl:"/chapter/pdf-preview/77601",authors:[{id:"146372",title:"Dr.",name:"Fernando",surname:"Cezar Juliatti",slug:"fernando-cezar-juliatti",fullName:"Fernando Cezar Juliatti"},{id:"344354",title:"Dr.",name:"Laércio",surname:"Zambolim",slug:"laercio-zambolim",fullName:"Laércio Zambolim"}],corrections:null},{id:"76438",title:"Barley Grain Development during Drought Stress: Current Status and Perspectives",doi:"10.5772/intechopen.97183",slug:"barley-grain-development-during-drought-stress-current-status-and-perspectives",totalDownloads:314,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Barley (Hordeum vulgare L.) belongs to small grain cereals that cover more than 78% of the daily calorie consumption of humans. With a prediction of 9.7 billion humans in 2050 (FAO stats) and climatic changes, the question of increasing small grain cereal’s production has become an agricultural challenge. Drought exerts a strong environmental pressure, causing large yield losses worldwide. Therefore, understanding the mechanisms responsible for grain development from the fertilization to the mature dry grain is essential to understand how drought can affect this developmental program. In this book chapter, we present the physiological, molecular and hormonal regulation of barley grain development. In a second part, we describe the consequences of drought at different stage of barley development, with a special focus on the reproductive phase. Finally, in the last part, we present the different methods used to decipher new genetic information related to drought-tolerance. All this knowledge contributes to understanding the tolerance mechanisms of barley and to developing breeding strategies aiming to bring about new varieties with sustained yield in harsh conditions.",signatures:"Mortaza Khodaeiaminjan and Véronique Bergougnoux",downloadPdfUrl:"/chapter/pdf-download/76438",previewPdfUrl:"/chapter/pdf-preview/76438",authors:[{id:"340789",title:"Dr.",name:"Véronique",surname:"Bergougnoux",slug:"veronique-bergougnoux",fullName:"Véronique Bergougnoux"},{id:"340793",title:"Dr.",name:"Mortaza",surname:"Khodaeiaminjan",slug:"mortaza-khodaeiaminjan",fullName:"Mortaza Khodaeiaminjan"}],corrections:null},{id:"77397",title:"Salinity Stress in Maize: Effects of Stress and Recent Developments of Tolerance for Improvement",doi:"10.5772/intechopen.98745",slug:"salinity-stress-in-maize-effects-of-stress-and-recent-developments-of-tolerance-for-improvement",totalDownloads:299,totalCrossrefCites:0,totalDimensionsCites:7,hasAltmetrics:0,abstract:"Soil salinity has emerged as a global threat to sustainability of farming systems by deteriorating the quality and productivity of crops particularly in the coastal regions of the world. Although, as a C4 plant, maize (Zea mays L.) has ability to tolerate a medium level of salinity; but initial growth stages of maize are sensitive to salinity stress. Therefore, it is crucial to expand our understanding pertaining to maize response to salt stress and tolerance mechanisms for devising approaches to enhance maize adaptability in saline environments. Moreover, maize crop undergoes several physiological changes and adapts some mechanism to overcome the salinity stress. Different mitigation strategies like application of chemicals, plant growth-promoting hormones, and use of genetic and molecular techniques are used to manage salinity and may ensure crop productivity under changing climate. This chapter aimed to assess the recent advancement pertaining to salinity stress influence on the physio-biochemical processes in maize and to draw the relationship between yield components and salinity stress. In addition, current study also highlights research gaps by focusing the seed enhancement techniques, phytohormones exogenous application and genetic improvement of maize under soil salinity.",signatures:"Ayman EL Sabagh, Fatih Çiğ, Seyithan Seydoşoğlu, Martin Leonardo Battaglia, Talha Javed, Muhammad Aamir Iqbal, Muhammad Mubeen, Musaddiq Ali, Mazhar Ali, Gülşah Bengisu, Ömer Konuşkan, Celaleddin Barutcular, Murat Erman, Semih Açikbaş, Akbar Hossain, Mohammad Sohidul Islam, Allah Wasaya, Disna Ratnasekera, Muhammad Arif, Zahoor Ahmad and Mahrous Awad",downloadPdfUrl:"/chapter/pdf-download/77397",previewPdfUrl:"/chapter/pdf-preview/77397",authors:[{id:"215584",title:"Dr.",name:"Ayman",surname:"EL Sabagh",slug:"ayman-el-sabagh",fullName:"Ayman EL Sabagh"},{id:"422991",title:"Dr.",name:"Fatih",surname:"Çiğ",slug:"fatih-cig",fullName:"Fatih Çiğ"},{id:"422992",title:"Dr.",name:"Seyithan",surname:"Seydoşoğlu",slug:"seyithan-seydosoglu",fullName:"Seyithan Seydoşoğlu"},{id:"422993",title:"Dr.",name:"Martin Leonardo",surname:"Battaglia",slug:"martin-leonardo-battaglia",fullName:"Martin Leonardo Battaglia"},{id:"422994",title:"Dr.",name:"Talha",surname:"Javed",slug:"talha-javed",fullName:"Talha Javed"},{id:"422995",title:"Dr.",name:"Muhammad Aamir",surname:"Iqbal",slug:"muhammad-aamir-iqbal",fullName:"Muhammad Aamir Iqbal"},{id:"422996",title:"Dr.",name:"Muhammad",surname:"Mubeen",slug:"muhammad-mubeen",fullName:"Muhammad Mubeen"},{id:"422997",title:"Dr.",name:"Musaddiq",surname:"Ali",slug:"musaddiq-ali",fullName:"Musaddiq Ali"},{id:"422998",title:"Dr.",name:"Mazhar",surname:"Ali",slug:"mazhar-ali",fullName:"Mazhar Ali"},{id:"422999",title:"Dr.",name:"Gülşah",surname:"Bengisu",slug:"gulsah-bengisu",fullName:"Gülşah Bengisu"},{id:"423000",title:"Dr.",name:"Ömer",surname:"Konuşkan",slug:"omer-konuskan",fullName:"Ömer Konuşkan"},{id:"423001",title:"Dr.",name:"Celaleddin",surname:"Barutcular",slug:"celaleddin-barutcular",fullName:"Celaleddin Barutcular"},{id:"423002",title:"Dr.",name:"Murat",surname:"erman",slug:"murat-erman",fullName:"Murat erman"},{id:"423003",title:"Dr.",name:"Semih",surname:"Açikbaş",slug:"semih-acikbas",fullName:"Semih Açikbaş"},{id:"423004",title:"Dr.",name:"Akbar",surname:"Hossain",slug:"akbar-hossain",fullName:"Akbar Hossain"},{id:"423005",title:"Dr.",name:"M Sohidul",surname:"Islam",slug:"m-sohidul-islam",fullName:"M Sohidul Islam"},{id:"423006",title:"Dr.",name:"Allah",surname:"Wasaya",slug:"allah-wasaya",fullName:"Allah Wasaya"},{id:"423007",title:"Dr.",name:"Disna",surname:"Ratnasekera",slug:"disna-ratnasekera",fullName:"Disna Ratnasekera"},{id:"423008",title:"Dr.",name:"Muhammad",surname:"Arif",slug:"muhammad-arif",fullName:"Muhammad Arif"},{id:"423009",title:"Dr.",name:"Zahoor",surname:"Ahmad",slug:"zahoor-ahmad",fullName:"Zahoor Ahmad"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"596",title:"Crop Plant",subtitle:null,isOpenForSubmission:!1,hash:"8f6c77633a473d10f044598b3768e23f",slug:"crop-plant",bookSignature:"Aakash Goyal",coverURL:"https://cdn.intechopen.com/books/images_new/596.jpg",editedByType:"Edited by",editors:[{id:"97604",title:"Dr.",name:"Aakash K.",surname:"Goyal",slug:"aakash-k.-goyal",fullName:"Aakash K. 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Frank",dateSubmitted:"September 1st 2021",dateReviewed:"September 8th 2021",datePrePublished:"October 15th 2021",datePublished:"April 20th 2022",book:{id:"11032",title:"Bats",subtitle:"Disease-Prone but Beneficial",fullTitle:"Bats - Disease-Prone but Beneficial",slug:"bats-disease-prone-but-beneficial",publishedDate:"April 20th 2022",bookSignature:"Heimo Mikkola",coverURL:"https://cdn.intechopen.com/books/images_new/11032.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"144330",title:"Dr.",name:"Heimo",middleName:"Juhani",surname:"Mikkola",slug:"heimo-mikkola",fullName:"Heimo Mikkola"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"423579",title:"Dr.",name:"Craig L.",middleName:"L.",surname:"Frank",fullName:"Craig L. Frank",slug:"craig-l.-frank",email:"frank@fordham.edu",position:null,institution:{name:"Fordham University",institutionURL:null,country:{name:"United States of America"}}}]}},chapter:{id:"78750",slug:"the-physiological-ecology-of-white-nose-syndrome-wns-in-north-american-bats",signatures:"Craig L. 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Frank",slug:"craig-l.-frank",email:"frank@fordham.edu",position:null,institution:{name:"Fordham University",institutionURL:null,country:{name:"United States of America"}}}]},book:{id:"11032",title:"Bats",subtitle:"Disease-Prone but Beneficial",fullTitle:"Bats - Disease-Prone but Beneficial",slug:"bats-disease-prone-but-beneficial",publishedDate:"April 20th 2022",bookSignature:"Heimo Mikkola",coverURL:"https://cdn.intechopen.com/books/images_new/11032.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"144330",title:"Dr.",name:"Heimo",middleName:"Juhani",surname:"Mikkola",slug:"heimo-mikkola",fullName:"Heimo Mikkola"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},ofsBook:{item:{type:"book",id:"11848",leadTitle:null,title:"Immunosuppression and Immunomodulation",subtitle:null,reviewType:"peer-reviewed",abstract:"\r\n\tImmunosuppression and immunomodulation are two different but related terms. Immunosuppression is the suppression of the immune system, and immunomodulation is the alteration of the immune response, which may be due to various infections or chemical exposures. These are health problems that are also induced by using various drugs and chemicals to treat immune system-related health complications. This book will cover various aspects, merits, and demerits of immunosuppression and immunomodulation. Natural and synthetic agents will also be discussed. Immunosuppression and immunomodulation are used for various disease treatments and therapies; therefore, we hope to throw light on the methods and drugs used in different diseases such as cancer, rheumatoid arthritis, and organ transplantation. The role of immunomodulation/immunosuppression in organ transplantation plays an important role, and this too shall be addressed. Overall, this book hopes to provide all the necessary and appropriate information for the practical use of the readers.
",isbn:"978-1-83768-072-6",printIsbn:"978-1-83768-071-9",pdfIsbn:"978-1-83768-073-3",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"ed8e45c9b1a36b2e913208c4d37dbc7f",bookSignature:"Dr. Rajeev K. Tyagi, Dr. Prakriti Sharma and Dr. Praveen Sharma",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11848.jpg",keywords:"Immune Response, Modulatory Response, Immunity, Cell-Mediated Immune Response, Engraftment, Immunoregulatory T Cells, Cytokines, Medicine, Inhibitory Immune Response, Antigen, Antibody, Humoral Immunity",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"May 17th 2022",dateEndSecondStepPublish:"July 15th 2022",dateEndThirdStepPublish:"September 13th 2022",dateEndFourthStepPublish:"December 2nd 2022",dateEndFifthStepPublish:"January 31st 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"a month",secondStepPassed:!0,areRegistrationsClosed:!1,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"Dr. Rajeev K. Tyagi is a member of the Indian Immunology Society (IIS), the Indian Parasitology Society, the Controlled Release Society, and the American Association of Immunologists. Currently, Dr. Tyagi is leading a group at the CSIR-Institute of Microbial Technology, Chandigarh, India, funded by the DST-SERB, CSIR, DBT, and ICMR from New Delhi.",coeditorOneBiosketch:"Dr. Prakriti Sharma completed her Ph.D. in Biotechnology at the Guru Angad Dev Veterinary and Animal Sciences University, India. Her doctoral theses focused on the Nuclear Factor of Activated T- cell (NFAT) signaling pathway in lung damage following exposure to deltamethrin insecticide by in vivo studies.",coeditorTwoBiosketch:"Dr. Praveen Sharma studied the mechanism used by the miRNA to regulate the mitochondrial metabolism and also validated mt-DNA encoded ND4, which is the most crucial subunit of the electron transport chain as the target of miRNA-let-7a. She has authored numerous papers in journals on the role of miRNA in breast cancer therapeutics.",coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"201069",title:"Dr.",name:"Rajeev",middleName:"K.",surname:"Tyagi",slug:"rajeev-tyagi",fullName:"Rajeev Tyagi",profilePictureURL:"https://mts.intechopen.com/storage/users/201069/images/system/201069.jpeg",biography:"Dr. Rajeev K. Tyagi completed his doctorate (Ph.D.) in Immunology/parasitology/Infectiology with a special mention of 'Tres Honorabel” at Biomedical Parasitology Unit, Institute Pasteur, Paris, France (2011) on a very challenging and demanding area of translational biomedical research. He developed 'humanized” mouse model(s) to study asexual blood and liver stage infection of P. falciparum with an objective to explore vaccine candidates, drug discovery and drug resistance.\r\nDr. Tyagi worked at the University of South Florida as Postdoc fellow and used the developed humanized mouse to characterize attenuated asexual blood stage falciparum parasite. In addition, he made efforts to develop human-liver chimeric mice using TK/NOG mice to study liver stage infections of P. falciparum. \r\nDr. Tyagi worked at Augusta University, USA as senior research associate and developed an understanding of the Pathogen differentiated dendritic cells and their implication in developing therapeutic interventional approaches for chronic periodontitis.\r\nDr. Tyagi has been working to understand the role of nano-carriers in order to develop therapeutic approaches to address cancer, rheumatoid arthritis and systemic inflammatory diseases. He has published 34 research articles in various journals of international repute and contributed 5 chapters to the international books.\r\nCurrently, he is working as Assistant Professor in Institute of Science, Nirma University, Ahmedabad and his lab is funded by DST-SERB, New Delhi.",institutionString:"CSIR-Institute of Microbial Technology (IMTECH)",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"1",institution:null}],coeditorOne:{id:"473376",title:"Dr.",name:"Prakriti",middleName:null,surname:"Sharma",slug:"prakriti-sharma",fullName:"Prakriti Sharma",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003Sa6udQAB/Profile_Picture_2022-05-10T13:32:17.jpg",biography:null,institutionString:"CSIR-Institute of Microbial Technology",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:null},coeditorTwo:{id:"473369",title:"Dr.",name:"Praveen",middleName:null,surname:"Sharma",slug:"praveen-sharma",fullName:"Praveen Sharma",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003Sa6anQAB/Profile_Picture_2022-05-10T13:00:33.jpg",biography:null,institutionString:"CSIR-Institute of Microbial Technology",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:null},coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"16",title:"Medicine",slug:"medicine"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"440204",firstName:"Ana",lastName:"Cink",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/440204/images/20006_n.jpg",email:"ana.c@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. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"6963",title:"Immune Response Activation and Immunomodulation",subtitle:null,isOpenForSubmission:!1,hash:"ac7ce04a130a57849a8d3adb55d688ed",slug:"immune-response-activation-and-immunomodulation",bookSignature:"Rajeev K. Tyagi and Prakash S. 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A significant blood flow disruption as seen in cardiovascular diseases and disorders is related to hemodynamic dysfunction. Doppler ultrasound has potential to serve as a non-invasive method for detecting and quantifying blood flow functions in cardiovascular diseases. However, the use of blood flow in clinical application is limited and development of blood flow is prevailing rather than blood flow [1].
\nGender influences the arterial hemodynamic functions. Cardiovascular disease is a leading cause of death for both women and men, but there are crucial gender-related differences in the prevalence and burden of cardiovascular disease. An approach to understand this disparity is to evaluate the underlying changes in hemodynamic functions and discover the relationship between the gender differences and cardiovascular disease risk. Gender-related differences in systolic blood pressure (SBP) are reported in previous studies [2, 3]. It is widely reported that gender differences in blood pressures (i.e. SBP and pulse pressure) and arterial wave reflections are associated to smaller body height of women [4, 5, 6].
\nAzhim et al. have developed a Doppler measurement system to evaluate flow velocity functions in common carotid artery with synchronized monitoring of blood pressure (BP) and electrocardiogram (ECG) [6, 7]. Firstly, this chapter presents about characteristic profile of carotid flow velocities in an attempt to extend the fundamental understanding of arterial hemodynamic functions in gender differences. Secondly, comparison of carotid flow velocity and other parameters at resting posture in gender are introduced. The extent to which body size including body height and weight have influenced on blood velocities in carotid artery is described in Section 3. Furthermore, the blood flow velocity also useful for comparing the effect of fat compositions in gender differences as presented in Section 4.
\nIn hemodynamics studies, abnormality of blood flow can be detected from Doppler waveforms, vascular structure and function may be identified through various quantitative measurements made [1, 8]. This section does not focus on hemodynamic disorders, aging, and response to exercise or during exercise. But, the findings do fill important literature gap in correlation between gender-related differences with hemodynamic variables. The normohemodynamics of carotid artery and other parameters are determined in healthy sedentary subjects to rule out the effects that exercise may have on the dependent variables. From a total of 85 sedentary subjects, 49 of them are men.
\nThe Doppler frequency shift represents temporal changes in peak velocities of blood cells movement during particular cardiac cycle. Several analytic techniques have been proposed for analyzing the velocity waveform. Most of these techniques involve analysis of maximum velocity at particular points on Doppler waveforms described as peak velocity envelope. By using the developed measurement system by Azhim et al., carotid blood flow velocity was measured simultaneously with commercialized ECG by three-leads and brachial BP [6, 7]. Measurements of ECG and BP were used as reference data. To extract peak velocity values from its velocity spectra, a threshold method and computation using ensemble averaging technique was implemented in this study. As shown in Figure 1, 30 consecutive cardiac cycles were selected from 2 minutes spectral to characterize the feature points of peak velocity envelope and calculate its indices. In this study, flow velocities in carotid artery were characterized into five feature points [9, 10]. The first peak systolic velocity wave was peak velocity S1. It represents the maximum velocity during systole. Consequently it is usually used as an ejection parameter in cardiac systole [11]. An augmented velocity in late systole wave was the second systolic velocity S2. Augmentation of S2 was related to both reflection of pulse wave velocity at branching site and reflection of pressure wave [1, 9]. The peak diastolic velocity, D velocity was the maximum velocity which rises due vascular elastic recoil during cardiac diastole, insicura between systole and diastole (I) [9] and the end-diastolic velocity, d represents the minimum velocity during diastole [9, 11].
\nDoppler indices derived from peak systolic velocity (S1), second systolic (S2), insicura between systole and diastole (I), peak diastolic (D) and end-diastolic (d) velocities.
Usually blood velocity indices or ratios were derived from various combinations of the peak systolic velocity, end-diastolic velocity, and temporal mean values of the maximum Doppler frequency shift envelope [11, 12]. Of various indices, resistance index (RI) has been used extensively to measure the pulsatility that reflects the resistance to blood flow [12]. RI has defined range limit which is between value of 0–1.0. It was suggested to be used for analyzing waveforms with continuous forward flow throughout the diastole such as in carotid artery [8]. Unlike S1/d ratio as developed by Stuart and Drumm [13], RI shows Gaussian distribution and therefore can be analyzed through parametric statistical analyses. The RI data also reported to have better discriminatory performance compared to pulsatility index (PI) data [11]. Velocity reflection index (VRI) and velocity elastic index (VEI) were first proposed by [9] to evaluate aging and exercise effects. The VRI was a relation with S1 and S2 which calculated from (S2 − S1)/S1. The validation of VRI was analyzed using linear regression analysis. It increased with pressure reflection wave of augmentation index (r2 = 0.836). The latter index was calculated from (D − I)/D. It corresponds to vascular elasticity properties during cardiac diastole [9] as shown in Figure 1. Because of the velocity features are obtained from same cardiac cycle, the indices are independent of insonation angle [11].
\nRough reference of gender-related differences in hemodynamic characteristics is summarized in Table 1. As previously we have reported that carotid flow velocities have influenced by multiple effects including regular exercise, aging and visceral fat accumulation [7, 14, 15, 16], the presented data of hemodynamics differences in gender are also considering the influenced effects of that. The age differences is taken into account by matching the age variable with keeping not significant mean and low standard error. The range subjects’ age for men and women are 20–58 years (38.4 ± 2.2) and 20–64 years (35.2 ± 1.9) respectively. Generally men are taller than women.
\nVariable | \nWomen (n = 36) | \nMen (n = 49) | \n|
---|---|---|---|
Age (years) | \n35.2 ± 1.9 | \n38.4 ± 2.2 | \nNS | \n
Height (cm) | \n157.9 ± 0.9 | \n168.8 ± 0.9 | \n<0.01 | \n
SBP (mmHg) | \n118.5 ± 2.4 | \n129.2 ± 2.1 | \n<0.01 | \n
DBP (mmHg) | \n73.7 ± 1.8 | \n80.5 ± 1.8 | \n<0.05 | \n
MBP (mmHg) | \n89.0 ± 2.0 | \n96.7 ± 1.9 | \n<0.01 | \n
HR (bpm) | \n73.8 ± 2.1 | \n73.6 ± 1.6 | \nNS | \n
d (cm/s) | \n23.7 ± 0.8 | \n18.9 ± 0.7 | \n<0.01 | \n
S1 (cm/s) | \n96.9 ± 3.2 | \n91.2 ± 3.1 | \nNS | \n
S2 (cm/s) | \n64.3 ± 2.0 | \n50.0 ± 1.8 | \n<0.01 | \n
I (cm/s) | \n35.6 ± 1.3 | \n27.5 ± 0.9 | \n<0.01 | \n
D (cm/s) | \n45.6 ± 1.2 | \n39.1 ± 1.0 | \n<0.01 | \n
RI | \n0.750 ± 0.010 | \n0.785 ± 0.009 | \n<0.05 | \n
VRI | \n−0.318 ± 0.026 | \n−0.423 ± 0.028 | \n<0.05 | \n
VEI | \n0.223 ± 0.016 | \n0.298 ± 0.017 | \n<0.01 | \n
Differences in hemodynamic characteristics in women and men.
Data are presented as mean ± standard error of mean. The
Study of blood pressure to explain gender-related differences in arterial hemodynamic functions is prevailing than blood flow velocity. It has been reported that hemodynamic dysfunction increases with SBP [17]. Women have a lower SBP when measured in both brachial and ankle-arm and pressure index than age-matched men [2]. Gender-related differences in body height has influenced to arterial hemodynamics such as SBP, pulse pressure, wave reflection and pulse wave velocity in carotid artery [4, 5]. We found that the gender differences in arterial hemodynamics in carotid flow velocities are largely accounted for body height and weight [6, 7].
\nWith increases of blood pressure in men, all velocity waveforms were homeostatically lower. Men and women have different envelope velocity waveforms in carotid artery shown in Figure 2. In this study, we found that women have a lower brachial SBP than men, but higher d, S2, I and D velocities. Therefore, women have lower RI and VEI, and had higher VRI than men. Consistent with previous studies, pressure wave reflection and propagation are known to be correlated with body height [2, 3, 18], Azhim et al. also suggests that the reflected wave in flow components was higher in women and is significantly correlated with body height [7]. Men have been reported to have more elastic arterial trees than women [2, 7].
\nComparison of typical envelope velocity waveforms in carotid artery for age-matched man (dashed line) and woman (solid line). d: end-diastolic velocity; S1: peak systolic velocity; S2: second systolic velocity; I: insicura between systole and diastole; D: peak diastolic velocity. Adapted from Azhim et al. [
Effective regulation of blood flow and blood pressure in order to maintain homeostasis is a primary aspect of cardiovascular health. In general young women have lower resting blood pressure [19, 20, 21] and in response to physiological changing [22]. The systolic and diastolic BP increased in response to the graded, incremental tilt and the difference observed between men and women is reflective of differences in body size (i.e. in particular height) as shown in Figure 3 [22]. Epidemiological studies based on brachial artery pressure indicate that blood pressures were lower in young women than in age-matched men [2, 6]. Generally, SBP and pulse pressure increased as a pulse travels from aorta towards the peripheral, the increase being all the more pronounced as the distance of pulse propagation [2].
\nBlood pressure variability in response to graded, incremental tilt in healthy young men (n = 13) and women (n = 10). (A) Systolic blood pressure and (B) diastolic blood pressure. Tilt angle is indicated in the bar above each panel (i.e., 0° (resting posture), 20°, 40°, 60°, and back to 40°). Adapted from Sarafian and Miles-Chan [
Changes in velocity envelope waveforms at peak systolic velocity, augmented velocity in late systole wave (i.e. S2) and end-diastolic velocity are focused on their relationship with aging and carotid diseases [23]. Addition to S1, d velocities and its index (i.e., RI) decreasing with age, S2, D velocities and its indices (i.e., VRI and VEI) decrease continuously with age that may increase the complication in cardiovascular disease risk [7]. Only few studies have considered the latter velocities and indices in association with gender or disease [22, 24]. To the best of our knowledge, no other studies have characterized the correlations of these velocities with gender, age, visceral fat accumulation and exercise [7, 16]. In this study, we found significant differences in the carotid velocity waveforms of age-matched men and women to contribute to clinical evaluations and healthcare monitoring [6].
\nWomen had larger reflected waves than men, in part due to shorter body height and closer physical proximity between heart and reflecting sites. However, body height was not sufficient to fully explain higher reflected wave flow and pressure in women. In the study we indicated that the reflected wave had higher in women and was significantly correlated to body height and weight as described in Figures 4 and 5 [6]. In addition to knowledge that pressure wave reflection and propagation are known to correlate with body height [2, 3], we also found that increased reflected flow wave was partially influenced by decreased body weight and increased heart rate level [6]. It had been reported that women had lower carotid artery distensibility compared with men [25]. From the proposed velocity indices (i.e. VEI), we agreed that women had lower arterial elasticity [6, 7]. The difference in the velocities and its indices were related to smaller body size in women that largely accounted for the gender differences. The difference in velocity indices may also contributed by concentrations of estrogen in women hormone status of women [26].
\nThe velocity indices correlated with height. (A) RI: resistive index (1 − d/S1); (B) VRI: velocity reflection index (S2/S1 – 1); (C) VEI: vascular elasticity index (1 − I/D). Men (n = 30) are represented by open circles and women (n = 20) represented by closed circles. Adapted from Azhim et al. [
The velocity indices correlated with weight. (A) RI: resistive index (1 − d/S1); (B) VRI: velocity reflection index (S2/S1 − 1); (C) VEI: vascular elasticity index (1 − I/D). Men (n = 30) are represented by open circles and women (n = 20) represented by closed circles. Adapted from Azhim et al. [
Although the risk for cardiovascular disease increases with age, occurrence and burden of cardiovascular disease may possibly higher in men as described by differences in blood flow velocities and blood pressures [2, 7]. Furthermore body fat composition in the specific body region could explain underlying relationship between the gender-related differences and cardiovascular disease risk such as hypertension [15, 27]. Men tend to accumulate upper body fat which mainly around the abdominal area in the form visceral fat (VF), whereas women tend to have fat deposited in the gluteofemoral region [28, 29]. In the Framingham Heart Study indicated that small differences in VF among three different body mass index classifications; normal-weight, overweight or obese groups can significantly change health risk profile including hypertension [30]. It also widely known that VF increase with aging and associated with clinical features of metabolic variables including elevated triglyceride, glucose and reduced high density lipoprotein [31, 32]. The presented data in Table 2 is to demonstrate a rough reference of gender-related differences in body compositions in sedentary healthy subjects. Men showed a greater body mass index, weight and muscle mass. An alternative to general indication of abdominal VF is waist circumference measurement. The prevalence of having higher VF and waist circumference in men was dominant. But, women showed higher total body fat.
\nVariable | \nWomen (n = 36) | \nMen (n = 49) | \n|
---|---|---|---|
VF (level) | \n3.1 ± 0.3 | \n8.0 ± 0.7 | \n<0.01 | \n
Weight (kg) | \n52.0 ± 1.1 | \n65.2 ± 1.5 | \n<0.01 | \n
BMI (kg/m2) | \n20.8 ± 0.4 | \n22.8 ± 3.2 | \n<0.01 | \n
WC (cm) | \n72.5 ± 1.2 | \n81.0 ± 1.3 | \n<0.01 | \n
Total body fat (kg) | \n28.2 ± 0.7 | \n19.2 ± 0.8 | \n<0.01 | \n
Muscle mass (kg) | \n34.0 ± 1.1 | \n49.7 ± 0.8 | \n<0.01 | \n
TCho (mmol/L) | \n191.4 ± 6.8 | \n194.3 ± 5.6 | \nNS | \n
LDL (mmol/L) | \n97.2 ± 7.6 | \n109.8 ± 5.3 | \n<0.01 | \n
Differences in body compositions in women and men.
Data are presented as mean ± standard error of mean. The
Extensive research in obesity when elucidating hypertension showed that site-specific fat accumulation is more important rather than total body fat [27]. Chandra et al. demonstrated that hypertension is mainly influenced by VF accumulation compared to lower body fat and subcutaneous fat [27]. The VF is also associated to coronary heart disease and systemic arteriosclerosis [33, 34]. Consequently, VF accumulation contributed to greater aortic stiffness in older adult as measured by pulse wave velocity [35]. Comparison data of gender difference is essential to provide rough indication risk of developing health problems related to fat composition.
\nIt is widely known from literature that rising blood pressure is associated with increased cardiovascular disease risk. Women has lower blood pressures, homeostatically higher velocity waveforms with the heart rate did not comparable different than men. The VF and age were two important determinants for increase in blood pressures in our study as shown in Table 3. Similar to this study, association between VF and blood pressures is found consistently in some studies [16, 27]. Using multiple regression analysis, VF becomes superior predictor to hypertension compared to lower body fat and subcutaneous fat in other study [27]. Aging is associated with a significant increase in the prevalence of hypertension and especially of systolic hypertension in elderly [36]. Elevation of blood pressure with aging is mostly associated with structural and functional changes in the arteries like large artery stiffness [9, 37]. However, the predictors for modulating blood flow velocities were not only limited on age, but also influenced by several body compositions that largely accounted for the gender differences as presented in Table 4.
\nVariable | \nPredictor | \nβ | \nr2 | \n|
---|---|---|---|---|
Constant | \n107.35 | \n<0.001 | \n0.304 | \n|
\n | VF (level) | \n1.30 | \n0.002 | \n\n |
\n | Age (years) | \n0.26 | \n0.045 | \n\n |
Constant | \n60.64 | \n<0.001 | \n0.354 | \n|
\n | Age (years) | \n0.34 | \n0.002 | \n\n |
\n | VF (level) | \n0.78 | \n0.017 | \n\n |
Constant | \n76.21 | \n<0.001 | \n0.359 | \n|
\n | Age (years) | \n0.31 | \n0.005 | \n\n |
\n | VF (level) | \n0.95 | \n0.005 | \n\n |
Stepwise linear regression analysis of blood pressure measurements.
Beta (β) value indicates regression coefficient. The
Variable | \nPredictor | \nβ | \nr2 | \n|
---|---|---|---|---|
Constant | \n30.45 | \n<0.001 | \n0.168 | \n|
\n | Muscle mass (kg) | \n−0.22 | \n<0.001 | \n\n |
Constant | \n125.93 | \n<0.001 | \n0.355 | \n|
\n | Age (years) | \n−0.87 | \n<0.001 | \n\n |
Constant | \n95.36 | \n<0.001 | \n0.308 | \n|
\n | Muscle mass (kg) | \n−0.79 | \n<0.001 | \n\n |
Constant | \n46.55 | \n<0.001 | \n0.193 | \n|
\n | Muscle mass (kg) | \n−0.36 | \n<0.001 | \n\n |
Constant | \n46.98 | \n<0.001 | \n0.251 | \n|
\n | VF (level) | \n−0.86 | \n<0.001 | \n\n |
Constant | \n0.76 | \n<0.001 | \n0.341 | \n|
\n | Age (years) | \n−0.002 | \n<0.001 | \n\n |
\n | Muscle mass (kg) | \n0.002 | \n<0.001 | \n\n |
Constant | \n−0.58 | \n<0.001 | \n0.667 | \n|
\n | Age (years) | \n0.01 | \n<0.001 | \n\n |
\n | Muscle mass (kg) | \n−0.01 | \n<0.001 | \n\n |
\n | Total body fat (kg) | \n0.004 | \n0.045 | \n\n |
Constant | \n0.24 | \n<0.001 | \n0.344 | \n|
\n | Age (years) | \n−0.004 | \n<0.001 | \n\n |
\n | Muscle mass (kg) | \n0.004 | \n<0.001 | \n\n |
Stepwise linear regression analysis of blood flow velocity measurements.
Beta (β) value indicates regression coefficient. The
To evaluate the predisposing factors for flow velocity in common carotid artery, stepwise regression analysis was performed with the following parameters: age, muscle mass, VF and total body fat. This study found that VF is an important predictor that inversely related to carotid peak diastolic velocity waveform. Using the proposed index by Azhim et al., peak diastolic velocity, D is an important feature waveform to determine arterial elasticity [7]. Consequently poor arterial elasticity is attributed by accumulation of VF [16, 32] and lower arterial elasticity through its index, VEI is observed in women compared to men. Vaidya et al. also reported the same results where postmenopausal women had lower carotid elasticity compared to matched-age men based on its carotid distensibility [38]. This study can only speculate that the difference in this index could also be influenced by the sex hormone stimulation [38].
\nWomen had greater vascular reflection wave using the proposed index (i.e. VRI) and second systolic velocity compared with men (see Table 1). The augmentation of second systolic flow velocity in carotid artery was related to wave reflection arriving from the lower body or thoracic aorta [39]. The wave reflection in women was related to shorter body height that reflects shorter distance to reflecting site [2, 3]. However, body height was not fully explaining the higher VRI. Significant correlations were observed between body composition variables and VRI, with age, muscle mass and total body fat also contributing to stepwise model for VRI.
\nMuscle mass found to be correlated with all blood flow velocities and blood pressures, but not with S1 velocity, likely due to a greater range of muscle mass among men. Interestingly, muscle mass was a stronger predictor for the most correlated blood flow velocities and indices, except for D velocity and all blood pressures. In agreement with the findings, study of healthy adults was shown an inversely correlation between thigh muscle mass and aortic pressure from wave reflections when characterized by augmentation pressure and its index [40]. By physiology and anatomy studies, left ventricular hypertrophy was observed in women via ventricular remodeling [41, 42] and had higher systolic left ventricular chamber function compared to men [43]. These factors might contribute consistent increase in the first velocity wave during systole in women. Furthermore RI was significantly lower due to increase of S1 velocity in women (RI = 1 − d/S1).
\nIn conclusion, monitoring of blood flow velocity and blood pressure synchronized measurements may be potential to support the assessment of some main hemodynamic functions in gender difference. A fundamental understanding of gender-related differences in arterial hemodynamics is required for effective prevention and detection of cardiovascular disease at the early stage. Women have lower brachial blood pressure components than men, but higher d, S2, I and D velocities. Therefore, women have lower resistive and vascular elastic indices and had higher velocity reflection than men. Gender difference in arterial hemodynamics in carotid velocity waveforms is largely accounted for body size in particular height and weight. Furthermore unlike blood pressures, the predictors for modulating blood flow velocity not limited on age and VF factors, but also influenced by muscle mass and total body fat. Improvable screening of health problem can be achieved by monitoring the blood flow velocity together with blood pressure measurements and considering its gender-difference to fully assessing hemodynamics function in circulatory system.
\nThis study was partly supported by Mediprotech Co. LTD., Korea under International Sponsored Research Grant (C18-058-0231) and Ministry of Higher Education Malaysia under MyBrain15 Postgraduate Scholarship Programme.
\nThe authors do not have any conflict of interest.
The under-five mortality rate (U5MR) represents children who die before reaching the age of 5 per 1000 live births [1]. The definition of live birth is a sign of life such as breathing, heartbeat, or voluntary muscular movements of the newborn after separation from the mother, regardless of the gestational age [2]. The majority of these deaths occur by preventable or treatable diseases, especially in low- and middle-income countries (LMICs). The most common causes of death under 5 years old are acute respiratory infections, diarrhea, malaria, and birth complications [3]. Underlying problems are also critical in U5MR. Malnutrition is the leading cause of about 45% of all childhood deaths [4].
The World Bank divides the world’s economies into four groups according to their income status: low-income, lower-middle-income, upper-middle-income, and high-income countries. The classification is made annually based on the gross national income (GNI) per capita in US dollars (USD) of the preceding year. According to the current data for 2021, countries with a GNI per capita of less than 1046 USD are classified as low-income countries, and those with less than 12,695 USD are classified as middle-income countries [5].
Child mortality under the age of 5 consists of several subgroups. These are neonatal mortality (birth—the first month of life), infant mortality (birth—the first year of life), and child mortality (1–5 years). Looking at the U5MR in each subgroup, it is observed that the neonatal group has the highest risk. Among this population, the youngest has the highest mortality rate. A review showed that approximately one-third of all neonatal deaths occur within the first day after birth, and nearly three-fourths occur within the first week of life [6].
Data from the last three decades show that the fastest decline in U5MR occurred between 2000 and 2009. Globally, the annual rate of reduction (ARR) was 1.9 percent in 1990–1999, 4.0 percent in 2000–2009, and 3.4 percent in 2010–2019. While 1 out of every 11 children could not see their 5th birthday in the 1990s, this number dropped to 1 in 27 in 2019. In 34 LMICs, U5MR was reduced by more than two-thirds between 1990 and 2019 [7].
Although there was a similar decrease in neonatal mortality rates (NMR), it was slower than the decline in child mortality rates between 1 and 59 months. Between 1990 and 2019, the average ARR for child mortality in the first 1–59 months was 3.6 percent, compared to only 2.5 percent in the neonatal period. As a result of these rates, deaths in children under 5 years of age began to concentrate in the neonatal period. While the ratio of newborn deaths to all childhood deaths under 5 was 40 percent in 1990, this rate increased to 47 percent in 2019 (Figure 1) [7].
Distribution of global under-five deaths by age, 1990–2019 [
The U5MR is a good indicator of the healthcare system and general social-economic development. The reasons are as follows:
First, these data precede results, not inputs. For example, the number of doctors and nurses per child is an input, it is related to child health, but positive/negative inputs do not necessarily mean that outcomes will be positive/negative. The U5MR clearly shows the extent to which these inputs achieve their goal.
The U5MR is closely related to some negative socio-economic factors (malnutrition, low immunization rates, poor maternal health, and education). Therefore, it is a strong indicator of inequality and systemic health problems.
At the same time, as many of these deaths are preventable, the rate reflects better than any other measure the lack of access to critical and essential quality health care, including family planning, antenatal and postnatal services, and disease prevention and case management.
For these and similar reasons, many global initiatives, mainly the United Nations Global Strategy for Women’s Children’s and Adolescents’ Health (2016–2030) [8] and the Sustainable Development Goals (SDG) [9], have set child survival goals to improve the U5MR.
In this chapter, we aim to examine the causes of death under the age of 5 and the methods of prevention.
In LMICs, maternal and neonatal diseases, respiratory infections and tuberculosis, enteric and other infections, and malaria are the leading causes of under-five mortality. While in high-income countries, complex neonatal conditions such as prematurity top the list of causes of under-five mortality, in LMICs, infectious diseases still rank high among causes of death.
Since the decline in NMR has not been achieved to a similar extent as in U5MR, the rate of deaths due to maternal and neonatal diseases among under-five mortality has increased recently, especially in high-income countries. In one study, the two most common causes of death in the neonatal period in LMICs were perinatal asphyxia and severe infections such as sepsis, meningitis, and pneumonia [10]. Approximately 23% of the 2.5 million annual infant deaths in the neonatal period are related to infections [7]. Deaths are due to complications associated with prematurity account for about one-fifth of neonatal deaths in these countries. These three causes account for 90% of total neonatal deaths in LMICs [11].
Despite improvements in living conditions and increases in vaccination rates, respiratory infections are the leading cause of under-five death after neonatal diseases in LMICs. It is estimated that approximately 100 million pneumonia episodes occur annually under 5 [12]. With the increase in Pneumococcal conjugate and Haemophilus influenza type b vaccination, changes in the etiology of pneumonia have occurred recently. Among bacterial pathogens, non-type b Haemophilus influenza and Staphylococcus aureus are more common, whereas RSV stands out among viral pathogens. Although less common, CMV pneumonia can be fatal in HIV-infected and immunosuppressed patients [12].
Within this group of diseases, tuberculosis occupies a special place in LMICs. About a quarter of the world’s population is infected with Mycobacterium tuberculosis, which is not always easy to treat with its extrapulmonary involvement and resistant strains [13]. About half of all people with tuberculosis live in eight countries: Bangladesh, China, India, Indonesia, Nigeria, Pakistan, Philippines, and South Africa [14]. In 2019, there were a total of 50,000 deaths due to tuberculosis in children under 5 years of age [15].
Enteral infections are the leading cause of death in children under 5 years among all infections, causing 1.5–2 million deaths per year [16, 17]. In LMICs, there are six episodes of diarrhea per year in infants and three episodes per year in children [18]. Rotavirus, Cryptosporidium, Shigella, and enterotoxigenic Escherichia coli (ETEC) are the most common pathogens observed in the moderate and severe diarrheal disease under 5 years of age in LMICs [19]. In the past, severe dehydration and fluid loss were the main causes of death from diarrhea. Other causes, such as septic bacterial infections, are now increasingly responsible for all diarrheal deaths [20].
Infection with Plasmodium falciparum potentially is fatal and most commonly manifests as a nonspecific febrile illness often without localizing signs. About 635,000 deaths from malaria occurred in LMICs in 2019, of which more than 50% were children under 5 years of age [14]. Moreover, malaria in pregnancy leads to fetal growth retardation, low birth weight, and later malaria infection in the infant, which increases neonatal mortality [21, 22]. In sub-Saharan Africa, a region at high risk of malaria, peripheral malaria is detected in the blood of about half of pregnant women during antenatal care [23].
In addition to these main causes, some factors increase the frequency and treatability or mortality of these diseases. The Covid-19 pandemic, which has been ongoing for about two years, has placed a heavy burden on the health care system. A survey by UNICEF conducted in 77 countries shows that almost 68 percent of countries reported slight reductions in health checks and immunizations for children. In addition, 63 percent of countries reported interruptions in antenatal checkups and 59 percent in postnatal care [24]. In regions with a high burden of HIV, malaria, and tuberculosis, the Covid-19 pandemic may increase HIV-related deaths by 10%, tuberculosis-related deaths by 20%, and malaria-related deaths by up to 36% over 5 years [7].
Some other exacerbating underlying factors include food insecurity, inadequate feeding practices, household air pollution, lack of hygiene, and access to safe water or adequate sanitation.
While the U5MR was about 85 per 1000 live births worldwide in 1990, it dropped to 38 per 1000 live births by 2019, a decline of over 50%. According to 2019 data, the global NMR was 17 per 1000 live births. While this rate was 11 per 1000 for children aged 1 month to 1 year, it was 10 per 1000 for children aged 1–5 years. The gap between the highest and lowest regional U5MR narrowed from 171 deaths per 1000 live births in 1990 to 73 in 2019. In 1990, the number of countries with a mortality rate above 100 per 1000 live births was over 50, while this number has dropped to 5 in 2019. Variation in NMR and U5MR in LMICs by year is shown in Figures 2–5.
Number of under-5 deaths between 1990 and 2019. Data were obtained from the healthdata.org website.
U5MR between 1990 and 2019. Data were obtained from the
Number of neonatal deaths between 1990 and 2019. Data were obtained from the
NMR between 1990 and 2019. Data were obtained from the
Despite these developments, U5MR in low-income countries remains high. These countries are all located in sub-Saharan Africa. In sub-Saharan Africa, the region with the highest U5MR, one in 13 children does not reach the age of five. This rate is 15–20 times higher than in developed countries. Of the 37 countries in this region, 31 have a high mortality rate (U5MR above 50 per 1000 live births). Although sub-Saharan Africa and Central and South Asia account for about 50% of children under 5, 80% of all under 5 deaths in 2019. On a country basis, nearly half of under-five deaths in 2019 occurred in five countries: Nigeria, India, Pakistan, the Democratic Republic of the Congo and, Ethiopia. Nigeria and India alone account for nearly a third. The alteration of mortality rates by regions over time is shown in Figure 6.
U5MR (deaths per 1000 live births) by regions, 1990, 2000, and 2019 [
When evaluating neonatal mortality, sub-Saharan Africa has the highest rate in 2019 (27 per 1000), followed by Central and South Asia (24 per 1000). Nearly 80% of neonatal deaths in 2019 occurred in these two regions. From 1990 to 2019, sub-Saharan Africa was the only SDG region without a decline in neonatal mortality due to the relatively low decrease in NMR and increase in the birth rate. In this period, newborn deaths did not decline in 21 of 48 countries in sub-Saharan Africa, and the total number of newborn deaths remained stable at about 1 million per year.
The difference between the sexes has tended to narrow over time in under-five mortality. In general, the risk of death is higher for boys under the age of 5 than for girls. However, due to regional risks, the mortality rate of girls is much higher than expected in some countries. These countries are located in the South and West Asia. After 1990, there were similar developments in this area, and the number of countries with higher than expected girl mortality dropped from 25 to 7.
The SDG aims to finish under-five mortality from preventable causes by reducing the NMR to 12 and below per 1000 live births and the U5MR to 25 and below per 1000 live births by 2030. If the current trend in under-five mortality continues, 27 percent of the 195 countries evaluated in the latest UNICEF report will not meet the SDG target. Achieving the 2030 target requires high-level efforts and a focus on child mortality in the remaining 53 countries. All these countries are in the status of LMICs. In light of current data, it is estimated that 48 million children under the age of 5 will die between 2020 and 2030. Nearly 80% of these deaths are expected to occur in sub-Saharan Africa and Central and South Asia, where almost all of the countries they host are LMICs. Moreover, if current trends continue, it does not seem possible for nearly 90% of sub-Saharan African countries to reach the neonatal mortality target of the SDG [7].
Access to life-saving interventions is at the forefront of consistently reducing mortality in LMICs. Examining the main causes of under-five deaths in these countries, it is observed that care during and after birth, vaccinations, and preventive and therapeutic services in early childhood play a crucial role [25]. An analysis conducted in 118 LMICs found that disrupting access to basic life-saving interventions could cause millions of under-five deaths in as little as six months [26]. We can consider protective interventions under several headings:
Due to the increase in the birth rate and the dependence of mother-infant life on basic life-saving interventions, prenatal, natal and postnatal care is a priority issue in LMICs. At this point, comprehensive prenatal care, skilled and rapid care during childbirth, regular postnatal care for mother and child, and high-quality and adequate care for premature and sick newborns should be the goal. For reasons other than congenital anomalies causing one in 10 neonatal deaths [27], the following precautions should be taken:
Home visits during pregnancy can play an active role in reducing NMR. A large-scale study in India has shown that antenatal care provided by Accredited Social Health Activists significantly reduces infant mortality rates under 1-year-old [28]. All pregnant women should be visited by experienced teams at least four times during pregnancy, including one visit in the first trimester. At these visits, preeclampsia and eclampsia can be diagnosed and treatment initiated in appropriate cases. In addition, these visits provide an opportunity to start folic acid and iron supplements that improve fetal health and to test for HIV, which is at risk of transmission from mother to fetus. Home visits can also help ensure that adequate precautions are taken in areas where malaria is common. Tetanus vaccinations recommended during pregnancy can be given during these visits. Finally, these visits can encourage pregnant women to deliver in the hospital and provide information about birth complications and nutrition.
Facility-based delivery should be provided to all pregnant women and, expectant mothers should be encouraged in this regard. Basic hygiene rules such as hand washing, sterile cord-cutting, and cord care should be followed in these facilities. To achieve this, using clean delivery kits (CDK) should be expanded for both home and facility deliveries. The use of CDK containing soap, gloves, cord ties, and other sterile equipment has been shown to reduce neonatal mortality and neonatal tetanus in studies in LMIC countries [29, 30, 31]. Drugs (oxytocin, etc.) and materials (partograph, etc.) used in the active management of labor should also be available. In communities where access to facilities is not possible, the number of staff with basic emergency obstetric and newborn care (BEmONC) training should be increased. However, a fast and safe referral and transport system should be ready in case of complications where the capabilities and knowledge of these staff may be inadequate. The purpose of this transportation is to transport the patient to facilities where comprehensive emergency obstetric and newborn care (CEmONC) can be provided.
In the postnatal period, attention should be paid to hypothermia and allow the mother to feed her baby within the first hour of life. It should be ensured that the mother and newborn stay in the facility for the first 24 hours, and an early postnatal visit should be scheduled to recognize the danger signs. In cases of suspected or proven infection, neonates should be treated with antibiotics, and newborns at risk should be followed up in neonatal intensive care units with adequate personnel and equipment.
Vaccination is an essential component of primary health care and an indisputable human right. Also, it is the single most effective prevention method for reducing mortality in children under 5. The following vaccines are at the forefront of preventing early childhood deaths: measles, polio, diphtheria, tetanus and pertussis, Haemophilus influenza type B, pneumococcal, and rotavirus vaccines. Reaching large populations with effective community health programs is crucial for vaccination success. Despite significant advances in immunization, too many children worldwide—including around 20 million infants each year—do not have adequate access to vaccines [32].
Since it is more difficult to diagnose tuberculosis (TB) in childhood, prevention may be more feasible than cure. At this point, neonatal use of the BCG vaccine, which is still the only vaccine against tuberculosis, could be the solution. Neonatal administration of BCG has been associated with a lower prevalence of TB disease [33].
Access to antibiotics and antimalarial to treat diarrhea, malaria, and lower respiratory tract infections also contribute to reducing child mortality. In diarrhea, oral rehydration solution and zinc supplementation help reduce mortality.
Community health workers play a vital role in providing health care to underprivileged communities. Public health workers organize public education programs, especially in the field of preventive health services. The performance of these workers is critical to increasing vaccination and breastfeeding rates, disseminating malaria prophylaxis devices such as insecticide-treated bed nets, and improving hygiene behaviors.
Studies in rural areas of three LMICs found that proximity to health facilities was a significant risk factor for infant, child, and general under-five mortality [34, 35, 36]. Similarly, a meta-analysis found that a distance of over 5 km from the health facility can increase mortality by up to 60% in newborns and children under five years of age [37]. In these and similar situations, governments should eliminate inequality of opportunity among communities and ensure access to health services for all. For example, maternity waiting homes, initiated under the leadership of the World Health Organization (WHO), can be expanded for pregnant women with limited access to facilities.
The integrated management of childhood diseases, in collaboration with national and international organizations, will help to address regional and cross-national disparities and share experience and knowledge. Finally, it is essential to build a people-centered and high-quality health system to implement all these preventive measures. At the same time, families’ desire for medical care and behavior to seek medical help when their children are ill should be encouraged.
Encouraging breastfeeding is a practical and cost-effective method of preventing early childhood deaths. However, about two out of three infants do not have access to exclusive breastfeeding for 6 months. Breast milk provides all the energy and nutrients a baby needs in the first months of life, and continues to meet at least one-third of the baby’s nutritional needs during the second half of the first year [38]. Breastfeeding not only improves the child’s nutrition but also protects the child from the dirty water used in food preparation and cleaning kitchen utensils. Vitamin A supplementation should be encouraged as it has been proven to reduce the risk of illness and death from measles and diarrhea. Access to clean water and ensuring hygiene will be particularly effective in reducing the incidence of diarrheal diseases. Screening for acute malnutrition allows early detection of cases with a risk for mortality.
The U5MR has been significantly reduced over the last 30 years through concerted action and resource allocation. The next goal of countries achieving the SDG targets should be to ensure the protection of children by eliminating inequalities that arise for reasons such as household income, race and ethnicity, and subnational division. While there are some developments in child health globally, 75% of countries failing to meet the SDG targets are found in sub-Saharan Africa clearly showing the inequality that children face in terms of their chances of survival due to birthplace. These inequalities are exacerbated in times of crisis, such as the Covid-19 pandemic, and have an even more negative impact on vulnerable children [39]. Attention should be given to sub-Saharan Africa, where mortality rates are highest in all age groups and the population continues to grow, considering that 11 million children could be saved by 2030 if all countries achieve the SDG targets.
On the other hand, newborns, whose mortality rate is declining more slowly than other age groups and therefore continues to increase their share in the under-five mortality rate, also deserve special attention. Moreover, it is more difficult to reduce the number of deaths during this period due to the establishment of more advanced health care facilities and the need for quality health care services over a longer time, beginning with the antenatal period. In addition to these, it is necessary to provide adequate health services during childbirth and in the early postnatal period. These services, along with NMR, will also reduce maternal mortality rates, the risk of stillbirths, and disability.
When we look at under-five deaths as a whole, it is essential that evidence-based life-saving interventions are accessible and accepted in the community. In addition, the impact of contextual factors such as female empowerment, nutrition, and health system resources should not be ignored in achieving success.
Another issue that should not be ignored in child mortality is the reliability of the data. In resource-poor areas, deaths may not be reported, or the cause of death may not be identified. This information may not be made available to national authorities and international health organizations promptly. Therefore, there is a need for a high-level integrated database at local, national, regional, and global levels, especially for under-five mortality data.
In summary, ending preventable child deaths is only possible by improving access to well-equipped health care professionals during pregnancy and childbirth, life-saving interventions such as vaccinations, breastfeeding, and the provision of low-cost medicines, and access to water and sanitation, which are now lacking in low-income countries.
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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"322007",title:"Dr.",name:"Maria Elizbeth",middleName:null,surname:"Alvarez-Sánchez",slug:"maria-elizbeth-alvarez-sanchez",fullName:"Maria Elizbeth Alvarez-Sánchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",country:{name:"Mexico"}}},{id:"337443",title:"Dr.",name:"Juan",middleName:null,surname:"A. Gonzalez-Sanchez",slug:"juan-a.-gonzalez-sanchez",fullName:"Juan A. Gonzalez-Sanchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico System",country:{name:"United States of America"}}},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}},{id:"338856",title:"Mrs.",name:"Nur Alvira",middleName:null,surname:"Pascawati",slug:"nur-alvira-pascawati",fullName:"Nur Alvira Pascawati",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universitas Respati Yogyakarta",country:{name:"Indonesia"}}}]}},subseries:{item:{id:"86",type:"subseries",title:"Business and Management",keywords:"Demographic Shifts, Innovation, Technology, Next-gen Leaders, Worldwide Environmental Issues and Clean Technology, Uncertainty and Political Risks, Radical Adjacency, Emergence of New Business Ecosystem Type, Emergence of Different Leader and Leader Values Types, Universal Connector, Elastic Enterprise, Business Platform, Supply Chain Complexity",scope:"