Parameters, their definitions, values and references.
\r\n\tThere will be a chapter on secondary causes of sexual dysfunction disorders related to diabetes, cardiovascular disease, and obesity. A chapter on remedial measures to enhance sexual activity and maintain human relationships will be discussed. As there is a growing number of cancer survivors a chapter on cancer-related sexual dysfunction will be welcomed for including it.
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Dr. Sheriff has authored five books including a textbook on medical biochemistry with additional interest in human sexology. He had editorials written in the British Journal of Sexology, Journal of Royal Society of Medicine, Postgraduate Medicine, and Scientist. 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This is important for counselling the patients regarding the disease long-term evolution and also for appropriate management of the disease.
Inner ear spaces of the anterior and posterior labyrinth communicate in between and endolymphatic hydrops present in the Menière’s disease usually affects both auditory and vestibular sensorial structures located in the two parts of the inner ear.
In this chapter, hearing and vestibular testing will be presented, as tests are recommended for positive and differential diagnosis of the Menière’s disease. Regarding Menière’s disease diagnostic, audiological and vestibular testing plays an important role in diagnosis of the disease
Audiological testing includes pure tone audiometry, with highlights of bone conduction especially in acute episodes of this disease, glycerol test when hearing loss is documented, auditory brainstem response (ABR) and electrocochleography.
Pure tone audiometry is a subjective method of hearing evaluation. Patient must signalize the faintest sound he/she hears. Pure tone with specific frequencies is used (125, 250, 500, 1000, 2000, 4000, and 8000 Hz), based on the human normal hearing frequency range (20–20,000 Hz).
Sounds are presented both in air and bone conduction in order to have an accurate image of the hearing.
The result of the test is shown in a graph, a Cartesian system with frequency tested (in Hz) on horizontal axis and intensity (in dB HL) on the vertical one. Frequency varies between 125 and 8000 Hz and intensity between −10 and 120 dB (the latest represents the painful sensation, not an audible one = uncomfortable level). Based on patient’s response, the least audible intensity (threshold) on each tested frequency is plotted.
Threshold notation is standardized internationally (ISO system) and colors as well: red for the right ear and blue for the left ear (Figure 1):
Standardized notation for hearing thresholds.
Air conduction: “circle” for the right ear and “X” for the left ear
Nose-opened brackets for bone conduction: “<” and “>” in unmasked condition and “[“ and “]” in masked condition
Normative for hearing thresholds (THR) were established based on nonotological history teenagers’ responses decades ago and normal hearing stands for hearing thresholds between −10 and +20 dB on all frequencies, without differences between air and bone conduction (Figure 2).
Pure tone audiometry—normal hearing in both ears.
Pure tone audiometry is the method of choice for hearing evaluation also in Menière’s disease patients in [1, 2]. When hearing loss (HL) is permanent, Menière’s disease patients experience sensorineural hearing loss (average of hearing THR on 0.5, 1, and 2 kHz greater than 20 dB), with pathological thresholds on low frequencies (Figure 3).
Low frequency sensorineural hearing loss in left ear.
Cochlear sensorineural hearing loss (SNHL) is accompanied by recruitment, a phenomenon of increased loudness perception—above an increase threshold, higher intensity sounds are as loud to the hearing impaired person as for a normal hearing one and thus disturbing.
Some authors describe in Menière’s disease patients a particular type of recruitment—hyper- or overrecruitment: loudness in the affected ear overtakes the normal ear at high intensities in [3–5].
When differences between air conduction thresholds in both ears exceed 40dB for supra-aural earphones or 55 dB when insert earphones are used, air conduction masking is mandatory for that specific frequency where this difference exists. For bone conduction, masking is mandatory whenever more than 10dB difference between bone and air conduction thresholds is present on that specific frequency. Bone conduction masking is essential in differentiating conductive and sensorineural hearing loss.
It is not unusual to have a conductive component of the hearing loss in Menière’s disease acute phase—disturbances in endolymph metabolism lead to pressure variations at the round and oval window with secondary increases of impedances. High impedances diminish air transmission of the sounds, with consecutive cochlear conductive hearing loss (Figure 4). In these cases, middle ear test (tympanometry and acoustically evoked stapedius reflex) shows no impairment of the middle ear as cause of the conductive component of the hearing loss.
Conductive (a) or mixed (b) hearing loss due to cochlear conductive hearing loss.
Besides pure tone audiometry, speech audiometry complements auditory evaluation. It is a more complex test, since evaluates the entire auditory pathway as hearing is a cortical process. Speech audiometry is also a subjective audiological test where the tested person has to repeat the heard stimuli—numbers, monosyllabic, disyllabic words, or sentences.
The result of the test is a Cartesian graphic with percentage of correct repeated stimuli on the vertical axis for each intensity tested and with intensity of the stimulus on the horizontal axis. For each intensity, a phonemic-balanced list of 10 stimuli (numbers, monosyllabic, disyllabic words, or sentences) is presented. These percentages draw a curve which crosses the 50% line at some specific intensity. This crossing represents the threshold of speech audiometry. For normal hearing, conductive or cochlear sensorial sensorineural hearing loss, this threshold must correlate with pure tone average ±7 dB (Figure 5).
Speech audiometry.
If in cochlear sensorineural hearing loss of other etiology there is a good correlation (±7 dB) between pure tone and speech audiometry THR, in prolonged Menière’s disease, some differences may appear.
Another parameter used in interpretation of the speech audiometry is the maxim of intelligibility/discrimination. It represents the highest percentage of correct repeated stimuli the patient obtains. For normal hearing or conductive hearing loss persons, 100% intelligibility is reached.
Sensorineural hearing loss induced distortions in audition which can limit the maximum of discrimination. Speech audiometry can draw attention on the estimated site of hearing loss, cochlear, or retrocochlear: in cochlear lesions, once the maximum score of discrimination is reached, it remains constant as higher intensities are tested. In retrocochlear sensorineural hearing loss an odd phenomenon occurs—as intensity increases, the patient understands less word (roll-over phenomenon).
In patients with Menière’s disease and permanent sensorineural HL, if low frequencies THR are greater than 40 dB, glycerol test is recommended. Since endolymphatic hydrops is the pathophysiological mechanism of the Menière’s disease, oral administration of a hypertonic solution will extract liquids from tissues, including from the endolymphatic space. Thus, the endolymphatic pressure is diminished and hearing and vestibular sensorial epithelium recovers from increased pressure. The clinical effect of this restoration is improvement of both auditory and vestibular system function 2 h and 30 min after the ingestion, when both pure tone audiometry and speech audiometry are repeated.
Hearing improvement can be documented by pure tone audiometry and speech audiometry. An improvement of the THR on at least 10dB on three consecutive frequencies in pure tone audiometry and/or a more than 12% improvement of speech audiometry THR is considered a positive glycerol test (Figure 6). Some authors consider this as an indication for diuretic treatment, since the endolymphatic system has the capacity to modify its pressure after oral administration of a hyperosmolar solution.
Positive glycerol test.
ABR—is an objective electrophysiological audiological method that allows recording of the electrical activity evoked by neural activity in the auditory pathways, from the cochlea to the brainstem (lateral lemniscus) in Refs. [6, 7]. Surface electrodes are used in this far-field technique. Most commonly used acoustic stimulus is the click—a brief (0.1 ms) rectangular stimulus. Click-evoked ABR reflects hearing sensitivity in the frequency range of 1–4 kHz with a high correlation with pure tone audiometry threshold in this frequency domain, especially at 4 kHz where the stimulus’ energy is maximum.
ABR is the first evoked potentials, with seven characteristic waves in the first 10 ms after click stimulation at high intensities: 70–90 dB normal hearing level (nHL). These waves were first described by Jewett, as response of different auditory pathway structures after acoustic stimulation:
wave I: proximal auditory nerve
wave II: distal auditory nerve
wave III: cochlear nuclei
wave IV: superior olivar complex
wave V: lateral lemniscus
wave VI: medial geniculate body (thalamus)—probable
wave VII: medial geniculate body (thalamus)—probable
First five are mostly used in interpretation of the BERA recordings. In Menière’s disease patients, BERA is mandatory in order to rule out a retrocochlear etiology of the sensorineural hearing loss. Latencies, interpeak intervals and interaural differences of the latencies and interpeak intervals are the parameters used for this differential diagnosis (Figure 7).
Parameters used in ABR interpretation.
In general, ABR exhibits a sensitivity of over 90% and a specificity of approximately 70–90%. Findings suggestive of retrocochlear pathology may include any one or more of the following:
Absolute latency interaural difference wave V (IT5)—prolonged as compared with normative data.
I–V interpeak interval interaural difference (IPI1-5)—prolonged as compared with normative data; greater than 0.2 ms in unilateral or symmetrical hearing loss, or greater than 0.3 ms in patients with asymmetrical or with noise-induced hearing loss. Interaural IPI difference criterion requires no correction for audiogram differences.
Absolute latency of wave V—prolonged as compared with normative data.
Absolute latencies and interpeak intervals latencies I–III, I–V, III–V—prolonged as compared with normative data.
Absence of the later waves.
Absent auditory brainstem response in the involved ear even though hearing is normal or mildly impaired.
ABR traces not replicable.
Abnormally low V:I amplitude ratio (less than 1.0)—less sensitivity than latency measurements.
Electrocochleography (ECochG) is an objective audiological test that measures the electrical potentials derived from the cochlear hair cells and the auditory nerve in [8–10]. These potentials are produced between an electrode on the cochlear promontory and an earlobe electrode, within a time frame of 5 ms after stimulation with alternative repetitive very short acoustic signals (click). Averaging of a large number of potentials (1000 sweeps) is needed in order to record the ECochG characteristic wave. Click is the most common stimuli used in ECochG due to its effect of very good synchronization of a large number of cochlear nerve fibers, mandatory for eliciting a measurable action potential. Click has an abrupt onset, very short duration and broad frequency spectra, thus stimulating a very large number of hair cells in the basal turn of the cochlea, where the speed of the travelling wave is the fastest.
Magnitude and quality of the response depends on the electrode type—transtympanic electrode fixed directly on the promontory gives the best recordings, but it is an invasive audiological investigation. Alternatively, with good clinical results are used extratympanic electrodes, place in the external auditory canal, as close as possible to the eardrum or on the eardrum itself.
Synchronization of the auditory nerve fibers after above-mentioned stimulation gives birth to global action potential. Its origin lies into the inner ear hair cells and cochlear nerve.
Global action potential consists of presynaptic and postsynaptic potentials (Figure 8).
Global action potential.
The first one includes cochlear microphonic (CM) that originates in the outer cochlear hair cells and summating potential (SP) arising from the inner cochlear hair cells. Postsynaptic potentials, known as global action potential of the cochlear nerve, is generated by all cochlear nerve fibers, fired in synchrony by the acoustic stimulus.
In endolymphatic hydrops, due to the increased pressure in scala media, basilar membrane vibrates asymmetrical. These changes of the traveling wave lead to several dysfunctions: distorted cochlear microphonics, enlargement of the summating potential and broadening of the action potential. Magnitude of the AP compared with SP (SP/AP ratio) is increased in endolymphatic hydrops (>30%). The SP/AP amplitude ratio has 50–60% sensitivity in Ménière’s disease diagnosis and 95% specificity in Refs. [11, 12] (Figure 9).
SP/AP amplitude ratio.
Recently, an area ratio (Figure 10) seems to be a more sensitive parameter for detecting endolymphatic hydrops [13]. An increase of more than 2 of SP/AP area together with the increase of SP/AP amplitude ratio increases sensitivity and specificity in Menière’s disease diagnosis to 92 and 83.9%, respectively [14]. Some EP machines enabled automatically measurement of the area ratio.
SP/AP area ratio (
Vestibular investigations are also recommended in Menière’s disease patients not only as a recommended battery test for positive diagnosis, but also in order to evaluate the degree of vestibular lesion which is present from the beginning of the Menière’s disease.
Both vestibulo-ocular reflex (VOR) and vestibulospinal reflex (VSR) should be evaluated. Besides bed-side evaluation, objective vestibular tests are performed for a quantitative measure of these two vestibular reflexes useful in understanding the vestibular deficits as the disease proceeds.
Electro- or videonystagmography allows quantification of the nystagmus, as specific sign of vestibule-ocular reflex dysfunction. Nystagmus, as a conjugate movement of eyes with a slow and a fast phase provoked by vestibular asymmetry, reflects variations of the corneo-retinian potential during eyes movement (Figure 11). The slow phase is the effect of vestibular stimulation and its amplitude is proportional to the intensity of vestibular stimulation. The fast phase is central in origin and reflects only the reflex movement of the eyes to return to their normal position in the orbit. The fast phase direction gives the nystagmus direction.
Nystagmus recording = variations of the corneo-retinian potential.
The corneo-retinian potential can be measured by surface electrodes fixed around the eyes, horizontal and vertical or registered with infrared camera (Figure 12) in Refs. [15–17]. Conventionally, for horizontal electrodes, the upward fast phase is considered right beating nystagmus, while the downward fast phase is considered left beating nystagmus. For vertical electrodes, the upward fast phase is considered superior beating nystagmus, while the downward fast phase is considered inferior beating nystagmus.
Calculation of nystagmus slow phase velocity.
Quantification of the nystagmus is based on several parameters:
Direction of the nystagmus—linear, vertical, rotatory; right-, left-, superior- or inferior-beating nystagmus.
Velocity of the slow phase, vestibular in origin (Figure 12).
Several tests are included in the electro-/videonystagmography (ENG/VNG): spontaneous nystagmus, positional, and positioning nystagmus, as well as provoked nystagmus (post or perrotatory nystagmus and caloric nystagmus). The provoked test is recommended only if patient is not in an acute vertigo phase.
Rotatory and caloric testing evaluates semicircular canal function in response to rotation or irrigation with warm and cold water/air of the external ear canal. Bithermal irrigation causes convective movement of endolymph in the ipsilateral horizontal semicircular canal, caloric test being the only available test that gives information regarding each horizontal semicircular canal. The movement of the endolymph provoked by variation of temperature and, secondary, endolymph density results in deflection of the cupula of the irrigated semicircular canal. Motion of the cupula leads to vestibular hair cell excitation or inhibition with consecutive change of the discharge rate in the superior vestibular nerve fibers. The difference between the excitatory and inhibitory discharge rates of the two superior vestibular nerves reaches the vestibular nuclei. From here compensatory eye movements are elicited (slow phase of nystagmus), followed by rapid corrective saccades (fast phase of nystagmus).
In Menière’s disease patients, results in ENG/VNG differ depending on the phase (acute, subacute, or chronic) and the duration of the disease.
At the beginning of an acute phase, due to the minor ruptures in the Reissner’s membrane and an increase of potassium concentration in the endolymph, the vestibular sensorial epithelium in the affected ear is stimulated and the spontaneous nystagmus beats toward the Menière’s ear (Figure 13). Soon after, due to constantly increasing of the potassium concentration, the vestibular hair cells are intoxicated and their function decrease. In this stage, spontaneous nystagmus changes its direction toward the healthy ear.
Spontaneous nystagmus: A—initial phase of the spell (towards the affected ear); B—end of the spell (towards the non-affected ear).
In the next days after the acute spell of the Menière’s disease results in rotatory and caloric test varies—either hypofunction in the affected ear (Figure 14), or symmetric functionality of the inner ears. The absence of a fixed vestibular lesion is the case in most of patients. In prolonged Menière’s disease (long-term/chronic effect) usually patients’ express caloric hypofunction of the affected ear (1/2—2/3 of patients) as VOR reflects the decreased input from the damaged ear. Caloric stimulation can be done sequential with warm and cold water, respectively, for each ear, or simultaneously. Bilateral cold water (30°C) irrigation shows rapidly the affected ear—the ear toward the nystagmus appears.
Left ear caloric hyporeflexia-hypofunction index > 30%.
In rotatory chair test, results are usually normal. Directional preponderance is rarely seen, usually in long-duration Menière’s disease, when vestibular lesion is stable at some extent (Figure 15). But immediately after an acute attack, VOR gain is increased in rotation toward the affected ear [18].
Symmetrical VOR response in rotatory test.
In between the acute spells, Menière’s disease patients can experience positional vertigo, usually due to benign paroxysmal positional vertigo (BPPV). Disturbances in endolymph metabolism affect the function of the
The video head impulse test (HIT) evaluates as well semicircular canal function. Integrity of the VOR allows the tested subject to maintain sight fixed during high-acceleration high-velocity head rotations in space (gain values close to 1.0, as the ratio between eye and head velocity). Rotation is performed in each plane with an excitatory effect on each of the six semicircular canals.
A positive HIT stands for complete lesion of the fibers connected with the tested semicircular canal. In comparison with caloric testing, video HIT is abnormal in much more small numbers of Menière’s disease patients, maybe because vestibular lesion is not complete.
Equilibrium is a complex process, essential in human well-being and daily activities. It allows standing on different supports as well as walking and other movements without falling or disequilibrium.
Body and head position in space, related to gravity and environment landmarks (of verticality for example), is based on normal and correlated information’s form sensorimotor, visual and vestibular systems. The most important, for sure until adult life, is the sensorimotor system—proprioceptors from feet and neck contribute mostly in equilibrium as we move in space.
As long as the child grows, visual information becomes more important in equilibrium, especially when visual surroundings are difficult.
A vestibular system develops in function in the first year of life and contributes progressively more to equilibrium. Its contribution increases in the case of a lesion in either of the other two systems [15–17]. Besides this, a severe unilateral vestibular deficit or bilateral vestibular lesion has a huge impact on equilibrium, at least for several weeks until a unilateral vestibular deficit is compensated by the other ear.
In Menière’s disease, pathophysiology of the disease explains the fluctuating vestibular function of the affected ear. So, we do not have a stable deficit, at least not a complete one, or from the very beginning of the disease. For this reason, vestibular investigations have different results, from patient to patient, as we discussed in the ENG section.
Computerized dynamic posturography (CDP) contributes with specific parameters in monitoring patients with Menière’s disease—for appropriate diagnostic and management. CDP is based on a force plate system capable of measuring the antero-posterior balance of the center of gravity of the tested subject and automatically compare this balance with normal values for patient’s group of age.
Sensory organization test (SOT) is the most common test of CDP. It allows a selective use of each of the three systems involved in equilibrium during six different conditions of testing (Figure 16) in [19] and thus a global and selective evaluation of equilibrium, based on the system used for maintaining the standing position during testing in [20].
CDP/SOT testing conditions (
As long as projection of the center of gravity (COG) during testing is inside the base support area and no external support is used for stabilize, patient is able to maintain his/her equilibrium and normal result will be displayed at the end of the test (Figure 17). When patient cannot voluntary control its balance within the parameters described, he will obtain a pathological score of equilibrium, displayed at glance with colors convention and also with numeric values (Figure 18).
CDP—normal result.
CDP—pathological result: vestibular deficit.
In Menière’s disease patients, CDP usually display normal results, since in between the spells patient has no equilibrium problems and the acute vestibular deficit of the affected ear was compensated already. Immediately after the acute phase, vestibular scores can be abnormal, mainly in vestibular condition.
Vestibular evoked miogenic potentials (VEMPs) area relatively new objective test designed to measure otolithic function in [21]. In response to loud sound stimulation (95–97dB nHL), saccular vestibular sensorial epithelium generates activity in the inferior vestibular nerve and further in the vestibulospinal and vestibule-ocular pathway.
Action potential transmitted through the vestibulospinal pathway generates muscular responses in the effectors of the vestibulospinal (cervical muscles—cervical vestibular evoked myogenic potential: cVEMP) or vestibule-ocular reflex (extraocular muscles—ocular vestibular evoked myogenic potential: oVEMP).
cVEMP represents an inhibitory biphasic response in the ipsilateral sternocleidomastoid muscle after loud sound stimulation of the sacculae, which can be recorded by surface electrodes. A positive-negative P13-N23 potential is recorded with normal latencies of 13 and 23 ms, respectively (Figure 19). The greatest sensitivity of sacculocolic reflex is for 200–1000 Hz stimuli in Refs. [22, 23], a frequency range highly correlated with saccular function and resonance properties as well (which are correlated with saccular size).
Montage and cVEMP biphasic potential.
Late N34-P44 potentials are not saccular in origins. The amplitude of the response varies with contraction level of the muscle (Figure 20).
Amplitude variation in relation with muscle contraction.
A clinical value of cVEMP is based on comparison of cVEMP amplitude in response to each saccular stimulation. For this reason, contraction level should be measure as well and rectified traces are evaluated. A difference of more than 30% between cVEMP amplitudes is considered abnormal, in result either to saccular hypofunction or hyperfunction depending on the pathology.
In Menière’s disease, endolymphatic hydrops involves the sacculae from the very initial stages of the disease with secondary variations in sacculae’s mechanical properties. Since cervical VEMP depends on the physical characteristics of the sacculae, cVEMP is included in the vestibular battery test for Menière’s disease diagnosis. In more than 50% of Menière’s disease patients, click-evoked cVEMP is abnormal or absent in Refs. [24, 25].
It also has been studied frequency tuning of cVEMP in endolymphatic hydrops and it appears that VEMP is recorded at higher frequencies and across broader frequency ranges than in normal inner ears due to changes in saccular resonance characteristics [26].
These two changes (blunting and frequency shift of cVEMP) are greater as the Menière’s disease has a longer evolution and greater severity in [27]. Additionally, over 20% of Menière’s disease patients have abnormal cVEMP results in the non-affected ear in Ref. [28], recommending VEMP as a predictor test for bilateral Menière’s disease.
Another study revealed a correlation between cVEMP threshold variations in between affected and nonaffected ear and the severity of Menière’s disease in Ref. [29].
In a small series of Menière’s disease patients, VEMP increased in amplitude, even three times at the end of positive glycerol test (Figure 21) as an argument of presence of the endolymphatic hydrops in the sacculae in Ref. [30].
VEMP amplitude variation in positive glycerol test.
Ocular VEMP (oVEMP) is a newer variant of VEMP which measures saccular function in response to very loud sound stimulation (about 120–130 dB SPL) or utricular function in response to vibrations applied to the cochlea. Electrodes placed below the orbit record excitatory response in the contralateral inferior oblique muscle when in a flexed state by looking upward in Ref. [31].
The first negative (excitatory) component of the oVEMP at a latency of about 10 ms is called n10. This n10 component most likely indicates the myogenic potentials of inferior oblique muscle.
Additionally, in patients with early Menière’s disease tested at attack, the contralateral oVEMP n10 is enhanced compared to measures in the same patients at quiescence. We speculate that this enhancement by Menière’s disease attack could be due to mechanical changes in the labyrinth that enhance the sensitive response of utricular receptors to bone conduction vibrator stimulation. It seems that alterations in frequency tuning discussed in cVEMP are also present in sound-evoked oVEMP in Menière’s disease patients in Ref. [32].
A month before the Chinese Spring Festival, the Chinese government reported multiple cases of pneumonia of unknown etiology in Wuhan, Hubei Province, China in December 2019. On January 20, 2020, there were 282 confirmed cases in and around Wuhan, of which 51 were severely ill, 12 were in a critical condition and six deaths as reported to the World Health Organization (WHO) [1]. Three days later public health officials in China implemented strict control measures in Wuhan with a complete lockdown of the population that lasted 76-days. Wuhan is the largest city in Hubei province with a population of over 14 million people [2].
A week later on January 30 2020, WHO declared this outbreak a public health emergency of international concern (PHEIC). The outbreak was caused by a novel coronavirus, SARS-CoV-2, and the disease was named COVID-19 [3, 4]. Since then, almost all countries started implementing several Nonpharmaceutical Interventions (NPIs) such as contact tracing, social distancing, mask wearing, self- isolation, school closures, business closures and countrywide lockdowns at different levels of strictness to stop the spread of the disease.
At the beginning of a pandemic several NPIs can be implemented by public health officials as a way to slow disease transmission until an effective vaccine or antiviral treatment becomes available. Implemented public health measures place restrictions on individuals and understanding how individuals respond and whether they are likely to comply or break new rules is extremely important. Measures can theoretically greatly influence and reduce the spread of the infection. However, human choice and self-interest chosen over altruism, among many other factors, can hamper NPI effectiveness and disease control efforts.
For example, lockdowns and self-isolation (self-quarantine) can be highly effective in reducing transmission but can result in population-wide socioeconomic and psychosocial impacts [5]. Adverse effects from extended isolation have been reported in a number of groups including children and adolescents [6, 7], immigrant workers [8, 9] and adults [10, 11]. Children experienced changes to their eating habits, sleep disturbances, depression and symptoms of anxiety [12, 13, 14]. Adults reported increased mental health issues, anxiety, stigma, depression, alcohol related harm, and domestic violence [10, 11, 15].
There are a number of demographics, social and psychological factors underpinning engagement with quarantine, lockdown, and compliance with public health directives regarding personal protective behaviors. Factors include perception of susceptibility to the infection, severity of the infection, perception of the effectiveness of ongoing public health measures, and their ability to conduct the activity safely (self-efficacy) [16]. One of the main reasons identified in research literature for non-adherence to quarantine and self-isolation is the perception of lower risk for the disease or having fewer risk factors [17]. Psychological fatigue is also suggested as a possible reason for NPI non-compliance [18, 19].
While cultural and social factors might be challenged by fear [20], the economic difficulty faced by some groups and especially minorities in some places, plays a role in human choice. This might partly explain the disproportionate COVID-19 incidence and mortality faced by minorities in the US, Australia, Canada, and the UK [21, 22, 23, 24]. Similarly, migrant workers in low-income countries are also an economically vulnerable population group [25]. Thus, cultural dimensions (see Figure 1) can greatly affect uptake and adherence to NPIs [26, 27, 28, 29, 30] as well as disease transmission and mortality [31].
A comparison of six cultural dimensions among six countries. For discussion see the text. (data source:
Initial and ongoing compliance by individuals is promoted by the existing level of infrastructure, resources, stockpiles, inter-pandemic planning, communication efforts from authoritative sources and the country’s capacity. People afraid of contracting a viral infection will adhere to the best hygienic procedures, use masks, practice social distancing and avoid crowded places. While such measures act to delay the spread of viral diseases, like COVID-19, it will not completely protect the population. Public health directives that seek to reduce population-level risk factors and disease transmission are closely aligned with the idea of each individual practicing the best hygienic procedures, collectively, to achieve high compliance.
Indeed, economic growth and capacity as measured by gross domestic product (GDP) provides a measure of the pre-existing infrastructure to maintain and enforce law and order, regulate economic activity, and provide public goods during a protracted pandemic wave [32]. Many countries in less-developed parts of the world lack this capacity and are more vulnerable to system shocks like pandemics that disrupt economic growth and reduce GDP (Figure 2) [33].
Daily new cases and lockdown stringency index for the six countries. The day ‘0’ starts with the date January 22, 2020. The percentage reduction in the growth rates of GDP in 2020 due to COVID are as follows: India −10.29%, US -5.91%, Nigeria −3.41%, Italy −10.6%, Japan −5.27%, UK -10.2%. Data source: Our world in data,
Two decades ago, British psychologist James Reason introduced the Swiss Cheese Model to describe how failures in complex systems occur [34]. In his model he suggested that multiple defenses can be in place, whose function is to protect individuals from hazards, but these can possess inherent weaknesses. Multiple safeguards or barriers are like slices of Swiss cheese, having many transient holes. Having holes in any one “slice” does not normally cause a bad outcome. If the holes in many layers line up so they permit a trajectory of accident opportunity through the layers, then it allows for hazard exposure resulting in victims. The holes in the established defenses arise for two reasons: active failures and latent conditions. Nearly all adverse events involve a combination of these two sets of factors.
Google mobility data trends reported from mid-February to mid-December 2020 provide insight into the conditions and active failures during the COVID-19 pandemic stemming from changes in human behaviors. In India (Figure 3a) there was good compliance at the beginning of the 74-day lockdown that began on March 25, 2020. However, as the lockdown progressed movement in all tracked mobility categories slowly increased until the end of lockdown. Retail and recreation showed an increase at the beginning of the lockdown as some people ignored social isolation to maintain their livelihoods.
Google mobility trends: Movement of people during COVID-19 lockdown period: (a) India, (b) United States (MA-Massachusetts, MI-Michigan, NY-New York, and WI, OR - Wisconsin, Oregon), (c) Nigeria, (d) Italy, (e) Japan, and (f) UK. For discussion, see the text. (data source: Our world in data,
Unlike India, the United States (Figure 3b) did not implement a nationwide lockdown, instead many states put in place lockdowns of various lengths ranging from 20–267 days (many states began lockdowns during the third week of March 2020). Compliance remained high for the first month and slowly mobility in all categories increased. Notably, mobility to parks and other open spaces increased significantly as shorter lockdowns in some states ended as spring weather arrived.
Nigeria (Figure 3c) imposed a 13-day lockdown on March 30 2020 with good compliance. Once the short lockdown ended mobility trended back upwards towards normal levels over the next two months.
Italy (Figure 3d) implemented a 70-day nationwide lockdown that began on March 9 2020 after large clusters of cases were reported in Northern regions of the country. Compliance was good with decreased mobility in all categories except visits to parks and outside spaces.
Japan (Figure 3e) was one of the few countries that did not use a lockdown strategy, mobility decreased to transit stations, retail businesses and workplaces as people followed government guidance and avoided hotspot areas and mass gatherings.
The UK (Figure 3f) used a 112-day nationwide lockdown that began on March 23, 2020 with good compliance during the first month then mobility increased in all categories. Changes in mobility were similar to what was observed in the United States and Italy. People in the UK spent increasing amounts of time outdoors and in parks during the lockdown [35].
The Swiss Cheese Model can be applied to pandemic defenses or safeguards showing that there are two levels protecting people: personal and interpersonal safeguards. When applying the Swiss Cheese Model to COVID-19 the pandemic barriers which can fail are the early NPIs such as social distancing, self-isolation and lockdowns. For the model we group these NPIs collectively as “social isolation” barriers. In this chapter, we focus on human behavior of social isolation decision-making during the pandemic and its impact on socio-economic growth. Integrating evolutionary game theory, economic growth model and a deterministic disease transmission model, we develop a conceptual framework to analyze the situation using a Swiss Cheese Model approach. We illustrate the main scenario of social isolation versus no social isolation and its effects on growth by numerically simulating the model.
We use a deterministic model of ordinary differential equations (ODE):
with seven states/compartments: susceptible (
Schematic illustration of the COVID-19 SEAIHRD model showing the force of infection
Parameters | Definitions | Values | References |
---|---|---|---|
Disease transmission rate | 0.2306 | Calibrated | |
Rate of leaving exposed state | 1/7 | [36] | |
Probability of becoming symptomatic | 0.75 | [37] | |
Recovery rate of asymptomatic | 1/14 | [38] | |
Recovery rate of infectious | 1/30 | [38] | |
Recovery rate of hospitalized | 1/13 | Calculated | |
Rate of hospitalization | 1/17 | Calculated | |
Death rate from disease | 0.01 | [39] | |
Imitation rate | 20 | Calibrated | |
Pandemic fatigue rate | 0–0.5 | Calibrated | |
Cost of infection | 10–1,000 | Calibrated | |
Fear of death | 100–10,000 | Calibrated | |
Sensitivity to relative economic loss | 5–500 | Calibrated | |
Cost of hospitalization | 20,000 | Calibrated | |
Investment rate | 0.02/365 | Calibrated | |
Elasticity | 0.3 | Calibrated | |
Depreciation rate | 0.01/365 | Calibrated | |
Initial per-capita GDP | 55,000 | Calibrated | |
Fraction of labor working with social isolation | 0.3 | Calibrated |
Parameters, their definitions, values and references.
We also use a population behavior dynamical Eq. (8) to model the dynamical changes of
The population economic growth/decline is modeled using the Solow economic model of the per-capita GDP (
We use the method of Next-generation matrix [40] to find the basic reproduction number
We use this formula for the basic reproduction number to calibrate some of the disease model’s parameters at
We simulated the model using the Runge–Kutta method via the function ode45 in MATLAB. The time unit is day. We assume that the epidemic started with 100 exposed, 50 asymptomatic and 30 infected individuals in a population of size 11,000,000.
Simulations were performed with values given in Table 1. In particular, when there is no pandemic fatigue (
Simulation of (from left to right) the disease prevalence, the proportion of those practicing social isolation, and per-capita GDP ($1000). The human behavior parameter values are
In the presence of pandemic fatigue (
In all of the cases, the per-capita GDP dwindles fast during the waves of the epidemic and slows down as the waves subside, due to the availability of labor and the decreased hospitalizations.
Human choice is an important influencer on disease dynamics, and it is dependent on cultural, social and economic factors that might lead to lack of choice. Our model results (Figure 5) exhibit that risk of infection, fear of death and the effect of economic loss are important factors as they influence the behaviors of individuals in both lower and higher GDP countries. In lower income countries, an individual’s daily wages depend on socioeconomic growth and GDP of the population. The majority of the population in low-income countries survive at or below the poverty line. The World Bank reports there are 33 countries with one-third of the population below the extreme poverty line ($1.90 international dollars/day income) and 69 countries with more than half their population living on less than $5.50 international dollars/day. The definitions of the poverty line vary considerably among nations, however, according to the World bank there are 23 countries with 50% or more of the population living below the nationally designated poverty line deemed appropriate - as defined by its own authorities [42]. The low-income countries include many African countries, Latin American countries (Guatemala, Honduras) or areas suffering military conflicts (Afghanistan, Yemen).
Thus, even small changes in income and GDP will be perceived as a larger income shock to individuals living near or below the poverty line. Individuals with very little capacity will ignore pandemic social distancing directives quicker than those with higher capacity, otherwise they will not have money for day-to-day food and basic necessities.
The perceived relative economical loss (
Policy resistance is often cast as a conflict between the Nash equilibrium and the
Previous coronavirus outbreaks Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) displayed an amplification of risk perception due to media coverage of the outbreaks [47, 48]. Studies affirm that individuals obtain their news about health and medicine from both mass and social media sources. Daily newspapers, TV channels are one of the biggest influencers of public perceptions of risk. The media plays an important role informing individuals about health risks, but it can also distort perceptions through social amplification of risk. The Social Amplification of Risk Framework (SARF) describes the process where some hazards and events become the focus of intense social and political concern and activity (amplification). This occurs even though experts and risk assessment can establish that the risk is of a relatively low probability, while other potentially more serious events receive comparatively little public attention (attenuation). Media coverage can magnify and change perceptions of risk. The alteration of risk by social amplification creates secondary effects such as stigmatization (of people, places, objects, technologies, and ideas), economic losses, and changes to regulatory oversight due to mass distortion of public risk perception [49, 50].
The efficacies of social distancing and media coverage causing amplification of risk perceptions during COVID-19 are crucial in developing policy acceptance or resistance. In many countries public health risk communication promoted a collectivist and altruistic approach while in other countries policy resistance arose to NPIs through social media. Evidence suggests that belief in conspiracy theories undermines engagement in pro-health behaviors and support for public health policies [51].
For example, in the USA expert messaging carried out by the US CDC regarding mask wearing to protect vulnerable individuals in society became co-opted by social media’s distortion of risk (ineffectiveness of masks, lowered perception of SARS-CoV2 infection risk, and as an infringement of personal choice) [52]. Under our model social media misinformation regarding the risk factors can alter the effective transmission rate through the proportion
Pandemic fatigue is recognized by the WHO to be natural and expected and is manifested through the decline in motivation of people to adhere to the recommended protective behaviors [53]. It is believed that fatigue emerges gradually [54] and is affected by a number of emotions, experiences and perceptions as well as the demographic, socio-economical, cultural, structural and legislative environment [55, 56]. During those periods, people will perceive personal, social and economic consequences of the social isolations [53]. Later, the perceived cost of infection and potential death will become smaller than the felt loss. For instance, college students reported physical exhaustion and decreased motivation among other feelings with more resilience expressed by senior students [57]. An increased adherence to preventive behavior and avoidance of risky behavior is positively associated with age [55]. A continued preventive behavior was found to be related to older ages; however, all ages grew weary of avoiding risky behaviors like meeting non-household members [55]. The needs of work and low socioeconomic status intensified the risky behaviors whereas lower education exacerbated both low adoption of preventive measures and high practice of risky behaviors [55]. Moreover, reports of regional COVID-19 cases and the fear of death increased the likelihood to implement both preventive measures and avoiding risky behaviors [55]. The disease-behavior-economic model presented in this chapter, including many of those aforementioned factors, showed that human behavior through pandemic fatigue can determine the fate of the epidemic as well as the economic growth.
One factor to overcome pandemic fatigue is resilience or the human ability to adapt to the new circumstances and to accept the existence of the disease risk while coping with it. The WHO recommended four strategies for governments to address pandemic fatigue: understanding people, engagement of people, acknowledgment of hardship, and allowing people to live with reduced risk [53].
While most countries around the world implemented early, stringent social distancing policy including lockdowns once the virus began spreading domestically, the Japanese strategy for the COVID-19 outbreak used voluntary guidance for social distancing measures and persuasive messaging. Public health authorities implemented voluntary measures with contact tracing and diagnostic testing. Widely adopted voluntary compliance behaviors appears to have achieved results similar to other countries that used more stringent social interventions (e.g., lockdowns). The policy strategy comes as a trade-off with more healthcare demand and more deaths than if early stringent control was implemented [58]. The strategy’s success depends on continued public good will and compliant behaviors. Hofstede cultural dimensions (see Figure 1) of high uncertainty avoidance, long-term orientation and masculinity in Japan resulted in high compliance with social isolation. Google mobility data confirms that even in the absence of lockdown the population avoided public transit (e.g., subways, busses, trains), retail stores, and workplaces (see Figure 3). The Japanese strategy requires ongoing public health risk communication efforts to maintain high levels of voluntary compliance.
Sweden used no lockdown approach with the public health goals of obtaining herd immunity to COVID-19 (where a threshold is reached where enough of the population would possess immunity to the virus), and secondly as a strategy to minimize economic shock impacts [59]. A similar no lockdown approach was also used in Japan.
In contrast to Japan’s voluntary approach, on January 23 2020 China implemented an early mandatory, stringent lockdown strategy in Hubei province affecting 16 cities (including Wuhan) restricting movement of about 57 million people [60]. The unprecedented scale of this lockdown was controversial resulting in an exodus of people out of Wuhan just prior to the lockdown which could have spread the virus. The strategy placed a cordon sanitaire around the city of 11 million people which raised ethical concerns [61]. After 76 days on April 8 2020 Wuhan ended its lockdown [62]. While the Wuhan lockdown was considered a draconian and unprecedented strategy, experts estimated that lockdown in the city of Wuhan prevented between 0.5–3 million infections and 18,000–70,000 deaths at the expense of the economy and in terms of restrictions to personal freedoms [63]. Other countries followed and implemented similar Wuhan-style lockdowns including Italy (provinces of Lombardy and Veneto), Spain, Russia, India and the Philippines [64, 65]. In this way China acted as an “influencer” or role model for other countries that adopted the same type of lockdown, this is an example of reinforcement.
Economic downfall due to social interventions including lockdown during COVID-19 have occurred especially in Low- and Middle-Income Countries (LMICs). Other countries like India and Kuwait showed that social interventions failed to effectively reduce local transmission occurring within large migrant laborer populations. The inelasticity occurred with migrant workers in another country (e.g., Indian migrant workers in Kuwait) or workers moving from one state to another state in their home country (e.g., India) [25, 66].
The vast majority of the migrant workers who traveled to Kuwait for work had very limited means. Non-Kuwaiti migrant workers make up more than 60% of the total population and are mostly employed in low-skilled sectors and domestic work. Migrant workers in Kuwait live in cramped dormitories with poor housing conditions having unmaintained and shared toilets, and poor or no ventilation. The lack of social distance and sanitation among occupants resulted in increased COVID-19 transmission among migrant workers [67].
In India, migrant workers usually live and work in megacities under crowded conditions that do not permit social distancing, putting them at an increased risk for disease transmission. Moreover, migrant workers in many LMICs have difficulty gaining access to health care services since they lack health insurance and lack of access to healthcare facilities as a result of administrative barriers [25]. During the COVID-19 pandemic migrant workers from LMICs face conditions that promote inelasticity (communal overcrowded housing, fear of job loss, unsanitary conditions, withheld income and lack of social distancing). Higher GDP countries also encounter this effect but to a much lesser degree with migrant workers (e.g., Canada’s Temporary Foreign Worker Program that allows an employer to hire a foreign worker to help harvest crops and fruit) [68]. Many low-income individuals and migrant workers simply cannot adhere to social interventions that reduce transmission risk due to their situation. Their behavioral responses result in unintentional non-compliance and outcome inelasticity.
In controlling and managing infectious diseases through social isolation, distancing or vaccination, the role of individual choice is becoming an increasingly important driver that subsequently affects underlying disease burden among the population. In particular, human behavior and social interactions played a significant role affecting the magnitude of the COVID-19 pandemic. Major factors behind such behavioral interactions are losing jobs and forgoing daily income from social distancing, fatigue from social isolation, and/or conscious or unconscious exploitation of uncertainty due to lack of awareness and knowledge. Thus, the dynamics of controlling infection through social isolation is a potentially complex interplay between individual behaviors and disease dynamics, informed by the perceived cost of being socially isolated and infection risks [69]. This complex interplay can be seen as a strategic game and is conveniently modeled and analyzed using the mathematical framework provided by Game Theory [70, 71]. Such behavior-prevalence game theoretical models have already explored vaccine exemption behavior for endemic diseases [72] but there is less emphasis on behavioral interactions like social distancing, especially analysis from the perspective of cultural dimensions of populations and also their socioeconomic conditions. The current study opens up a forum for further research on how individual choice, especially at the population level, is of utmost concern for public health policymakers to curb a pandemic.
Our model scenario highlights the interplay between economic impact and human choice in social distancing measures. Individuals with limited resources must choose between complying with public health guidance (a collectivist approach where personal actions can help the population) at the expense of losing income that is necessary for basic sustenance (an individualist approach). Changes in public policy are essential to combat the long-standing problems associated with health and economic inequities since these are more pronounced during a health care crisis, such as the COVID-19 pandemic.
To address these inequities there needs to be changes in public policy during inter-pandemic phases to ensure planning in place that is activated at the beginning of an outbreak. Policies should act to provide increased resilience and capacity at the beginning of an outbreak to minimize economic losses. Both the public and private sectors can put planning in place to reduce the magnitude of the economic disruption from NPI compliance in the workforce, supply chains, and healthcare system to prevent unforeseen economic crises.
It was suggested that sharing or pooling of available resources and networking can occur at several different levels including: the individual, household, local community, city, state or province, regional and national scale as a strategy to increase resilience and avoid negative mental health and economic outcomes [73].
Pandemic crises such as COVID-19 have particular characteristics within a complex system requiring a number of different types of resilience be addressed including population health resilience (the population recovering from the disease), healthcare system resilience (the recovery of the healthcare system), economic resilience (recovery from the economic consequences) and psychological resilience (individual recovery from fear, anxiety, depression) [74].
In the context of the COVID-19 pandemic drawing on the different types of resilience can reduce psychosocial effects such as depression, anxiety, stress and non-compliance to public health NPIs during curfew, self-isolation and lockdowns. Indeed, previous studies have shown that resilience decreases the negative effects of stress both at the individual and regional levels [75, 76]. The city, regional and country-level attention and support for designated essential workers is important to ensure that they are adequately equipped and compensated for vital services performed to maintain public health standards [74, 75, 77].
Dr. Tamer Oraby thanks Dr. Susie Elsaadany (Department of Pathology and Laboratory Medicine, University of Ottawa) for the continuous critical discussions and insights regarding COVID-19 modeling.
This is a brief overview of the main steps involved in publishing with IntechOpen Compacts, Monographs and Edited Books. Once you submit your proposal you will be appointed a Author Service Manager who will be your single point of contact and lead you through all the described steps below.
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The amphizoic organisms can exist as facultative parasites - causative agents of serious human disease, Acanthamoeba keratitis. The vision-threatening eye disease occurring particularly in contact lens wearers is reported with increasing prevalence in different regions of the world. The amoebic keratitis is difficult to diagnose as clinical symptoms are similar to those observed in other eye diseases. Moreover, bacterial, viral, fungal, and amoebic co-infections frequently occur; also amoebae act as carriers for ~ 20 species pathogenic for humans, e.g. from Pseudomonas, Legionella, Mycobacterium and Escherichia genera; thus the corneal disease is frequently misdiagnosed. Complex etiology, late proper recognition of amoebic infections, and the exceptional resistance of Acanthamoeba cysts to chemicals are important factors influencing diagnostic and therapeutic difficulties. Surgical interventions are needed as an alternative treatment in refractory Acanthamoeba keratitis. It should be taken into consideration that the knowledge and awareness of increasing threat generated by the amphizoic amoebae are still insufficient. This compilation presents selected aspects of eye disease that is becoming the increasingly significant for human health worldwide.",book:{id:"5080",slug:"advances-in-common-eye-infections",title:"Advances in Common Eye Infections",fullTitle:"Advances in Common Eye Infections"},signatures:"Lidia Chomicz, Jacek P. Szaflik, Marcin Padzik and Justyna Izdebska",authors:[{id:"176610",title:"Prof.",name:"Lidia",middleName:null,surname:"Chomicz",slug:"lidia-chomicz",fullName:"Lidia Chomicz"},{id:"176663",title:"Dr.",name:"Jacek P.",middleName:null,surname:"Szaflik",slug:"jacek-p.-szaflik",fullName:"Jacek P. 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Endophthalmitis often results in partial or complete loss of vision despite aggressive therapeutic and surgical intervention and hence it is considered as a medical emergency. Diagnosis of infectious agent is critical in the management of these agents. Intravitreal antimicrobial therapy along with anti-inflammatory agents is the key ingredient for successful management of endophthalmitis, while surgical procedures like vitrectomy become necessary in severe endophthalmitis cases. This is a brief review regarding classification, etiological agents causing endophthalmitis, diagnosis and therapeutic challenges of endophthalmitis that will help in improving the visual outcome.",book:{id:"5080",slug:"advances-in-common-eye-infections",title:"Advances in Common Eye Infections",fullTitle:"Advances in Common Eye Infections"},signatures:"S. Malhotra, S. Sharma, N. J. K. Bhatia, C. Hans and P. Kumar",authors:[{id:"176430",title:"Dr.",name:"Shalini",middleName:null,surname:"Malhotra",slug:"shalini-malhotra",fullName:"Shalini Malhotra"}]},{id:"51510",doi:"10.5772/64137",title:"Ocular Parasitic Infections – An Overview",slug:"ocular-parasitic-infections-an-overview",totalDownloads:3456,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"Eyes are said to be the windows of body, by which this beautiful world is visualized. Human eye has a unique structure and is vulnerable to numerous infections. Whenever anatomical structures are breached, host defenses come into play, but if infection is severe and not treated timely, it could lead to visual impairment or blindness. Parasitic infections are considered, the significant causes of ophthalmic diseases worldwide. In this chapter, an overview of ocular parasitic infections (OPI) is detailed out, with an initial brief introduction followed by description of anatomy of the human eye and various defense mechanisms to provide better understanding of the parasitic infections affecting different parts of human eye. The last part includes individual details of various human ocular parasitic infections.",book:{id:"5080",slug:"advances-in-common-eye-infections",title:"Advances in Common Eye Infections",fullTitle:"Advances in Common Eye Infections"},signatures:"Nancy Malla and Kapil Goyal",authors:[{id:"91568",title:"Prof.",name:"Nancy",middleName:null,surname:"Malla",slug:"nancy-malla",fullName:"Nancy Malla"},{id:"177665",title:"Dr.",name:"Kapil",middleName:null,surname:"Goyal",slug:"kapil-goyal",fullName:"Kapil Goyal"}]},{id:"52910",doi:"10.5772/65957",title:"Overview of Common and Less Common Ocular Infections",slug:"overview-of-common-and-less-common-ocular-infections",totalDownloads:2166,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Infection may occur in any tissue of the eye, orbit, and adnexa. Infection may spread directly through contact and indirectly through blood vessels (especially valveness veins) and nerves. A proper treatment for ocular infections is imperative because it dictates the prognosis. Ocular infections may share identical clinical finding and be caused by different etiologic agents. To obtain the best outcome, a systematic approach for ocular infections is essential. This chapter describes the characteristic clinical features and manifestations of some common ocular infections and the differentiation between them and inflammations and other diseases even without using new imaging modalities such as confocal electron microscopy, anterior segment optical coherence tomography, and laboratory tests including polymeraze chain reaction.",book:{id:"5080",slug:"advances-in-common-eye-infections",title:"Advances in Common Eye Infections",fullTitle:"Advances in Common Eye Infections"},signatures:"Shimon Rumelt",authors:[{id:"54335",title:"Dr.",name:"Shimon",middleName:null,surname:"Rumelt",slug:"shimon-rumelt",fullName:"Shimon Rumelt"}]},{id:"50922",doi:"10.5772/64243",title:"The Risk of Infection in Dry Eye Syndrome Accompanying Primary Sjögren’s Syndrome",slug:"the-risk-of-infection-in-dry-eye-syndrome-accompanying-primary-sj-gren-s-syndrome",totalDownloads:1511,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Primary Sjögren’s syndrome (pSS) is an autoimmune disease, which dominates the symptoms resulting from inflammatory infiltrates in exocrine glands. Frequently, patients complain of a feeling of sand under the eyelids, eye irritation, and red eye caused by a decrease in tear secretion. The ophthalmic examination beyond lowering the secretion of tears in Schirmer’s test evaluation in cases with a significant intensification of dry eye disease (DED) can be visualized by measuring ocular staining score (OSS) using lissamine green and fluorescein staining. OSS can demonstrate the degree of damage to the corneal surface. It is known that keratoconjunctivitis sicca (KCS) in pSS is not only limited to the complaints of unpleasant feeling of sand under the eyelids but also can lead to serious corneal damage and decreased vision even to blindness. And between the others, complications of KCS in pSS must be replaced with an increased susceptibility to infection. We should also pay attention to possible co-infection with Epstein-Barr virus (EBV) virus and bacterial co-infections, e.g., Chlamydia pneumoniae, Staphylococcus aureus, or latent conjunctival infections Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum in group of patients with DED, not only in pSS group. Another issue is simultaneous with hepatitis C virus (HCV) infection coexistance of clinical and laboratory features of Sjogrens syndrome and accompanying this situation clinical signs of KCS. To sum up symptoms of KCS in primary Sjögren’s syndrome and in all patients with DED should be evaluated individually and should take into account the increased risk of infection among these patients.",book:{id:"5080",slug:"advances-in-common-eye-infections",title:"Advances in Common Eye Infections",fullTitle:"Advances in Common Eye Infections"},signatures:"Maria Maślińska and Brygida Kwiatkowska",authors:[{id:"77007",title:"Dr.",name:"Maria",middleName:null,surname:"Maślińska",slug:"maria-maslinska",fullName:"Maria Maślińska"}]}],mostDownloadedChaptersLast30Days:[{id:"51510",title:"Ocular Parasitic Infections – An Overview",slug:"ocular-parasitic-infections-an-overview",totalDownloads:3456,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"Eyes are said to be the windows of body, by which this beautiful world is visualized. Human eye has a unique structure and is vulnerable to numerous infections. Whenever anatomical structures are breached, host defenses come into play, but if infection is severe and not treated timely, it could lead to visual impairment or blindness. Parasitic infections are considered, the significant causes of ophthalmic diseases worldwide. In this chapter, an overview of ocular parasitic infections (OPI) is detailed out, with an initial brief introduction followed by description of anatomy of the human eye and various defense mechanisms to provide better understanding of the parasitic infections affecting different parts of human eye. The last part includes individual details of various human ocular parasitic infections.",book:{id:"5080",slug:"advances-in-common-eye-infections",title:"Advances in Common Eye Infections",fullTitle:"Advances in Common Eye Infections"},signatures:"Nancy Malla and Kapil Goyal",authors:[{id:"91568",title:"Prof.",name:"Nancy",middleName:null,surname:"Malla",slug:"nancy-malla",fullName:"Nancy Malla"},{id:"177665",title:"Dr.",name:"Kapil",middleName:null,surname:"Goyal",slug:"kapil-goyal",fullName:"Kapil Goyal"}]},{id:"49606",title:"Bacterial Endophthalmitis",slug:"bacterial-endophthalmitis",totalDownloads:1645,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"Endophthalmitis is an ocular inflammation involving vitreous cavity along with the retinal and uveal components of the eye mostly due to infectious agent. The source of infection could be exogenous or endogenous. Exogenous endophthalmitis results from direct inoculation as a complication of ocular surgery, foreign bodies or penetrating ocular trauma, while endogenous endophthalmitis results from haematogenous spread of organisms from a distant source of infection. Endophthalmitis often results in partial or complete loss of vision despite aggressive therapeutic and surgical intervention and hence it is considered as a medical emergency. Diagnosis of infectious agent is critical in the management of these agents. Intravitreal antimicrobial therapy along with anti-inflammatory agents is the key ingredient for successful management of endophthalmitis, while surgical procedures like vitrectomy become necessary in severe endophthalmitis cases. This is a brief review regarding classification, etiological agents causing endophthalmitis, diagnosis and therapeutic challenges of endophthalmitis that will help in improving the visual outcome.",book:{id:"5080",slug:"advances-in-common-eye-infections",title:"Advances in Common Eye Infections",fullTitle:"Advances in Common Eye Infections"},signatures:"S. Malhotra, S. Sharma, N. J. K. Bhatia, C. Hans and P. Kumar",authors:[{id:"176430",title:"Dr.",name:"Shalini",middleName:null,surname:"Malhotra",slug:"shalini-malhotra",fullName:"Shalini Malhotra"}]},{id:"52910",title:"Overview of Common and Less Common Ocular Infections",slug:"overview-of-common-and-less-common-ocular-infections",totalDownloads:2166,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Infection may occur in any tissue of the eye, orbit, and adnexa. Infection may spread directly through contact and indirectly through blood vessels (especially valveness veins) and nerves. A proper treatment for ocular infections is imperative because it dictates the prognosis. Ocular infections may share identical clinical finding and be caused by different etiologic agents. To obtain the best outcome, a systematic approach for ocular infections is essential. This chapter describes the characteristic clinical features and manifestations of some common ocular infections and the differentiation between them and inflammations and other diseases even without using new imaging modalities such as confocal electron microscopy, anterior segment optical coherence tomography, and laboratory tests including polymeraze chain reaction.",book:{id:"5080",slug:"advances-in-common-eye-infections",title:"Advances in Common Eye Infections",fullTitle:"Advances in Common Eye Infections"},signatures:"Shimon Rumelt",authors:[{id:"54335",title:"Dr.",name:"Shimon",middleName:null,surname:"Rumelt",slug:"shimon-rumelt",fullName:"Shimon Rumelt"}]},{id:"51734",title:"Acanthamoeba Keratitis: The Emerging Vision-Threatening Corneal Disease",slug:"acanthamoeba-keratitis-the-emerging-vision-threatening-corneal-disease",totalDownloads:1814,totalCrossrefCites:3,totalDimensionsCites:5,abstract:"Some Acanthamoeba species are distributed in natural and man-made environments, in a wide range of soil and aquatic habitats, also in clinical settings. The amphizoic organisms can exist as facultative parasites - causative agents of serious human disease, Acanthamoeba keratitis. The vision-threatening eye disease occurring particularly in contact lens wearers is reported with increasing prevalence in different regions of the world. The amoebic keratitis is difficult to diagnose as clinical symptoms are similar to those observed in other eye diseases. Moreover, bacterial, viral, fungal, and amoebic co-infections frequently occur; also amoebae act as carriers for ~ 20 species pathogenic for humans, e.g. from Pseudomonas, Legionella, Mycobacterium and Escherichia genera; thus the corneal disease is frequently misdiagnosed. Complex etiology, late proper recognition of amoebic infections, and the exceptional resistance of Acanthamoeba cysts to chemicals are important factors influencing diagnostic and therapeutic difficulties. Surgical interventions are needed as an alternative treatment in refractory Acanthamoeba keratitis. It should be taken into consideration that the knowledge and awareness of increasing threat generated by the amphizoic amoebae are still insufficient. This compilation presents selected aspects of eye disease that is becoming the increasingly significant for human health worldwide.",book:{id:"5080",slug:"advances-in-common-eye-infections",title:"Advances in Common Eye Infections",fullTitle:"Advances in Common Eye Infections"},signatures:"Lidia Chomicz, Jacek P. Szaflik, Marcin Padzik and Justyna Izdebska",authors:[{id:"176610",title:"Prof.",name:"Lidia",middleName:null,surname:"Chomicz",slug:"lidia-chomicz",fullName:"Lidia Chomicz"},{id:"176663",title:"Dr.",name:"Jacek P.",middleName:null,surname:"Szaflik",slug:"jacek-p.-szaflik",fullName:"Jacek P. Szaflik"},{id:"176664",title:"Dr.",name:"Marcin",middleName:null,surname:"Padzik",slug:"marcin-padzik",fullName:"Marcin Padzik"},{id:"176665",title:"Dr.",name:"Justyna",middleName:null,surname:"Izdebska",slug:"justyna-izdebska",fullName:"Justyna Izdebska"}]},{id:"50922",title:"The Risk of Infection in Dry Eye Syndrome Accompanying Primary Sjögren’s Syndrome",slug:"the-risk-of-infection-in-dry-eye-syndrome-accompanying-primary-sj-gren-s-syndrome",totalDownloads:1511,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Primary Sjögren’s syndrome (pSS) is an autoimmune disease, which dominates the symptoms resulting from inflammatory infiltrates in exocrine glands. Frequently, patients complain of a feeling of sand under the eyelids, eye irritation, and red eye caused by a decrease in tear secretion. The ophthalmic examination beyond lowering the secretion of tears in Schirmer’s test evaluation in cases with a significant intensification of dry eye disease (DED) can be visualized by measuring ocular staining score (OSS) using lissamine green and fluorescein staining. OSS can demonstrate the degree of damage to the corneal surface. It is known that keratoconjunctivitis sicca (KCS) in pSS is not only limited to the complaints of unpleasant feeling of sand under the eyelids but also can lead to serious corneal damage and decreased vision even to blindness. And between the others, complications of KCS in pSS must be replaced with an increased susceptibility to infection. We should also pay attention to possible co-infection with Epstein-Barr virus (EBV) virus and bacterial co-infections, e.g., Chlamydia pneumoniae, Staphylococcus aureus, or latent conjunctival infections Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum in group of patients with DED, not only in pSS group. Another issue is simultaneous with hepatitis C virus (HCV) infection coexistance of clinical and laboratory features of Sjogrens syndrome and accompanying this situation clinical signs of KCS. To sum up symptoms of KCS in primary Sjögren’s syndrome and in all patients with DED should be evaluated individually and should take into account the increased risk of infection among these patients.",book:{id:"5080",slug:"advances-in-common-eye-infections",title:"Advances in Common Eye Infections",fullTitle:"Advances in Common Eye Infections"},signatures:"Maria Maślińska and Brygida Kwiatkowska",authors:[{id:"77007",title:"Dr.",name:"Maria",middleName:null,surname:"Maślińska",slug:"maria-maslinska",fullName:"Maria Maślińska"}]}],onlineFirstChaptersFilter:{topicId:"1095",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:122,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"August 2nd, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:33,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:42,paginationItems:[{id:"82914",title:"Glance on the Critical Role of IL-23 Receptor Gene Variations in Inflammation-Induced Carcinogenesis",doi:"10.5772/intechopen.105049",signatures:"Mohammed El-Gedamy",slug:"glance-on-the-critical-role-of-il-23-receptor-gene-variations-in-inflammation-induced-carcinogenesis",totalDownloads:8,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chemokines Updates",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",subseries:{id:"18",title:"Proteomics"}}},{id:"82875",title:"Lipidomics as a Tool in the Diagnosis and Clinical Therapy",doi:"10.5772/intechopen.105857",signatures:"María Elizbeth Alvarez Sánchez, Erick Nolasco Ontiveros, Rodrigo Arreola, Adriana Montserrat Espinosa González, Ana María García Bores, Roberto Eduardo López Urrutia, Ignacio Peñalosa Castro, María del Socorro Sánchez Correa and Edgar Antonio Estrella Parra",slug:"lipidomics-as-a-tool-in-the-diagnosis-and-clinical-therapy",totalDownloads:7,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82440",title:"Lipid Metabolism and Associated Molecular Signaling Events in Autoimmune Disease",doi:"10.5772/intechopen.105746",signatures:"Mohan Vanditha, Sonu Das and Mathew John",slug:"lipid-metabolism-and-associated-molecular-signaling-events-in-autoimmune-disease",totalDownloads:17,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82483",title:"Oxidative Stress in Cardiovascular Diseases",doi:"10.5772/intechopen.105891",signatures:"Laura Mourino-Alvarez, Tamara Sastre-Oliva, Nerea Corbacho-Alonso and Maria G. 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Waisundara",profilePictureURL:"https://mts.intechopen.com/storage/users/194281/images/system/194281.jpg",biography:"Dr. Viduranga Waisundara obtained her Ph.D. in Food Science\nand Technology from the Department of Chemistry, National\nUniversity of Singapore, in 2010. She was a lecturer at Temasek Polytechnic, Singapore from July 2009 to March 2013.\nShe relocated to her motherland of Sri Lanka and spearheaded the Functional Food Product Development Project at the\nNational Institute of Fundamental Studies from April 2013 to\nOctober 2016. She was a senior lecturer on a temporary basis at the Department of\nFood Technology, Faculty of Technology, Rajarata University of Sri Lanka. She is\ncurrently Deputy Principal of the Australian College of Business and Technology –\nKandy Campus, Sri Lanka. 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He previously worked as a post-doctoral fellow at the Ben-Gurion University of Negev, Israel; University of the Free State, South Africa; and Central University of Technology Bloemfontein, South Africa. He obtained his Ph.D. in Organic Chemistry from Nagaoka University of Technology, Japan. He has published more than seventy-four journal articles and attended several national and international conferences as speaker and chair. Dr. Kendrekar has received many international awards. He has several funded projects, namely, anti-malaria drug development, MRSA, and SARS-CoV-2 activity of curcumin and its formulations. He has filed four patents in collaboration with the University of Central Lancashire and Mayo Clinic Infectious Diseases. 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He worked as a Executive Research & Development @ Cadila Pharmaceuticals Ltd, Ahmedabad. He received DBT-postdoc fellow @ Molecular Biophysics Unit, Indian Institute of Science, Bangalore under the supervision of Prof. P. Balaram, later he moved to NIH-postdoc researcher at Drexel University College of Medicine, Philadelphia, USA, after his return from postdoc joined NITK-Surthakal as a Adhoc faculty at department of chemistry. Since from August 2013 working as a Associate Professor, and in 2016 promoted to Profeesor in the School of Basic Sciences: Department of Chemistry and having 20 years of teaching and research experiences.",institutionString:null,institution:{name:"Rani Channamma University, Belagavi",country:{name:"India"}}},{id:"158492",title:"Prof.",name:"Yusuf",middleName:null,surname:"Tutar",slug:"yusuf-tutar",fullName:"Yusuf Tutar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/158492/images/system/158492.jpeg",biography:"Prof. Dr. Yusuf Tutar conducts his research at the Hamidiye Faculty of Pharmacy, Department of Basic Pharmaceutical Sciences, Division of Biochemistry, University of Health Sciences, Turkey. He is also a faculty member in the Molecular Oncology Program. He obtained his MSc and Ph.D. at Oregon State University and Texas Tech University, respectively. He pursued his postdoctoral studies at Rutgers University Medical School and the National Institutes of Health (NIH/NIDDK), USA. His research focuses on biochemistry, biophysics, genetics, molecular biology, and molecular medicine with specialization in the fields of drug design, protein structure-function, protein folding, prions, microRNA, pseudogenes, molecular cancer, epigenetics, metabolites, proteomics, genomics, protein expression, and characterization by spectroscopic and calorimetric methods.",institutionString:"University of Health Sciences",institution:null},{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",biography:"Hiroyuki Kagechika received his bachelor’s degree and Ph.D. in Pharmaceutical Sciences from the University of Tokyo, Japan, where he served as an associate professor until 2004. He is currently a professor at the Institute of Biomaterials and Bioengineering (IBB), Tokyo Medical and Dental University (TMDU). From 2010 to 2012, he was the dean of the Graduate School of Biomedical Science. Since 2012, he has served as the vice dean of the Graduate School of Medical and Dental Sciences. He has been the director of the IBB since 2020. Dr. Kagechika’s major research interests are the medicinal chemistry of retinoids, vitamins D/K, and nuclear receptors. 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He received his post-doctoral training in oncology and cancer proteomics for two years at the Cancer Research Institute of Human Medical University in China. In 2001, he went to the University of Tennessee Health Science Center (UTHSC) in USA, where he was a post-doctoral researcher and focused on mass spectrometry and cancer proteomics. Then, he was appointed as an Assistant Professor of Neurology, UTHSC in 2005. He moved to the Cleveland Clinic in USA as a Project Scientist/Staff in 2006 where he focused on the studies of eye disease proteomics and biomarkers. He returned to UTHSC as an Assistant Professor of Neurology in the end of 2007, engaging in proteomics and biomarker studies of lung diseases and brain tumors, and initiating the studies of predictive, preventive, and personalized medicine (PPPM) in cancer. In 2010, he was promoted to Associate Professor of Neurology, UTHSC. Currently, he is a Professor at Xiangya Hospital of Central South University in China, Fellow of Royal Society of Medicine (FRSM), the European EPMA National Representative in China, Regular Member of American Association for the Advancement of Science (AAAS), European Cooperation of Science and Technology (e-COST) grant evaluator, Associate Editors of BMC Genomics, BMC Medical Genomics, EPMA Journal, and Frontiers in Endocrinology, Executive Editor-in-Chief of Med One. He has\npublished 116 peer-reviewed research articles, 16 book chapters, 2 books, and 2 US patents. His current main research interest focuses on the studies of cancer proteomics and biomarkers, and the use of modern omics techniques and systems biology for PPPM in cancer, and on the development and use of 2DE-LC/MS for the large-scale study of human proteoforms.",institutionString:null,institution:{name:"Xiangya Hospital Central South University",country:{name:"China"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. 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He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a Principal Investigator and Scientist at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via machine-learning-based analyses of exosomal signatures. Dr. Paul has published in more than fifty peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award, a senior member of the Institute of Electrical and Electronics Engineers (IEEE), and an editorial board member for several international journals.",institutionString:"University of California Los Angeles",institution:{name:"University of California Los Angeles",country:{name:"United States of America"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals. He is currently working on the protective activity of phenolic compounds in disorders associated with oxidative stress and inflammation.",institutionString:null,institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Dr.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329248",title:"Dr.",name:"Md. Faheem",middleName:null,surname:"Haider",slug:"md.-faheem-haider",fullName:"Md. Faheem Haider",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329248/images/system/329248.jpg",biography:"Dr. Md. Faheem Haider completed his BPharm in 2012 at Integral University, Lucknow, India. In 2014, he completed his MPharm with specialization in Pharmaceutics at Babasaheb Bhimrao Ambedkar University, Lucknow, India. He received his Ph.D. degree from Jamia Hamdard University, New Delhi, India, in 2018. He was selected for the GPAT six times and his best All India Rank was 34. Currently, he is an assistant professor at Integral University. Previously he was an assistant professor at IIMT University, Meerut, India. He has experience teaching DPharm, Pharm.D, BPharm, and MPharm students. He has more than five publications in reputed journals to his credit. Dr. Faheem’s research area is the development and characterization of nanoformulation for the delivery of drugs to various organs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/system/329795.png",biography:"Dr. Mohd Aftab Siddiqui is an assistant professor in the Faculty of Pharmacy, Integral University, Lucknow, India, where he obtained a Ph.D. in Pharmacology in 2020. He also obtained a BPharm and MPharm from the same university in 2013 and 2015, respectively. His area of research is the pharmacological screening of herbal drugs/natural products in liver cancer and cardiac diseases. He is a member of many professional bodies and has guided many MPharm and PharmD research projects. Dr. Siddiqui has many national and international publications and one German patent to his credit.",institutionString:"Integral University",institution:null}]}},subseries:{item:{id:"92",type:"subseries",title:"Health and Wellbeing",keywords:"Ecology, Ecological, Nature, Health, Wellbeing, Health Production",scope:"\r\n\tSustainable approaches to health and wellbeing in our COVID 19 recovery needs to focus on ecological approaches that prioritize our relationships with each other, and include engagement with nature, the arts and our heritage. This will ensure that we discover ways to live in our world that allows us and other beings to flourish. We can no longer rely on medicalized approaches to health that wait for people to become ill before attempting to treat them. We need to live in harmony with nature and rediscover the beauty and balance in our everyday lives and surroundings, which contribute to our well-being and that of all other creatures on the planet. This topic will provide insights and knowledge into how to achieve this change in health care that is based on ecologically sustainable practices.
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Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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