Most frequently found
\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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Species | Characteristic |
---|---|
Usually the most frequently found | |
Related to cancer | |
Usually resistant to azoles, seen more frequently in developed scenarios and older patients | |
Less pathogenicity | |
Potentially resistant to amphotericin | |
Intrinsically resistant to azoles | |
Difficult to differentiate from | |
Responsible for a global outbreak |
Most frequently found
They grow in agar as colonies with a smooth, creamy, white appearance. The formal identification can be made by use of biochemical physiological reactions, which can differentiate an important number of isolates. The metabolic reactions include carbohydrate fermentation, nitrate use, and urease production.
Susceptibility testing can be performed by different methods, including broth microdilution (recommended in the USA and Europe), but there are other different commercial methods available in hospitals. Two slightly different standards for susceptibility testing are currently available. One is suggested by the Clinical Laboratory Standards Institute (CLSI, in USA), while the other is proposed by the European Committee on Antimicrobial Susceptibility Testing (EUCAST), sponsored by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). Basic differences between both methodologies include time and instrument to read the results. Different clinical breakpoints have been established for the most commonly found species, with the intention of differentiating the risk of clinical failure after treatment. The experience with fluconazole has allowed to develop better prediction models, in comparison with newer antifungals [6]. In summary, an isolate of
As mentioned before,
Patients in the ICU have the highest rate of
Patients in the ICU have higher rates of
Another commonly identified risk factor is the use of parenteral nutrition or the length of its use [15, 19]. This group of patients shares several risk factors, but parenteral nutrition has been identified in multivariate analysis [20]. Usually, they have an abdominal procedure (see below) and they require parenteral nutrition for several days. Lack of appropriate measures to handle the nutrition, colonization of the catheter or the ports used to infuse it, and probably the availability of optimal growing conditions are conditions related to its use. But clearly, the use of parenteral nutrition leads to the development of mucosal atrophy and a loss of mucosal epithelial barrier function [21], which might affect the relationship between microorganisms in the gut and the possibility of gaining access to blood vessels. Total parenteral nutrition has also a profound effect in the gastrointestinal microbiome [22].
Several studies have shown the relationship between candidemia and a previous surgical procedure [19, 23], specially an abdominal surgery. There are several explanations to this observation, but gut manipulation, and the effect of resected sections over the gut microbiology, microbiota abundance, and epithelial function might contribute to the possibility of candidemia. Studies have shown that patients with high anastomotic leak, as well as those with recurrent gastrointestinal perforation, or acute necrotizing pancreatitis, have a higher risk of candidemia [15].
Almost all studies of candidemia have shown an extremely high use of antibiotics previous to the identification of bloodstream or tissue infection. The proportion of patients with antibiotic use is over 80% [24]. The number and spectrum of the antibiotics used might affect the risk of candidemia. Antimicrobials also have an effect over gut microbiota, and some studies have shown some impact from antibiotics with anti-anaerobic effect, and those with higher gastrointestinal concentration [25]. They contribute to the observed increased colonization over time observed in patients in the ICU. With more antibiotic effect, there is a net decrease in the number of species in the gastrointestinal tract, an increase in the number of patients colonized, and the proportion of them being heavily colonized [26].
Studies have identified several risk factors that alone, or in combination, might increase the probability of having candidemia. The presence of renal failure, the use of antihistaminic blockers, the severity of illness, and the length of stay in the ICU contribute to colonization and development of candidemia [24, 27]. All these factors contribute to the acquisition of
The identification of risk factors lead to the use of some scores based in the presence of such factors to identify patients with higher risk of
A second score to identify risk factors in patients was developed in Spain by León and his collaborators [20]. They identified colonization (with a different definition from that used by Pittet et al.), surgery at ICU admission, and use of total parenteral nutrition as risk factors independently associated with candidemia. They also identified sepsis as independently related, but this is clearly more a clinical syndrome than a risk factor. A third score was developed by a multicenter collaboration group, in which they again identified the same risk factors [28]: antibiotic use, having an intravascular catheter, in conjunction with at least two additional risk factors such as any surgery, immunosuppressive use, pancreatitis, total parenteral nutrition, dialysis, or steroid use.
Common to these scores has been the presence of the aforementioned risk factors. The problem, however, is that such scores identify a huge number of patients at risk with a final intermediate risk of developing candidemia, in a range from 7 to 30% [29, 30]. The great advantage of the diagnostic scores relies in their high negative predictive value. Patients with a negative score have a low probability of candidemia, below a 1% probability.
These disorders share a common factor: immunosuppression. However, different types of immunocompromise entail different risks for the patients. The incidence of candidemia among patients with cancer is higher in comparison with other patients in the hospital. In a multicenter study in Greece, patients with hematological disease had an incidence of candidemia of 1.4 cases per 1000 admissions, while other patients hospitalized had an incidence of 0.83 cases per 1000 admissions [31]. A multicenter European study found an incidence of 1.2% cases of candidemia among patients with bone marrow transplantation (BMT) and leukemia [32]. An Italian multicenter study from a surveillance network showed a diminishing trend for candidemia among patients with cancer, especially among those with acute myeloid leukemia [33]. Whether this trend can be inferred to other European countries or not is not known, and the most likely explanation for this decrease in the number of cases could be related to the use of prophylaxis among those patients with acute leukemia with posaconazole. In general, non-albicans
Neutropenia, a count of leukocytes in peripheral blood below 500 cells per μl, is the common risk factor among patients with hematological disorders (i.e., leukemia, lymphoma, multiple myeloma among others) as well as those with bone marrow transplantation (BMT). Neutropenia might be a consequence of the activity of the hematological disease, an effect of chemotherapeutic strategies or side effect of multiple medications including antimicrobials. It also is a marker of the intensity of chemotherapy. Patients with chemotherapy-induced neutropenia accumulate various risk factors: they usually receive wide spectrum antibiotics for several days, they have serious gastrointestinal epithelial tissue dysfunction, usually with diarrhea and signs of mucosal damage, and the use of vascular catheters for the infusion of chemotherapeutic drugs and antibiotics [34]. Several studies have shown that isolates of
In patients with prolonged neutropenia, a condition called hepatosplenic candidiasis might be seen. In it, seeding of yeasts occurs during the neutropenic phase which might be not clinically evident until neutropenia recovery. In these patients, fever persists and lesions can be seen in the liver, usually known as bull-eye lesions [37] (Figure 1).
Tomographic image of liver and spleen showing abscesses (bull’s eye, arrows) and hypodense lesions in a patient with chronic disseminated candidiasis. Reproduced with permission from Cortés et al. [
In patients with cancer and candidemia, several factors were identified in comparison with those with cancer and bacterial infections [38]. Total parenteral nutrition over 5 days, urinary catheter for more than 2 days, distant metastasis of cancer, and gastrointestinal cancer were independent risk factors. Patients with solid tumors might accumulate factors as patients in critical care, since they have abdominal surgery (gastrointestinal neoplasm), require vascular catheters for extended periods of time (for chemotherapy or antibiotics), total parenteral nutrition and received antibiotics frequently [39]. A study to identify factors predicting catheter-related infections with
Among patients with leukemia and BMT, the risk factors for occurrence of candidemia included bone marrow or cord blood stem cell source, T-cell depletion, use of total body irradiation, and acute graft versus host disease [32]. These data were derived from a huge multicenter registry of patients with cancer and transplantation, which allowed to identify more precisely the risk factors.
Newborns have no gastrointestinal flora at birth and have to be colonized by enterobacteria and other microorganisms, which is made via maternal breast feeding. Any alteration in the normal process can lead to colonization by pathogenic microorganisms, including yeasts [40]. Neonates in the intensive care unit usually have limited breastfeeding, indwelling vascular catheters, total parenteral nutrition, and antibiotics [41]. Such combination of risk factors put. this group of patients at a higer risk of infection, reaching over 10% of patients in units with extreme prematures and low weight at birth (the group that requires more invasive interventions) [42]. Some studies have illustrated this relationship with proportion of candidemia between 3 and 10% among those with a weight of less than 1000 g while showing an incidence of less than 1% for those weighting over 2500 g [43]. In this scenario, disseminated candidemia can be found and near 10% of those with invasive disease can compromise the central nervous system. Another important risk factor includes the time that the patient has been in the unit [44]; clearly, patients with low weight, lower gestational age, and more comorbidity tend to spend more time in the neonatal ICU and to accumulate other risk factors (surgery, indwelling catheter, antibiotics, etc.) [45]. There are some high-risk units, in which the incidence of candidemia traditionally has been high, usually over 10% of the admitted cases. In this scenario, prophylaxis has been suggested for the prevention of infection [46].
As shown, colonization is the preliminary step to infection. Besides, a number of interventions are common to immunosuppressed and critically ill patients including indwelling catheters (urinary and vascular), severity of illness, total parenteral nutrition, etc. These conditions predispose the patients to cross contamination. An outbreak among newborns was demonstrated to be due to poor practices of catheter ports disinfection [51].
A study in China in a cancer institute showed that 21 out of 36 episodes of candidemia were caused by two endemic genotypes [52]. In this study, gastrointestinal cancer and insertion of a nasogastric tube were related to infection. As mentioned before, cancer patients with solid and hematological tumors share several of the risk factors of colonization and infection.
Since 2013, the Leading International Fungal Education (LIFE) portal has facilitated an important effort to know the epidemiology and burden of fungal infections around the world and allowed a better understanding of their epidemiology in different countries [53]. The real incidence of candidemia is difficult to calculate due to differences in the approach. While studies based on hospitals might overestimate the importance of some groups of high-risk patients, they are difficult to compare. Data from population studies might reflect better the real situation, but this kind of information is scarce. Studies have shown ample differences in the incidence in some regions and at specific times [54].
Traditionally,
Area and publication year | References | ||||
---|---|---|---|---|---|
USA 2012 | 38 | 29 | 17 | 10 | [49] |
Latin America 2013 | 37.6 | 6.3 | 17.6 | 26.5 | [48] |
Spain 2014 | 45.4 | 13.4 | 7.7 | 24.9 | [50] |
Asia-Pacific region 2016 | 20–55 | 5–22 | 2–20 | 8–27 | [51] |
France 2014 | 56 | 18.6 | 9.3 | 11.5 | [52] |
Proportion of
Two studies deserve a detailed description. The first one is a multicenter study from the Southeast Asia region, including 25 hospitals from 6 countries: China, Hong Kong, India, Singapore, Taiwan, and Thailand [60]. They found differences between the countries that include the frequency of
There are data from some population surveillance surveys in Europe and United States. In general, the incidence might be lower than in some other areas of the world. Table 3 shows the incidence from data from North America and European countries [61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77]. In Europe, the highest incidence has been observed in Hungary, while in North America the highest incidence has been seen in some cities in United States.
Country/region | Publication Year | Incidence (per 100.000 inhabitants) | References |
---|---|---|---|
Belgium | 2015 | 5 | [54] |
Denmark | 2008 | 10.4 | [55] |
Finland | 2010 | 2.8 | [56] |
Germany | 2015 | 4.6 | [57] |
Hungary | 2015 | 11 | [58] |
Ireland | 2015 | 7.3 | [59] |
Norway | 2018 | 3.8 | [60] |
Portugal | 2017 | 2.57 | [61] |
Romania | 2018 | 6.8 | [62] |
Russia | 2015 | 8.29 | [63] |
Serbia | 2018 | 10 | [64] |
Spain | 2015 | 8.1 | [65] |
Sweden | 2013 | 4.2 | [66] |
Ukraine | 2015 | 5.8 | [67] |
Canada | 2017 | 2.91 | [68] |
México | 2015 | 8.6 | [69] |
USA | 2015 | 9.5–14.4 | [70] |
Estimated incidence of invasive candidiasis or candidemia in countries of the European or North American regions.
This region has profound differences in healthcare systems, access to care, and medical technology development. With a transition toward a higher income, a growing number of institutions with capacity to attend cancer patients, and more complex medical needs, the number of candidemia cases seems to be higher than in developed countries.
Ample information exists about the problem in Brazil, where a number of studies have been carried out in high-complexity hospitals in the main cities of the country [78, 79]. These studies show a higher frequency of invasive candidiasis in comparison with developed countries, an increased isolation of
Country/region | Publication year | Incidence (per 100,000 inhabitants) | References |
---|---|---|---|
Argentina | 2018 | 6.25 | [71] |
Brazil | 2016 | 14.9 | [72] |
Chile | 2017 | 5.8 | [73] |
Colombia | 2018 | 14.7 | [74] |
Ecuador | 2017 | 7.2 | [75] |
Guatemala | 2017 | 6.4 | [76] |
Jamaica | 2015 | 5.8 | [77] |
Perú | 2017 | 5.8 | [78] |
Trinidad and Tobago | 2015 | 5.8 | [79] |
Uruguay | 2018 | 36.5 | [80] |
Estimated incidence of invasive candidiasis or candidemia in countries of Central and South America and the Caribbean.
A multicenter in Asia gathered information from various countries, including nine hospitals from China [60]. The incidence rate among patients hospitalized was 0.38 per 1000 admissions, which is lower than that observed in the Latin-American region with 1.08 cases per 1000 admissions [55]. The estimated incidence of candidemia in countries in Asia is shown in Table 5 [90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100]. In Asia, the highest incidence has been observed in Pakistan, followed by Qatar and Israel. In China, geographic variations in the causative species and susceptibilities were noted, with increasing isolates resistant to fluconazole [101]. The numbers for the African countries are lacking and for some countries like Algeria, Burkina Faso, Cameroon, Egypt, Malawi, Mozambique, and Tanzania, the estimated incidence is 5.8 cases per 100,000 inhabitants, a standard calculation based on previously reported incidence in other countries [102, 103, 104, 105, 106, 107, 108].
Country/region | Publication year | Incidence (per 100,000 inhabitants) | References |
---|---|---|---|
Bangladesh | 2017 | 5 | [83] |
Israel | 2015 | 11 | [84] |
Jordan | 2018 | 5.75 | [85] |
Kazakhstan | 2018 | 4.3 | [86] |
Korea | 2017 | 4.57 | [87] |
Malaysia | 2018 | 5.8 | [88] |
Pakistan | 2017 | 21 | [89] |
Philippines | 2017 | 2.25 | [90] |
Qatar | 2015 | 15.4 | [91] |
Thailand | 2015 | 13.3 | [92] |
Uzbekistan | 2017 | 5.93 | [93] |
Estimated incidence of invasive candidiasis or candidemia in countries of Africa and Asia.
Azole-resistant
Among patients with cancer, not only are non-albicans
Up to 2009, there was no report on
Patients with candidemia and cancer are considered to have higher mortality, but this issue has not been clearly assessed. Older studies showed an attributable mortality around 40%. Although mortality among patients with candidemia or invasive candidiasis is reported usually around 40–50%, they occur in patients with important comorbidity. A recent multicenter analysis showed a crude mortality for patients with candidemia of 53%, while those without candidemia had a mortality of 26% [128]. After adjusting in a propensity score analysis, the crude mortality was 51% for the candidemic patients and 37% for the others and the difference was not statistically significant. The study shows that an increase in mortality might exist for those patients with candidemia, but it is clear that patients with candidemia also have severe comorbidity and some of them can die with candidemia instead of because of it.
Risk factors for mortality among patients with candidemia include ascites, presence of septic shock, ICU admission, concomitant bacterial infection and catheter-related infections [129]. Studies with diverse population have shown that elderly patients have higher mortality [130]. In these patients, a combination of comorbidity, poor clinical situation, and more pathogenic species might contribute to their mortality [131]. A pooled analysis from patients included in randomized clinical trials comparing micafungin and amphotericin B showed differences among geographic regions, severity of disease (measured with Apache score for patients critically ill), and catheter removal [132]. In those with abdominal candidiasis, the lack of control of the source of infection has been related to increased risk of death [133]. Among patients with cancer, risk factor for mortality includes infection by a
The impact of the antifungal treatment in the mortality of patients with candidemia is not entirely clear. There are several constrains to identify the benefits of the antifungal treatment: An important proportion of patients did not receive antifungal treatment despite the identification of a bloodstream infection; of those that receive the treatment, some of them can receive it as empirical treatment, based on the risk factors, clinical condition, while others have an antifungal started upon detection of candidemia. Besides, some of them are infected with a resistant isolate and some do poorly, and an additional antifungal must be started. Although meta-analysis with patient-level data has showed the benefit of equinocandin use (in contrast to azole treatment) [136], neither the cohort data [137], nor the randomized trials have confirmed this finding [138]. There is an additional complication in understanding this relationship; the laboratory breakpoints for identification of susceptible versus resistant isolates have changed over the time, especially for azoles [130]. Among those patients with septic shock, the delay in the administration of the antifungal treatment has been associated with increased mortality.
Candidemia is the most frequently found form of invasive candidiasis. The
There is no conflict of interest to declare.
Population aging is a human success story. A reason to celebrate the triumph of public health, medical advancement, and economic and social development over the diseases, injuries and early deaths that have limited human life spans throughout history. Globally, there were 703 million people aged 65 and over in 2019. In the next three decades, the number of older people in the world is projected to double, reaching more than 1.5 billion in 2050. All regions will see an increase in the size of their older population between 2019 and 2050.
There are not only improvements in life expectancy at birth, but also even faster improvements in life expectancy at later ages. Globally, a 65-year-old could expect to live 17 more years in 2015-2020 and 19 more years by 2045-2050 [1]. The World Health Organization (WHO) notes that life expectancy in older age is increasing at a much faster rate in high-income countries than in lower-resource settings conditions. See Figure 1 [2].
Changes in life expectancy from 1950, with projections until the year 2050, by region of the WHO and worldwide [
This demographic transition is a major challenge for health authorities around the world, particularly as disease patterns will change at the same time. With age, the risk of losing years of healthy life is compounded by low individual resistance, poor nutritional status, chronic diseases, and adverse socio-environmental conditions [3]. Responding to this challenge requires the whole society.
One of the most important strategies we have to control and lessen the danger that this represents is the promotion of health. Health promotion uses education, prevention and health protection. This is of particular importance among developing countries where economic resources are scarce and where the largest growth in the older adult population is taking place in the world [4]. All these efforts to keep away older people from suffering and physical, emotional and social limitations as a result of disease must include the maintenance of oral health.
In the last decades of the 20th century and the beginning of the 21st, a global agenda has been disseminated on the implementation of public policies that reduce the burden of disease in the older adults. For example, since 1995, in response to the global challenges of population aging, the WHO launched a program on aging and health. This was designed to promote knowledge about health care in old age through specific research and training activities, information dissemination, and policy development.
In 1998 in the World Health Report, WHO reported the need to strengthen health promotion among older people. The health implications of aging should be better clarified and understood. Later, in 2000, WHO reiterated the priority of older people’s health through the “Aging and Life Cycle” program, which focused on the concept of “active aging”. In 2002, WHO published a document entitled “Active Aging: A Policy Framework”, which outlines essential approaches to achieving healthy aging. The proposed policy framework was based on three basic pillars: health, social participation and security [4].
The WHO in its report on aging and health, 2015, emphasized: “Oral health is a crucial and often neglected area of healthy aging” [5].
In this regard, oral health is a key component in maintaining and promoting a healthy body and a high quality of life [6]. The growing body of scientific evidence confirms that good oral health is integral and essential to a person’s overall health. Oral health and disease are closely related to health and disease in general. Unfortunately, older people are representative of a vulnerable population group that suffers heavily from oral diseases.
Given the comorbidities associated with the chronic disease profiles of older people, poor oral health further compromises healthy aging. The literature consistently describes oral health as a significant determinant of an individual’s quality of life [7].
Health authorities around the world now face a growing public health problem, including an increasing burden of oral disease among older people. Globally, poor oral health in this age group has been shown particularly in high levels of tooth loss, decay tooth, periodontal disease, xerostomia, and oral cancer [2].
In oral health, global inequalities persist both within and between regions and societies and undermine the fabric, productivity and quality of life of many communities of the world [8]. Despite advances in prevention, restorative techniques, and dental materials, tooth loss remains a reality in both industrialized and developing countries [9]. While there have been significant improvements in oral health in the last 30 years, inequalities persist and a marked social gradient in oral health is observed similar to that of general health [8].
According to the WHO Oral Health Database, high levels of decay tooth are found in national surveys of older people; regionally, the average number of teeth affected by decay varies from an average of 9 teeth in the countries of the African region to an average of 24 teeth in Europe. In all regions, the experience of decay tooth in older people led to tooth loss, while the number of teeth treated after decay is quite limited, especially in the countries of the African region.
Regarding periodontitis, globally, surveys have reported that the percentage of older people with deep periodontal pockets is within the range of 5–30%. Data from Madagascar reported that 17.1% of people aged 65 to 74 had superficial or deep periodontal pockets, while these conditions were observed in 55.5% of Chinese older adults [10].
Poor oral health negatively affects the daily performance of older people, this condition can lead to reduced chewing performance, limited food choices, weight loss, poor communication, low self-esteem and well-being. Obviously, these conditions influence the quality of life. The increase in life expectancy without a better quality of life has a direct impact on government spending on health, and is becoming a key public health problem in the most developed countries. It will also be of great concern to developing countries and countries with high population density and emerging economies, such as China and India [2].
At all ages, a healthy natural dentition and a pleasant dental appearance contribute to quality of life. Bad breath and tooth decay can promote social isolation, limit participation in social activities, and influence our judgments about personality traits [9].
Older people in good health can contribute to society, their families, their communities and economic productivity through formal or informal channels, e.g. through volunteer work, etc. [11]. Searching for effective, systematic and wide-ranging interdisciplinary solutions aimed at the current and future burden of oral diseases in our older people will be a great challenge and opportunity in the 21st century [6].
Goals in dentistry cannot be achieved solely on the basis of providing clinical treatment alone. As for any age, health promotion and self-managed disease prevention measures are important to achieve better oral health outcomes. Health promotion interventions are key to improving oral health in old age, as it encourages older people to be proactive about their health [11].
Through the Ottawa Charter, WHO, 1986, health promotion was defined as: “the process of allowing people to increase control over their health and improve it”. To achieve a state of complete physical, mental, and social well-being, an individual or group must be able to identify and realize aspirations, satisfy needs, and change or cope with the environment [12].
Failure to prevent or control the progression of oral disease can increase the risk of adverse health outcomes. A recent systematic review in Cochrane found evidence that periodontal disease treatment improved metabolic control among people with type 2 diabetes. Also, it was shown that better care of oral hygiene can prevent respiratory infections and death from pneumonia. in older people in hospitals and nursing homes. Furthermore, frequent tooth brushing was reported to be associated with lower levels of cardiovascular disease [13].
The literature also indicates that health promotion activities should include the active participation of stakeholders in their planning, implementation, and evaluation. This will ensure that health promotion activities are based on the target group’s own goals and needs.
Greater efforts should be made to identify opportunities for health promotion activities and the development of community models that encourage older people to improve and maintain their oral health. Ignoring health promotion and disease prevention opportunities in these groups is unfair and can increase inequalities in health standards [11].
Health promotion uses education, prevention and health protection. This is of particular importance among developing countries where economic resources are scarce and where the world’s largest population growth is taking place [3].
Health literacy, which is within the framework of health promotion and preventive strategies, is necessary to counter oral diseases. Health literacy has been defined as “the cognitive and social skills that determine people’s motivation and ability to access, understand, and use information in a way that promotes and maintains good health.” In the case of older people, it is important to take into account, in addition to health literacy, functional literacy. Health professionals should consider literacy difficulties among older people than younger adults, if they associate aging with visual and/or cognitive impairments, or think that older cohorts had more likely to have missed school as children. Therefore, they need to provide clear or improved oral instruction to older people [14].
In recent years, the WHO developed a series of essential principles for the prevention of oral and general diseases and the quality of life, which must be followed by all actors involved in the health care of older people. In the report on health in the world of 2015, the strengthening of health promotion and the creation of healthy environments adapted to the older adults are highlighted in the first place. Promote a healthy diet and nutrition, especially less sugar consumption and increased consumption of fruits and vegetables, in accordance with the “WHO Global Strategy on Diet, Physical Activity and Health, and Reduction of Malnutrition.”
One of the most relevant recommendations of this report is to emphasize the importance of educating caregivers about oral health knowledge, to dependent older people, in addition to involving their families, it is extended to independent older adults. As well as, to “other important people”, which can be interpreted as the entire team that cares for older people. A relevant point is to ask that care models be developed thinking of older people with primary oral health care capacity. As well as, nursing homes and institutions for dependent older people in order to meet the needs of the many people neglected.
On the other hand, the economic cost of treatments is identified as a barrier to oral health care in older people. So it is requested to improve social security for this age group, and to establish health care financially fair mouthpiece for the older adults. Attention is paid to evidence-based medicine, and this report calls for the implementation of national evidence-based public health programs to achieve better oral health, general health, and quality of life. Finally, within these principles of the WHO, the surveillance of the oral health of the older adults and important risk factors is recommended [10].
Meeting the oral health needs of the growing older population will require a diverse and capable dental workforce. A two-pronged approach is required, focusing both on (a) new entrants to the profession through dental schools and (b) existing dentists. The latter will be achieved through the continuing professional development of most dentists, but there will also be a greater need for postgraduate education and training. Undergraduate education is the hotbed of conscientious professionals, so it is important to place appropriate emphasis on oral health care for older patients in the undergraduate curriculum [15].
In this regard, the group made up of The common Task and Finish of the European College of Gerodontology (ECG) and the European Society of Geriatric Medicine (EUGMS), proposes a series of educational training actions aimed at dentists, and non-dentists in order to improve dental care for the older adults. They call this strategy “Educational Action Plans”, and which in our opinion are of such importance for the prevention of oral diseases in older adults that we underline them.
According to this proposal, educational action plans should involve dental and non-dental health care providers, giving them the opportunity for interprofessional training, practical training and improvement of attitudes towards the promotion of oral health. Better training for dental professionals in oral care for frail dependent older people.
Non-dental health professionals should receive education at the undergraduate, graduate and specialty levels, in the evaluation and promotion of oral health. This includes physicians, nurses, nursing assistants, physical therapists, occupational therapists, medical assistants, pharmacists, dietitians and others. It is proposed that these health providers should recognize oral health as part of multimorbidity. Also relate medication to the impact on oral health, initially assess oral health status, and demonstrate oral hygiene measures for the older adults and their caregivers. All this by developing strategies to overcome barriers to maintaining oral health and access to dental care, deciding when to refer to the dentist, and supporting collaborative practice [16, 17].
As the population ages, one of the main challenges for the future will be to translate existing knowledge and strong experiences in disease prevention and health promotion into appropriate programs [3]. Educational interventions on oral health in older people have shown their potential benefit to improve the level of knowledge and their application in preventive oral care measures. The most remarkable result to emerge from the data is the significant decrease in the O’Leary index and in the index of tongue coating [18].
Educational interventions have shown to significantly reduce the number of plaque-covered teeth and improve prosthetic hygiene in older people who require the care of a home health nurse. However, multiple approaches based on individual needs are required to improve the oral health of vulnerable older people, including integrating preventive dental care into the daily care plan carried out by home care nurses. It is important to consider the functional capacity and cognitive function of the older adult, as it has been associated with poorer oral hygiene [19]. Oral hygiene education programs for institutionalized older people caregivers have shown a positive impact on improving this condition of residents. The ratio of residents to caregivers should be considered, as it could play an important role in the provision of oral hygiene services, and has received little attention in the literature [20].
Unfortunately, oral health competence and attitudes towards oral care have been reported to be inadequate in nursing home care. Poor oral health has been reported for people most dependent on care, showing the need for preventive actions [21].
Considering only biological factors as the cause of oral diseases is not enough to explain the social differences in oral health. Consequently, addressing these factors alone, has led to reductionist approaches to prevention and treatment. Unfortunately there is a lack a sound theoretical basis and which, in general, have also failed to reduce the burden of oral diseases, and oral health inequalities [22].
In this regard, as reported by Link & Phelan, 1995, it is necessary to “contextualize risk factors” and understand the “fundamental social causes” of the disease. “Contextualize” risk factors based on the individual means that it is required (1) use an interpretive framework to understand why people become exposed to risk or protective factors and (2) determine the social conditions under which individual risk factors are related to disease [23].
In the case of oral health, there is considerable evidence of the influence of the social gradient on the oral health status of individuals. We know that many oral diseases are associated with socioeconomic status, which is linked to family income, educational level, employment status, housing, physical health, and mental health [23].
The fundamental social causes of disease essentially involve the resources that determine the degree to which people can avoid the risks of morbidity and mortality. Resources broadly can include money, knowledge, power, prestige, and the types of interpersonal resources incorporated into the concepts of social support and social network. Variables examined by medical sociologists and social epidemiologists, such as race/ethnicity and gender, are linked to resources such as money, power, prestige and/or social connection that should be considered as possible root causes of the disease [24].
Oral diseases share the same determinants and risk factors as the major Non-communicable Diseases (NCDs), which include heart disease, cancer, chronic obstructive pulmonary disease, diabetes, dementia, and stroke [23]. For NCDs, risk factors have been identified and many are related to lifestyle. Risk reduction is associated with smoking cessation, diet control (including reducing excessive consumption of calories, saturated fat and salt), moderate alcohol consumption, and exercise. Furthermore, many of these risk factors are important for the development of oral diseases. Table 1, resumes both biological and social risk factors [25].
Biological risk factors | Social risk factors |
---|---|
Interaction between the microbial plaque and the host’s immune response Aging of oral tissues: Changes in the healing capacity of cells and tissues | Related to lifestyle: Smoking, alcohol consumption, Diet: excessive consumption of carbohydrates |
Decreased salivary gland secretion; xerostomia | Socioeconomic status |
Medical conditions: Disabling musculoskeletal disease Cognitive and functional impairment Frailty syndrome Depression | Educational level |
Ethnicity and gender |
Biological and social risk factors of oral disease in old age.
It is important to recognize that in the older adults, there are risk factors, biological and social that favor the prevalence of oral pathologies such as tooth decay and chronic periodontitis [26]. These diseases continue to appear in old age. Global data indicate that the incidence of untreated tooth decay shows an upward trend after age 60. It was suggested that this was due to the development of root decay among older people. Similarly, periodontal diseases and their sequelae are highly prevalent among older people. The age-standardized prevalence and incidence of severe periodontitis showed a slight increase worldwide during 1990-2010, with a peak incidence in the fourth decade of life [27].
From a biological perspective, the etiology of periodontal disease has consistently been related to the interaction between the microbial plaque and the host’s immune response. Previous research shown, although periodontal conditions are initiated by dental plaque, the perpetuation of inflammation and the severity and progression of the disease depend on the effectiveness of the innate immune response to the bacterial biofilm. For its part, tooth decay is an essentially diet-mediated disease, in which host factors such as immune components in the microbial biofilm and saliva contribute to its progression [22].
Age can affect both oral diseases directly. When analyzing national studies of older people from the USA and Germany to observe, among other issues, the vulnerability to periodontitis and tooth decay in this population. The results showed that changes in susceptibility to periodontitis with age could be explained by exposure to pro-inflammatory conditions and changes in the healing capacity of cells and tissues [26].
The greater severity of periodontal diseases with age has been related to the length of time that periodontal tissues have been exposed to dentogingival plaque and is considered to reflect the accumulated oral history of the individual. However, the susceptibility of the periodontium to microbial plate induced periodontal degradation can be influenced by the aging process or by health problems specific to the aging patient. Differences in eating habits, increased flow of gingival exudate from the inflamed gum, and possible age-related changes in salivary gland secretions can similarly alter the conditions for growth and multiplication of microorganisms in the biofilm [28].
On the other hand, due to accumulated periodontal destruction, the number of surfaces at risk of tooth decay increases. The sequelae of restorative treatment contribute to an increased susceptibility to tooth decay development. Risk indicators for root decay include tooth decay experience, number of surfaces at risk, and poor oral hygiene [26].
With regard to tooth decay and the immune system and the impact of aging, a systematic review showed that studies are still in an early stage. A small number of studies have reported components of innate and adaptive immunity that affect the composition of dental saliva and biofilms with possible impacts on caries progression. Some conclusions could, at this stage, be considered more theoretical [29].
The general health of older people involves a variety of medical, cognitive and functional conditions and/or limitations that can have a direct effect on the onset and progression of oral diseases. And, by extension, the self-sufficiency of older people with respect to the performance of oral hygiene and the search for timely professional dental care [27].
In general, obtaining medical or dental care is known to be a problem for many older people with impaired functional status, especially those who are homebound or reside in long-term care facilities. People with disabling musculoskeletal conditions are likely to be among those affected in this way.
It is estimated that 10% of the world’s population aged 60 years or older have significant clinical problems attributable to osteoarthritis, a condition that is associated with joint pain, limited movement and sensation and occurs most frequently in the knee, hip and joints of the hands [30]. While the prevalence of rheumatoid arthritis is lower, it also affects a large number of people and is associated with aging [31].
Many people with these conditions, osteoarthritis and arthritis in the hands, cannot maintain proper oral hygiene, causing plaque and stone buildup, increasing the likelihood of tooth decay and periodontal disease. The limitation of mobility resulting from these diseases, particularly in the lower extremities, makes it difficult for those affected to visit dental offices for both routine hygiene and treatment [32].
Although cognitive impairment has not yet met the diagnostic criteria for dementia, people with mild cognitive impairment have been found to have poorer oral hygiene, a high gingivitis score, and more impaired root surfaces than those with intact cognition [33]. Tooth loss was reported to be independently associated with the development of cognitive impairment among older people living in the community. This finding supports the hypothesis that tooth loss may be a predictor or risk factor for cognitive decline [34].
Frail older patients in hospitals and long-term care homes, who depend on others for oral hygiene care, are at risk of poor health due to impaired functional and cognitive abilities. They are at high risk for tooth decay because foods containing sugar and refined carbohydrates remain in contact with the teeth for long periods between brushing [35].
One of the oral conditions that affect the quality of life of the older adults is xerostomia. A high prevalence of xerostomia and hypofunction of the salivary glands has been found in vulnerable older people. Etiologic factors include polypharmacy (especially with antihypertensives, antidepressants, and antipsychotics), poor general health, female sex, and advanced age. People with dry mouth require preventive measures against the consequences of the absence of saliva, including tooth decay, periodontal disease, and candidiasis [36].
Older people with depressive symptoms are less likely to make self-care, including oral hygiene and preventive dental care, a priority - many older people experience a chronic course of depressive symptoms. Depression in old age and depressive symptoms may be associated with poor nutrition, decreased salivary flow, distorted taste, increased oral lactobacillus counts, dental caries, advanced periodontal disease, and oral discomfort [37]. Older people with tooth loss were shown to be at increased risk of depressive symptoms [38].
Oral cancer poses a great threat to the health of adults and the older adults in high- and low-income countries [36]. Oral cavity cancer can be easily prevented and treated if it is diagnosed early [39].
It includes cancer of the lip, oral cavity, and pharynx, and is the eighth most common cancer worldwide. Incidence and mortality rates are higher in men than in women. The prevalence increases with advancing age, and oral cancer is of particular concern among people over 65 years of age. Variations between countries are attributable to differences in risk profiles and the availability and accessibility of health services, among others [36].
Oropharyngeal cancers, a subset of head and neck cancers, have the human papillomavirus (HPV) as a major risk factor. Modifiable lifestyle behaviors, such as smoking and alcohol use, are implicated in the etiology of oral cavity cancers. Previous studies demonstrated that smoking was associated with a 2-fold increased likelihood of oral cavity cancers among those who had never drunk alcohol and binge drinking was associated with a higher likelihood of oral cancers among those who never had they had smoked [40].
Other risk factors are the consumption of betel quid and areca nuts, poor oral hygiene, poor nutrition, a weakened immune system, genetic and immune predisposition. In most cases, it is preceded by visible painless changes in the mouth known as precancerous lesions, such as a whitish (leukoplakia) or reddish (erythroplastic) discoloration of the mucosa, an ulcer, or a swelling. The self-examination of the mouth serves for prevention and early detection. It is an easy to perform, non-invasive method, and low-cost [39].
In the context of social determinants in health, as mentioned above, these have a significant influence on health inequalities. It will modulate people’s health and disease during the life course. Returning to the concept of the WHO [41], which defines them as “the combination of the social conditions in which the individual is born, grows and the ages that affect his health”. Cueto et al. [42] in a deeper analysis revealed two edges in this matter. In first place, older adults linked to work have less of time to go to a dentist appointment. They commonly attend when there is an emergency or pain that affects their job performance or social life. On the other hand, the older adults that are unemployed, or not perceive a pension are more likely to suffer damage to their health by the psychic instability that this condition entails, leading to a deterioration of their oral health.
An unhealthy lifestyle appears to be the most relevant SDH in older adults [43].
Kuh and Ben-Shlomo [44] defined life-course epidemiology as the “study of long-term effects on chronic disease risk of physical and social exposures during gestation, childhood, adolescence, young adulthood and later adult life”. In other words, it links exposure to risk factors and consequences by considering the importance of the duration and timing of the development of the illness.
The sum in the biological systems could be influenced by independent and individual exhibitions. Specifically, the person is vulnerable to the risk factors, a series of separated situations at different phases of life and this combination increases the illness risk in later life. This is the “
As stated by the WHO [45] clinically, oral diseases are caused by bad oral habits such as poor oral hygiene, high consumption of sugars, the use and abuse of alcohol and tobacco and a lack of fluoride. Moreover, it is well known that oral illnesses share behavioral risks with non-communicable diseases. For instance, a diet high in added sugars is the principal cause of dental decay and it is related to obesity and overweight.
Heilmann et al. [46] proposed a theoretical framework for oral health. In which they integrated a life course perspective, with the models of the social determinants of oral health illness and their effect on the usual risk factors that link general health and oral health. The model highlights the significance of socioeconomic factors in the infancy and adulthood, like as education and salary. These elements are affected by economic, political and social variables at the societal level. In this sense, the model shows the degree in which infancy socioeconomic status will influence adulthood socioeconomic status. For example, the advancement of dental decay over the course of life follows different patterns directions, to be specific caries levels calculated at one age predicts dental caries levels al later ages.
In 2010, Sheiham and Sabbah [47] reported in their study that the presence of caries in the infancy is a strongly precursor of caries in permanent dentition. Likewise, Hallet and O’Rourke [48] the incidence and severity of dental decay in the primary dentition is linked to the individual, together with socio-economic aspects just as income and maternal education.
However, this is not particularly surprising given the fact that the most significant outcome of enamel defects is a high susceptibility to dental decay. Seen from the
Caries and periodontal disease are thus more common than other chronic health conditions and increase in older age. Good oral health is an important aspect of general health and wellbeing contributing to self-esteem, dignity, social integration and nutrition.
Aging is a physiological process that affects in unique ways to each person. It is influenced by different factors such as social, economic, environmental conditions and lifestyle of the individual developed through the course of life. It represents a challenge for the professional due to the oral cavity is the first place of the body where the signs of the nutritional deficiencies are manifested clinically [50].
According to the WHO [51] malnutrition refers to “deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients”. Who enlists some of the causes that lead to malnutrition in older adults. See Figure 2.
Oral health and nutrition risk factors enlisted by the WHO [
It is important to highlight the fact that polypharmacy, chronic diseases and aspects associated to mental health also affect the nutritional status, circumstances that are frequently present in older adults. Poor oral health conditions in this group are associated with discomfort, pain and a reduced appetite, which lead to an inappropriate selection of aliment, with a low or none nutritional content. There is a reduced intake of harder foods, fruits, proteins, vegetables, fiber, vitamins and minerals and a high intake of cholesterol and saturated fat, which alters the nutritional status [52].
Dental loss is related to the reduction of masticatory ability, affecting the maximal biting force and leading to problems in bolus formation. As the number of teeth present in mouth diminishes, the bolus size increases, generating a swallowing dysfunction. This decline can impact seriously in older adult’s health, resulting in of chronic disease like cardiovascular problems, diabetes, frailty, sarcopenia and an increased risk of malnutrition [53]. This last condition increases the risk of oral infections.
Frailty is defined as a state, highly prevalent in older adults, of diminished functional reserves that lead to an increased vulnerability to stressors and adverse health results. It includes falls, reduced strength, mortality, growing dependency, a reduced ability to recover from tension situations and increased health care usage [54]. When taking care for frail people is important to be aware of seemingly minor issues. Clegg et al. [55] declared “an apparently small insult (e.g. a new drug; “minor” infection; or “minor” surgery) results in a dramatic and disproportionate change in health state: from independent to dependent; mobile to immobile; postural stability to falling; lucid to delirious”.
As mentioned by Castrejón-Pérez et al. [56] the relation that lies between oral health and frailty is considerable and it comes from different pathways:
nutritional, as dentition impact the nutritional status
biological, through the relation with chronical inflammatory answer in the body
psychological, by the impact of oral health on depression and self-esteem.
Hakeem et al. [54] study demonstrated that frailty index was associated with periodontal disease and tooth loss in older adults. Poor nutritional status contributes to the progression of many morbidities involved in the complex and multiple etiology of frailty. This low nutritional intake leads older adults to an increased risk of oxidative stress, malnutrition, inflammation and frailty. There is a strong association between oral health and frailty. This last condition affects the oral status through loss of functions, which guide older adults to complications to take care of their oral hygiene and access to dental services [57].
The concept of vulnerability can be described as that subject who will not necessarily experience damage, but who is in fact more susceptible since it has higher inequalities. This condition is specially associated with individual and community situations and contexts. Aging involves an augmented risk for the development of vulnerability, since it is a process of variations that influence on life and health conditions of the individual [58].
Vulnerable groups commonly experience barriers to access oral health and are affected by oral diseases. The World Dental Federation [FDI] made a classification of this barriers [59]. See Table 2.
Main causes | Examples |
---|---|
Individuals themselves | Low income, lack of perceived need, psychological reasons such as fear and anxiety |
Dental profession | Lack of sensitivity or compassion to patient’s attitude, inappropriate work team resources, difficult location access |
Society | Lack of public support to healthy attitudes, low support for research and inadequate dental health work team planning |
Barriers for access on oral health services.
On a previous study, we found some different barriers that affect how older adults take care of their health. Lack of time, was reported as the main concern. Older adults sometimes have up to three jobs, because of their working record, since they do not count with a pension. Another example of lack of time is that some older adults (e.g. wife, mother) are caregivers of their partner or parents and therefore no time left for themselves. This is more rooted in women as part of the sociocultural inheritance and traditions; women are more tended to be a caregiver, which affects their social life and self-esteem, increasing stress factors and physical and mental fatigue.
On the other hand, education plays an important role too. Even knowing the consequences of not having good habits, older adults let the time go by without receiving oral health attention and only assist to the dentist in case of an emergency and when the pain is unbearable [60].
Moreover, is important to identify that some subjects experience accumulative challenges as they relate to simultaneous vulnerable groups. For example, an unemployed adult with physical disabilities living in a non-urban community, from a native group. In this way, more efforts are needed to facilitate access for this groups and specially be focused in address the complicated nature of the barriers meted [61].
As mentioned by the WHO, healthy aging is described as “the process of fostering and maintaining the functional capacity that enables well-being in old age. Functional capacity consists of having the attributes that allow all people to be and do what is important to them” [62]. Oral health is an important element of healthy aging as the mouth influences the whole body through the course of life. A healthy mouth contributes to good nutrition, promotes a safer swallowing and prevents infections [63].
Poor oral health conditions could be inescapable in the aging process, but through prevention, patient care and education, these objectives can be achieved. Therefore, professional clinicians and researchers should work together to develop behavioral interventions for the promotion of dental health in family, community and health care settings [64].
A growing body of literature has analyzed that keeping a healthy natural dentition in old age has many benefits including the psychosocial, functional and structural point of view. Knowing this, the goals of mouth healthcare should be targeted to treat and prevent oral infection, promote oral health related to quality of life and give the resources to restore oral health function where necessary and guarantee an acceptable dental appearance [9].
Among the great challenges that humanity is facing, there is the aging population. Promoting healthy aging is a task of the whole society. Oral health is part of general health, and participates in a relevant way in the quality of life. Proper oral health promotion activities are essential to protect the oral health of the population.
Understanding the pathways through which social determinants and biological risk factors interact over the life course and shape oral health inequalities can help achieve healthy aging.
Oral health care for older people should begin with interprofessional education, and the exchange between different health care providers for older people should be expanded. The older person, and their family, should be included. Knowing the risks involved in oral diseases allows us to prevent them.
The authors declare no conflict of interest.
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\n\nThe Open Access Publishing Fee of your IntechOpen Compacts, Monograph or Edited Book depends on the volume of the publication and includes: project management, editorial and peer review services, technical editing, language copyediting, cover design and book layout, book promotion and ISBN assignment.
\n\nWe will send you your price quote and after it has been accepted (by both the author and the publisher), both parties will sign a Statement of Work binding them to adhere to the agreed upon terms.
\n\nAt this step you will also be asked to accept the Copyright Agreement.
\n\n5. LANGUAGE COPYEDITING, TECHNICAL EDITING AND TYPESET PROOF
\n\nYour manuscript will be sent to Straive, a leader in content solution services, for language copyediting. You will then receive a typeset proof formatted in XML and available online in HTML and PDF to proofread and check for completeness. The first typeset proof of your manuscript is usually available 10 days after its original submission.
\n\nAfter we receive your proof corrections and a final typeset of the manuscript is approved, your manuscript is sent to our in house DTP department for technical formatting and online publication preparation.
\n\nAdditionally, you will be asked to provide a profile picture (face or chest-up portrait photograph) and a short summary of the book which is required for the book cover design.
\n\n6. INVOICE PAYMENT
\n\nThe invoice is generally paid by the author, the author’s institution or funder. The payment can be made by credit card from your Author Panel (one will be assigned to you at the beginning of the project), or via bank transfer as indicated on the invoice. We currently accept the following payment options:
\n\nIntechOpen will help you complete your payment safely and securely, keeping your personal, professional and financial information safe.
\n\n7. ONLINE PUBLICATION, PRINT AND DELIVERY OF THE BOOK
\n\nIntechOpen authors can choose whether to publish their book online only or opt for online and print editions. IntechOpen Compacts, Monographs and Edited Books will be published on www.intechopen.com. If ordered, print copies are delivered by DHL within 12 to 15 working days.
\n\nIf you feel that IntechOpen Compacts, Monographs or Edited Books are the right publishing format for your work, please fill out the publishing proposal form. For any specific queries related to the publishing process, or IntechOpen Compacts, Monographs & Edited Books in general, please contact us at book.department@intechopen.com
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The Gram-positive pathogen is armed with battery of virulence factors that facilitate to establish infections in the hosts. The organism is well known for its ability to acquire resistance to various antibiotic classes. The emergence and spread of methicillin-resistant S. aureus (MRSA) strains which are often multi-drug resistant in hospitals and subsequently in community resulted in significant mortality and morbidity. The epidemiology of MRSA has been evolving since its initial outbreak which necessitates a comprehensive medical approach to tackle this pathogen. Vancomycin has been the drug of choice for years but its utility was challenged by the emergence of resistance. In the last 10 years or so, newer anti-MRSA antibiotics were approved for clinical use. However, being notorious for developing antibiotic resistance, there is a continuous need for exploring novel anti-MRSA agents from various sources including plants and evaluation of non-antibiotic approaches.",book:{id:"5471",slug:"frontiers-in-i-staphylococcus-aureus-i-",title:"Frontiers in Staphylococcus aureus",fullTitle:"Frontiers in Staphylococcus aureus"},signatures:"Arumugam Gnanamani, Periasamy Hariharan and Maneesh Paul-\nSatyaseela",authors:[{id:"192829",title:"Dr.",name:"Arumugam",middleName:null,surname:"Gnanamani",slug:"arumugam-gnanamani",fullName:"Arumugam Gnanamani"},{id:"204388",title:"Dr.",name:"Periasamy",middleName:null,surname:"Hariharan",slug:"periasamy-hariharan",fullName:"Periasamy Hariharan"},{id:"204389",title:"Dr.",name:"Maneesh",middleName:null,surname:"Paul-Satyaseela",slug:"maneesh-paul-satyaseela",fullName:"Maneesh Paul-Satyaseela"}]},{id:"32282",doi:"10.5772/33983",title:"Bacteriophages of Ralstonia solanacearum: Their Diversity and Utilization as Biocontrol Agents in Agriculture",slug:"bacteriophages-of-ralstonia-solanacearum-their-diversity-and-utilization-as-biocontrol-agents-in-agr",totalDownloads:3757,totalCrossrefCites:7,totalDimensionsCites:23,abstract:null,book:{id:"555",slug:"bacteriophages",title:"Bacteriophages",fullTitle:"Bacteriophages"},signatures:"Takashi Yamada",authors:[{id:"98151",title:"Dr.",name:"Takashi",middleName:null,surname:"Yamada",slug:"takashi-yamada",fullName:"Takashi Yamada"}]},{id:"32276",doi:"10.5772/34642",title:"Bacteriophages and Their Structural Organisation",slug:"bacteriophages-and-their-structural-organisation-",totalDownloads:12434,totalCrossrefCites:9,totalDimensionsCites:17,abstract:null,book:{id:"555",slug:"bacteriophages",title:"Bacteriophages",fullTitle:"Bacteriophages"},signatures:"E.V. 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Clonal complex 398 (CC398), a predominant clonal lineage of livestock-associated-MRSA in domestic animals and retail meat, is capable of infecting humans. In order to monitor and prevent MRSA contamination, it is critical to understand its source and transmission dynamics. In this review, we describe MRSA in food-producing animals (pig, cattle, chicken), horses, pet animals (dogs, cats), and food products (pork, beef, chicken, milk, and fish).",book:{id:"5471",slug:"frontiers-in-i-staphylococcus-aureus-i-",title:"Frontiers in Staphylococcus aureus",fullTitle:"Frontiers in Staphylococcus aureus"},signatures:"Jungwhan Chon, Kidon Sung and Saeed Khan",authors:[{id:"189634",title:"Dr.",name:"Kidon",middleName:null,surname:"Sung",slug:"kidon-sung",fullName:"Kidon Sung"},{id:"190400",title:"Dr.",name:"Jungwhan",middleName:null,surname:"Chon",slug:"jungwhan-chon",fullName:"Jungwhan Chon"},{id:"190401",title:"Dr.",name:"Saeed",middleName:null,surname:"Khan",slug:"saeed-khan",fullName:"Saeed Khan"}]}],mostDownloadedChaptersLast30Days:[{id:"69731",title:"Isolation and Purification of Sulfate-Reducing Bacteria",slug:"isolation-and-purification-of-sulfate-reducing-bacteria",totalDownloads:1551,totalCrossrefCites:1,totalDimensionsCites:6,abstract:"Sulfate-reducing bacteria (SRB) are a widespread group of microorganisms that are often isolated from the anoxygenic environments (lake depths, soil, or swamps), and they are also present in the human and animal intestines. This group is often detected in patients with inflammatory bowel disease, including ulcerative colitis. That is why new rapid methods for their isolation, purification, and identification are important and necessary. In this chapter, the methods of mesophilic SRB isolation from various environments are described. Particular attention is paid to the purification of mesophilic SRB since they can be in close interaction with other microorganisms (Clostridium, Bacteroides, Pseudomonas, etc.), which are their frequent satellites. Moreover, the main methods of mesophilic SRB identification based on their morphological, physiological, biochemical, and genetical characteristics are presented.",book:{id:"8997",slug:"microorganisms",title:"Microorganisms",fullTitle:"Microorganisms"},signatures:"Ivan Kushkevych",authors:[{id:"252191",title:"Associate Prof.",name:"Ivan",middleName:null,surname:"Kushkevych",slug:"ivan-kushkevych",fullName:"Ivan Kushkevych"}]},{id:"65773",title:"Life Cycle of Trypanosoma cruzi in the Invertebrate and the Vertebrate Hosts",slug:"life-cycle-of-em-trypanosoma-cruzi-em-in-the-invertebrate-and-the-vertebrate-hosts",totalDownloads:1497,totalCrossrefCites:4,totalDimensionsCites:7,abstract:"Trypanosoma cruzi (T. cruzi) is a protozoan parasite that causes Chagas disease, a zoonotic disease that can be transmitted to humans by blood-sucking triatomine bugs. T. cruzi is a single-celled eukaryote with a complex life cycle alternating between reduviid bug invertebrate vectors and vertebrate hosts. This article will look at the developmental stages of T. cruzi in the invertebrate vector and the vertebrate hosts, the different surface membrane proteins involved in different life cycle stages of T. cruzi, roles of different amino acids in the life cycle, carbon and energy sources and gene expression in the life cycle of T. cruzi. The author will also look at extracellular vesicles (EV) and its role in the dissemination and survival of T. cruzi in mammalian host.",book:{id:"8806",slug:"biology-of-em-trypanosoma-cruzi-em-",title:"Biology of Trypanosoma cruzi",fullTitle:"Biology of Trypanosoma cruzi"},signatures:"Kenechukwu C. Onyekwelu",authors:[{id:"245368",title:"Dr.",name:"Kenechukwu C.",middleName:null,surname:"Onyekwelu",slug:"kenechukwu-c.-onyekwelu",fullName:"Kenechukwu C. 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However, being notorious for developing antibiotic resistance, there is a continuous need for exploring novel anti-MRSA agents from various sources including plants and evaluation of non-antibiotic approaches.",book:{id:"5471",slug:"frontiers-in-i-staphylococcus-aureus-i-",title:"Frontiers in Staphylococcus aureus",fullTitle:"Frontiers in Staphylococcus aureus"},signatures:"Arumugam Gnanamani, Periasamy Hariharan and Maneesh Paul-\nSatyaseela",authors:[{id:"192829",title:"Dr.",name:"Arumugam",middleName:null,surname:"Gnanamani",slug:"arumugam-gnanamani",fullName:"Arumugam Gnanamani"},{id:"204388",title:"Dr.",name:"Periasamy",middleName:null,surname:"Hariharan",slug:"periasamy-hariharan",fullName:"Periasamy Hariharan"},{id:"204389",title:"Dr.",name:"Maneesh",middleName:null,surname:"Paul-Satyaseela",slug:"maneesh-paul-satyaseela",fullName:"Maneesh Paul-Satyaseela"}]},{id:"55437",title:"Biological Control of Parasites",slug:"biological-control-of-parasites-2017-07",totalDownloads:4334,totalCrossrefCites:7,totalDimensionsCites:7,abstract:"Parasites (ectoparasites or endoparasites) are a major cause of diseases in man, his livestock and crops, leading to poor yield and great economic loss. To overcome some of the major limitations of chemical control methods such as rising resistance, environmental and health risks, and the adverse effect on non‐target organisms, biological control (biocontrol) is now at the forefront of parasite (pests) control. Biocontrol is now a core component of the integrated pest management. Biocontrol is defined as “the study and uses of parasites, predators and pathogens for the regulation of host (pest) densities”. Considerable successes have been achieved in the implementation of biocontrol strategies in the past. This chapter presents a review of the history of biocontrol, its advantages and disadvantages; the different types of biological control agents (BCAs) including predators, parasites (parasitoids) and pathogens (fungi, bacteria, viruses and virus‐like particles, protozoa and nematodes); the effect of biocontrol on native biodiversity; a few case studies of the successful implementation of biocontrol methods and the challenges encountered with the implementation of biocontrol and future perspectives.",book:{id:"5527",slug:"natural-remedies-in-the-fight-against-parasites",title:"Natural Remedies in the Fight Against Parasites",fullTitle:"Natural Remedies in the Fight Against Parasites"},signatures:"Tebit Emmanuel Kwenti",authors:[{id:"191763",title:"Dr.",name:"Tebit Emmanuel",middleName:null,surname:"Kwenti",slug:"tebit-emmanuel-kwenti",fullName:"Tebit Emmanuel Kwenti"}]},{id:"70336",title:"Plastics Polymers Degradation by Fungi",slug:"plastics-polymers-degradation-by-fungi",totalDownloads:1459,totalCrossrefCites:3,totalDimensionsCites:8,abstract:"The studies on plastic degradation are very important for the development of biodegradable plastics, and for reduction of pollution, since plastic waste can remain in the environment for decades or centuries. We have showed the degradation of oxo-biodegradable plastic bags and green polyethylene by Pleurotus ostreatus. This fungus can also produce mushrooms using these plastics. The plastic degradation was possibly by three reasons: (a) presence of pro-oxidant ions or plant polymer, (b) low specificity of the lignocellulolytic enzymes, and (c) the presence of endomycotic nitrogen-fixing microorganisms. In this chapter, the plastic bags’ degradation by abiotic and microbial process using the exposure to sunlight and the use of a white-rot fungus will described. The physical, chemical, and biological alterations of plastic were analyzed after each process of degradation. The degradation of plastic bags was more effective when the abiotic and biotic degradations were combined.",book:{id:"8997",slug:"microorganisms",title:"Microorganisms",fullTitle:"Microorganisms"},signatures:"José Maria Rodrigues da Luz, Marliane de Cássia Soares da Silva, Leonardo Ferreira dos Santos and Maria Catarina Megumi Kasuya",authors:[{id:"217699",title:"Dr.",name:"Jose Maria",middleName:null,surname:"Da Luz",slug:"jose-maria-da-luz",fullName:"Jose Maria Da Luz"}]}],onlineFirstChaptersFilter:{topicId:"151",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:140,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,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:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,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. 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",coverUrl:"https://cdn.intechopen.com/series/covers/23.jpg",latestPublicationDate:"August 12th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:0,editor:{id:"280770",title:"Dr.",name:"Katherine K.M.",middleName:null,surname:"Stavropoulos",slug:"katherine-k.m.-stavropoulos",fullName:"Katherine K.M. Stavropoulos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRdFuQAK/Profile_Picture_2022-05-24T09:03:48.jpg",biography:"Katherine Stavropoulos received her BA in Psychology from Trinity College, in Connecticut, USA and her Ph.D. in Experimental Psychology from the University of California, San Diego. She completed her postdoctoral work at the Yale Child Study Center with Dr. James McPartland. Dr. Stavropoulos’ doctoral dissertation explored neural correlates of reward anticipation to social versus nonsocial stimuli in children with and without autism spectrum disorders (ASD). 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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. 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The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:"Shenzhen Technology University",institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda R.",middleName:"R.",surname:"Gharieb",fullName:"Reda R. Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. 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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