\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"2221",leadTitle:null,fullTitle:"Tsunami - Analysis of a Hazard - From Physical Interpretation to Human Impact",title:"Tsunami - Analysis of a Hazard",subtitle:"From Physical Interpretation to Human Impact",reviewType:"peer-reviewed",abstract:'This book, the third in the InTech Tsunami series, has been published in order to deepen efforts towards the understanding of tsunami dynamics that seems to be never enough. As the previous books in this series, "The Tsunami Threat - Research and Technology" (January 2011) and "Tsunami - A Growing Disaster" (December 2011), this multi-disciplinary volume compiles a collection of scientific papers showing the state-of-the-art of tsunami research at different levels. The various contributions cover an array of themes that span from geological evidence to post-trauma human care, encompassing pre-tsunami analyses and modeling to post-tsunami management and preparedness techniques. As its counterparts, "Tsunami - Analysis of a Hazard: from physical interpretation to human impact" continues to present evidence and case studies from different regions of the World: from the isolated Hawaiian Islands and Northern Indian Ocean, to the edges of the Atlantic and Eastern Mediterranean.',isbn:null,printIsbn:"978-953-51-0865-8",pdfIsbn:"978-953-51-5340-5",doi:"10.5772/2614",price:119,priceEur:129,priceUsd:155,slug:"tsunami-analysis-of-a-hazard-from-physical-interpretation-to-human-impact",numberOfPages:270,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"a7ce45cda9743300d394136417028a84",bookSignature:"Gloria I. 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López is a Colombian-Canadian Professional Geologist and Research Scientist currently affiliated to the School of Marine Sciences, University of Haifa, and a Visiting Scholar at the Geological Survey of Israel. She obtained her Ph.D. in Geology in 2007 from McMaster University, Canada, where she served as Sessional Faculty - Senior Lecturer until 2010. Her background in old-school Geology was obtained during her undergraduate years (Diploma Level) at EAFIT University, Colombia (1993), where she also served as a Lecturer and Research Associate until 1998. 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Onychomycosis is a common nail infection caused by fungi, namely yeasts, dermatophytes, and non-dermatophyte molds (NDMs) [1]. The prevalence keeps increasing with age and it is commonly identified in elderly populations. Approximately 20% of adults in their second to fourth decades are affected by this disease. Yeasts contribute to 24–50% cases of onychomycosis with
The prevalence of onychomycosis differs based on geographical location with worldwide prevalence of approximately 10% [5]. The incidence onychomycosis in North America ranges from 8.7–13.8% while the prevalence in Southeast Asia ranges from 2–6% [2, 3]. Higher prevalence is reported in countries with humid climates, such as Greece (27.99%) and Ethiopia (60,4%), [6, 7]. While there are three groups of fungi responsible for onychomycosis, dermatophytes are the most common cause of onychomycosis (60–70%) [3].
Yeasts, most commonly identified as
In assessing the treatment outcome of CO patients, there are three types of cure to be considered, which area mycological cure, clinical cure, and complete cure. Clinical cure is described as a previously infected nail without signs and symptoms of onychomycosis. Mycological cure is described as negative results on both direct microscopic examination and culture. Complete cure is described as achieving both clinical and mycological cure [8]. Various prognostic factors have been identified for the treatment outcome of onychomycosis. In general, they can be divided into three groups, which are patient’s characteristics, nail features, and the infectious agents (Table 1) [9].
Poor Prognostic Factors | |
---|---|
Patient’s characteristics | Male gender |
Increasing age | |
History of nail trauma | |
History of onychomycosis | |
Poor immune status | |
Poor peripheral circulation | |
Uncontrolled diabetes mellitus | |
Repeated exposure to water and detergents | |
Repeated exposure to mud and soil | |
Barefoot walking | |
Nail features | Subungual hyperkeratosis >2 mm |
Fingernail and toenail involvement | |
More than 3 infected nails | |
Matrix involvement | |
Significant lateral disease | |
Dermatophytoma | |
Nail plate involvement >50% | |
Slowly growing nails | |
Hallux involvement | |
Severe onycholysis | |
Paronychia | |
Melanonychia | |
Total dystrophic onychomycosis | |
Infectious agents | Fungal and bacterial coinfections |
Yeasts | |
Non-dermatophytes molds |
Most studies reported that the onychomycosis is more commonly diagnosed in men. Male patients are associated with poor outcome because they are more likely to be exposed to repeated nail trauma and they usually do not seek health care until the disease becomes too advanced. Furthermore, they are more likely to have low compliance; hence, male patients become more resilient when it comes to treatment and have 2,6 times risk of not achieving clinical cure [8]. Increasing age is also known to be associated with poor prognosis in onychomycosis patients because elderly populations usually suffer from poor circulation system, poor immune status, decreased nail growth, and mixed fungal infections. Hence, their response to therapy might be lacking and they have 3,7 times risk of not achieving clinical cure [8, 9].
Nail trauma can exert significant and irreversible damage which will predispose patients to onychomycosis. Patients who have abnormal nails with positive mycology examination had 5,4 times risk of developing onychomycosis [9]. Other poor prognostic factor is history of onychomycosis. Patients with prior infection have 2,3 times risk of not achieving clinical cure. These patients are more likely not to respond standard treatment course since they have been treated before. There might also be involvement of genetic susceptibility in the development of recurrent onychomycosis [8].
As most fungi are opportunistic agents, poor immune status can predispose patients to onychomycosis, especially in HIV patients with CD4 count <400/mm3. The onychomycosis is more likely to involve fingernails and toenails also more severe [9]. Patients with hand and foot involvement have 1.1 times risk of not achieving complete cure and if the patients have more than 3 infected nails, they have 1.5 times risk of not achieving complete cure [4]. Furthermore, hallux involvement presents as poor prognostic sign because it is more likely to suffer repeated trauma lead to predisposition of continuous infection.
In addition, poor peripheral circulation caused by chronic venous disease is associated with poor prognosis. Chronic venous disease can cause nail dystrophy, hyperkeratosis, discoloration, hyperplastic nail bed, and onychogryphosis. Only 25% of patients treated with itraconazole are cured [9]. Poor peripheral circulation can also identified in patients with uncontrolled diabetes mellitus which associates with secondary infections and nonhealing ulcers. This population is also reported to have more severe onychomycosis, high recurrence rate and longer duration to achieve complete cure [9].
Repeated exposure to water and detergents will predispose patients to chronic paronychia and affect the drug delivery since the tissue is more edematous and inflamed. While repeated exposure to mud and soil, also barefoot walking will predispose the patients to repeated minor trauma. Most fungi are saprophytic; hence, they can invade nails easily in this condition. This often happened in tropical countries [10].
Subungual hyperkeratosis is host’s reaction towards fungal infection by thickening the stratum corneum. The thick debris presents as a barrier to antifungal agents, both systemic and topical agents [9]. Furthermore, patients with matrix involvement have 2.1 times risk of not achieving complete cure [8]. Matrix is known to be the nail’s origin [11]. Hence, matrix involvement in onychomycosis will affect the nail growth and drug delivery [8]. In addition, the slow nail growth is also a poor prognostic factor since the patients shed the infected portion of the nail more slowly. This association is also described in elderly populations. Slow nail growth is also seen in significant nail plate involvement. Greater surface involved is associated with greater fungi load; hence, lower cure rates [9].
Significant lateral disease affects the treatment outcome since there is poor attachment of the lateral edge to the nail groove. This can reduce the drug delivery about two thirds of normal nail. Similar cases are seen in severe onycholysis [9]. Patients with lateral disease have 3,5 times risk of not achieving complete cure [8]. Another poor prognostic factor is dermatophytoma, a dense thick-walled fungal elements presenting as white to yellow patch or longitudinal streak in nail plate. This dense mass is difficult to be penetrated by antifungal agents. Therefore, the patients with dermatophytoma have 2.9 times risk of not achieving clinical cure [8, 9].
Melanonychia is black pigmentation identified on the nail plate. This feature is associated with poor prognosis in onychomycosis. However, the association has not been elucidated yet. Total dystrophic onychomycosis (TDO) is the final destructive stage of onychomycosis, in which there is thickened nail bed, crumbling nail plate, and significant involvement of nail matrix. Patients with TDO have 1.1 times risk of not achieving complete cure [4, 9].
As for the infectious agents, CO and NDMs onychomycosis indicate poor prognosis. CO is associated with immunosuppression, especially in case of chronic mucocutaneous candidiasis (CMC) and HIV patients. While NDMs infections are difficult to be diagnosed and lack of data for treatment course. In addition, fungal and bacterial infections can complicate the treatment. Therefore, these factors can implicate in poor prognosis of onychomycosis patients [9].
In order to aid the clinicians in have better treatment outcome, several instruments have been developed to predict the prognosis in onychomycosis patients. The first developed instrument was Scoring Clinical Index for Onychomycosis (SCIO Index). This scoring assesses the nail’s clinical component based on its clinical form, nail involvement, and subungual hyperkeratosis. In addition, it assesses the growth component based on the patient’s age and location of onychomycosis. As the score increases, the onychomycosis might be more difficult to treat [12]. However, this scoring has not been validated and has other limitations, such as exclusion of important prognostic factors and complex calculation [9].
Another scoring was developed by Baran et al. (Table 2). The higher the score, the more likely the treatment failure will happen [13]. Albeit being the most comprehensive instrument, this index has not been validated and time-consuming [9].
Descriptor | Subdivision | Score | |
---|---|---|---|
1 | Extent of involvement | Distal one-third of nail plate | 1 |
Distal two-thirds of nail plate | 2 | ||
Proximal nail plate involvement | 3 | ||
2 | Diffuse nail plate thickening | Mild or moderate | 1 |
Associate with onychogryphosis | 3 | ||
3 | Nail plate thickening associated with the appearance of linear streaks – includes the change confined to the lateral border | One streak only | 2 |
Two or more streaks | 3 | ||
If the streaks are black do not score but see 7 | |||
4 | Onycholysis | Affecting the distal two-thirds of nail plate | 2 |
5 | Location | Any one of: | |
Second to fifth toes or thumb | 1 | ||
Great toenail | 2 | ||
6 | Paronychia associated with nail plate disease | With diffuse melanonychia | 3 |
With melanonychia at the lateral edges of the nail | 3 | ||
7 | Melanonychia (without paronychia) | With one or more longitudinal streaks | 3 |
Diffuse pigmentation | 4 | ||
8 | Age of patient | Under 7 years | 3 |
7–25 years | 1 | ||
25–60 years | 2 | ||
Over 60 years | 3 | ||
9 | Presence of the following predisposing factors | Diabetes mellitus | 1 |
Known severe trauma to affected nail | 2 | ||
Immunosuppression (due to therapy, e.g., prednisolone, or disease, e.g., AIDS) | 4 | ||
Symptomatic peripheral vascular disease | 2 | ||
10 | Causative organism | 4 | |
Other mold fungi | 2 | ||
Yeasts | 1 |
The most commonly used instrument is Onychomycosis Severity Index (OSI). OSI is simpler by assessing three major components, which are area of involvement, proximity of disease to matrix, presence of dermatophytoma or subungual hyperkeratosis >2 mm (Table 3). The score is multiplication of score for area of involvement with score for proximity of disease and addition of score for the presence of dermatophytoma or subungual hyperkeratosis >2 mm. Score 1–5 indicates mild onychomycosis; 6–15 indicates moderate onychomycosis; and 16–35 indicates severe onychomycosis [14]. This index has been validated with high reliability. However, this index only assesses one nail, does not correlate the severity of disease with treatment outcome, and excludes other important prognostic factor [9].
Predictor | Subdivision | Score |
---|---|---|
Area of involvement (%) | 0 | 0 |
1–10 | 1 | |
11–25 | 2 | |
26–50 | 3 | |
51–75 | 4 | |
76–100 | 5 | |
Proximity of disease to matrix | <1/4 | 1 |
1/4–1/2 | 2 | |
>1/2–3/4 | 3 | |
>3/4 | 4 | |
Matrix involvement | 5 | |
Presence of dermatophytoma or subungual hyperkeratosis >2 mm | No | 0 |
Yes | 10 |
The most common causative agent of yeast onychomycosis is candida species. Fingernails are the predilection site of CO, especially in patients who are regularly submerging their hands in water [3]. Candida species are a commensal part of the normal skin flora, which are present in nature. However, these species may exhibit opportunistic quality in an immunocompromised host. Candida species can be either primary or secondary causative agent in onychomycosis. Primary CO can be commonly encountered in a severe immunocompromised host, for example, in HIV patient. On the contrary, secondary CO is usually related to predisposing diseases or circumstances, for instance, diabetes mellitus, malnutrition, peripheral vascular disease, chronic nail trauma, smoking, and vulnerable age (elderly and children). Particular occupations such as housekeepers, fishers, and farmers are also at risk of CO due to the frequent trauma and excessive moisture on the nails, exposure to contaminants, and contact with chemicals [2].
Instead of appearing as individual spores and hyphae, fungal organisms tend to integrate, forming a biofilm which is a syntrophic group of fungi adhering to the host’s surface. When not infiltrating a substrate, fungi may fluctuate between free-floating types and parts of a superficial biofilm. This particular feature provides benefits for fungi development while being surrounded by extracellular matrix (ECM). The surrounding ECM defends fungi from the host’s immune response and antifungal treatments. ECM also supports fungi to distribute nutrients to the biofilm. Fungi biofilm contributes to the rationale of why onychomycosis is relatively refractory to antifungal treatment and challenging to eliminate the spores in chronic manifestation entirely [3].
The biofilm development by
There are 3 definite stages of
In addition to biofilm, yeast factors that contribute to the virulency of CO are synthetization of hydrolytic enzymes, including proteinase, hemolysin, and phospholipase, which are unique between each type of Candida species. Moreover, proteinase plays a part in the breakdown of protein and phospholipase contributes to the destruction of the host cell, allowing
Most CO cases involve fingernails compared to toenails, with an estimated prevalence of up to 50% of onychomycosis cases in fingernails. Women at risk of developing CO are typically wet workers due to the recurrent moist in the hands, exposure to trauma, regular contact with washing liquids, and contamination to vaginal flora during cleansing, which ultimately provides a suitable niche for the development of Candida species [2].
Clinical presentations that are predictive for CO are nail plate dystrophy and off-white discoloration, commonly followed by pigmentation. Melanisation, one of the virulence factors for Candida, suggests an indication of progressive resistance to antifungal treatment. Classification of CO is established because of the complex etiopathogenesis and diverse clinical presentations. The first clinical classification of CO was suggested based on the clinical presentation, the affected location, and the infection route, which are Candida paronychia, Candida granuloma, and Candida onycholysis [2].
The most frequent type of CO is paronychia. Humidity plays an essential role in the development of Candida paronychia. Clinical manifestation of Candida paronychia comprises erythema and swelling in the nail folds followed by gradual dystrophy in the nail plate accompanied by paronychia and Beau lines, which is depicted by an oblique dent in the nail plate suggesting parasite infestation on the nail matrix. The most severe type of CO is granuloma, which is frequently observed in patients with chronic mucocutaneous candidosis. Clinical manifestation of Candida granuloma displays brittle nails and a deformity resembling drumstick which is also referred to as pseudoclubbing. The last type of CO is onycholysis. Clinical manifestation of Candida onycholysis is characterized by subungual distal hyperkeratosis, which further develops into a group of keratosis separating the nail plate from the bed. Moreover, a recent classification was proposed, including four clinical groups of CO, which are chronic paronychia with secondary nail dystrophy, distal onychomycosis, chronic mucocutaneous candidosis, and secondary candidosis [17].
Chronic paronychia initially emerges from the proximal nail fold, although lateral nail folds are occasionally affected in the beginning. Swelling of the periungual skin and a noticeable gap between the fold and nail plate is observed, followed by the nail plate involvement. Marks with a white, green, or black color can be detected at the lateral and distal parts, respectively. The longitudinal ridges and opaqueness appear on the nail that develops into a brittle and easily detached nail. Pressure and movement on the nail can be painful in contrast to dermatophyte infections. A superimposed infection caused by bacteria into the subcuticular space usually occurs, leading to a vicious cycle. Chronic paronychia usually appears in adults whose occupations regularly contact water and children because of the thumb sucking habit [17].
Distal candida nail infection manifests as subungual hyperkeratosis along with onycholysis. Differentiating the clinical manifestation with dermatophytosis can be challenging, however the candida results in less extent damage to the nail compared to dermatophyte. In addition, the predilection of CO usually affects the fingernails, while most dermatophytes invade the toenails. The prevalence of distal candida nail infection is infrequent and most of the cases are related to vascular problems, such as Raynaud’s phenomenon [17].
Total dystrophic onychomycosis occurs in patients with chronic mucocutaneous candidosis. The organism invasion on the nail plate results in hyperkeratotic and gross thickening of the nail. Chronic mucocutaneous candidosis has multifaceted etiology which results in the weakened cell-mediated immunity. The variety of clinical appearance depends on the severity of immunosuppression; however, thickening of the nails can be observed in advanced cases due to the Candida granuloma. In addition, the involvement of the mucous membrane is nearly presented in most cases [17].
Secondary candida onychomycosis results because of other diseases involving the nail apparatus, most commonly psoriasis [17].
Common tests utilized in the diagnosis of onychomycosis are potassium hydroxide (KOH) preparation, fungal culture, histopathology, polymerase chain reaction (PCR), and flow cytometry (Table 4). The combination tests are usually performed; however, the gold standard of diagnostic tests are microscopy and culture [3].
Dissolved large keratinocytes result in the flattening of nail segment and decreasing reflection from cell borders. Examined with microscopy | Quick, on-the-spot | Low sensitivity | No | No | |
Cleaned and clipped subungual debris of the nail are scraped into the gauze. Culture developed in the agar with or without cycloheximide. Examined with microscopy | Precise | Results obtained in ≥3 weeks, high false-negative rate | Yes | Yes | |
Stained by hematoxylin and eosin to depict the elements of the fungi. Periodic acid-Schiff or Grocott’s methenamine-silver can be utilized to enhance the appearance of hyphae | Validate the presence of fungus | Involves specific laboratory equipment | No | No | |
Employ a target gene part of ribosomal DNA or chitin synthase genes | Quick, 48 hours | Costly | Yes (real-time PCR) | Yes | |
Employ granulosity, cell volume, DNA, and protein markers to produce definite profiles for fungi | Very specific | Involves great sample size, costly | No | Yes |
Onychoscopy can also be used for initial diagnosis of onychomycosis. The most common findings in onychomycosis are jagged edge with spikes of the proximal part of the onycholysis, parallel bands of various color resembling aurora borealis pattern, and ruin appearance at the subungual part [3].
KOH microscopy and fungal culture are presently the gold standards to establish the diagnosis of onychomycosis. However, it remains questionable because KOH microscopy demonstrates a false-negative rate between 5% to 15% and false-positive for evaluating the medication, given that KOH microscopy visualizes both live and dead hyphae which are identical through microscope. Furthermore, fungal culture has a wide-ranging sensitivity from 30% to 57% and requires incubation for weeks. Latest studies comparing a variety of diagnostic tests indicate that histopathology staining has higher sensitivity than KOH microscopy or culture, although another study suggests PCR for a quicker and precise alternative for fungal culture, particularly in NDM onychomycosis. Therefore, the combination of diagnostic tests is recommended to diagnosis onychomycosis accurately. A feasible option can be a KOH microscopy and PCR (or culture in a resource-limited setting) if the KOH shows positive results [3].
In the case of CO, obtaining sample for KOH microscopy and culture can be performed from the proximal and lateral parts of the nail. Nevertheless, sample can be obtained from the distal part in the case of onycholysis. Culture result may reveal creamy-whitish colonies on Sabouraud dextrose agar media or primary isolation can also be attained using chromogenic media, for instance CHROMagar Candida®. Anti-fungal susceptibility should be performed following the identification of the isolated strains to achieve the most effective therapy. Histopathological results of CO usually display hyphae and pseudomycelia on the nail through Schiff’s periodic acid stains or Grocott’s methenamine silver stains. PCR can also be utilized for further identification [2].
Defining the resolution of onychomycosis can be achieved through clinical, mycological, and complete cure. Clinical cure is described as 100% improvement depicted by clear nail, while mycological cure is described as negative KOH microscopy and negative fungal culture, respectively. Ultimately, complete cure comprises 100% clear nail and mycological cure. The goal of treating onychomycosis for physicians and affected stakeholders are achieving the complete cure. However, it is difficult for an infected nail to return into an utterly normal appearance, particularly in advanced stage although mycological cure has been attained [3].
The treatment choices (Figure 1) available for managing onychomycosis are oral medication, topical therapy, and devices. Oral antifungals (Table 5) are the first-line therapy because they result in high success rates. Nevertheless, oral antifungals are contraindicated in patients with chronic or active liver disease, congestive heart failure, and kidney failure. Besides, oral antifungals may interact with other pharmacological agents, which can trigger a severe adverse reaction. These setbacks urged the request for the safer option which leads to the awareness of topical therapy. Topical treatments (Table 6) are indicated in mild–moderate cases and patients with contraindication for oral antifungals. However, they also have limitations which are smaller cure rate, prolonged therapy and difficulty applying for patients with mobility problems. Ultimately, lasers are FDA-approved device therapy for short-term clearance and/or nail enhancement. However, laser therapy is lacking conclusive guidance and its efficacy demonstrates notable disparities among all treatment modalities. Topical antifungals eradicate the fungus from the outward penetrating the dorsal part of the nail, whereas oral antifungals eliminate from the inward infiltrating the ventral part of the nail [3].
Treatment algorithm of onychomycosis [
Trade name | Lamisil | Sporanox | Diflucan | |
Chemical structure | Allylamine | Triazole | Triazole | |
Molecular formula | C21H25N•HCl | C35H38Cl2N8O4 | C13H12F2N6O | |
Mass (g/mol) | 291.3 | 705.64 | 306.27 | |
Mechanism of action | Squalene epoxidase inhibitor | Lanosterol 14α-demethylase inhibitor | Lanosterol 14α-demethylase inhibitor | |
CYP+ inhibition | CYP2D6 | CYP3A4 | CYP2C9, CYP2C19, CYP3A4 | |
Spectrum of action | Dermatophytes, some activity against NDMs | Dermatophytes, NDMs, and | Dermatophytes, some NDMs, and | |
Efficacy | MC | 70% | 54% | 47–62% |
CC | 38% | 14% | 28–36%* | |
Approval | US–1996 | US–1995 | US–1990† | |
EU–1991 | EU–1989 | EU (UK)–1988 | ||
Canada–1993 | Canada–1993 | EU (Finland)–1993 | ||
China–1993 | ||||
Canada–1990* | ||||
FDA pregnancy class | B | C | D |
Summary of available oral antifungal [3].
Data provided are clinical cure rates.
Fluconazole was FDA-approved for use in humans in 1990, but is not yet approved for treatment of onychomycosis in the US or Canada.
CYP, cytochrome P450; NDM, non-dermatophyte molds; MC, mycological cure; CC, complete cure.
Cited as is from Gupta et al. [3].
Trade name | Jublia | Kerydin | Penlac | Loceryl | |
Chemical structure | Triazole | Oxaborole | Hydroxypyridone | Morpholine | |
Molecular formula | C18H22F2N4O | C7H6BFO2 | C14H24N2O3 | C21H35NO | |
Mass (g/mol) | 348.39 | 151.93 | 207.27 | 317.51 | |
Mechanism of action | Lanosterol 14α-demethylase inhibitor | Aminoacyl †RNA synthetase inhibitor | Chelation of polyvalent heavy metal ions | Δ14-sterol reductase and cholestenol | |
Δ-isomerase inhibitor | |||||
Spectrum of action | Dermatophytes, NDMs, and | Dermatophytes, NDMs, and yeasts | Dermatophytes, | Dermatophytes, NDMs, and yeasts | |
Efficacy | MC | 53.4–55.3% | 31.1–35.9% | 29–36% | 60%125 |
CC | 15.2–18.8122 | 6.5–9.1%121 | 5.5–8.5%123 | ||
Approval | US–2014 | US–2014 | US–1999 | EU–1991 | |
Canada–2013 | Canada–2004 | Australia–1996 | |||
Japan–2014 | |||||
FDA pregnancy class | C | C | B | Poor systemic absorption, safe in animals, no studies in pregnant women† |
Another proposed treatment algorithm is based on the severity of onychomycosis assessed with SCIO (Table 7) [12].
SCIO | Treatment approach |
---|---|
1–3 | Topical treatment: remove (cut or scrape off) affected marginal parts of the nail |
Use topical antifungals until healthy nail regrows | |
3–6 | Topical treatment with lower success, which often depends on growth rate |
Systemic therapy recommended in slower-growing nails or proximal onychomycosis type | |
6–9 | Systemic therapy. Use scheme proposed for fingernails (e.g., itraconazole: 2 pulses of 200 mg bid) |
9–12 | Systemic therapy. Use scheme proposed for toenails (e.g., itraconazole: 3 pulses of 200 mg bid) |
12–16 | Systemic therapy. Use scheme proposed for fingernails with any antifungal (e.g., 4–5 pulses of itraconazole, 200 mg bid) |
16–20 | Combination therapy (systemic antifungal + topical measures) |
Adequate keratolytic treatment recommended | |
20–30 | Consider nail avulsion (e.g., with urea paste), continue with systemic therapy |
As CO commonly recurs with overall onychomycosis recurrence rate of 10–53%, additional measures should be implemented to prevent this recurrence. For the clinicians, it is imperative to confirm the diagnosis and identify the infectious agent before providing treatment. Assessing and treating the comorbidities is also crucial since some comorbidities are risk factors for onychomycosis, also portend as poor prognostic factors. Tinea pedis should be treated properly as the infected skin can play a role as reservoir for the pathogens [3].
When the patients are diagnosed, the clinicians should provide them with optimal onychomycosis therapy, provide counseling on the expectations and adherence to treatment. The patients should also be provided with information to maintain hand and foot hygiene, avoid occlusive shoes, trim the nails regularly, use broad toed shoes with absorbent materials, and avoid barefoot walking in locations with abundant fungal density (e.g., swimming pool, communal showers, gymnasium floors). Good sanitization measures should be taken for previous infected socks and shoes. Socks should be washed with hot water (60 °C) for 45 minutes and shoes should be exposed to ultraviolet rays or ozone or can be sprayed with antifungal sprays. The close contacts or family members of the patients should be examined and treated if they suffer from onychomycosis or tinea pedis [3, 18].
Prophylaxis can be considered for patients with high probability to suffer from recurrence. Topical antifungal agent in the form of solution or lacquer can be applied once daily for a month then twice weekly for at least two years after the cure have been achieved [3].
CO is a common nail infection affecting people worldwide. Establishing the diagnosis of CO becomes a challenge for the clinicians since
The authors declare no conflict of interest.
Chronic Mucocutaneous Candidiasis Candida Onychomycosis Human Immunodeficiency Virus potassium hydroxide Non-Dermatophyte Molds Polymerase Chain Reaction Scoring Clinical Index of Onychomycosis Total Dystrophic Onychomycosis
Climate change is a debatable subject these days. Dealing with this topic is considered an enormous challenge of the coming years [1]. There are many definitions of climate; however, the common term of climate is the long-term pattern of meteorological conditions in a specific area [2]. It is measured by evaluating variations in temperature, humidity, atmospheric pressure, wind, precipitation, atmospheric particle, and other meteorological variables. Climate change can have significant impacts on weather conditions around the world, such as storms and heavy rainfall. Climate changes can occur due to different processes internal to the earth, external forces (e.g., variations in sunlight intensity), and human activities that have been increasing recently. Many shreds of strong evidence in many regions regarding the climate changes and variability that is impacted by anthropogenic activities, industries and natural specifications of climate systems are recently available. Among these factors that caused climate change due to changing of the composition of the atmosphere are the greenhouse gas emissions, CO2, CH4, and N2O [3, 4, 5].
\nMany studies related to climate change have emphasized that there is an increase in the rainfall events recently regarding frequency and intensity [6, 7, 8, 9, 10, 11, 12, 13, 14]. Rainfall patterns and rate over a region are reliant on the ambient and global water evaporation and to a significant extent on altitude, latitude, and level of humidity [15]. Warmer conditions brought out from increased emissions of greenhouse gases through industrialization cause evaporation and precipitation with varying degree of intensity on individual regions [16].
\nVarious environmental impacts have been witnessed according to climate change including change in the hydrological cycles, availability of water resources, unprecedented rainfalls and floods, unexpected drought frequencies, and changes in natural ecosystems [5, 14, 17, 18, 19, 20]. Rain is an essential natural phenomenon which can influence the human life and properties. There are many factors which affect rainfall, such as geographical position, monsoon, topographic, and other factors. Flash flood frequency and severity in the desert areas are generally unpredictable and vary from year to year due to variability in the rainfall values [21, 22, 23]. Rainfall in arid areas is spatially variable than that of humid regions and is often described as “spotty,” and the impacted area is often limited by the radius of the clouds [24].
\nIt is tough for hydrologists to use unreliable hydrological data (rainfall data) in the design of water-related structures. In most cases, the available rainfall data are limited (few records) and contain some gaps in the time series; rainfall stations are far from each other, with no intensity records; and records are not authentic values due to human errors. Previous studies used historical information to carry out the rainfall frequency analysis to understand the flooding behavior [25, 26]. These studies generally show that the use of historical information can be of great value in the reduction of the uncertainty in flood quantity estimators. A frequency analysis of the data is the most commonly applied method. Several studies were found dealing with the analysis of rainfall intensity in many areas [27, 28, 29, 30, 31, 32].
\nA rain gauge is an instrument that measures how much rain falls in a given set time. Automatic rain gauges are rain gauges that electronically start working once it feels rain on the gauge. They automatically record the data, from measuring to removing the rainfall afterward [33]. Automatic rain gauge systems are required to collect rainfall data at remote locations, especially oceanic sites where logistics prevent regular visits [34]. It is usually based on tipping-bucket rainfall sensor and data logger for measuring the rainfall quantity and intensity during a given period and transmits the data through the GSM/GPRS modem to the desired e-mails and server at user-defined time intervals, and records obtained are of high reliability.
\nThe Kingdom of Saudi Arabia (KSA) is one of the other countries that is impacted by severe events of rainfall in the last decade due to climate change. The intensity and frequency of the rainfalls are unprecedented and cause devastating floods in many KSA regions. Due to the lack of short-duration data in the Kingdom in general and in Jeddah in particular, and the limited number of studies that have determined the pattern of rainstorms, the current research will be a cornerstone in establishing rainfall pattern and behaviors. Determination of rainstorm pattern and method of distribution is one of the most critical factors affecting peak flow calculations. In this work, the Jeddah area was chosen as a unique example of unprecedented rainfall events in the last decade. The rainfall rate and patterns of the Jeddah area will be discussed in detail to extract the adequate rainfall intensity patterns that could be used for future predictions. In the current study, the short duration rainfall data recorded by climate stations of the Saudi Geological Survey during the period from 2011 to 2017, as well as the data available at station J134 of the Ministry of Environment, Water and Agriculture, And the conclusion of the general pattern prevailing in these storms, as well as their comparison with the distribution of SCS-Type II, and the conclusion of the intensity curves based on available data. Many rainfall storms were analyzed in this study. It includes the following events (intensity records) 2011, 2014, 2015, 2016 and 2017. However, in the devastating floods that occur in 2009, we do not have intensity records for that event.
\nThe KSA climate is mainly arid and semiarid, except in the northern and southern areas. The arid and semiarid regions have an extreme continental climate with warm and dry summer and very cold winter especially in the central regions of the KSA. To assess rainfall pattern over the study area, it is necessary to define the dominant climatic patterns that have an influence on rainfall distribution over the western province of the KSA. The climatic pattern can best be described by considering the various air masses that affect the rainfall distribution over the KSA area. The influence of the different air masses and the rainfall patterns over the KSA has been discussed and mapped by several investigators [35, 36, 37, 38].
\nDifferent air masses, which influence the Kingdom’s climate, are illustrated in Figure 1. These air masses include (1) the monsoon front during the late autumn (maritime tropical air mass) reaches the area from the south, southwest, and southeast. This front that originates in the Indian Ocean and the Arabian Sea during the autumn brings warm and moist air. Outbreaks of westerly air become more frequent, characterized by medium to high intensity over the western and northwesterly regions of the country. This front often picks up further moisture while moving through the Red Sea Trough. (2) The continental tropical air masses are warm and moist coming from the Atlantic Ocean through the Central and North African continent. (3) The maritime polar air masses are derived from the Eastern Mediterranean Sea. In early winter the Mediterranean-borne maritime air increasingly disturbs the monsoonal air movement and displaces it in the low altitudes. These maritime depressions draw the tropical continental air masses into the warm sectors, and extreme weather conditions occur that are associated with the passage of a hot sector. Both (2) and (3) move toward the east and prevail in the winter season. During this season, the western region, particularly the coastal area, is characterized by its relatively low rate of rainfall [38], whereas, due to the topographic effects, the highlands receive a considerable amount of rainfall. In spring, the impact of the Mediterranean air movement diminishes, whereas the monsoon from the south takes its place, penetrating the southern part of the Kingdom. During summer, the cyclonic flow sweeps along the Mediterranean Sea from the west toward the east and continues moving over the northern and central regions of the country preventing the maritime air masses of the northeasterly monsoon from penetrating the north regions of the Kingdom. Due to this, the summer season will be somewhat dry in the area considered.
\nAir masses affecting the climate of the KSA: (1) maritime tropical air masses, (2) continental tropical air masses, and (3) maritime polar air masses [
The mean annual rainfall (from 1960 to 2018) over the KSA can be shown in Figure 2. The rainfall rate in the KSA (except for the Empty Quarter desert) is 109 mm per year. The southwestern region is characterized by a heavy rainfall compared with the rest of the Kingdom. Rainfall is more than 500 mm per year in some locations. The peaks of the Sarawat Mountains, which extend from the northern part of the Kingdom to the south, parallel to the Red Sea, are the dividing line for the distribution of surface water. The rains that fall in the east of this line take place in the valleys heading east, and in the west, the valleys are steep and flowing towards the Red Sea.
\nAverage annual rainfall values for 270 rainfall stations distributed across the KSA area (from 1960 to 2018).
Recently, there is a definite increasing trend in rainfall in frequency and intensity in the KSA. Many areas in the KSA have shown an increasing trend in the annual rainfall and flood events. Most of the rainfall in the KSA occurs during the monsoon. Monsoon is a term derived from the Arabic word “mausim,” meaning season. It was used to describe the seasonal winds of the Arabian Sea. The Jeddah area is characterized by wet and dry seasons that generally occur from November to May and from June to October, respectively. One example is Jeddah city which has shown an increasing trend in the rainfall events. These events cause disasters that result in human, property, and economic loss. These unprecedented events have affected the KSA, causing considerable damage to highways, railroads, urban zones, and agricultural areas [39]. Most of the flash flood hazards in the KSA are caused by a combination of natural conditions (heavy rainfall and climate changes) and human interference (poor drainage systems and urban expansion). Recently, heavy rainfall events have triggered flash floods in various areas of the KSA (e.g., Jeddah city flash floods in the years 2009, 2011, 2015, 2017, and 2018 and Al Riyadh flash floods in 2015 and 2018). The severely hit areas are generally in the western part of the KSA, particularly in the city of Jeddah during November 2009 and January 2011 [39, 40]. These events were characterized by 70 and 111 mm of rainfall, respectively, within 3 h and were considered catastrophic flash floods for Jeddah city. They caused a death toll of 113 people in 2009, and, together, they damaged more than 10,000 homes and destroyed approximately 17,000 vehicles. Other areas impacted by flash floods are As Sail Al Kabir area, Taef; Najran city; Ar Riyadh city; Ha’il city; Makkah city; and Tabuk city [41, 42, 43, 44, 45, 46, 47, 48].
\nThe study area, the Jeddah area, is located in the western region of the KSA covering an area of ~1731 km2 and lies between latitudes 21°15′ and 21°57′N and longitudes 39°06′ and 39°31′E (Figure 3). From the latitude point of view, the Jeddah area is considered to be in the arid zone (Köppen’s climate classification). The Jeddah area has different geomorphological features. It represents a part of the Red Sea coastal zone. Jeddah drainage system comes from the east (a series of hills) toward the city which is located to the west. The catchment areas have a variety of landforms such as low- and midsize hills and flattened foothills in some places followed to the west by the floodplain areas. The monthly average relative humidity ranges between ~85% from September to October and ~34% from April to June. The Jeddah area is characterized by scarce rainfalls with high variability, which occur most often in November–December–January (the winter season). Additionally, monsoonal rainstorms take place in March and April due to the moist air currents from the Indian Ocean and the Arabian Sea. The average annual precipitation is ~52.5 mm/year. The maximum rainfall was recorded in 1996, with ~284 mm/year. Recently these thunderstorms increased in their frequencies and intensities causing flash floods and inundation events within Jeddah city.
\nStudy area and its meteorology station locations.
In this study, all the current stations have automatic rain gauges that can record the intensity of the rainfall events (minute-base). This technique did not occur before, and most of the hydrological studies were depending on the daily rainfall data analysis which brings some uncertainty to the hydrological results. The stations used in the current study are shown in Figure 3. In the present work, trend and pattern analysis is based on intensity rainfall values for each rainfall station. Detailed analysis and discussion of the different recently occurred storms will be carried out in the following sections. This analysis and comparison work will give us the ability to deduce the general pattern prevailing in the storms in the city of Jeddah. Table 1 has a list of different storms that will be considered in this study.
\nNo. | \nDate | \nLocation | \nName | \nTotal rainfall (mm) | \nDuration (h) | \n
---|---|---|---|---|---|
1 | \nJanuary 26, 2011 | \nSGS site | \nSGS | \n112.0 | \n4.7 | \n
2 | \nNovember 22, 2014 | \nSGS site | \nSGS | \n43.0 | \n10.0 | \n
3 | \nNovember 17, 2015 | \nRadwa farms | \nRadwa | \n21.7 | \n2.7 | \n
4 | \nNovember 17, 2015 | \nKhulays, Ad Daff | \nKhulays | \n20.6 | \n2.7 | \n
5 | \nNovember 17, 2015 | \nOld Jeddah airport | \nJ134 | \n79.0 | \n3.2 | \n
6 | \nNovember 17, 2015 | \nWadi Qaws | \nQaws | \n61.0 | \n1.77 | \n
7 | \nDecember 02, 2016 | \nSGS site | \nSGS | \n44.91 | \n2.75 | \n
8 | \nNovember 21, 2017 | \nSGS site | \nSGS | \n88.04 | \n15.75 | \n
Rainstorms occurred between 2011 and 2017 in the Jeddah area and the stations’ names.
The data recorded by the rainfall station located at the headquarter of the Saudi Geological Survey shows that the precipitation began at 10:56 am on Saturday, January 26, 2011; continued until 12:27 noon, for ~91 min; and remained after a short break until 3:38 pm. The total precipitation is ~112.0 mm. It is difficult to distinguish two separate storms, but this rainstorm can be separated into two phases. The first phase of rainfall was ~54 mm, while the second one was ~58 mm. Figure 4a shows the rainfall recorded plotted against the whole rainfall time (4.7 h), which shows ~48% of the rainfall depth is fallen in the first phase for a period of ~78 min. The first phase is shown in Figure 4b.
\nThe rainstorm on January 26, 2011, at SGS station. (a) Distribution of cumulative rainfall intensity of the total storm. (b) Distribution of cumulative rainfall intensity of the first phase.
This event was recorded in one rainfall station located at the headquarter of the Saudi Geological Survey. The data recorded by this station shows that the precipitation began at 0:22 am on Saturday, November 22, 2014; continued until 1:03 am, for ~41 min; then resumed at 9:53; and stayed until 10:19 am. The total precipitation is ~42.87 mm. This rainstorm can be separated into two storms. The rainfall of the first storm was ~33 mm, while the second one was ~9.61 mm. Figure 5a shows the rainfall recorded plotted against the whole rainfall time (10 h), which shows ~77% of the rainfall depth is fallen in the first storm for a period of ~41 min. The first storm is shown in Figure 5b.
\nThe rainstorm on November 22, 2014, at SGS station. (a) Distribution of cumulative rainfall intensity of the total storm. (b) Distribution of cumulative rainfall intensity of the first storm.
This event was recorded in four rainfall stations including Radwa farms, Wadi Khulays, Station J134, and Wadi Qaws.
\nThe data recorded by the rainfall station at Radwa farms shows that the precipitation began with a slow rate at 8:44 am on Tuesday, November 17, 2015; continued until 9:51 am, for ~67 min; and remained with a moderate rate until 11:25 am of the same day. The total precipitation is ~21.7 mm. The main storm in this event lasted ~41 min and reached a precipitation amount of ~19 mm. Figure 6a1 shows the rainfall recorded plotted against the whole rainfall time (2.7 h), which shows ~88% of the rainfall depth is fallen at a period of ~41 min (the main storm; see Figure 6a2).
\nThe rainstorm on November 17, 2015, at Radwa, Khulays, J134, and Qaws stations. (a1, b1, c1, d1) Distribution of cumulative rainfall intensity of the total storm. (a2, b2, c2, d2) Distribution of cumulative rainfall intensity of the first storm.
The data recorded by the rainfall station at Wadi Khulays shows that the precipitation began at 9:18 am on Tuesday, November 17, 2015; continued until 9:45 am, for ~27 min; and continued intermittently until 12:00 noon. The total precipitation is ~20.6 mm. The main storm in this station lasted ~27 min and reached a precipitation amount of ~18 mm. Figure 6b1 shows the rainfall recorded plotted against the whole rainfall time (2.7 h), which shows ~87% of the rainfall depth is fallen at a period of ~27 min. The first storm is shown in Figure 6b2.
\nThe data recorded by rainfall station J134 (located in the old Jeddah airport) shows that the precipitation began at 10:00 am on Tuesday, November 17, 2015; continued until 12:20 am, for ~140 min; and continued intermittently until 1:10 pm. The total precipitation is ~79.0 mm. The main storm in this station lasted ~140 min and reached a precipitation amount of ~60 mm. Figure 6c1 shows the rainfall recorded plotted against the whole rainfall time (3.2 h), which shows ~76% of the rainfall depth is fallen at a period of ~140 min. The first storm is shown in Figure 6c2.
\nThe data recorded by the rainfall station at Wadi Qaws shows that the precipitation began at 10:48 am on Tuesday, November 17, 2015; continued until 11:41 am, for ~53 min; halted at 12:09; and then continued intermittently until 12:34 pm. The total precipitation is ~61.0 mm. The main storm in this station lasted ~53 min and reached a precipitation amount of ~58.7 mm. Figure 6d1 shows the rainfall recorded plotted against the whole rainfall time (1.8 h), which shows ~96% of the rainfall depth is fallen at a period of ~53 min. The first storm is shown in Figure 6d2.
\nThis event was recorded in one rainfall station located at the headquarters of the Saudi Geological Survey. The data recorded by this station shows that the precipitation began at 7:18 am on Friday, December 2, 2016 and continued until 7:38 am, for ~20 min; then it resumed at 8:11 and stayed until 8:43 am, followed by a precipitation of 0.25 mm at 10.03 am. The total rainfall is ~44.91 mm. This rainstorm can be separated into two storms. The rainfall of the first storm was ~12.43 mm, while the second one was ~31.47 mm. Figure 7a shows the rainfall recorded plotted against the whole rainfall time (2.75 h), which shows ~28% of the rainfall depth is fallen in the first storm for a period of ~20 min and the second storm which lasted 43 min shows 70% of the total rainfall depth. Figure 7b shows the main storm which lasted 43 min (the second storm).
\nThe rainstorm on December 2, 2016 at SGS station. (a) Distribution of cumulative rainfall intensity of the total storm. (b) Distribution of cumulative rainfall intensity of the second storm.
This event was recorded in one rainfall station located at the headquarters of the Saudi Geological Survey. The data recorded by this station shows that the precipitation began at 8:19 am on Tuesday, November 21, 2017; continued until 10:50 am, for ~152 min; then resumed at 11:30 pm; and continued until 12:01 night. The total precipitation is ~88.04 mm. This rainstorm can be separated into two storms. The rainfall of the first storm was ~76 mm, while the second one was ~12.0 mm. Figure 8a shows the rainfall recorded plotted against the whole rainfall time (15.75 h), which shows ~85% of the rainfall depth is fallen in the first storm for a period of ~152 min. The first storm is shown in Figure 8b.
\nThe rainstorm on November 21, 2017, at SGS station. (a) Distribution of cumulative rainfall intensity of the total storm. (b) Distribution of cumulative rainfall intensity of the first storm.
In the current work, a comparison between the storms which occurred in the Jeddah area during the period (2011–2017) was carried out. The results indicated that there is some similarity in the behavior of these storms. The presence of the two main storms characterizes most of them during the rainfall time which is usually separated by a period of partial cessation. The most substantial amount of rainfall always exceeding 70% of the recorded rainfall appears in the first storm. Also, it was found that there is one exception in this rule which seems in the storm recorded on January 26, 2011, at the Saudi Geological Survey Station, which is different from other storms in terms of the amount of precipitation where the rain value reached 112 mm. Figure 9a shows a comparison of the major storms that have been occurred in the Jeddah area. Figure 9b shows comparison between storms which exceeded a rain value (50 mm). The results also indicated that based on the rainstorm that hit the city of Jeddah on November 21, 2017, with the storms that had a definite impact in the Jeddah city, we find that all these storms exceeded the amount of rainfall 50 mm during the first 100 min (Table 2).
\nA comparison between different rainstorms occurred in the period between 2011 and 2017: (a) all storms and (b) storms recorded rainfall more than 50 mm (the first 100 min).
Source | \nReturn period | \n||||
---|---|---|---|---|---|
5 | \n10 | \n25 | \n50 | \n100 | \n|
SGS 2016 (mm) | \n53.1 | \n71.1 | \n93.4 | \n110.0 | \n125.0 | \n
AECOM 2011 (mm) | \n57.6 | \n75.6 | \n98.4 | \n115.0 | \n132.0 | \n
Average (mm) | \n
Rainfall analysis of the historical records for the Jeddah area.
The storm recorded at Wadi Qaws station on November 17, 2011, is the highest intensity, followed by the storms occurred at J134 on November 17, 2015; then the station at the headquarters of the Saudi Geological Survey on November 21, 2017; and then the storm recorded at the station at the headquarter of the Saudi Geological Survey on January 26, 2011. However, the storm occurred on January 26, 2011, left a massive damage and problems to the Jeddah area. It caused failure of the Umm al-Khair dam and paralyzed traffic in the province. Maybe the reason for that is related to the duration time of the storm on January 26, 2011. The impact of the storm on November 21, 2017, was within the city of Jeddah and led to the flooding of a large number of roads and tunnels, although considers moderate intensity, however, the storm was concentrated in the center of the city, where almost urban areas are located. The lack of a proper drainage system inside the city has increased the impact of this storm.
\nTo deduce the characteristic patterns of rainfall in the Jeddah area, we need a large number of reordering storms which are not available in the whole KSA. However, in the current work depending on the storms collected in the Jeddah area from the new installed automated rainfall stations, some suggestions can be made to understand the behavior of storms in the Jeddah area. To achieve this, the data available for each storm were converted to dimensionless data (Figure 10). The behavior of all possible storms was compared with the SCS-type II distribution curve. It is noticed that these storms can be divided into two groups. The first group represents the storms, which exceeded 50 mm of precipitation (Figure 11a). This group is represented by the storms recorded at the headquarters of the SGS station on November 21, 2017; January 26, 2011; and November 17, 2011, in both the Wadi Qaws and J134 stations. The second group represents short-term storms which recorded precipitation quantities less than 50 mm (Figure 11b). This group includes the storms registered at the headquarters of the SGS station on November 22, 2014, and December 2, 2016. For both groups, the average curves of each storm set were derived. To verify that these two storm groups are different from each other and have different behaviors, a distribution histogram of the average curve for each storm group was extracted and simplified as shown in Figure 12.
\nCumulative dimensionless hyetographs for rainstorms occurred in the period 2011–2017.
Cumulative dimensionless hyetographs: (a) for storms above 50 mm and (b) for storms below 50 mm.
(a) Dimensionless histogram for storms above 50 mm. (b) Dimensionless histogram for storms below 50 mm.
Rainfall depth of return periods 5–100 years was estimated by the Saudi Geological Survey and AECOM company (Table 2). The values are due to the analysis of the historical records of all rain stations located in and around the Jeddah area. An average value for each return period was calculated and used in the current study.
\nBy comparing the average data of Table 2 with the rainfall amounts recorded in the recent storms, it was found that the storms of the first group, which exceeded the amount of rainfall of 55 mm, fall within the rainfall depth above the 5-year return period. The storm recorded on January 26, 2011, 111.6 mm, falls below the 50-year return period; the storm recorded on November 21, 2017, 88 mm, falls below the rainfall value of the 20-year return period; the storm recorded on November 17, 2015, in the Wadi Qaws, 61 mm, falls under the value of the 10-year return period; and the storm recorded on November 17, 2011, at the J134 station, 79 mm, falls under the storms of the 12-year return period, while in the second group storms, they did not exceed the amount of rainfall of 50 mm, which falls below the return period of 5 years.
\nAccordingly, our results indicated that instead of using the SCS distribution curve type II which has happened before in our studies, we can use these new distribution curves. For storms that exceed 50 mm, we can use the distribution curve extracted from the first group (average curve) (Figures 11a and 12a). However, for storms less than 50 mm, we can use the average distribution of the second group (small storm distribution can be applied) (Figures 11b and 12b).
\nOur findings indicated that Jeddah rainfall is characterized by two patterns: one for the rain values less than 50 mm and the other one for the rain values above 50 mm. The study shows that dealing with rainfall data in the Jeddah area required the following points to be considered: (1) it is necessary to pay attention to the details of rainstorms (intensity values) and not only to the recorded daily values. (2) There is a convergence of the nature of storms with impact (greater than 30 mm), which begins to rise after the onset of the storm almost immediately and continue the same tendency to the end of the storm. (3) There is a slight difference between the nature of these storms and the SCS-type II distribution, which assumes that about 60% of the depth of the rain falls in a fraction of the duration of the storm ranging from 8 to 20% and the rest distributed over the rest of the storm. (4) The average length of storms should be considered within the study areas. (5) In short-term storms of less than 2 h or even (with some reservation) up to 3 h, the distribution of SCS type II can be used safely but with duration limited to the same span of the storm rather than 24 h.
\nThe authors would like to thank the Saudi Geological Survey for providing scientific and logistical support for this work.
\nThe authors declare no conflict of interest.
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She is now a lecturer at the University of Witwatersrand, South Africa, and a principal researcher at the Health Economics and Epidemiology Research Office (HE2RO), South Africa. Dr. Moolla holds a Ph.D. in Psychology with her research being focused on mental health and resilience. In her professional work capacity, her research has further expanded into the fields of early childhood development, mental health, the HIV and TB care cascades, as well as COVID. She is also a UNESCO-trained International Bioethics Facilitator.",institutionString:"University of the Witwatersrand",institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"342152",title:"Dr.",name:"Santo",middleName:null,surname:"Grace Umesh",slug:"santo-grace-umesh",fullName:"Santo Grace Umesh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/342152/images/16311_n.jpg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"333647",title:"Dr.",name:"Shreya",middleName:null,surname:"Kishore",slug:"shreya-kishore",fullName:"Shreya Kishore",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333647/images/14701_n.jpg",biography:"Dr. Shreya Kishore completed her Bachelor in Dental Surgery in Chettinad Dental College and Research Institute, Chennai, and her Master of Dental Surgery (Orthodontics) in Saveetha Dental College, Chennai. She is also Invisalign certified. She’s working as a Senior Lecturer in the Department of Orthodontics, SRM Dental College since November 2019. She is actively involved in teaching orthodontics to the undergraduates and the postgraduates. Her clinical research topics include new orthodontic brackets, fixed appliances and TADs. She’s published 4 articles in well renowned indexed journals and has a published patency of her own. Her private practice is currently limited to orthodontics and works as a consultant in various clinics.",institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"323731",title:"Prof.",name:"Deepak M.",middleName:"Macchindra",surname:"Vikhe",slug:"deepak-m.-vikhe",fullName:"Deepak M. Vikhe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/323731/images/13613_n.jpg",biography:"Dr Deepak M.Vikhe .\n\n\t\n\tDr Deepak M.Vikhe , completed his Masters & PhD in Prosthodontics from Rural Dental College, Loni securing third rank in the Pravara Institute of Medical Sciences Deemed University. He was awarded Dr.G.C.DAS Memorial Award for Research on Implants at 39th IPS conference Dubai (U A E).He has two patents under his name. He has received Dr.Saraswati medal award for best research for implant study in 2017.He has received Fully funded scholarship to Spain ,university of Santiago de Compostela. He has completed fellowship in Implantlogy from Noble Biocare. \nHe has attended various conferences and CDE programmes and has national publications to his credit. His field of interest is in Implant supported prosthesis. Presently he is working as a associate professor in the Dept of Prosthodontics, Rural Dental College, Loni and maintains a successful private practice specialising in Implantology at Rahata.\n\nEmail: drdeepak_mvikhe@yahoo.com..................",institutionString:null,institution:{name:"Pravara Institute of Medical Sciences",country:{name:"India"}}},{id:"204110",title:"Dr.",name:"Ahmed A.",middleName:null,surname:"Madfa",slug:"ahmed-a.-madfa",fullName:"Ahmed A. Madfa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204110/images/system/204110.jpg",biography:"Dr. Madfa is currently Associate Professor of Endodontics at Thamar University and a visiting lecturer at Sana'a University and University of Sciences and Technology. He has more than 6 years of experience in teaching. His research interests include root canal morphology, functionally graded concept, dental biomaterials, epidemiology and dental education, biomimetic restoration, finite element analysis and endodontic regeneration. Dr. Madfa has numerous international publications, full articles, two patents, a book and a book chapter. Furthermore, he won 14 international scientific awards. Furthermore, he is involved in many academic activities ranging from editorial board member, reviewer for many international journals and postgraduate students' supervisor. Besides, I deliver many courses and training workshops at various scientific events. Dr. Madfa also regularly attends international conferences and holds administrative positions (Deputy Dean of the Faculty for Students’ & Academic Affairs and Deputy Head of Research Unit).",institutionString:"Thamar University",institution:null},{id:"210472",title:"Dr.",name:"Nermin",middleName:"Mohammed Ahmed",surname:"Yussif",slug:"nermin-yussif",fullName:"Nermin Yussif",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210472/images/system/210472.jpg",biography:"Dr. Nermin Mohammed Ahmed Yussif is working at the Faculty of dentistry, University for October university for modern sciences and arts (MSA). Her areas of expertise include: periodontology, dental laserology, oral implantology, periodontal plastic surgeries, oral mesotherapy, nutrition, dental pharmacology. She is an editor and reviewer in numerous international journals.",institutionString:"MSA University",institution:null},{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",biography:"Dr. Al Ostwani Alaa Eddin Omar received his Master in dentistry from Damascus University in 2010, and his Ph.D. in Pediatric Dentistry from Damascus University in 2014. Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. He is also a Member of the Reviewer Board of International Journal of Dental Medicine (IJDM), and the Indian Journal of Conservative and Endodontics since 2016.",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",country:{name:"India"}}},{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null},{id:"178412",title:"Associate Prof.",name:"Guhan",middleName:null,surname:"Dergin",slug:"guhan-dergin",fullName:"Guhan Dergin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178412/images/6954_n.jpg",biography:"Assoc. Prof. Dr. Gühan Dergin was born in 1973 in Izmit. He graduated from Marmara University Faculty of Dentistry in 1999. He completed his specialty of OMFS surgery in Marmara University Faculty of Dentistry and obtained his PhD degree in 2006. In 2005, he was invited as a visiting doctor in the Oral and Maxillofacial Surgery Department of the University of North Carolina, USA, where he went on a scholarship. Dr. Dergin still continues his academic career as an associate professor in Marmara University Faculty of Dentistry. He has many articles in international and national scientific journals and chapters in books.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178414",title:"Prof.",name:"Yusuf",middleName:null,surname:"Emes",slug:"yusuf-emes",fullName:"Yusuf Emes",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178414/images/6953_n.jpg",biography:"Born in Istanbul in 1974, Dr. Emes graduated from Istanbul University Faculty of Dentistry in 1997 and completed his PhD degree in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery in 2005. He has papers published in international and national scientific journals, including research articles on implantology, oroantral fistulas, odontogenic cysts, and temporomandibular disorders. Dr. Emes is currently working as a full-time academic staff in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery.",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"192229",title:"Ph.D.",name:"Ana Luiza",middleName:null,surname:"De Carvalho Felippini",slug:"ana-luiza-de-carvalho-felippini",fullName:"Ana Luiza De Carvalho Felippini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192229/images/system/192229.jpg",biography:null,institutionString:"University of São Paulo",institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"256851",title:"Prof.",name:"Ayşe",middleName:null,surname:"Gülşen",slug:"ayse-gulsen",fullName:"Ayşe Gülşen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256851/images/9696_n.jpg",biography:"Dr. Ayşe Gülşen graduated in 1990 from Faculty of Dentistry, University of Ankara and did a postgraduate program at University of Gazi. \nShe worked as an observer and research assistant in Craniofacial Surgery Departments in New York, Providence Hospital in Michigan and Chang Gung Memorial Hospital in Taiwan. \nShe works as Craniofacial Orthodontist in Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi, Ankara Turkey since 2004.",institutionString:"Univeristy of Gazi",institution:null},{id:"255366",title:"Prof.",name:"Tosun",middleName:null,surname:"Tosun",slug:"tosun-tosun",fullName:"Tosun Tosun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255366/images/7347_n.jpg",biography:"Graduated at the Faculty of Dentistry, University of Istanbul, Turkey in 1989;\nVisitor Assistant at the University of Padua, Italy and Branemark Osseointegration Center of Treviso, Italy between 1993-94;\nPhD thesis on oral implantology in University of Istanbul and was awarded the academic title “Dr.med.dent.”, 1997;\nHe was awarded the academic title “Doç.Dr.” (Associated Professor) in 2003;\nProficiency in Botulinum Toxin Applications, Reading-UK in 2009;\nMastership, RWTH Certificate in Laser Therapy in Dentistry, AALZ-Aachen University, Germany 2009-11;\nMaster of Science (MSc) in Laser Dentistry, University of Genoa, Italy 2013-14.\n\nDr.Tosun worked as Research Assistant in the Department of Oral Implantology, Faculty of Dentistry, University of Istanbul between 1990-2002. \nHe worked part-time as Consultant surgeon in Harvard Medical International Hospitals and John Hopkins Medicine, Istanbul between years 2007-09.\u2028He was contract Professor in the Department of Surgical and Diagnostic Sciences (DI.S.C.), Medical School, University of Genova, Italy between years 2011-16. \nSince 2015 he is visiting Professor at Medical School, University of Plovdiv, Bulgaria. \nCurrently he is Associated Prof.Dr. at the Dental School, Oral Surgery Dept., Istanbul Aydin University and since 2003 he works in his own private clinic in Istanbul, Turkey.\u2028\nDr.Tosun is reviewer in journal ‘Laser in Medical Sciences’, reviewer in journal ‘Folia Medica\\', a Fellow of the International Team for Implantology, Clinical Lecturer of DGZI German Association of Oral Implantology, Expert Lecturer of Laser&Health Academy, Country Representative of World Federation for Laser Dentistry, member of European Federation of Periodontology, member of Academy of Laser Dentistry. Dr.Tosun presents papers in international and national congresses and has scientific publications in international and national journals. He speaks english, spanish, italian and french.",institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"256417",title:"Associate Prof.",name:"Sanaz",middleName:null,surname:"Sadry",slug:"sanaz-sadry",fullName:"Sanaz Sadry",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256417/images/8106_n.jpg",biography:null,institutionString:null,institution:null},{id:"272237",title:"Dr.",name:"Pinar",middleName:"Kiymet",surname:"Karataban",slug:"pinar-karataban",fullName:"Pinar Karataban",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272237/images/8911_n.png",biography:"Assist.Prof.Dr.Pınar Kıymet Karataban, DDS PhD \n\nDr.Pınar Kıymet Karataban was born in Istanbul in 1975. After her graduation from Marmara University Faculty of Dentistry in 1998 she started her PhD in Paediatric Dentistry focused on children with special needs; mainly children with Cerebral Palsy. She finished her pHD thesis entitled \\'Investigation of occlusion via cast analysis and evaluation of dental caries prevalance, periodontal status and muscle dysfunctions in children with cerebral palsy” in 2008. She got her Assist. Proffessor degree in Istanbul Aydın University Paediatric Dentistry Department in 2015-2018. ın 2019 she started her new career in Bahcesehir University, Istanbul as Head of Department of Pediatric Dentistry. In 2020 she was accepted to BAU International University, Batumi as Professor of Pediatric Dentistry. She’s a lecturer in the same university meanwhile working part-time in private practice in Ege Dental Studio (https://www.egedisklinigi.com/) a multidisciplinary dental clinic in Istanbul. Her main interests are paleodontology, ancient and contemporary dentistry, oral microbiology, cerebral palsy and special care dentistry. She has national and international publications, scientific reports and is a member of IAPO (International Association for Paleodontology), IADH (International Association of Disability and Oral Health) and EAPD (European Association of Pediatric Dentistry).",institutionString:null,institution:null},{id:"202198",title:"Dr.",name:"Buket",middleName:null,surname:"Aybar",slug:"buket-aybar",fullName:"Buket Aybar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202198/images/6955_n.jpg",biography:"Buket Aybar, DDS, PhD, was born in 1971. She graduated from Istanbul University, Faculty of Dentistry, in 1992 and completed her PhD degree on Oral and Maxillofacial Surgery in Istanbul University in 1997.\nDr. Aybar is currently a full-time professor in Istanbul University, Faculty of Dentistry Department of Oral and Maxillofacial Surgery. She has teaching responsibilities in graduate and postgraduate programs. Her clinical practice includes mainly dentoalveolar surgery.\nHer topics of interest are biomaterials science and cell culture studies. 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