Some emerging and re-emerging infectious diseases reported in Africa [3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13].
\\n\\n
IntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\\n\\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\\n\\nLaunching 2021
\\n\\nArtificial Intelligence, ISSN 2633-1403
\\n\\nVeterinary Medicine and Science, ISSN 2632-0517
\\n\\nBiochemistry, ISSN 2632-0983
\\n\\nBiomedical Engineering, ISSN 2631-5343
\\n\\nInfectious Diseases, ISSN 2631-6188
\\n\\nPhysiology (Coming Soon)
\\n\\nDentistry (Coming Soon)
\\n\\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\\n\\nNote: Edited in October 2021
\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/132"}},components:[{type:"htmlEditorComponent",content:'With the desire to make book publishing more relevant for the digital age and offer innovative Open Access publishing options, we are thrilled to announce the launch of our new publishing format: IntechOpen Book Series.
\n\nDesigned to cover fast-moving research fields in rapidly expanding areas, our Book Series feature a Topic structure allowing us to present the most relevant sub-disciplines. Book Series are headed by Series Editors, and a team of Topic Editors supported by international Editorial Board members. Topics are always open for submissions, with an Annual Volume published each calendar year.
\n\nAfter a robust peer-review process, accepted works are published quickly, thanks to Online First, ensuring research is made available to the scientific community without delay.
\n\nOur innovative Book Series format brings you:
\n\nIntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\n\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\n\nLaunching 2021
\n\nArtificial Intelligence, ISSN 2633-1403
\n\nVeterinary Medicine and Science, ISSN 2632-0517
\n\nBiochemistry, ISSN 2632-0983
\n\nBiomedical Engineering, ISSN 2631-5343
\n\nInfectious Diseases, ISSN 2631-6188
\n\nPhysiology (Coming Soon)
\n\nDentistry (Coming Soon)
\n\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\n\nNote: Edited in October 2021
\n'}],latestNews:[{slug:"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:"481",leadTitle:null,fullTitle:"Biomedical Engineering, Trends in Materials Science",title:"Biomedical Engineering",subtitle:"Trends in Materials Science",reviewType:"peer-reviewed",abstract:"Rapid technological developments in the last century have brought the field of biomedical engineering into a totally new realm. Breakthroughs in materials science, imaging, electronics and, more recently, the information age have improved our understanding of the human body. As a result, the field of biomedical engineering is thriving, with innovations that aim to improve the quality and reduce the cost of medical care. This book is the second in a series of three that will present recent trends in biomedical engineering, with a particular focus on materials science in biomedical engineering, including developments in alloys, nanomaterials and polymer technologies.",isbn:null,printIsbn:"978-953-307-513-6",pdfIsbn:"978-953-51-4533-2",doi:"10.5772/992",price:159,priceEur:175,priceUsd:205,slug:"biomedical-engineering-trends-in-materials-science",numberOfPages:576,isOpenForSubmission:!1,isInWos:1,isInBkci:!0,hash:null,bookSignature:"Anthony N. 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Laskovski completed his Bachelor of Engineering (Electrical) Degree at the University of Newcastle, Australia in 2006 on a UNISS industrial scholarship with the power distributer Energy Australia.\nHis research interests include RF electronics and implantable electronic devices for biomedical applications, with a particular focus on wireless power transmitters, inductive coils and implantable telemetry architecture. 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With many procedures, inguinal hernia interventions continue to be the most common general surgery operations worldwide and approximately 2 million people are operated for inguinal hernia every year. There are many techniques described on the surgical treatment of inguinal hernias. There is no other example of disease preoccupied in the surgical literature. Existence of the postoperative complications suggests that we have not found the ideal treatment option yet because a wide variety of techniques have been described and most of the surgeons engaged in this procedure have completed learning curves a long time ago. In 1984, about hernia, Sir Astley Paston Cooper says: “No disease from the human body, belonging to the surgeon, demands in its treatment, a better mixture of precise, anatomical knowledge along with surgical skill, compared to hernia in most of its variations”. In this chapter, the details and results of two laparoscopic techniques, which have become common in inguinal hernia treatment today, are evaluated in detail.
\nThe incidence of inguinal hernia varies according to age and sex. There is a bi-modal distribution in males and it increases in the first year of life and in older ages. The rate of 15% in the second decade increases with age and reaches 47% in the seventh decade. In females, this rate is 3% for life. There is a significant difference between the male/female ratio and is reported as 1:15. Although the majority of the inguinal hernia patients do not face great problems in resuscitating their lives, the incidence of general incidence and emergency case incidence (incarceration-strangulation) increases with age [1].
\nInguinal hernias are classified as direct or indirect inguinal hernia according to their mechanism and anatomical characteristics. Indirect inguinal hernias are the most common subtype and the risk of strangulation is much higher compared to direct hernias. In the case of strangulation, it is also necessary to mention that the femoral hernias head to this issue. Femoral hernias, which are found in 70% of women and generally settled in the principle of “should be fixed when they are detected”, due to the risk of strangulation, have not been included in this section [2].
\nWhen the side is concerned, it is a fact that all inguinal hernias are seen more on the right side. One of the theories developed to explain this is that there is anatomically protective effect of the sigmoid colon present on the left side and delayed atrophy of the processus vaginalis due to the slower descent of the scrotum on the right side during embryological development.
\nThe word “hernia” came from the Latin word “rupture” and was described as a disease in the first fifteenth century in papyrus. The idea of repairing surgery came out between fifteenth and seventeenth centuries although the inguinal region anatomy has been described in detail by Hesselbach, Cooper, Camper, Scarpa and Gimbernat during eighteenth and nineteenth centuries. In the twentieth century, “tension-free repairs” started to be proposed and in the last 25 years, parallel to technological developments, videoscopic repairs became widespread. As a result of this development, surgical procedures have now become the standard procedure for “strengthening the abdominal wall in the transverse fascia plan” and are accepted all over the world [3].
\nThe idea of laparoscopic repair was first alleged by Ger in 1982 by the collapse of the internal loop. In 1990, Schultz used transperitoneal plugs and developed the intraperitoneal onlay mesh (IPOM) technique, which was performed in the same year by patching the Fitzgibbons peritoneum. Transabdominal preperitoneal (TAPP) patch application was first performed by Leroy in 1990. Then in 1991 Dulucq and in 1992 McKernan introduced total extraperitoneal (TEP) intervention [4].
\nIn the inguinal region, four different types of hernia—indirect, direct, femoral and obturator—can develop. One of the most important advantages of the posterior approach is the ability to reveal the entirety of hernia types. There are median, medial and lateral ligaments in the anterior wall of the abdomen after fetal period, followed by urachus obliteration, umbilical artery obliteration and inferior epigastric vessels, respectively. In addition, there are iliopubic tractus, pectineal ligament (Cooper) and lacunar ligament in pubic region, pubic tubercule, spina iliaca anterior superior (SIAS) and superior pubic ramus bones [5].
\nThere are two potential gaps in the preperitoneum. The “Bogros gap” is located between the transverse fascia and the peritoneum. Preperitoneal fatty tissue and porous connective tissue fill this area. The medial part of the preperitoneal cavity on the bladder is known as the “Retzius cavity”. The posterior view angle allows examination of the myofektineal orifice, which is a relatively weak part of the abdominal wall and is divided by the inguinal ligament [6].
\nThe external iliac vessels are anastomosed with the inferior epigastric vessels and the superior epigastric vessels. They supply the abdominal wall and penetrate the rectus abdominus through the cranial route within the vagina musculature rectus. Posteriorly inspected anulus inguinalis profundus will reveal the deep location of inferior epigastric vessels. In addition, the aberrant obturator arteries formed by the anastomosis of the pubic ramus of the epigastric artery with the obturator artery, known as “Corona Mortis”, constitute the basis of the death triangle. The medial side of this triangle is vas deferens, the lateral side is the spermatic cord and the posterior border is the peritoneal margin.
\nThe inferolateral border of the iliopubic tract, the superomedial border of the gonadal vessels and the lateral border of the peritoneal catheter is defined as the area of the pain triangle and the intermediate cutaneous branches of the lateral femoral cutaneous nerve, the femoral branch of the genitofemoral nerve and the anterior branch of the femoral nerve contain posterior anatomical approach.
\nWe performed laparoscopic inguinal hernia surgery in 163 patients between January 2017 and 2018 in our clinic. Laparoscopic hernia repair was recommended to patients who are suitable for general anesthesia, had no previous abdominal surgery or incarceration or strangulated hernia or without acute mechanical intestinal obstruction. In terms of learning curve, TAPP was performed on first 50 cases and TEP on the following cases. A total of 155 (95%) patients were male and 8 (5%) were female. A total of 51 patients received TAPP (31.2%) and 112 patients (68.7%) received TEP. Eight patients who underwent TAPP (15.6%) were operated for recurrence. Thirteen patients (25.4%) underwent bilateral repair while three (5.8%) patients underwent the same session umbilical hernia repair. The groups were evaluated in terms of operation time, pain scores, recurrence rates, duration of hospitalization and return to daily activity and complication rates. TAPP average operation time is 58 min while in bilateral cases this duration is 72 min. The duration of operation of recurrent cases was 59 min average and there was no significant difference between these patients and the primary cases. A total of 112 patients were treated with TEP technique. Nineteen patients (16.9%) were operated for recurrent hernia, and 14 patients (12.5%) underwent bilateral repair. In three patients (2.6%), the same session umbilical hernia repair was also performed. Average duration of TEP is 47 min while in bilateral cases this duration is observed as elongated, 56 min. The duration of operation in recurrent cases was 56 min and there was no significant difference between these patients and the primary cases. The hospital stay was measured as 1.2 days for TAPP and 1.1 days for TEP, and no significant difference was found between the groups. It was also found that the pain scores between the two groups were similar as 3.2 and 2.9 for TAPP and TEP, respectively. The time to return to the daily activity for TAPP was 5.6 days and for TEP was 5.3 days and no significant difference was found between the two groups. As a complication, seroma in four patients (2.4%), recurrent hernia in two patients (1.2%) and chronic persistent pain in six patients (3.6%) occurred. Patients with recurrence were reoperated. Five patients with chronic persistent pain were treated with medical therapy within 6 months, and one patient with osteitis pubis was detected and curettage was performed by orthopedics clinic. In our study, no significant difference in recurrence, return duration to work, pain score, duration of hospitalization and postoperative complication were detected between the groups.
\nThe use of laparoscopic methods for inguinal hernia surgery is advanced minimal invasive surgery with less tissue trauma, less postoperative pain, lower postoperative infection risk and faster postoperative recovery. It is possible to combine positive effects such as faster return to work and better cosmetic results. As with all surgical techniques, minimally invasive techniques also have advantages. Compared to open surgery, some disadvantages of inguinal hernia surgery are the initial operation time and the long learning curve. Also, the cost is relatively high. In addition, unlike open surgery, the lack of sense of depth in the image, that is, the operation with the 2D image requires the surgeon to dominate the inguinal region anatomy at a high level. Instead of cost problem, by time, the integration of the learning curve and the increase in the experience reduce most of the problems.
\nThere are two main techniques when laparoscopic inguinal hernia repair is concerned. These are defined as transabdominal preperitoneal approach (TAPP) and total extraperitoneal approach (TEP). According to the International Endohernia Group’s 2011 Guidelines, revised in 2015, TAPP and TEP have become the preferred repair techniques for the Lichtenstein technique, especially after hernia recurs by open pre-repair [7].
\nIt is stated that TAPP is the first method to be learned because it is applicable in all inguinal region hernia types. As an advantage of the intraabdominal approach, the posterior wall anatomy can be better dominated, so proper and adequate parietalization can be made more comfortable. Compared to TEP, the cost is lower and the learning curve is shorter. TAPP is a highly successful method for both incarcerated and scrotal hernias. Due to intraabdominal vision, providing a wide field of view study is one of its greatest advantages and is a method that can be used in laparoscopically repaired recurrent hernias.
\nThe opposite side of the surgical field and both legs are in closed position. In bilateral hernia repair, both arms are in closed position. The videomonitor laparoscopy tower is placed on the patient’s foot, on the side to be operated. The operator can be placed on the opposite side of the area to be operated and the camera assistant can be placed on the same side or opposite side of the surgeon depending on the experience and habits of the team. We prefer the camera assistant to sit on the same side of the surgeon (Figure 1).
\nOperating room: The surgeon and camera assistant placed on the opposite side of the surgical area.
\n
Standard laparoscopic equipment consisting of camera, monitor, light and bag
10 mm diameter and 30° angle camera
One 10 mm and two 5 mm in diameter totally 3 trocars
Veress needle
Endoinstruments (Atraumatic pens, dissector, scissors, hook, acutenaculum, aspirator)
5 mm diameter vessel sealing device
15 × 15 cm polypropylene or polyester special shaped patch
Fixing material for mesh detection and peritoneal closure (mechanical stapler, tissue adhesive or non-absorbable suture material) (Figure 2).
Surgical instruments for TAPP procedure.
A single dose of 1 g second-generation cephalosporin as prophylactic antibiotic is injected half an hour before the onset of operation. The patient should urinate before operation and preoperative fluid resuscitation should be kept to a minimum. Before the operation, the patient is scrubbed and covered in the supine position for sterility. Under general anesthesia, by Hasson technique or with Veress needle which is placed in the infraumbilical region, produces caphno pneumoperitoneum. General intraabdominal exploration is completed with a 10 mm trocar inserted in the infraumbilical region. The operating table position is kept (30° Trendelenburg and 15°–20°opposite to the operating area). Two operating ports (5 mms) are placed on the umbilical level transverse line, with the lateral sides of both rectus muscles localized and placed under direct vision. The trocars on the operative side are placed on infraumbilical transverse line, while the opposite trocar is placed 4–5 cm caudal side on this line (Figure 3). In bilateral hernias, it is suggested that both trocars to be placed on the transverse line at the same level.
\nTrocar placement for TAPP procedure.
As the trocar placements are complete, the inguinal area is examined with care. The hernia type is detected and the content—if present—of the hernia is carefully reduced to origin with atraumatic clamp. If there are elements such as intestine or omentum in the hernia sac, the vitability of intestine or omentum is checked after reducement.
\nThe preparation of the peritoneal flap starts on approximately 5 cm above the hernia canal at the level of the anterior superior crista iliaca on the upper outer side of the annulus inguinalis. The incision is advanced to the medial side of the transverse plane through the upper 5 cm of the inguinal canal’s inner ring and terminated at approximately 2 cm to median ligament.
\nThe peritoneal incision can be done with endoscissors or hooks. Rest of the peritoneal flap on the inguinal canal inner ring can be easily disrupted with the help of intraabdominal CO2 pressure, stretched with endograsper. Peritoneal dissection, below the inguinal canal inner ring, is a little more difficult. The lower peritoneal flap is liberated until lateral visualization of the iliopubic tract, and medial visualization of the Cooper ligament. The hernia sac is carefully dissected from the spermatic cord and elements that are attached through the lower peritoneal membrane (Figure 4). The peritoneal upper and lower flaps are dissected in each direction to provide large parietalization and vision of myopectineal orifice. Thus, enough space is available to lay a mesh on probable direct, indirect and femoral herniation defect sources. If bilateral hernias are present, the peritoneal incision can be extended from one side of the crista iliaca to the other side of the crista iliaca, but in the literature it is suggested that a single incision should be made and a peritoneal bridge could be released in the midline.
\nAnatomic details of left inguinal region after peritoneal flap preparation.
Special shaped polypropylene or polyester patches prepared in size appropriate to the anatomical characteristics of the hernia of the patient are used. The patch is rolled from the outside to the inside and from top to bottom in the form of a roll with limb or without limb (Figure 5). It is placed into the abdomen through a 10 mm trocar. With the help of two endograspers, placed in the working ports, the roll is unfolded in the opposite direction and is laid to cover the existing hernia defect and potential hernia sources. Also, it must be ensured that the patch is placed with a proper tension. When a limb patch is applied the lower limb is passed under the spermatic cord and it is wrapped in a tie and is joined laterally with the upper limb again. The location and number of staples is very important for the immobilization of the mesh patch. The basic rule—with different suggestions about this—is that the staples must be placed on the ileo-pubic tract. We prefer to fix it with two absorbable staples totally, one medially to the Cooper ligament and one to the back of the transverse fascia (Figure 6). Tissue adhesives or absorbable suture materials may also be used for detection.
\nMesh preparation.
After mesh fixation in TAPP procedure.
After the integration of fixation, the upper and lower leaves of the peritoneum are covered on the patch and the opposite edges are closed with either continuous stitches or with clips. Closing the peritoneum with stitches is more convenient but requires more time and experience. The hernia sac, which is usually left in the lower peritoneal sheet and reduced into the peritoneum, can be left if it is small, also the larger sacs can be partially resected before closing the peritoneal leaves. According to experience and preference, a drain can be placed behind the peritoneal flap. After the peritoneum is closed, 5 mm ports are removed under direct vision and the operation is terminated.
\nOral intake can be started a few hours after surgery and the patient is mobilized the same evening. The following day the patient can be discharged by removal of the drain. There is no need to regulate postoperative medical treatment other than oral analgesics.
\nDespite discussions about the use of laparoscopy in the repair of primary unilateral groin hernias, the superiority of TEP in bilateral or recurrent hernias is accepted. The major advantages of this method are that it is extraperitoneal and there is no break in peritoneum. The dominance of the anatomy of the posterior wall is not as good as TAPP, but sufficient parietalization is possible with TEP. Nowadays it becomes the first choice especially for athletes both men and women.
\nThe opposite side of the surgical field and both legs are in closed position. In bilateral hernia repair, both arms are in closed position. The videomonitor laparoscopy tower is placed on the patient’s foot, on the side to be operated. The operator can be placed on the opposite side of the area to be operated and the camera assistant can be placed on the same side or opposite side of the surgeon depending on the experience and habits of the team. We prefer the camera assistant to sit on the same side of the surgeon.
\nStandard laparoscopic equipment consisting of a camera, a monitor, a light and an insuflator
10 mm diameter balloon trocar
Laparoscope with a diameter of 10 mm and a 30° angle
A 10 mm, two 5 mm diameter, totally 3 trocars
Atraumatic clamps, endodissectors, endoscissors, endohooks, endoclapms, endoaspirators
5 mm diameter vessel sealing device
15 × 15 cm polypropylene or polyester special shaped patch
Fixation material (mechanical staple or tissue adhesive)
A single dose of 1 g second-generation cephalosporin as prophylactic antibiotic is injected half an hour before the onset of operation. The patient should urinate before operation and pre-operatory fluid resuscitation should be kept to a minimum. With general anesthesia, the operation starts in supine position. In method of TEP, the patient should be wider painted than the TAPP technique, from the nipple to the perineum. Infraumbilical, slightly lateralized incision is made on the hernia side and then the rectus sheath is opened by transverse incision. Rectus fibers are removed with Farabeuf retractor and blunt dissection is performed to reach the Bogros area. A tunnel is made between umbilicus to pubis. In front of this tunnel, there is a parietal peritoneum from the back of the rectus muscle and from the end of this fascia to the transverse course of the linea semilunaris. After blunt dissection and cannula is completely inserted from the preperitoneal tunnel to the pubis, it is removed from the trocar cannula and replaced with a telescope, and the cannula is inflated with a balloon attached to the mandrel. Air is discharged 20–25 times with puar after waiting for 30 s and this process is repeated three times. With some balloons, it is possible to view inside with scope as it inflates. It can also be monitored whether the definite surgical area is viewed during this observation. Upper view of rectus fibrils and lower view of parietal peritoneum indicates the right position. A 10 mm trocar is placed in the infraumbilical incision to prevent gas leakage and the telescope is placed. The preperitoneal space is inflated with 10–12 mmHg CO2. Two 5 mm ports are placed at a distance of 5 cm from the midline in direct view (Figure 7).
\nTrocar placement for TEP procedure.
After the 30° camera is inserted, the inferior epigastric artery and vein are observed along the bottom of the rectus muscle. The parietal peritoneum is dissected in the medial and lateral directions to remain underneath. The Cooper ligament is visible in the inferomedial area and it is removed. The lateral aspect of the rectus is up to the border of the crista iliaca and the fascia transversalis is opened with blunt and sharp dissections posteriorly. The potential hernia areas are examined and the hernia type is determined (Figure 8). In the indirect inguinal hernia, the hernia sac is found adhered to the spermatic cord. The hernia sac should be dissected from the pubic tuberculum to the level of the external iliac vein. Large scrotal or indirect hernia may be released by Zig technique if it is confirmed that the hernia sac does not contain omentum or intestinal contents. The anatomic regions described as Femoral and Hasselbach triangles should be examined in terms of direct and femoral hernia that may be accompanied. The ililopubic tract must be detected not to injure the femoral and lateral femoral cutaneous nerves of the underlying genitofemoral nerve. The lateral dissection does not need to be as wide as the TAPP technique. The hernia sac should be gently released and reduced from the spermatic cord and cremaster fibers. If the peritoneum is wounded during the dissection procedure, the defect can be closed with a clip. If gas insufflation flows through the gap to the peritoneal defect, the enlarged abdomen will restrict the area of dissection. In order to prevent this, intraperitoneal air could be taken out from the upper left quadrant of the midclavicular line through the abdominal cavity (Palmer’s point) with Veress needle. The valve is left open, the evacuation of the gas is provided and the operation can be continued.
\nPotential hernia areas for TEP procedure.
Special shaped 15 × 15 cm polypropylene or polyester patch can be used according to the anatomy of the patient. The patch can be prepared with limb or without limb. It is rolled up from the top and laid to the extraperitoneal space by the 10 mm camera trocars. With the help of two endograspers placed in the working ports, the patch is unfolded in the opposite direction and is laid to cover the existing hernia defect and potential hernia areas. It should be ensured that the area where the patch is applied covers it with a proper tension. When a limb patch is applied, the lower limb is passed under the spermatic cord and it is wrapped in a tie and is laterally joined to the lower limb (Figure 9). The lower edge of the patch is placed so that it remains at least 2 cm above the released hernia sheath. The locations and numbers are very important if the absorbable staple is preferred for the detection of the mesh. The basic rule, with different suggestions about this, is that the mesh must be placed on the ileo-pubic tract. We prefer to fix it with a total of two absorptive staples, one medially to the Cooper ligament and one to the back of the transverse fascia laterally. On the lateral edge of the spermatic cord there are anatomical areas defined as the triangle of pain mentioned above and the death triangle at the medial border. Staples must be avoided in these areas. Tissue adhesives have also been used today as fixing material. The use of drains varies according to experience and habits. We routinely use aspirative drain after TEP.
\nAfter mesh fixation.
Oral intake can be started a few hours after surgery and the patient is mobilized the same evening. The following day the patient can be discharged by removal of the drain. There is no need to regulate postoperative medical treatment other than oral analgesics.
\nIn this chapter, details take place as noted; details in current practice are given while applying the laparoscopic hernia repair. The points to be considered are evaluated for both techniques. In addition, the difficulties faced by the surgeon are itemized.
\n\n
As all laparoscopic operations, the first point to note in laparoscopic hernia surgery is trocar entry sites. Correct positioning of the appropriate points will prevent intestinal injuries that may occur at the time of first entry and bleeding which may be caused by the injury of the abdominal wall, especially the epigastric vessels.
A complete exploration should be done in terms of hernia type, size, presence of accompanying incarceration and other pathologies in intraabdominal exploration.
Taking enough width for dissection during the preparation of the peritoneal flap will ensure that the exploration area is convenient. Working on a sufficient width of dissection will facilitate the spread of the patch, the adequate closure of the hernia defect and the operator’s work during the detection of the patch.
A very careful dissection should be performed in order to avoid damage to the spermatic cord structures, especially in the presence of indirect hernia, when the hernia incision is dissected, as interference with the anatomical planes may result in attempts made for recurrent hernia.
Should be very careful not to hold Vas Deferens by endo-devices so as to not disturb.
The dissection should be performed at an adequate width of the myopectinale opening, but should be avoided from the extreme dissection in front of the psoas site in the lateral direction. There is an anatomic area defined as triangular pain in this region and it should be especially noted that the cutaneous femoral lateralis and femoral branches of genitofemoral nerves are not damaged. Postoperative chronic pain syndromes can be encountered in the event of a possible nerve injury.
Death triangle is defined as the anastomotic area between the external iliac vein and the obturator vein and should be avoided from the extreme dissection. Because, in the event of a possible vascular injury in this region, catastrophic consequences may be encountered.
The staples used for patch detection due to the same reasons should never be used under the iliopubic tract.
Should be sure to place the staples on the medial side, especially on the Cooper ligament, so that postoperative osteitis pubis is avoided.
It is generally advised to use the least amount of other materials that can be used for stapling or patch fixation.
Wide laying of the mesh will reduce the recurrence rate by covering the three hernia areas.
Reducing the intraabdominal CO2 pressure during the peritoneal flap closure and correcting the patient’s position will facilitate closure because it will reduce tension. The effective closing of the flap is important to prevent postoperative intestinal adhesions.
\n
The infraumbilical incision should be made from slightly left or right lateral. What should be noted here is to be on the rectus front sheath. If the linea alba is opened by mistake, the gas will flow to the intraabdominal region and strengthen the technique at the start.
It is important to notice the bright white color of the rectus posterior sheath, and it is important that the balloon is inflated by advancing the balloon trocar in this space. The balloon dissection between the fibers of the rectus will cause bleeding between the muscle fibers, disturbing the dissection plans and preventing the vision.
If gas flows into the abdomen during possible peritoneal injuries in the TEP technique, as mentioned in the techniques section, the gas must be evacuated with the Veress needle, which will be entered from the Palmer point.
Large peritoneal defects may cause postoperative patchy contact with the intestines and lead to postoperative intestinal adhesion development. For this reason, large peritoneal defects should be closed with endoclips.
In this section, complications related to laparoscopic inguinal hernia surgery, literature information about management of these complications and suggestions based on our own experience are included.
\nThe most common complications are serous fluid deposits (seroma) and bleeding(hematoma) which may develop during operation. Patients should be informed in the preoperative period about these complications. Postoperative seromas usually resorb spontaneously within 2 weeks and do not require treatment. Therapeutic drainage needs arise in the presence of seroma persistent for longer than 6–8 weeks or in the presence of seroma causing clinical symptoms. The use of peroperative aspirative drains in risky patients of who may be predicted seroma and hematoma development may prevent the development of these complications. Scrotal elevation is recommended in the postoperative period. If abdominal wall ecchymosis occur, mechanical compression, cold application and medical treatment can be tried. Subcutaneous emphysema is often untreated and spontaneous. In rare occasional hydrocele cases, it will be more appropriate to consult with a urologist.
\nThe treatment of chronic pain syndromes after laparoscopic hernia surgery is often long and difficult. Chronic postoperative pain has been reported in up to 63% of all groin repairs and significantly affects clinical outcomes. The pain following laparoscopic surgery is usually neuropathic pain. The cause is usually the damage or trapping of the lateral femoral cutaneous or femoral branch of the genitofemoral nerve. Clinically it occurs as acute burning and/or crushing pain in a particular dermatome. Mareljia parestetika is the name of a pain clinic that develops after a lateral femoral cutaneous nerve injury and persistent paresthesia lateral of the femoral area. It is recommended to apply corticosteroids or anesthetic injections which can be applied at rest, cold application, NSAIDs, physical therapy, locally. Osteitis pubis is; the name of the pain clinic that occurs due to public inflammation and arises especially on the middle of the groin or on the pubis, especially with femoral adduction. Diagnosis can be made by excluding recurrent hernia diagnosis radiographically and performing bone imaging. The treatment approach is the same as neuropathic pain. Often, 6 months are required to respond to treatment. However, if the cure is not available, the orthopedic consultation may be needed to consider possible bone resection or curettage options.
\nIschemic orchitis should be considered in the complaints of hardened, enlarged and painful testicles that appear about 10 days after the repair of the inguinal hernia. It is often self-limiting. It is usually the result of a possible damage to the pampiniform plexus, not the testicular artery. Ultrasound can distinguish necrosis or ischemia. If testicular necrosis is detected, urgent orchiectomy may be necessary. Treatment includes IV hydration and NSAIDs. If testicular artery is damaged, it can be caused testicular atrophy after long periods of operation. Vas deferens may not be manipulated during surgery and maximum effort to avoid disturbing their nutrition may help to avoid these complications.
\nPostoperative pain, swelling and the presence of a mass in the inguinal region should be considered. Diagnosis can be made by radiological examinations. Technical factors that play a role in the development of recurrence include inappropriate patch size, inadequate patch, stress or inaccurate detection, lack of experience, tissue ischemia and infections. Factors related to the patient include malnutrition, obesity, wound healing disorders and uncontrolled diabetes mellitus. Surgical intervention should be considered in the treatment.
\nOther complications include urinary retention, which can be prevented by the patient’s urination before surgery or by peroperative urinary catheterization. Paralytic ileus, visceral injuries, vascular injuries, intestinal obstruction, hypercapnia, pneumothorax and gas embolism are also uncommon complications.
\nThe results of laparoscopic and open inguinal hernia surgeries are now being compared very much. Postoperative pain complications, recurrence rates, patient satisfaction, cost analysis are frequently discussed. Papachariston and colleagues in their postoperative evaluation of pain study [8], even though it was reported to require more analgesic in the first 6 h in the TAPP group, pain was reported in 2–11% of the open surgery group and reported as 1–4.2% in the laparoscopic group. In the same study, persistent pain lasting from seventh day to 1 year in the open surgical group was associated with postoperative fibrosis, while point pain in the laparoscopic group was associated with scar tissue rupture. In a meta-analysis evaluating persistent pain [9], patch repair has been shown to reduce persistent pain as opposed to pain relief, and it has also been found that chronic pain is less in the laparoscopic method.
\nIn a study in which approximately 10,000 patient outcomes were assessed in the United States and patients were followed for 3 years [10], the recurrence rate of the laparoscopic method was found to be 0.4%, and it was emphasized that the most important difference between open and laparoscopic operations was the achievement of sufficient experimentation, the number of operations performed. According to this recommendation, a randomized controlled trial conducted by the Veterans Affairs Cooperative Study and reporting of 2-year follow-ups [11], recurrence rates were reported as 10% for laparoscopic repair and 5% for open repair, but after 250 laparoscopic cases techniques, results were improved. In a more recent study, Lal et al. [12] has shown that surgeons have reduced recurrence rates from 9 to 2.9% after 100 operations. In different studies, it has been reported that the laparoscopic techniques are spreading and the time to assess the competence of the surgeons is between 50 and 100 cases. A meta-analysis by Köckerling et al. [13] evaluating the relationship between patch fixation and recurrence, cases that patch fixation was performed and in cases not performed, there was no difference in the duration of operation, patch-related complications, recurrence and duration of hospital stay.
\nIn a randomized controlled meta-analysis in which Wei and colleagues evaluated the outcomes of 1000 patients published in 2015, there was no difference between the two surgeries, pain score, operation time, return to daily activity, hospitalization time, complication and cost between the two surgeries. In conclusion, TEP was found to be more complicated than TAPP and advised to start laparoscopic surgery with TAPP to inexperienced surgeons [14]. In a study published by Köckerling et al. [15] there was no difference between two surgeries in terms of intraoperative complications and reoperation rates. However, after TAPP surgery, complication rates were found to be higher due to possible large complications, more scrotal hernia, elderly patient selection.
\nIn a study conducted by Payne et al. [16] to measure postoperative quality of life, it has been shown that patients’ compliance with straight leg exercises is better after laparoscopic surgery. Designed in the same way and studied by Lawrence et al. [17], this difference was more evident in bilateral hernia repair.
\nThe problem of cost is still an important problem, with the fact that it has been removed from the big picture compared to the past. In the study conducted by Stylopoulos et al. [18] in 2003 and the results of 1.5 million patients evaluated, laparoscopic operations have been claimed to reduce costs compared to long-term open surgery when salary, health insurance costs, reduced job quality, delayed work shifts and the salary of the worker looking after the patient are taken into consideration. Farinas et al. [19] showed that 60% reduction in indirect costs could be achieved despite the 40% increase in the direct costs of using non-disposable devices and shortening of the operation time.
\nWhen TEP and TAPP were compared, there was no difference between the two techniques in terms of hospitalization time, recovery time and short term recurrence rates. The duration of the TEP technique is shorter than that of the TAPP technique [20]. However, according to the International Endohernia Association, it has been suggested that surgeons should apply the TEP technique after learning the TAPP technique and acquiring a certain experience in the learning curve [21].
\nIn our study, we have found that there is only a minimal difference between TAPP and TEP techniques, in terms of operative time. There was no difference in both techniques when recurrence, return to work, pain score, duration of hospitalization and complications were evaluated. Particularly, we observed that bilateral and recurrent hernia had high patient satisfaction. Also we observed that TAPP surgery in the early stages of surgery, shortened the learning curve.
\nIn conclusion, laparoscopic inguinal hernia surgery takes place in daily practice as an increasingly widespread up-to-date treatment method in which training and experience gained over time and patient satisfaction of clinical outcomes are very good.
\nThe authors declare that they have no conflict of interest.
Infectious diseases are caused by microbes such as bacteria, viruses, fungi, or parasite, which often affect human and animal health. The mode of transmission can be direct, such as spread from person to person, or indirect contact via insect bites, food and water contaminations, among others [1].
Africa with the fastest growing population in the world, is now catching up with Asia as infectious diseases hotspot [2]. Infectious diseases have accounted for about one-quarter of deaths, and are globally responsible for at least ten million deaths annually, especially in tropical countries at the beginning of the 21st century. Some of the infectious diseases are emerging while some are re-emerging in nature. Examples of these diseases reported in Africa include meningococcal meningitis, hepatitis B, C, and E viruses, tuberculosis, Dengue fever, Lassa fever, yellow fever, Ebola virus, COVID-19, measles, HIV/AIDS, plague, avian influenza, chikungunya, syphilis and poliomyelitis, monkey pox, Marburg virus, Zika virus, rift valley fever, malaria, cholera, rickettsia, among others (Table 1).
Disease | Type | Countries |
---|---|---|
Covid-19 | Emerging | Nigeria, among other African countries |
Lassa fever | Emerging | Nigeria, Liberia, Benin Republic |
Ebola virus | Emerging | Sierra Leone, Liberia, Guinea, Democratic Republic of Congo (DRC), Uganda, Senegal |
HIV/AIDS | Emerging | All African Countries |
Hepatitis B, C, E | Emerging | Nigeria, Kenya, Uganda, Rwanda, most African countries |
Typhoid fever | Emerging | Nigeria, Ghana, Madagascar, Senegal, Ethiopia, Burkina Faso, Kenya, Guinea Bissau, South Africa, Sudan, and Tanzania |
Dengue fever | Emerging | Burkina Faso, Cote d’ivoire, Egypt, Cape Verde |
Monkey pox | Emerging | Nigeria, Cameroon, Central Africa Republic (CAR) |
Chikungunya | Emerging | Congo, Sudan, Kenya, Senegal |
Zika virus | Emerging | Cape Verde |
Malaria | Emerging/ Re-emerging | Nigeria, Tanzania, Mozambique, DRC |
Measles | Re-emerging | Nigeria, DRC, Zambia, Ethiopia |
Cholera | Re-emerging | Nigeria, Guinea Bissau, Zimbabwe, Niger, Chad, Cameroon, DRC, Sierra Leone, South Sudan, Zambia, Kenya, Somalia and Mozambique |
Tuberculosis | Re-emerging | Nigeria, South Africa |
Meningococcal meningitis | Re-emerging | Nigeria, Liberia, Togo, Niger, Guinea, South Sudan, Benin Republic, Chad, Burkina Faso, Ghana, DRC, Uganda, Cote d’ivoire |
Syphilis | Re-emerging | Nigeria, Morocco, Burkina Faso, Togo, Ghana, Tanzania, Ethiopia, Rwanda, Cameroon, Gabon, Mozambique, Swaziland, South Africa |
Plague | Re-emerging | Madagascar |
Trypanosomiasis | Emerging/ Re-emerging | Nigeria, DRC, South Sudan, Angola, CAR, Chad, Congo, Malawi, Guinea Bissau, Cameroon, Cote d’Ivoire, Equatorial Guinea, Tanzania, Uganda, Zambia, Zimbabwe, Burkina Faso, Ghana, Kenya |
Anthrax | Re-emerging | Tanzania, Zimbabwe, Botswana, Uganda, Namibia, Chad |
The burden of infectious diseases in Africa is huge, and it has topped the list of diseases that frequently require consultation, hospitalization and also remain a major cause of morbidity and mortality. Antimicrobials play important roles in their treatment, emergence of resistance, persistence, and transmission. They have also saved hundreds of millions from infectious agents. However, antimicrobial resistant (AMR) organisms are increasing globally, threatening to render existing treatments ineffective. They prolong illness, increase case fatality, facilitate transmission, and increase treatment costs.
Antimicrobial resistance caused by bacteria and viruses are of greater public health significance. This is because they account for a large share of clinical infections observed. Their emergence has compromised the effectiveness of antimicrobials [14]. The use of antibiotics makes them serve as reservoirs of resistant genes with the propensity to spread via ecological niche through the human, animal, and environmental interactions [15, 16].
Some factors associated with antimicrobial resistance include microbial adaptation and change, human susceptibility to infection, poor environmental practices, human demographics and behavior, international travel and commerce, technology and industry, breakdown of public health measures, poverty and social inequality, war, and famine and lack of political will [3].
Antimicrobials are global public good that has improved health care, saved lives, and enhanced economic gains [17]; and they are the cornerstone on which the health system is standing on [18]. Antimicrobial resistance is the alteration of microbes when exposed to the antimicrobial making them not sensitive. These drugs become ineffective and infections persist in the body, increasing the risk of spread to others.
Antimicrobial resistance is the development of resistance in a microorganism to an antimicrobial agent to which it was previously sensitive [19]; and it is a multifaceted ecosystem problem that threatens the interdependent humans, animals, and environmental health [15, 20]. In view of this importance, the World Health Organization theme for 2011 was tagged “antimicrobial resistance: no action taken, no cure tomorrow”.
The World Health Organization (WHO) has declared that antimicrobial resistance is one of the top ten global public health threats the world is battling with [4]. Antimicrobials such as antibacterial, antivirals, antifungals, and antiparasitics are used to prevent and treat infections in human, animals and plants [4].
United Nations General Assembly, World leaders of G7 and G20, and WHO declared AMR as a global health security challenge today. It is a transboundary problem that concerns every country irrespective of its level of income and development, where the organisms require no international passports [15, 20]. Antimicrobial resistance is a global crisis that risks reversing a century of progress in health [21]. Alarming levels of resistance have been reported in both developing and developed countries, with the result that common diseases are becoming untreatable, and lifesaving medical procedures more at risk to perform [21].
Antimicrobial resistance is also an ecosystem problem threatening the interrelated human-animal-environment health under the “One Health” framework. Resistant bacteria arising in one geographical area can spread via cross-reservoir transmission to other areas worldwide either by direct exposure or through the food chain and the environment [22, 23]. Sixty percent of pathogens harmful to humans are of animal origin; humans and animals share the same bacteria [17].
The economic burden of AMR is difficult to calculate due to insufficient data and the need to account for externalities, especially in Africa [24]. Globally, drug-resistant microbes account for at least 700,000 yearly deaths and 230,000 deaths from resistant mycobacteria are projected to increase to 10 million deaths globally by 2050 in no action is taken. Around 2.4 million people could die in high-income countries between 2015 and 2050 without a sustained effort to contain antimicrobial resistance [21]. Estimates of the impact of AMR on the US economy are exceedingly high, including $20 billion in direct health care costs with additional indirect costs as high as $25 billion, 2 million illnesses, and 23000 deaths per year [25].
The World Bank projected that 24 million people could fall into extreme poverty by 2030 because of AMR and most would come from low- and middle-income countries [15]. Globally, AMR will cost over US$100 trillion in lost output by 2050 [23] and about 4,150,000 deaths in Africa by 2050 [19, 23]. The problem of AMR is global but is particularly more serious in sub-Saharan Africa, second only to that of Asia.
The increase in AMR could lead to a reduction in options available to treat infectious diseases, support chemotherapy, and surgery, and this will have a significant impact on the Health System and economies [19]. Infections with resistant organisms have been associated with an increased hospital stay, increased morbidity and mortality, use of additional drugs, laboratory tests, and increased treatment cost [26, 27]. This has financial implications for the individuals, families, communities, and the health system (HS) [19]. This has increased poverty as it has been documented that millions of Africans fall into poverty due to high out-of-pocket health payments [28]. Antimicrobial resistance could lead to loss of productivity from the spread of diseases to other animals and death of the animals, thereby threatening the sustainability and security of food production and the livelihood of farmers. The proportion of antimicrobials resistance has at least doubled in chickens and in pigs in the past two decades [25].
Reports have identified significant gaps in surveillance, standard methodologies, and data sharing related to AMR; and Africa and South East Asia as regions without established AMR surveillance systems [29]. This results in a lack of quality data leading to treatment guidelines that are not adequate for the local situation. Consequently, the rise and spread of AMR threaten the effective control and treatment of various bacterial diseases world wide [15, 20]. In addition, the lack of consistency in the measurement and reporting of susceptibility data makes it difficult to compare findings among different countries and laboratories, sometimes even within one country [30].
Infections caused by antimicrobial resistance are now alarming globally, and the increasing rates of antimicrobial resistance are resulting in fewer treatment options [31]. The world’s known antimicrobials are becoming increasingly ineffective as drug resistance spreads globally leading to more difficult to treat infections and deaths [4]. The problem is further compounded by the fact that very few new antibiotics have been developed within the last thirty years. We effectively do not have any new weapon in the fight against AMR. Therefore, new antimicrobials are urgently needed to treat especially carbapenem-resistant gram-negative bacterial infections as identified by the WHO priority pathogen list [4].
Without effective tools for the prevention and adequate treatment of drug-resistant infections, the maternal number of death due to drugs resistant infections will increase, and medical procedures such as surgery, including cesarean sections, hip replacements, cancer chemotherapy, and organ transplantation will become riskier [4].
Statistics indicated that malaria claims more than one million lives yearly, and African countries bear the brunt of malaria accounting for more than 90% of all cases occurring worldwide [32]. In Africa, malaria has devastating consequences on agricultural households. It is estimated that malaria cost Africa more than twelve billion United State dollar per year slowing its economic growth by 1.3% annually [33]. Tuberculosis is one of the top leading causes of mortality globally and the highest incidence rates are found in Africa and south-east Asia [34].
HIV/AIDS kills and disable adults in the productive part of their lives affecting businesses, investments, industries, agricultural sustainability, and African agricultural labor force in particular affected [35]. It is worth noting, that bacterial diarrhea, malaria, tuberculosis, and HIV infections, responsible for high mortality rates in sub-Saharan Africa, are also showing increased resistance to hitherto effective antimicrobials.
Antimicrobial resistance is complex, multi-sectoral and a cross-boundary challenge being driven by clinical, biological, social-political, economical, and environmental drivers and exerts effect not only on humans, but also animals and the ecosystem. However, the key drivers of antimicrobial resistance include poverty, lack of access to clean water, sanitation, and hygiene for both human and animals; poor infections and diseases prevention and control in healthcare facilities and farms; changing population density; poor management of pharmaceutical and hospital wastes; antibiotic misuse and overuse; poor access to quality and affordable medicines, vaccines, and diagnostics; poor public knowledge about antimicrobials and its resistance; lack of enforcement of legislation; lack of surveillance systems; lack of food safety and control measures; poor environmental practices, poor documentation of AMR in animals, poor evidence-based data on the magnitude and economic burden of AMR in humans; poor rules and regulations to control counterfeit drugs in the market and unique transmission properties of antimicrobial resistant organism, chemical stressors in an environment, among others [37].
Bacteria usually adopt some mechanisms to resist antibiotic action against them. These mechanisms include the inactivation of the antibiotic through enzymatic degradation, or modification of the antibiotic targets, alteration of the permeability of the cell membrane, and the expression of efflux pumps to keep intracellular of antibiotic below inhibitory level [37].
Several unique properties of antimicrobial resistant bacteria enable their development and propagation in the environment. Autochthonous bacteria constitute environmental reservoirs of antibiotic resistance genes or “resistomes” that can subsequently be transferred to pathogens via horizontal gene transfer (HGT) [37, 38]. This HGT can occur through conjugation, transduction or transformation. However, the key global concern is the development of resistance of last resort, such as the cephalosporins, carbapenems, and polymyximises [39]. Resistance to third-generation cephalosporins has increased worldwide to bacterial acquisition of the ability to produce extended-spectrum beta-lactamase enzymes (ESBL) that mediate resistance to most beta – lactams [40]. Bacteria and mobile genetic elements conferring resistance linger on animal skin and in feces and by various means can be transferred between bacteria, and these organisms can make their way to human beings [41]. Evidence of transmission from livestock to human beings ESBL and AmpC – B – Lactamase genes on plasmids and
In developing countries with scarce resources, poor sanitation, poor food safety measures, sales of antimicrobial over the counter, overcrowding, use of antimicrobials in animal and fish farming, and weak government regulations are some of the leading causes of antimicrobial resistance [42, 43]. There has been documentation of antibiotics being added directly to dairy products by vendors in order to increase shelf-life in Ethiopia [44]. Others showed high antimicrobial residues in eggs and meat in Nigeria [45], Ghana [46], Senegal [47], Kenya [48], and Tanzania [49].
Movement of people from rural to urban areas (urbanization) brings considerable negative and positive changes in their living and working conditions. In the urban areas, housing density increases, there is overcrowding, animals and humans may share dwelling places and drinking water, among others with resultant negative health consequences. One of the problems associated with rural-urban migration of people includes AMR infection transmission, which has been documented [50].
Antimicrobial are among the most commonly prescribed drugs in human and veterinary medicine but about 50% of these are considered unnecessary [51]. This is associated with misuse, overuse, and underuse especially in low, middle, and high-income countries (LMIC) [52, 53]. These consumptions could be a major driver of AMR. When antibiotics are used, either for medicinal purposes or for food animal production, they inevitably make their way into the environment [40].
Antibiotics have been in use in livestock, cattle, and aquaculture, among others to enhance production and growth for human consumption. A study showed that among different countries using veterinary antibiotics, Myanmar, Indonesia, Nigeria, Peru, and Vietnam have been projected to have the greatest increase by 2030 in that descending order [54].
Treatment of ailing fish with antibiotics used for human medicine and then dumping these treatments directly into the water or via fish food is one of the leading causes of bacterial resistance in the aquatic environment. Substantial evidence supports the link between antibiotic resistance in livestock and the emergence of bacterial resistance in humans [55, 56].
Counterfeit antibiotics are a type of substandard drug and the influx into the global pharmaceutical market is estimated at 5% [57]. The majority of these products originating from south-East-Asia and Africa, are destined mainly for emerging countries including South-East –Asia, sub-Saharan Africa, Europe, and North America [57]. Even though it is a worldwide problem, it is still not eradicated and it continues to exert a devastating negative impact mainly because of poverty, globalization, ease of international trade, the lack of regulations, and law enforcement, among others.
Globally, antibiotics are becoming more and more available over-the-counter or via unregulated supply chains [58, 59], which is a problem in both developing and developed countries [60]. This results from weak law enforcement or even the absence of policies and regulations [61]. In developing countries mainly Africa, the community is providing different unauthorized services like consulting, diagnosing, prescribing, and dispensing medications [62]. These illegal practices if no care is taken can increase selection pressure and consequently AMR.
Antimicrobial stewardship is the effort to measure and improve how antimicrobials are prescribed by clinicians and used by patients. Improving antimicrobials prescribing and use is critical to effectively treat infections, protect patients from harms caused by unnecessary antimicrobial use, and combat antimicrobial resistance. (www.cdc.gov/antibiotic-use/core-elements/index.html).
CDC’s Core Elements of Antibiotic Stewardship offers providers and facilities a set of key principles to guide efforts to improve antibiotic use and, therefore, advance patient safety and improve outcomes. These frameworks complement existing guidelines and standards from key healthcare partner organizations, including the Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, American Society of Health System Pharmacists, Society of Infectious Diseases Pharmacists, and The Joint Commission (CDC www.cdc.gov/antibiotic-use/core-elements/index.html).
It is the use of standard antibiotic regimens for the treatment of infections thus optimization of antibiotic use. This program has been implemented in some countries with impressive results [48], leading to a reduction in the use of antibiotics especially broad-spectrum antibiotics in addition to a decrease in healthcare costs and the improvement of patient outcomes and AMR containment [63, 64]. Similar programs in South Africa, a lower-middle-income country, in both the private and public hospital sectors, have shown reductions in inappropriate antibiotic use, among others [65].
The Core Elements of Hospital Antibiotic Stewardship Programmes [66] include:
Hospital Leadership Commitment which dedicates necessary human, financial, and information technology resources.
Accountability appoints a leader or co-leaders, such as a physician and pharmacist, responsible for program management and outcomes.
Pharmacy Expertise (previously Drug Expertise) which appoints a pharmacist, ideally as the co-leader of the stewardship program, to help lead implementation efforts to improve antibiotic use.
Action that implements interventions, such as prospective audit and feedback or preauthorization, to improve antibiotic use.
Tracking which monitors antibiotic prescribing, impact of interventions, and other important outcomes, like
Regularly reporting information on antibiotic use and resistance to prescribers, pharmacists, nurses, and hospital leadership.
Education of prescribers, pharmacists, nurses, and patients about adverse reactions from antibiotics, antibiotic resistance, and optimal prescribing.
Because the drivers of antimicrobial resistance lie in humans, animals, plants, food, and the environment (i.e., beyond the hospital), a sustained One Health response is essential to engage and unite all stakeholders around a shared vision and goals.
Human resources for health (HRH) are key in the hospital antimicrobial resistance containment. However, inadequate and inequity in the distribution of health workers is a huge problem, especially in Africa, and Nigeria [67]. The maldistribution of health workforces is central to the existing inequalities in health service coverage and the burden of disease for populations in need.
Weak health system: Although the battle of AMR is a global one, Africa is currently at a disadvantage in the fight because of weak healthcare systems and other factors that are slowing the continent’s efforts in the fight. This will have serious negative human, social, economic, and developmental consequences in the region [15]. Africa is a continent bellied with challenges such as widespread poverty, armed conflicts, high level of illiteracy, poverty, and very weak medical and veterinary health institutions [68]
One Health is an approach of multiple disciplines working locally, nationally, and globally to obtain better health for people, animals, and the environment. It has the potential to mitigate the negative externality of AMR [69].
Studies have shown that implementing one health, especially in low-income countries will save lots of money for the veterinary and medical health systems [44, 68]. This money can be used to enhance surveillance and improve capacities in medical and veterinary HS. Surveillance systems are the foundation for a better understanding of the epidemiology of AMR and the key for tackling this public health threat [46].
Tackling antimicrobial resistance from the “One Health” perspective is emaced by the WHO/FAO/OIE Tripartite, the Declaration from the 2016 high-level meeting on antimicrobial resistance at the United Nations General Assembly, and is supported by the World Bank [20, 70, 71]. This model engenders broad effectiveness and efficiency outcomes generating savings in operating costs. It is based on building veterinary/human public-health capacity and enhancing awareness in order to reach effective global governance. Capitalizing on these capacities or reducing the vulnerabilities, especially in low-income countries will prevent or mitigate the leading causes of antimicrobial resistance and infectious pandemic.
The adoption and implementation of laboratory-based surveillance and monitoring system in the African WHO regional office is poor. In LMICs, the challenges are enormous due to weak laboratory and communications infrastructure, lack of trained and qualified staff, and higher incidence of counterfeit antibiotics [72]. Current surveillance capabilities are variable across the world. Europe and the USA have the best surveillance coverage while Sub-Saharan Africa, South and Southeast Asia have the least developed [51]. Therefore, there is need for global public health awareness on the importance of rational antibiotic use and emergence of resistance.
The importance of antimicrobial resistance cannot be neglected in view of its consequences globally, regionally, nationally, and locally. It is a hazard that must be prevented and/or mitigated. Health Education of the general population and clinicians on wrong antibiotic choice, wrong dose, wrong dose interval, wrong route, wrong duration, and delayed administration could be helpful.
Multimodal strategies for the control of AMR, Research and Development, environmental control, market control, and manufacturing should be explored.
Establishment of laboratory for human and animal diseases research: Adequate funding is critical; however, the sources of funding can be from governmental and non-governmental entities.
Surveillance of antibiotic consumption in medical and veterinary medicine is fundamental; and a massive global public awareness is important to enhance knowledge about AMR in general and antibiotic uses and resistance in particular. Surveillance systems are the foundation for a better understanding of the epidemiology of AMR and the key for tackling this public health threat.
Medical prescriptions should be based on the local antibiogram. There is a need to explore alternatives to antimicrobials, such as phages and probiotics, among others.
I sincerely acknowledge my teachers, namely Professors JKP Kwaga, Junaidu Kabir, TO Aken’Ova, Clara Ladi Ejembi, Kabir Sabitu, Mohammed Bello, and Dr FJ Giwa of Ahmadu Bello University, Zaria, Nigeria.
Others are Late Professors Andrew Nok, James Adagadzu Kagbu and Stephen Nkom, Late Dr TT Gbem and Late Colonel (Dr) Chinedu John Camillus Igboanusi, Yahuza Suleiman, Bawa Egga, Eunice Azimheye Mamedu, and Esther Jonah.
I also acknowledge Mrs Wazi Istifanus, Ovye Istifanus, Ahogbresha Istifanus, Ashe-ulu Istifanus, and Abesla Istifanus for all their support.
The authors declare no conflict of interest.
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\\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.
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\n\n2. SUBMIT YOUR MANUSCRIPT
\n\nAfter approval, you will proceed in submitting your full-length manuscript. 50-130 pages for compacts, 130-500 for Monographs & Edited Books.Your full-length manuscript must follow IntechOpen's Author Guidelines and comply with our publishing rules. Once the manuscript is submitted, but before it is forwarded for peer review, it will be screened for plagiarism.
\n\n3. PEER REVIEW RESULTS
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\n\n4. ACCEPTANCE AND PRICE QUOTE
\n\nIf the manuscript is formally accepted after peer review you will receive a formal Notice of Acceptance, and a price quote.
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\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:
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\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.
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The discrete-continuum model is a relatively new modeling method, which accounts for turbulent and laminar flow in karst aquifer. MODFLOW-CFP (Conduit Flow Process) is compared to the MODFLOW, a numerical code based on Darcy law, to evaluate the accuracy in a sub-regional scale karst aquifer. MODFLOW-CFP is more accurate than the MODFLOW when comparing the head simulation results with field measurements. After that, the CFPv2 and UMT3D numerical models are applied in the WKP to establish a sub-regional scale model to simulate chloride transport processes in the last four decades, and to predict contamination development. Numerical simulation results indicate sprayfields are the major chloride source in the study region. Conduit networks significantly control solute transport and contaminant distribution in the study region. Chloride transports through conduits rapidly and spread to several large contamination plumes in a short period. Chloride concentration started to increase in 1980s due to the operation of sparyfield. Solute transport simulation results by discrete-continuum models are more accurate because of the precise description of conduit network.",book:{id:"5255",slug:"groundwater-contaminant-and-resource-management",title:"Groundwater",fullTitle:"Groundwater - Contaminant and Resource Management"},signatures:"Bill X. Hu and Zexuan Xu",authors:[{id:"181982",title:"Dr.",name:"Bill",middleName:"X.",surname:"Hu",slug:"bill-hu",fullName:"Bill Hu"},{id:"181983",title:"Mr.",name:"Zexuan",middleName:null,surname:"Xu",slug:"zexuan-xu",fullName:"Zexuan Xu"}]},{id:"50765",doi:"10.5772/63496",title:"Modelling Water Dynamics, Transport Processes and Biogeochemical Reactions in Soil Vadose Zone",slug:"modelling-water-dynamics-transport-processes-and-biogeochemical-reactions-in-soil-vadose-zone",totalDownloads:2021,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"Large numbers of numerical models are nowadays available for the description of physical and chemical processes affecting water flow and solute transport in soil vadose zone. This chapter explains basic principles of water flow and solute transport modelling in soil vadose (variably saturated) zone and some of the most important processes present in it. First part deals with water dynamics in the soil, that is, soil water content, pressure head, soil porosity, and water flow. Also, some of the measurement techniques used to estimate water dynamics in soil are explained. Water retention curve and soil hydraulic properties needed for modelling are briefly discussed with the explanation of basic (i.e. most commonly used) hydraulic relationship in soil (van Genuchten equation) and water flow (Richards equation) approaches. Second part includes solute transport description in vadose zone, including processes such as advection, diffusion, dispersion, and adsorption. Basic advection‐dispersion equation is explained and also the implementation of boundary and initial conditions in the numerical model. Preferential flow is shortly discussed with the basic principles behind its occurrence and modelling in the soil vadose zone. One real case one‐dimensional (1D) example of modelling with HYDRUS software is presented in which water flow and nitrate transport is simulated on the lysimeter study. Short overview of the most widely used numerical models for simulating vadose zone processes is also presented, whereas the final part is focused on chemical speciation modelling in relatively homogeneous soil solutions using visual MINTEQ interface.",book:{id:"5255",slug:"groundwater-contaminant-and-resource-management",title:"Groundwater",fullTitle:"Groundwater - Contaminant and Resource Management"},signatures:"Vilim Filipović, Gabrijel Ondrašek and Lana Filipović",authors:[{id:"46939",title:"Prof.",name:"Gabrijel",middleName:null,surname:"Ondrasek",slug:"gabrijel-ondrasek",fullName:"Gabrijel Ondrasek"},{id:"182575",title:"Dr.",name:"Vilim",middleName:null,surname:"Filipović",slug:"vilim-filipovic",fullName:"Vilim Filipović"},{id:"185968",title:"MSc.",name:"Lana",middleName:null,surname:"Matijević",slug:"lana-matijevic",fullName:"Lana Matijević"}]},{id:"50700",doi:"10.5772/63508",title:"Spatiotemporal Analysis of Groundwater Recharge Trends and Variability in Northern Taiwan",slug:"spatiotemporal-analysis-of-groundwater-recharge-trends-and-variability-in-northern-taiwan",totalDownloads:1779,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"In this study, the base flow estimation method was used to assess long‐term changes of groundwater recharge in Northern Taiwan. The Mann‐Kendall test was used to examine the characteristics of the trends. This was followed by trend slope calculation and change‐point analysis. The annual groundwater recharge was found to exhibit a significant upward trend for the Fushan and Hengxi stations (Tamsui river basin). On the other hand, the Ximen Bridge station (Lanyang river basin) recorded a significant downward trend. Calculations showed that the rate of change for the Fengshan and Touqian river basins was small (less than 10%). However, that for the following stations was greater than 30%: Fushan, Hengxi, Ximen Bridge, and Niudou (also in the Lanyang river basin). The results of the change‐point analysis further indicated a significant change‐point for the annual recharge at Fushan, Hengxi, and Ximen Bridge stations in 1999, 1983, and 2001, respectively. The findings can be used for regional hydrological studies and as reference for water resource planning.",book:{id:"5255",slug:"groundwater-contaminant-and-resource-management",title:"Groundwater",fullTitle:"Groundwater - Contaminant and Resource Management"},signatures:"Hsin‐Fu Yeh, Chen‐Feng Yeh, Jhe‐Wei Lee and Cheng‐Haw Lee",authors:[{id:"180104",title:"Dr.",name:"Hsin-Fu",middleName:null,surname:"Yeh",slug:"hsin-fu-yeh",fullName:"Hsin-Fu Yeh"},{id:"185794",title:"Mr.",name:"Chen-Feng",middleName:null,surname:"Yeh",slug:"chen-feng-yeh",fullName:"Chen-Feng Yeh"},{id:"185795",title:"Dr.",name:"Jhe-Wei",middleName:null,surname:"Lee",slug:"jhe-wei-lee",fullName:"Jhe-Wei Lee"},{id:"185796",title:"Prof.",name:"Cheng-Haw",middleName:null,surname:"Lee",slug:"cheng-haw-lee",fullName:"Cheng-Haw Lee"}]},{id:"50779",doi:"10.5772/63324",title:"Appraisal of Groundwater Flow Simulation in the Sub- Himalayan Watershed of Pakistan",slug:"appraisal-of-groundwater-flow-simulation-in-the-sub-himalayan-watershed-of-pakistan",totalDownloads:1895,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Numerical modeling of an aquifer is increasingly used as a power tool for monitoring and management of groundwater. This paper focuses on conceptualizing hydrogeological condition and establishing numerical simulation model using Visual MODFLOW to simulate the continuous depletion of groundwater in the southwestern part of the Soan watershed in Pakistan. An integrated groundwater modeling and management approach was adopted to provide suitable alternatives for water management in different hydro-environments. Geospatial techniques were employed for spatial database development, integration with a remote sensing (RS), and numerical groundwater flow modeling capabilities to simulate groundwater flow behavior. The calibration results indicated a reasonable agreement between the calculated and observed heads. The calibrated heads were used as initial conditions in the transient-state modeling. The modeling approach facilitated in identifying potential groundwater regime besides providing artificial recharge options for sustainable groundwater development.",book:{id:"5255",slug:"groundwater-contaminant-and-resource-management",title:"Groundwater",fullTitle:"Groundwater - Contaminant and Resource Management"},signatures:"Zulfiqar Ahmad, Arshad Ashraf and Mohsin Hafeez",authors:[{id:"13305",title:"Prof.",name:"Zulfiqar",middleName:null,surname:"Ahmad",slug:"zulfiqar-ahmad",fullName:"Zulfiqar Ahmad"},{id:"99395",title:"Dr.",name:"Arshad",middleName:null,surname:"Ashraf",slug:"arshad-ashraf",fullName:"Arshad Ashraf"}]},{id:"51278",doi:"10.5772/63903",title:"Study of Unsaturated Soils by Coupled Numerical Analyses of Water Flow-Slope Stability",slug:"study-of-unsaturated-soils-by-coupled-numerical-analyses-of-water-flow-slope-stability",totalDownloads:2007,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"The geotechnical engineering, among the problems related to water flow, is specifically interested in soil and water that it contains, and also on the movement of water through their pores, in addition to the laws governing this phenomenon. A very important subject is to quantify the retention and filtration of water within the soil structure; however, the emphasis should be not only on how much water flows through the soil but also on the state of pore water pressures because this pressure, either positive or negative, has a direct influence on the stress state and changes in volume of soil. Several publications address the issue of water flow in saturated state; however, only some of them consider the flow under unsaturated conditions. In this chapter, the main emphasis is focused on the study of water flow in unsaturated soils.",book:{id:"5255",slug:"groundwater-contaminant-and-resource-management",title:"Groundwater",fullTitle:"Groundwater - Contaminant and Resource Management"},signatures:"Norma Patricia López-Acosta and José Alfredo Mendoza-Promotor",authors:[{id:"139295",title:"Dr.",name:"Norma Patricia",middleName:null,surname:"Lopez-Acosta",slug:"norma-patricia-lopez-acosta",fullName:"Norma Patricia Lopez-Acosta"},{id:"188534",title:"MSc.",name:"José Alfredo",middleName:null,surname:"Mendoza-Promotor",slug:"jose-alfredo-mendoza-promotor",fullName:"José Alfredo Mendoza-Promotor"}]}],mostDownloadedChaptersLast30Days:[{id:"51278",title:"Study of Unsaturated Soils by Coupled Numerical Analyses of Water Flow-Slope Stability",slug:"study-of-unsaturated-soils-by-coupled-numerical-analyses-of-water-flow-slope-stability",totalDownloads:2001,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"The geotechnical engineering, among the problems related to water flow, is specifically interested in soil and water that it contains, and also on the movement of water through their pores, in addition to the laws governing this phenomenon. A very important subject is to quantify the retention and filtration of water within the soil structure; however, the emphasis should be not only on how much water flows through the soil but also on the state of pore water pressures because this pressure, either positive or negative, has a direct influence on the stress state and changes in volume of soil. Several publications address the issue of water flow in saturated state; however, only some of them consider the flow under unsaturated conditions. In this chapter, the main emphasis is focused on the study of water flow in unsaturated soils.",book:{id:"5255",slug:"groundwater-contaminant-and-resource-management",title:"Groundwater",fullTitle:"Groundwater - Contaminant and Resource Management"},signatures:"Norma Patricia López-Acosta and José Alfredo Mendoza-Promotor",authors:[{id:"139295",title:"Dr.",name:"Norma Patricia",middleName:null,surname:"Lopez-Acosta",slug:"norma-patricia-lopez-acosta",fullName:"Norma Patricia Lopez-Acosta"},{id:"188534",title:"MSc.",name:"José Alfredo",middleName:null,surname:"Mendoza-Promotor",slug:"jose-alfredo-mendoza-promotor",fullName:"José Alfredo Mendoza-Promotor"}]},{id:"50543",title:"Mobility and Transformation of Inorganic Contaminants in Mining-impacted Groundwater",slug:"mobility-and-transformation-of-inorganic-contaminants-in-mining-impacted-groundwater",totalDownloads:1900,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Mining often results in the contamination of groundwater by metal, sulphate and radionuclide ions following their percolation from tailings impoundments. This chapter discusses the processes by which elements within tailings are transformed and translocated to groundwater and the role of aquifer characteristics and colloids in these processes. The prevention and remediation of contaminated groundwater is also discussed, with particular attention given to the use of permeable reactive barriers and sulphate reducing bacteria.",book:{id:"5255",slug:"groundwater-contaminant-and-resource-management",title:"Groundwater",fullTitle:"Groundwater - Contaminant and Resource Management"},signatures:"Anita Etale and Sabelo Mhlanga",authors:[{id:"181427",title:"Dr.",name:"Anita",middleName:null,surname:"Etale",slug:"anita-etale",fullName:"Anita Etale"},{id:"185134",title:"Prof.",name:"Sabelo",middleName:null,surname:"Mhlanga",slug:"sabelo-mhlanga",fullName:"Sabelo Mhlanga"}]},{id:"51394",title:"Numerical and Analytical Methods for the Analysis of Flow of Water Through Soils and Earth Structures",slug:"numerical-and-analytical-methods-for-the-analysis-of-flow-of-water-through-soils-and-earth-structure",totalDownloads:2664,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"This chapter presents a compendium of the primary methods that are used to perform water flow analyses with a focus on computational approximation methods. Some of the current algorithms for carrying out this type of analysis are summarized. In addition, general guidelines are provided for using the methodologies for specific types of analysis, such as transient-state flow caused by water drawdown and flow in unsaturated media. Emphasis is placed on the need for stochastic analysis of water flow. Lastly, conclusions and general recommendations are given for performing numerical groundwater seepage analyses in soils.",book:{id:"5255",slug:"groundwater-contaminant-and-resource-management",title:"Groundwater",fullTitle:"Groundwater - Contaminant and Resource Management"},signatures:"Norma Patricia López-Acosta",authors:[{id:"139295",title:"Dr.",name:"Norma Patricia",middleName:null,surname:"Lopez-Acosta",slug:"norma-patricia-lopez-acosta",fullName:"Norma Patricia Lopez-Acosta"}]},{id:"50779",title:"Appraisal of Groundwater Flow Simulation in the Sub- Himalayan Watershed of Pakistan",slug:"appraisal-of-groundwater-flow-simulation-in-the-sub-himalayan-watershed-of-pakistan",totalDownloads:1894,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Numerical modeling of an aquifer is increasingly used as a power tool for monitoring and management of groundwater. This paper focuses on conceptualizing hydrogeological condition and establishing numerical simulation model using Visual MODFLOW to simulate the continuous depletion of groundwater in the southwestern part of the Soan watershed in Pakistan. An integrated groundwater modeling and management approach was adopted to provide suitable alternatives for water management in different hydro-environments. Geospatial techniques were employed for spatial database development, integration with a remote sensing (RS), and numerical groundwater flow modeling capabilities to simulate groundwater flow behavior. The calibration results indicated a reasonable agreement between the calculated and observed heads. The calibrated heads were used as initial conditions in the transient-state modeling. The modeling approach facilitated in identifying potential groundwater regime besides providing artificial recharge options for sustainable groundwater development.",book:{id:"5255",slug:"groundwater-contaminant-and-resource-management",title:"Groundwater",fullTitle:"Groundwater - Contaminant and Resource Management"},signatures:"Zulfiqar Ahmad, Arshad Ashraf and Mohsin Hafeez",authors:[{id:"13305",title:"Prof.",name:"Zulfiqar",middleName:null,surname:"Ahmad",slug:"zulfiqar-ahmad",fullName:"Zulfiqar Ahmad"},{id:"99395",title:"Dr.",name:"Arshad",middleName:null,surname:"Ashraf",slug:"arshad-ashraf",fullName:"Arshad Ashraf"}]},{id:"50700",title:"Spatiotemporal Analysis of Groundwater Recharge Trends and Variability in Northern Taiwan",slug:"spatiotemporal-analysis-of-groundwater-recharge-trends-and-variability-in-northern-taiwan",totalDownloads:1776,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"In this study, the base flow estimation method was used to assess long‐term changes of groundwater recharge in Northern Taiwan. The Mann‐Kendall test was used to examine the characteristics of the trends. This was followed by trend slope calculation and change‐point analysis. The annual groundwater recharge was found to exhibit a significant upward trend for the Fushan and Hengxi stations (Tamsui river basin). On the other hand, the Ximen Bridge station (Lanyang river basin) recorded a significant downward trend. Calculations showed that the rate of change for the Fengshan and Touqian river basins was small (less than 10%). However, that for the following stations was greater than 30%: Fushan, Hengxi, Ximen Bridge, and Niudou (also in the Lanyang river basin). The results of the change‐point analysis further indicated a significant change‐point for the annual recharge at Fushan, Hengxi, and Ximen Bridge stations in 1999, 1983, and 2001, respectively. The findings can be used for regional hydrological studies and as reference for water resource planning.",book:{id:"5255",slug:"groundwater-contaminant-and-resource-management",title:"Groundwater",fullTitle:"Groundwater - Contaminant and Resource Management"},signatures:"Hsin‐Fu Yeh, Chen‐Feng Yeh, Jhe‐Wei Lee and Cheng‐Haw Lee",authors:[{id:"180104",title:"Dr.",name:"Hsin-Fu",middleName:null,surname:"Yeh",slug:"hsin-fu-yeh",fullName:"Hsin-Fu Yeh"},{id:"185794",title:"Mr.",name:"Chen-Feng",middleName:null,surname:"Yeh",slug:"chen-feng-yeh",fullName:"Chen-Feng Yeh"},{id:"185795",title:"Dr.",name:"Jhe-Wei",middleName:null,surname:"Lee",slug:"jhe-wei-lee",fullName:"Jhe-Wei Lee"},{id:"185796",title:"Prof.",name:"Cheng-Haw",middleName:null,surname:"Lee",slug:"cheng-haw-lee",fullName:"Cheng-Haw Lee"}]}],onlineFirstChaptersFilter:{topicId:"867",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:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:318,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:106,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:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:15,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"24",title:"Sustainable Development",doi:"10.5772/intechopen.100361",issn:null,scope:"\r\n\tThe environment is subject to severe anthropic effects. 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