",isbn:"978-1-80356-948-2",printIsbn:"978-1-80356-947-5",pdfIsbn:"978-1-80356-949-9",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,hash:"c0d1c1c93a36fd9d726445966316a373",bookSignature:"Dr. Sylvanus Gbendazhi Barnabas",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11434.jpg",keywords:"Indigenous People, Natives, First People, Minorities, United Nations, UN Declaration, Indigenous People Rights, Self-Determination, States, Independence, Struggle for Rights, Contemporary Times",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 7th 2022",dateEndSecondStepPublish:"May 5th 2022",dateEndThirdStepPublish:"July 4th 2022",dateEndFourthStepPublish:"September 22nd 2022",dateEndFifthStepPublish:"November 21st 2022",remainingDaysToSecondStep:"15 days",secondStepPassed:!0,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"Legal practitioner, consultant and a law academic with a diversity of interest in multi and intra-disciplinary scholarship on legal issues at national regional and international levels.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"293764",title:"Dr.",name:"Sylvanus",middleName:"Gbendazhi",surname:"Barnabas",slug:"sylvanus-barnabas",fullName:"Sylvanus Barnabas",profilePictureURL:"https://mts.intechopen.com/storage/users/293764/images/system/293764.jpg",biography:"Sylvanus Barnabas is a Senior Lecturer in Law at the Faculty of Law, Nile University of Nigeria where he teaches various subjects in law; he obtained the degree of Doctor of Philosophy in international human rights law from Northumbria University at Newcastle upon Tyne, United Kingdom; he has a Master of Laws degree obtained with distinction in Environmental Law and Policy from University of Kent at Canterbury, Kent, United Kingdom; he also holds a Bachelor of Laws degree from Ahmadu Bello University, Zaria, Nigeria; and he is also a qualified a barrister and solicitor of the Supreme Court of Nigeria.",institutionString:"Nigerian Turkish Nile University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Nigerian Turkish Nile University",institutionURL:null,country:{name:"Nigeria"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"21",title:"Psychology",slug:"psychology"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"440204",firstName:"Ana",lastName:"Cink",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/440204/images/20006_n.jpg",email:"ana.c@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"6494",title:"Behavior Analysis",subtitle:null,isOpenForSubmission:!1,hash:"72a81a7163705b2765f9eb0b21dec70e",slug:"behavior-analysis",bookSignature:"Huei-Tse Hou and Carolyn S. Ryan",coverURL:"https://cdn.intechopen.com/books/images_new/6494.jpg",editedByType:"Edited by",editors:[{id:"96493",title:"Prof.",name:"Huei Tse",surname:"Hou",slug:"huei-tse-hou",fullName:"Huei Tse Hou"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9052",title:"Psychoanalysis",subtitle:"A New Overview",isOpenForSubmission:!1,hash:"69cc7a085f5417038f532cf11edee22f",slug:"psychoanalysis-a-new-overview",bookSignature:"Floriana Irtelli, Barbara Marchesi and Federico Durbano",coverURL:"https://cdn.intechopen.com/books/images_new/9052.jpg",editedByType:"Edited by",editors:[{id:"174641",title:"Dr.",name:"Floriana",surname:"Irtelli",slug:"floriana-irtelli",fullName:"Floriana Irtelli"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10981",title:"Sport Psychology in Sports, Exercise and Physical Activity",subtitle:null,isOpenForSubmission:!1,hash:"5214c44bdc42978449de0751ca364684",slug:"sport-psychology-in-sports-exercise-and-physical-activity",bookSignature:"Hilde G. Nielsen",coverURL:"https://cdn.intechopen.com/books/images_new/10981.jpg",editedByType:"Edited by",editors:[{id:"158692",title:"Ph.D.",name:"Hilde",surname:"Nielsen",slug:"hilde-nielsen",fullName:"Hilde Nielsen"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10211",title:"The Science of Emotional Intelligence",subtitle:null,isOpenForSubmission:!1,hash:"447fc7884303a10093bc189f4c82dd47",slug:"the-science-of-emotional-intelligence",bookSignature:"Simon George Taukeni",coverURL:"https://cdn.intechopen.com/books/images_new/10211.jpg",editedByType:"Edited by",editors:[{id:"202046",title:"Dr.",name:"Simon George",surname:"Taukeni",slug:"simon-george-taukeni",fullName:"Simon George Taukeni"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7811",title:"Beauty",subtitle:"Cosmetic Science, Cultural Issues and Creative Developments",isOpenForSubmission:!1,hash:"5f6fd59694706550db8dd1082a8e457b",slug:"beauty-cosmetic-science-cultural-issues-and-creative-developments",bookSignature:"Martha Peaslee Levine and Júlia Scherer Santos",coverURL:"https://cdn.intechopen.com/books/images_new/7811.jpg",editedByType:"Edited by",editors:[{id:"186919",title:"Dr.",name:"Martha",surname:"Peaslee Levine",slug:"martha-peaslee-levine",fullName:"Martha Peaslee Levine"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"63322",title:"Challenges to Hygiene Improvement in Developing Countries",doi:"10.5772/intechopen.80355",slug:"challenges-to-hygiene-improvement-in-developing-countries",body:'\n
\n
1. Introduction
\n
This chapter defines hygiene in the context of developing countries. It then outlines the various major types of hygiene before tackling the challenges in the implementation of projects aimed at hygiene improvement. The chapter then suggests possible solutions to these problems.
\n
\n
1.1. What are developing countries?
\n
There are different definitions of developing countries; however, the broad definition is that; this is a term often used to refer to countries with medium to low human development index (HDI) or sometimes the gross domestic product (GDP) is used. These countries are mainly found in Africa, Asia, and some in South America that generally lack a high degree of industrialization, infrastructure and other capital investment, sophisticated technology, widespread literacy, and advanced living standards among their population as a whole [1, 2]. In short, these are countries with low income per capita of population that are trying to improve their conditions through industrialization [3]. In addition, the United Nations (UN) describes a developing country as a country with a relatively low standard of living, undeveloped industrial base, and moderate to low HDI, with a high employment share of 60–70% in agriculture [4]. Developing countries also have low life expectancies [5, 6]. However, regardless of the low income in developing countries, there is high population growth in these countries. It is this high population growth in developing countries that is seriously outstripping the capacity of most countries to provide adequate services for their citizens [5].
\n
Currently, many developing countries already struggle to cope with consistent water shortages and they lack adequate water infrastructure. High population growth and rapid urbanization cause more pressure to these limited water resources which in turn results in poor access to improved water source and limits hygienic practices in the communities, as these hygienic practices highly depend on the availability of safe water [6]. Hygiene causes a global health challenge especially in the developing world even though thus far, hygiene has been barely prioritized on the international development agenda despite the fact that a hygienic behavior such as hand washing with soap could save lives of people annually [6, 7].
\n
\n
\n
1.2. What is hygiene?
\n
According to Oxford English Dictionary, 2018, the word “hygiene” is defined as “conditions or practices conducive to maintaining health and preventing disease, especially through cleanliness” [8].
\n
The World Health Organization (WHO) and other studies have similar definitions as the Oxford English Dictionary, and they define hygiene as the concept of cleaning and any practice aimed at maintaining health and preventing the spread of diseases [9, 10]. Other literatures define it as the science of preventive medicine and preservation of health through cleanliness [11]. However, it should be noted that the term cleanliness is not the same as hygiene. Hygiene is far more than just cleanliness because cleanliness mostly involves the removal of dirt, wastes or unwanted things from the surface of objects using detergents and other necessary equipment. On the other hand, hygiene practices focus on the prevention of disease through the use of cleaning as one of the several inputs [12, 13]. Hygiene can be achieved through cleanliness and not vice versa. All disease control interventions to a greater extent rely on hygiene for them to achieve their goal.
\n
\n
\n
1.3. Types of hygiene
\n
Hygiene is applied in different areas with the aim of prevention of disease transmission and promoting health. The common types of hygiene include:
Personal hygiene includes taking care on one’s body and clothes. Personal hygiene encompasses oral hygiene, hand hygiene, hair hygiene, mouth hygiene, and menstrual hygiene including any form of hygiene relating to a personal body.
Water hygiene involves the collection, transportation, storage, and use of water without contaminating it.
Food hygiene is the practical process of ensuring that food is fit to eat. It is what the food handler does to prevent contamination.
Waste handling hygiene relates to how solid, liquid, and gas wastes are handled from generation, collection, storage, transportation, and disposal to prevention contamination of the environment.
\n
Hygiene can be practiced at personal, domestic, and community levels [14].
\n
\n
\n
1.4. Importance of hygiene to health in developing countries
\n
The greatest benefit of practicing hygiene is the reduction in disease transmission and improved health. The maximum benefits of hygiene are achieved, if improvements in hygiene are concurrently made with improvements in the food industry, water supply, and sanitation coupled with other interventions such as improved nutrition [14]. Good hygiene practices are among the essentials of the survival and development of children. Without hygiene, the lives of millions of people especially children and the vulnerable populations would be at risk of suffering from water, sanitation, and hygiene-related diseases which are one of the leading causes of death among children, despite being preventable [15]. In 2015, diarrhea was the leading cause of death among all ages. The most affected were children under the age of five where it claimed the lives of more than 499,000 children each day [16]. Most of the diarrhea is attributed to poor water, sanitation, and hygiene practices. Children in developing countries are the worst affected as they experience about 4–5 episodes of diarrhea each year [17, 18, 19]. Diarrhea is caused by fecal-oral transmission, whereby one ingests feces directly through contaminated hands or indirectly through contaminated food and water [20]. The organisms that cause diarrhea include bacteria, viruses, protozoa, and helminths [19]. This might be through contaminated hands when ingesting food or contaminated water. Hands (mainly fingers) can directly or indirectly be contaminated with feces of one self or of another. Contamination of the hands during activities such as defecation and changing/washing of a child’s bottom facilitates the transmission of infections. Hand washing with soap is one of the most important hygiene behavior in disease transmission reduction and promotion of good health. In 2012, it was found that 35.3% of all the total deaths from diarrhea were due to poor hand hygiene [19].
\n
Systematic reviews done from 1997 to 2010 have shown that hand washing with soap reduced diarrhea by either 32 or 48%. Furthermore, hand washing with soap including water supply and sanitation has been shown to reduce undernutrition by 50% [19]. In Kenya, water, sanitation, and hygiene intervention showed a reduction of 58% in absenteeism for girls [21]. Apart from health benefits and school absenteeism, hygiene has other social benefits including boosting confidence and status [19]. It should, however, be noted that the impact of hygiene cannot be easily evident in short term projects, and it required time for it to show significant impact especially on health [22].
\n
\n
\n
1.5. Hand washing
\n
Hand washing with soap at critical moments, such as after visiting a toilet, before cooking, and after helping a child defecate, can prevent infectious diseases by interrupting the transmission of infectious agents. Evidence suggests that hand washing with soap reduces the risk of diarrhea by 47% [23, 24], acute lower respiratory infections by up to 34% [25], and soil-transmitted helminths by 55% [26]. Hand washing with soap has been recognized as one of the most cost-effective health interventions to reduce the burden of disease [27]. Yet, only 19% of the global population is estimated to wash their hands with soap after using sanitation facility or handling children’s excreta [28]. Hand washing facilities close to toilet are important if people are to wash hands after using the toilet facility (Figure 1).
\n
Figure 1.
Tippy tap close to toilet for hand washing in rural areas of Malawi.
\n
Good hygiene is of vital importance in Malawi due to the lack of basic sanitation in the country. Hygiene, for example, washing hands with soap after using a toilet may reduce the transmission of fecal-related diseases. Although, evidence of actual hand washing practice is scanty, but some studies done in rural areas of the country suggest that the actual practice of hand washing with soap (HWWS) at key times is between 3 and 18% but more likely on the low end of this scale, as responses tend to exaggerate actual and regular practice. Observations in Malawi and other countries show that HWWS promotion is undertaken as an ad hoc activity both at national and local level. Current efforts to promote good hygiene and HWWS, in particular, have not been sufficient to bring about mass behavior change on the scale that is needed. Efforts producing piecemeal village-by-village and pilot approaches have had some impact but nothing on a large or national scale has been attempted [29]. Our hands frequently get dirty during our normal activities, with microorganisms likely to attach to our hands along with the dirt. Hand hygiene, however, especially hand washing with soap plays a critical role in prevention of such transmissions, through hygienic hand washing. Soap helps remove dirt and microorganism from the hands. Global waters [30] in 2017 put coverage of hand washing facilities at 27% in Sub-Saharan Africa and below 50% in Africa. The critical times for hand washing with soap include:
Before cooking food
Before eating food
After visiting a toilet
After cleaning or touching dirt
After changing baby nappies
\n
Hand washing should not only involve getting the hands wet or a quick rinse under a tap or in a bowl, but it should rather be a hygienic hand washing, where there is removal of microorganisms from contaminated hand surfaces using soap or detergent. Hand washing with nonantibacterial soap and clean water was found to be more effective than just using water [31]. For most of the people in the rural communities of the developing countries, they cannot afford to get soap for hand washing. Nonetheless, alternatives such as wood ash and mud have been found to be better than using only water [32]. However, it should be noted that communities which can afford soap should be encouraged not to use ash and mud because of their varying abilities to remove germs from hands and other risks than may come due their use. It should be further noted that hand washing should involve the use of running water that carries away the microorganisms unlike dipping in a bowl. Washing in the same bowl may be a way of transmitting pathogens that are found in hands [33]. Clean sand with water or local seeds such as indod (Lemma’s plant) can also be used as an alternative just as wood-ash, which rubs off both the dirt and the smells [34]. The correct hand washing procedure according to WHO [35], includes the following 10 modified steps:
\n
\n
\n
\n\n
\n
Step one
\n
First wetting the hands with clean water and apply enough soap to cover the hand surfaces
\n
\n
\n
Step two
\n
Rub hands palm to palm
\n
\n
\n
Step three
\n
Rub right palm over left dorsum with interlocked fingers and vice versa
\n
\n
\n
Step four
\n
Rub palm to palm with fingers interlocked
\n
\n
\n
Step five
\n
Rub backs of fingers to opposing palms with fingers interlocked
\n
\n
\n
Step six
\n
Make rotational rubbing of left thumb clasped in right palm and vice versa
\n
\n
\n
Step seven
\n
Perform rotational rubbing, backwards and forwards with clutched fingers of right hand in left palm and vice versa
\n
\n
\n
Step eight
\n
Rinse hands well with clean running water or pour from jug
\n
\n
\n
Step nine
\n
Dry hands thoroughly with a single use towel or dry in the air to avoid recontamination
\n
\n
\n
Step ten
\n
Use towel or back of hand depending on design to turn off tap
\n
\n\n
\n
Rubbing of hands should take approximately 20–30 s to make sure germs are dislodged [35].
\n
Hand washing with soap is also an important infection prevention tool in health facilities [36]. Daily works will involve many situations when people need to wash their hands, and sometimes people forget to wash their hands. However, it is of great importance to identify critical situations/times for hand washing. These are times, activities or incidents that indicate the possibility that pathogenic microorganisms are present on hand fingers and nail surfaces. Most people remember to wash hands after defecation than after doing other things that may equally have the risk of disease transmission [37].
\n
To encourage hand washing, there is need to locate the hand washing facilities in suitable places such as close to the latrine and/in the kitchen where they will be needed. These hand washing facilities should be provided with soap (or its alternative) and running water. In the absence of a tap, cans and plastic bottles can be used. These alternatives are mostly used in the rural areas where communities do not have adequate access to piped water [38].
\n
\n
\n
1.6. Menstrual hygiene
\n
Another aspect of personal hygiene that greatly affects women and adolescent girls is menstrual hygiene. This is special care that is needed during the time of the month when women and girls experience their menstruation. This special care is needed to take care of the sanitary products that are used by the women. In the developing countries, not many women can afford to buy enough sanitary products such as disposable pads, tampons or menstrual cups. The women tend to use locally available clothes which they reuse, while others have been introduced to reusable pads [39, 40]. Nonetheless, regardless of the product used, women are supposed to change their sanitary products frequently, and for those that use reusable products, there is need for soap, clean water, and proper drying area for the reusable towels. Not only does poor menstrual hygiene causes bad odor, but it can further cause fungal infections, urinary tract infections (UTI), and reproductive tract infections (RTI) [41]. Women are further vulnerable to infertility when their menstrual hygiene practices are unhygienic, for example, not changing their sanitary towels frequently, lack of adequate cleaning of reusable products, and the use of unclean water for cleaning both their bodies and their sanitary towels. Good menstrual hygiene practice further involves proper disposal of sanitary materials, but this is a problem in most developing countries [42].
\n
\n
\n
1.7. Domestic and community hygiene
\n
While hygiene measures are taken at personal, domestic, and industrial levels, some can be done at a community level. Community members have a role to play in keeping their communities clean [14]. The members play a role to ensure a clean surrounding of their households, protecting the water sources, proper disposal of wastes (solid wastes and excreta), proper drainage for waste water, control of animal rearing, and hygiene of public places such as markets, schools, health facilities, and prayer areas (e.g., churches and mosques) [6, 12, 13].
\n
Clean compounds in communities should be encouraged, as a single unhygienic house can affect the surrounding neighbors and increase the spread of disease. Presence of shrubs, lack of drainage, and poor waste management in households can act as breeding grounds for vectors, resulting in vector-borne diseases such as malaria, affecting a larger part of the community [14, 43]. Households should be properly ventilated to allow fresh air in the house as this would also reduce transmissions of infections such as flu [44].
\n
Most markets in developing countries lack proper water resources, sanitation facilities, proper solid waste management, and drainage. However, in most of these markets, raw food such as fruits and vegetables are usually sprinkled with water, which is at most times unclean [13]. Such unhygienic practices poses a risk to the consumers, that is why it is encouraged that a market should have a proper water source, not only for cleaning the goods but also for the sellers, since they use the same water for drinking and cooking.
\n
The Government of Malawi in a bid to improve sanitation and hygiene coverage adopted the open defecation free (ODF) and hand washing with soap (HWWS) strategies in 2011. The strategies were up to 2015. By 2015, the strategies had improved the percentage of the country’s population practicing open defecation from 29 to 4% and access to improved sanitation increased from 29 to 41%. Hand washing with soap was also improved from less than 10 to 34% [45]. The government adopted Community Led Total Sanitation (CLTS) as a technique that was used to make sure communities are using toilets and also making sure all households own and use a hand washing facility after visiting a toilet. The approach has managed to increase toilet coverage and usage especially in rural areas by 96% as stated above. CLTS encourages the use of local resources to build sanitation and hygiene facilities, and its sustainability relies on the availability of these local resources. Since CLTS was being implemented as a project, there is a need to incorporate the approach in village and district plans for it to be sustainable. The weakness with the approach was that it did not emphasize much on hygiene behavior but rather on ownership of hygiene promoting facilities [46].
\n
\n
\n
\n
2. Challenges faced when implementing hygiene in developing nations
\n
\n
2.1. Poverty
\n
Poverty is high in developing countries, most households spend less than a dollar a day, and these are classified as extremely poor [47]. This makes them prioritize income so that they buy food, clothes, and other immediate needs placing sanitation and hygiene low in the priority list. Most families struggle to find food, and to them getting food is enough than considering hygiene. Most families start prioritizing hygiene after they move up the development ladder especially when basics like food are no longer a problem [48]. Due to poverty, communities find it difficult to use the only available soap at a household for hand washing [32]. Similarly, hand washing facilities used after visiting a toilet are usually temporary and are made from local materials which are not durable (Figure 2).
\n
Figure 2.
Hand washing facility at a toilet in rural Malawi.
\n
\n
\n
2.2. Lack of political commitments
\n
Most of the hygiene initiatives are implemented by nongovernmental organizations (NGOs) and rarely by the government. Despite advocating for water sanitation and hygiene (WASH), there is not enough initiatives introduced by the government through relevant ministries (i.e., Ministry of Health and Ministry of Agriculture, Irrigation and Water Development in Malawi), to enhance hygiene practices [49]. Hygiene is the major component of provision of safe water and improved sanitation yet it is forgotten during planning of settlements [50]. In general, most countries do not provide enough resources to preventive health, which limits preventive health effectiveness, such as good hygiene practices [51]. For example, in Malawi, the government adopted a Hand Washing with Soap Campaign 2011 to 2012, but after it expired, no new efforts have been made. In addition, the government did not put aside finances to fund hand washing activities. This means hygiene activities will still continue to be implemented by NGOs whenever they have funding. The inconsistencies which the campaign wanted to eliminate will continue to exist [52]. For hygiene to improve, we need governments to plan for implementation and commit resources.
\n
\n
\n
2.3. Lack of community participation during planning phase
\n
As much as there might be a solution, if the people who are receiving the solution do not realize the need for a solution, then the solution becomes ineffective. That is why it is of utmost importance to involve the community during the whole hygiene project. This offers proper understanding of the whole project, and the people further understand the need for the project initiative hence making the projects sustainable. When the people are involved, they get a feeling of ownership of the hygiene project and also understand the benefit of the solution [51]. Additionally, hygiene technologies that are introduced may contradict with some cultural beliefs and this affects adoption and implementation of the hygiene projects in most developing nations. Most hygiene technologies are not user friendly which makes acceptability a challenge [53]. For example, most hand washing facilities have design problems. Some hand washing facilities require users to perform several steps before washing hands and this discourages users from practicing the behavior. The tippy taps are the preferred ones, but they also face problems of durability and use of unpleasant containers and sometimes unsafe water which discourages users just by looking at it [38, 54].
\n
\n
\n
2.4. Lack of gender inclusion
\n
In most cultures, women have the primary responsibility for water, sanitation, and hygiene at the household level [55]. However, most women are left out when it comes to the planning or designing of hygiene projects making the implementation of the project a challenge especially to the women that do not have enough information on the designs [56]. In addition, women sometimes need special consideration when it comes to hygiene infrastructure, for example, a menstrual hygiene management compartment in schools and homes to accommodate women’s menstrual hygiene needs [57]. But most times, there is a lack of gender inclusion in the planning and designing [53]. There is less participation in hygiene issues including water supply by men. In African countries, it is the man who is supposed to construct hand washing facilities especially the tippy tap at the toilet and other sanitation facilities including a toilet, but in most of the gatherings related to sanitation and hygiene, its mostly women who participate. Nongovernmental organizations have taken a leading role to encourage women get involved in construction of hygiene facilities including tippy taps [58]. The low participation of men in hygiene intervention limits the translation of messages passed mainly through women into practices due to the lack of physical enabling environment which is supposed to be provided and supported by men as head of households. In addition, men seem to be less inconvenienced by the lack of hygiene at a household [59].
\n
\n
\n
2.5. Lack of information on hygiene infrastructure and practices
\n
There is a lack of recent, reliable information on the condition of existing hygiene infrastructure and practices, including whether or not the infrastructure are actually functioning or benefits of some hygiene practices. This makes needs and demands, particularly in remote rural areas frequently unknown, making the task of setting implementation priorities more difficult [53]. However, the rural areas may sometimes have the information but due to the high levels of illiteracy in the developing countries, the community members may not be able to understand the hygiene messages. Making implementation of hygiene is rather difficult. It has also been identified that some people access hygiene information in parts, and they are not fully aware of the hygiene benefits, hence making implementation a challenge.
\n
\n
\n
2.6. Lack of coordination by hygiene actors
\n
As regard to Malawi, a country in southern Africa, there is a lack of coordination by different sectors involved in hygiene. Different NGOs are after their targets and are not interested in other similar NGOs in the area. In addition, there is institutional fragmentation in developing nations as they lack clarity over whom or which institution(s) is responsible for hygiene. For instance, water, sanitation, and hygiene services are located to ministries of water, thus disregarding Ministry of Health who also have expertise in implementing them [53].
\n
\n
\n
2.7. Lack of clean and adequate water
\n
Hundreds of millions of people do not have access to clean water in developing nations [15, 60]. The Malawi Demographics and Health Survey, 2016 indicates that on average, 87% of households obtain their water from safe sources. Despite the high reported figure (87%), the situation reveals that most people are not accessible to these improved sources due to their concentration on one geographical location or because the water points often breakdown or sometimes the water from the source is salty especially from boreholes [61]. This makes developing nations to face challenges when it comes to hygiene implementation as most of the hygiene practices require the use of clean water. When water is inadequate and unclean, it results into contamination of hands and foods, thereby spreading infections. Furthermore, insufficient water supply limits good hygiene practices such as bathing and hand washing. Children in developing countries, sometimes clean only some parts of their bodies and not the whole body due to inadequate water and this affects their health [62].
\n
\n
\n
2.8. Culture and behavioral issues
\n
Culture shapes the behavior and beliefs of most people as it is the way of people’s life. Culture makes people in developing nations to resist to new hygiene facilities and ideas. Additionally, men and women have different perspectives on hygiene due to cultural differences. Different ethnic groups have varying beliefs and customs on hygiene. Lastly, attitudes also vary among people on hygiene in rural and urban areas [7, 50]. Thus, implementation of hygiene faces more challenges due to differences in attitudes, beliefs, and lifestyles of the participants on hygiene projects. One of the hygienic practices that was common is the washing hands by dipping in the same bowl of water by a group of people or family members who eat from the same plate. This practice was common in rural areas of some African countries, but is now slowly being replaced with a better practice where each member is poured water when hand washing. The behavior has changed due to serious communicable diseases that were transmitted through washing hands in the same container, for example, cholera [33].
\n
\n
\n
\n
3. How hygiene can be improved to promote health
\n
\n
3.1. Community empowerment
\n
Households need to be taught on how to make priorities and aim to accomplish them in order of their importance. According to the vicious circle of underdevelopment by Schutte De Wet in 2015, if the very basic needs of a community are met, new and higher ones emerge until the community starts living a better life [63]. Households who are in constant poverty are those who do not use the few resources they find to address their immediate priorities instead they jump and buy things that they do not need in order to conform to society expectation and fulfill their desires. Later, they sell them at cheap price only to come back and buy the priority need. This practice makes them unable to move out of the poverty circle. Once a household is in poverty, it is difficult for them to realize the importance of hygiene and to buy soap or spend resources on hygiene infrastructure. A project in Malawi on healthy settings approach showed that using De Wet tools, it was possible to make community move out of poverty through proper planning using prioritization tools. The project also found out that in communities where people lack basic needs like food and shelter, the issues of sanitation and hygiene are not a priority [48]. In addition, governments need to come up with deliberate pro-poor policies that are aimed at uplifting lives of people in slums and rural areas. Some of the strategies that governments need to employ include targeted subsidies and loans for agriculture and businesses, respectively. In Tanzania, Kagera Region, a project showed that agriculture and trade were the routes for people to move out of poverty [64]. Nepal is one country that has managed to move out of poverty. Absolute poverty decrease by an average rate of 2.2% points between 1995 and 2011 and continued to decline to date. Despite the gains, Nepal needs to come up with policies that will equalize opportunities and level the playing field to enable all people participating in the economy [65].
\n
\n
\n
3.2. Push for equitable access
\n
Different people have different hygiene needs and requirements. As much as millions of people lack access to improved water, sanitation, and hygiene, the situation is worse for people who are physically and socially disabled. They find challenges in using most of the hygiene infrastructure. According to a study conducted in rural and urban Malawi to assess the barriers to accessing water, sanitation and hygiene for disabled people, it was found out that individuals did not report of the same set of barriers. In addition to being physically disabled, factors like being a female, being from a rural setting, and being of limited worth intensify the challenges faced by an individual [66]. It is for this reason that it is essential to understand the needs of different disabled people to ensure equitable access to hygiene, since there is no solution that can solve the challenges of all disabled people. This can be achieved by offering an accommodating hygiene infrastructure and technology for the physically challenged and also at an affordable price to ensure equal access [60].
\n
\n
\n
3.3. Provision of menstrual hygiene kits
\n
Despite being a natural process, menstrual hygiene has been considered a taboo in most parts of the world and is rarely talked about, which leads to misinformation. This results in poor menstrual hygiene management among girls and women which further leads to stigma and ill health, absenteeism in schools and increased school drop-out rates. In order for women and girls hygienically manage their menstruation, there is need for a private place to change sanitary cloths and pads, clean water and soap for hand washing, body washing, and washing of reusable clothes [39]. However, most women and girls in developing countries, lack access to clean water for hygiene management. Even worse, they lack proper sanitary cloths to use during menstruation, and they end-up using rags which may result into vaginal infections [67]. For this reason, it is important to introduce menstrual hygiene technologies such as reusable pads so that they may have a safe menstruation, reducing absenteeism in schools and offering them dignity. Furthermore, underwear should be provided to them to make sure that the sanitary pads are used as other girls and women do not have underwear at all [40, 51].
\n
\n
\n
3.4. Making political commitments
\n
Political commitments especially at high level involving senior government officials are essential toward achieving hygiene improvements. India, Indonesia, and Ethiopia are some of the countries where political commitment by the Prime Minister, Senior Civil Servants, and Ministers, respectively, led to greater achievements in sanitation [68]. Similarly, high level political commitment is required to improve hygiene in developing countries. Most of the times, hygiene is mentioned during promotion of sanitation, but it should be noted that during implementation, it is often forgotten and hence need to be advocated to separately. National governments should have commitments on hygiene by commissioning a thorough review of policy, making explicit budget allocation on hygiene programs to district and local governments, funding hygiene promotion, training and capacity building. National governments and NGOs must be in forefront in provision of safe and clean water to be used for hygiene by the users [53]. Political commitment have been found to humper scale up of policies including food and nutrition-related policies and hence need to be given priority in hygiene improvement [69]. To improve hygiene, high level political commitment is crucial.
\n
\n
\n
3.5. Creating strong legislation and regulations
\n
Governments should develop national hygiene strategy and create necessary legislation/regulation to advance the strategy. Additionally, roles and responsibilities of different national institutions to implement the law must be defined properly. Stakeholders must be involved at all the stages of the process to ensure the acceptance of the legislation/regulation by the public. In addition, there must be creation of the mechanisms for monitoring and enforcing implementation of legislation/regulation. This will help those implementing hygiene programs to request specific hygiene regulations to make their programs successful. Lastly, officials that check for compliance of hygiene requirements should be committed to reduce corruption as this will help to ensure quality production and healthy environments which will prevent the transmission of diseases and infections [70].
\n
\n
\n
3.6. Promote gender and equity
\n
Governments and NGOs should frame their policies in the way that include the idea of gender and equity on hygiene promotion. Additionally, they should invest in training or retraining frontline staff to work with men, women, and children [57]. The hygiene framework should be gender sensitive, by enabling women in the development of hygiene policy. They should also ensure that gender provisions address practical and strategic needs for both men and women by taking into consideration of differences in culture and traditions of communities.
\n
\n
\n
3.7. Promoting community participation
\n
Community participation is very important as it promotes acceptability and sustainability of hygiene projects [71]. Thus, community members must be involved from initiation phase of the hygiene project to the end phase of the project [72]. This promotes the ownership of projects and communities that are more likely to make use of innovations where they have contributed. Top down approach to projects limits community participation and ownership because the community takes the interventions as external and usually they do not have local input. For example, in Tanzania, a pilot project that used bottom up approach using community structures recorded successful results in terms of reduction of prevalence of schistosomiasis and diarrhea. The project also increased awareness in water, sanitation, and hygiene for disease control [73].
\n
\n
\n
3.8. Involving the youth
\n
Hygiene promotion campaigns are most effective when young population and students involved as beneficiaries and as agents of behavioral change within their families and their communities. Hygiene education that is included in school curricula should be taught conclusively in all schools. Early schools should be the target for hygiene behavior change interventions. Once a child learns about good hygiene at an early age, that child will grow with the behavior and will be able to influence his/her family members and in the long term, the whole community might easily change [71].
\n
\n
\n
\n
4. Conclusion
\n
Hygiene is a broad subject with so many various aspects and is a key aspect in prevention of diseases and promotion of good health. Hygiene has been identified to reduce diarrheal diseases and infections among others, and proper hygiene practices increase dignity, self-esteem, and prestige in the social life. Hygiene can be practiced at personal, domestic, industrial, institutional, and community level, with various sectors playing various roles in enhancement of hygiene as it improves human health. However, for effective hygiene, there is need to incorporate hygiene with sanitation and adequate and clean water supply, since these go hand in hand.
\n
Even though hygiene practices may seem basic, there are a large number of people that lack proper information on hygiene. Such lack of information on hygiene leads to poor hygiene practices that result in disease outbreaks within a society. It is thus important to ensure a proper information flow that helps to communicate to different classes of people in the easiest ways. Effective hygiene communication in schools, markets, industries, and health facilities helps to reach out to a group of people at once and in a specific area. However, for the implementation of hygiene projects in developing countries, there is a need for promotion of community participation with high youth involvement, strive for equitable access, political commitments, creation of strong legislation, adequate financial resources, and promote gender and equity and make sure that there is the right information flow with the people and that awareness has been raised before the implementation of the projects.
\n
\n
Acknowledgments
\n
I would like to thank Taonga Mwapasa for her assistance in writing this chapter. I would also like to thank all authors whose work I cited in this document for their valuable contribution to knowledge.
\n
Conflict of interest
I would like to declare that I do not have conflict of interest.
\n',keywords:"hygiene, hand washing, soap, developing countries, communities and challenges",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/63322.pdf",chapterXML:"https://mts.intechopen.com/source/xml/63322.xml",downloadPdfUrl:"/chapter/pdf-download/63322",previewPdfUrl:"/chapter/pdf-preview/63322",totalDownloads:2606,totalViews:1033,totalCrossrefCites:7,totalDimensionsCites:13,totalAltmetricsMentions:1,impactScore:12,impactScorePercentile:98,impactScoreQuartile:4,hasAltmetrics:1,dateSubmitted:"November 13th 2017",dateReviewed:"July 17th 2018",datePrePublished:null,datePublished:"April 3rd 2019",dateFinished:"August 31st 2018",readingETA:"0",abstract:"Hygiene is defined as conditions or practices conducive to maintaining health and preventing disease. Hygiene has been shown to reduce diarrheal diseases and assist to improve social outcomes in the community. Improving hygiene faces several problems especially in countries with low income per capita of population. Currently, many developing countries already struggle to cope with consistent water shortages and rapid urbanization causing more pressure to limited resources which in turn result in poor hygienic practices in the communities. The common types of hygiene include personal hygiene, water hygiene, food hygiene, and hygiene during waste handling. Different nongovernmental and governmental organizations face different challenges in achieving high levels of hygiene in communities. Some of these challenges include poverty, lack of political commitment, lack of full community participation, inadequate gender inclusion, inadequate data, lack of coordination among actors, and behavioral issues. To reduce these challenges, several measures have been proposed including community empowerment, pushing for equitable access to hygiene needs, advocating for political commitment, promoting gender equity, and enhancing youth involvement.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/63322",risUrl:"/chapter/ris/63322",book:{id:"6682",slug:"the-relevance-of-hygiene-to-health-in-developing-countries"},signatures:"Save Kumwenda",authors:[{id:"233913",title:"Mr.",name:"Save",middleName:null,surname:"Kumwenda",fullName:"Save Kumwenda",slug:"save-kumwenda",email:"skumwenda@poly.ac.mw",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_1_2",title:"1.1. What are developing countries?",level:"2"},{id:"sec_2_2",title:"1.2. What is hygiene?",level:"2"},{id:"sec_3_2",title:"1.3. Types of hygiene",level:"2"},{id:"sec_4_2",title:"1.4. Importance of hygiene to health in developing countries",level:"2"},{id:"sec_5_2",title:"1.5. Hand washing",level:"2"},{id:"sec_6_2",title:"1.6. Menstrual hygiene",level:"2"},{id:"sec_7_2",title:"1.7. Domestic and community hygiene",level:"2"},{id:"sec_9",title:"2. Challenges faced when implementing hygiene in developing nations",level:"1"},{id:"sec_9_2",title:"2.1. Poverty",level:"2"},{id:"sec_10_2",title:"2.2. Lack of political commitments",level:"2"},{id:"sec_11_2",title:"2.3. Lack of community participation during planning phase",level:"2"},{id:"sec_12_2",title:"2.4. Lack of gender inclusion",level:"2"},{id:"sec_13_2",title:"2.5. Lack of information on hygiene infrastructure and practices",level:"2"},{id:"sec_14_2",title:"2.6. Lack of coordination by hygiene actors",level:"2"},{id:"sec_15_2",title:"2.7. Lack of clean and adequate water",level:"2"},{id:"sec_16_2",title:"2.8. Culture and behavioral issues",level:"2"},{id:"sec_18",title:"3. How hygiene can be improved to promote health",level:"1"},{id:"sec_18_2",title:"3.1. Community empowerment",level:"2"},{id:"sec_19_2",title:"3.2. Push for equitable access",level:"2"},{id:"sec_20_2",title:"3.3. Provision of menstrual hygiene kits",level:"2"},{id:"sec_21_2",title:"3.4. Making political commitments",level:"2"},{id:"sec_22_2",title:"3.5. Creating strong legislation and regulations",level:"2"},{id:"sec_23_2",title:"3.6. Promote gender and equity",level:"2"},{id:"sec_24_2",title:"3.7. Promoting community participation",level:"2"},{id:"sec_25_2",title:"3.8. Involving the youth",level:"2"},{id:"sec_27",title:"4. Conclusion",level:"1"},{id:"sec_28",title:"Acknowledgments",level:"1"},{id:"sec_31",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'Taiwo R, editor. Handbook of Research on Discourse Behavior and Digital Communication: Language Structures and Social Interaction [Internet]. IGI Global; 2010. Available from: http://services.igi-global.com/resolvedoi/resolve.aspx?doi=10.4018/978-1-61520-773-2 [cited Ap. 29, 2018]\n'},{id:"B2",body:'Crabtree A. Climate change and mental health following flood disasters in developing countries, a review of the epidemiological literature: What do we know, what is being recommended? Australasian Journal of Disaster and Trauma Studies. 2012;2012(1):10\n'},{id:"B3",body:'Kuepper J. What Defines “Developing Countries”? [Internet]. The Balance; 2017. Available from: https://www.thebalance.com/what-is-a-developing-country-1978982 [cited Ap. 29, 2018]\n'},{id:"B4",body:'Das RC. Handbook of Research on Global Indicators of Economic and Political Convergence. 1st ed. IGI Global: Hershey, PA; 2016. 616p\n'},{id:"B5",body:'Cohen B. Urbanization in developing countries: Current trends, future projections and key challenges for sustainability. In: Technology in Society. Science Direct; 2006. pp. 63-80\n'},{id:"B6",body:'Eid E. The Importance of Water, Sanitation and Hygiene as keys to National Development. John Hopkins; 2015\n'},{id:"B7",body:'WHO. Water Sanitation and Health [Internet]. WHO; 2017. Available from: http://www.who.int/water_sanitation_health/en/ [cited Jan 4, 2018]\n'},{id:"B8",body:'Oxford Dictionaries. Hygiene Definition [Internet]. Oxford Dictionaries|English; 2018. Available from: https://en.oxforddictionaries.com/definition/hygiene [cited Feb 2, 2018]\n'},{id:"B9",body:'Rasool Hassan BA. Importance of Personal Hygiene. Pharmaceutica Analytica Acta. 2012;03(08):1. Available from: https://www.omicsonline.org/importance-of-personal-hygiene-2153-2435.1000e126.php?aid=8931 [cited Ap. 29, 2018]\n'},{id:"B10",body:'Oosterom J. The importance of hygiene in modern society. International Biodeterioration and Biodegradation. 1998;41(3):185-189\n'},{id:"B11",body:'Definition of Hygiene [Internet]. 2016. Available from: https://www.medicinenet.com/script/main/art.asp?articlekey=7324 [cited Jan 1, 2018]\n'},{id:"B12",body:'Hygiene. Wikipedia [Internet]. 2018. Available from: https://en.wikipedia.org/w/index.php?title=Hygiene&oldid=818349525 [cited Jan 4, 2018]\n'},{id:"B13",body:'Hygiene and Environmental Health Module: 3. Personal Hygiene: View as single page [Internet]. Available from: http://www.open.edu/openlearncreate/mod/oucontent/view.php?id=189&printable=1 [cited Jan 1, 2018]\n'},{id:"B14",body:'WHO. Personal, domestic and community hygiene. In: Water, Sanitation and Health [Internet]. p. 9. Available from: http://who.int/water_sanitation_health/hygiene/settings/hvchap8.pdf\n\n'},{id:"B15",body:'UNICEF. Water Sanitation and Hygiene [Internet]. 2015. Available from: https://www.unicef.org\n\n'},{id:"B16",body:'GBD Diarrhoeal Diseases Collaborators. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: A systematic analysis for the Global Burden of Disease Study 2015. The Lancet Infectious Diseases. 2017;17(9):909-948\n'},{id:"B17",body:'Gurgel RQ, Alvarez ADJ, Rodrigues A, Ribeiro RR, Dolabella SS, Da Mota NL, et al. Incidence of rotavirus and circulating genotypes in Northeast Brazil during 7 years of national rotavirus vaccination. PLoS One. 2014;9(10):1-8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215980/ [cited May 1, 2018]\n'},{id:"B18",body:'Mondal D, Minak J, Alam M, Liu Y, Dai J, Korpe P, et al. Contribution of enteric infection, altered intestinal barrier function, and maternal malnutrition to infant malnutrition in Bangladesh. Clinical Infectious Diseases. 2012;54(2):185-192\n'},{id:"B19",body:'Mills JE, Cumming O. The Impact of Water, Sanitation and Hygiene on Key Health and Social Outcomes. Sanitation and Hygiene Applied Research for Equity (SHARE) and UNICEF; p. 112\n'},{id:"B20",body:'de Graaf M, Beck R, Caccio SM, Duim B, Fraaij PL, Le Guyader FS, et al. Sustained fecal-oral human-to-human transmission following a zoonotic event. Current Opinion in Virology. 2017;22:1-6\n'},{id:"B21",body:'Freeman MC, Greene LE, Dreibelbis R, Saboori S, Muga R, Brumback B, et al. Assessing the impact of a school-based water treatment, hygiene and sanitation programme on pupil absence in Nyanza Province, Kenya: A cluster-randomized trial. Tropical Medicine & International Health. 2012;17(3):380-391\n'},{id:"B22",body:'Carter RC. Can and should sanitation and hygiene programmes be expected to achieve health impacts? Waterlines. 2017;36(1):92-103\n'},{id:"B23",body:'Curtis V, Cairncross S. Water, sanitation, and hygiene at Kyoto. BMJ. 2003;327(7405):3-4\n'},{id:"B24",body:'Cairncross S, Bortram J, Cumming O, Bracklehurst C. Hygine, sanitation &water. What needs to be done? PLoS Medicine. 2010;7(11):e1000365. DOI: 10.1371/journal.pmed.1000365\n'},{id:"B25",body:'Luby S et al. Effect of Handwashing on Child Health: A Randomised Controlled Trial. NCBI; 2005. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16023513 [cited Feb 4, 2018]\n'},{id:"B26",body:'Strunz EC, Addiss DG, Stocks ME, Ogden S, Utzinger J, Freeman MC. Water, sanitation, hygiene, and soil-transmitted helminth infection: A systematic review and meta-analysis. PLoS Medicine. 2014;11(3):e1001620\n'},{id:"B27",body:'Bartram J, Cairncross S. Hygiene, sanitation, and water: Forgotten foundations of health. PLoS Medicine. 2010;7(11):e1000367\n'},{id:"B28",body:'Freeman MC, Stocks ME, Cumming O, Jeandron A, Higgins JPT, Wolf J, et al. Hygiene and health: Systematic review of handwashing practices worldwide and update of health effects. Tropical Medicine & International Health. 2014;19(8):906-916\n'},{id:"B29",body:'Ministry of Agriculture, Irrigation and Water Development. Open Defecation Free (ODF) Malawi Strategy (2011–2015). Lilongwe, Malawi: Malawi Government; 2011\n'},{id:"B30",body:'Nguyen NK, Campbell D. Handwashing with Soap, Where Are We? [Internet]. GLOBALWATERS.ORG (Beta); 2017. Available from: https://www.globalwaters.org/resources/assets/handwashing-soap-where-are-we [cited Ap. 29, 2018]\n'},{id:"B31",body:'Burton M, Cobb E, Donachie P, Judah G, Curtis V, Schmidt W-P. The effect of handwashing with water or soap on bacterial contamination of hands. International Journal of Environmental Research and Public Health. 2011;8(1):97-104\n'},{id:"B32",body:'Bloomfield SF, Nath KJ. Use of ash and mud for handwashing in low income communities. International Scientific Forum on Home Hygiene (IFH) [Internet]. An IFH expert Review; 2009. Available from: http://www.ifh-homehygiene.org [cited Jan 5, 2018]\n'},{id:"B33",body:'Tetteh-Quarcoo PB, Anim-Baidoo I, Attah SK, Abdul-Latif Baako B, Opintan JA, Minamor AA, et al. Microbial content of “bowl water” used for communal handwashing in preschools within Accra Metropolis, Ghana. International Journal of Microbiology. 2016;1:1-40. Available from: https://www.hindawi.com/journals/ijmicro/2016/2617473/ [cited May 1, 2018]\n'},{id:"B34",body:'Open University. Personal Hygiene [Internet]. The Open University; 2001. Available from: www.open.edu/openlearncreate/pluginfile.php/4701/…/3._personal_hygiene.doc\n\n'},{id:"B35",body:'WHO. Hand Hygiene: Why, How and When? [Internet]. World Health Organization; 2009. Available from: http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf [cited Ap. 29, 2018]\n'},{id:"B36",body:'Mathur P. Hand hygiene: Back to the basics of infection control. The Indian Journal of Medical Research. 2011;134(5):611-620\n'},{id:"B37",body:'Rabbi SE, Dey NC. Exploring the gap between hand washing knowledge and practices in Bangladesh: A cross-sectional comparative study. BMC Public Health. 2013;13:89\n'},{id:"B38",body:'CDC. Tippy Tap: A Design for Simple, Economical and Effective Handwashing Stations. Centre for Disease Control and Prevention. 2010\n'},{id:"B39",body:'Menstrual Hygiene Management|SSWM [Internet]. 2014. Available from: https://www.sswm.info/content/menstrual-hygiene-management [cited Jan 10, 2018]\n'},{id:"B40",body:'Environmental Health Group. Menstrual Hygiene [Internet]. London School of Hygiene and Tropical Medicine; 2018. Available from: http://ehg.lshtm.ac.uk/menstural-hygiene/ [cited Jan 10, 2018]\n'},{id:"B41",body:'Impact of Unhygienic Sanitary Practices on Women’s Health [Internet]. Soothe Healthcare; 2017. Available from: http://soothehealthcare.com/impact-of-unhygienic-sanitary-practices-on-womens-health/[cited Jan 10, 2018]\n'},{id:"B42",body:'Kaur R, Kaur K, Kaur R. Menstrual hygiene, management, and waste disposal: Practices and challenges faced by girls/women of developing countries. Journal of Environmental and Public Health. 2018;2018:1-9. Available from: https://www.hindawi.com/journals/jeph/2018/1730964/ [cited May 1, 2018]\n'},{id:"B43",body:'How WASH relates to Health, Education and Development [Internet]. UNICEF; 2015. Available from: https://www.unicef.org/wash/index_healthandeducation.html [cited Dec 18, 2017]\n'},{id:"B44",body:'Atkinson J, Chartier Y, Pessoa-Silva CL, Jensen P, Li Y, Seto W-H. Infection and Ventilation [Internet]. World Health Organization; 2009. Available from: https://www.ncbi.nlm.nih.gov/books/NBK143278/ [cited Ap. 30, 2018]\n'},{id:"B45",body:'World Health Organization, UNICEF. WHO/UNICEF Joint Water Supply and Sanitation Monitoring Programme. Progress on Sanitation and Drinking Water; 2015\n'},{id:"B46",body:'Kumwenda S, Kalulu K, Chidziwisano K, Kalumbi L, Doyle V, Ngwira B. Viability of community led total sanitation in rural Malawi a case of Ntcheu, Balaka and Phalombe Districts. Malawi Journal of Applied Sciences and Innovation. 2018;2(1):67-88\n'},{id:"B47",body:'Banerjee AV, Duflo E. The economic lives of the poor. Journal of Economic Perspectives—American Economic Association. 2007;21(1):141-167\n'},{id:"B48",body:'Morse T. Healthy Settings: Scotland Chikwawa Health Initiative [Internet]. Addressing Healthy Settings in Malawi; 2014. Available from: https://scotlandchikhwawahealthinitiative.wordpress.com/tag/healthy-settings/ [cited Ap. 30, 2018]\n'},{id:"B49",body:'The HandyPod: Sanitation for Floating Communities in Cambodia|WASH Matters [Internet]. 2015. Available from: /blog/the-handypod-sanitation-for-floating-communities-in-cambodia [cited Dec 22, 2017]\n'},{id:"B50",body:'WHO. The Sanitation Challenge: Turning Commitment into Reality [Internet]. 2004. Available from: https://www.who.intl…./hygiene/sanchallengeco\n\n'},{id:"B51",body:'Center for Disease Control and Prevention. Hygiene Challenges and Resources in Lower Income Countries [Internet]. 2015. Available from: www.cdc.gov/healthywater/hygiene/idc/hygiene..challenges.html\n\n'},{id:"B52",body:'Ministry of Health. National Hand Washing Campaign 2011–2012 [Internet]. 2011. Available from: www.healthpromotion.gov.mw/ [cited Jan 5, 2018]\n'},{id:"B53",body:'Tearfund. Sanitation and Hygiene in Developing Countries: Identifying and Responding to Barriers. A Case Study from Burkina Faso. [Internet]. 2007. Available from: http://tilz.tearfund.org/Researc0h/Water+and+Sanitation\n\n'},{id:"B54",body:'CDC. Hygiene challenges and resources in lower income countries. Water, Sanitation & Environmentally Related Hygiene [Internet]. 2015. Available from: https://www.cdc.gov/healthywater/hygiene/ldc/hygiene_challenges.html [cited May 1, 2018]\n'},{id:"B55",body:'Watts S. Women, water management, and health. Emerging Infectious Diseases. 2004;10(11):2025-2026\n'},{id:"B56",body:'Bayeh E. The role of empowering women and achieving gender equality to the sustainable development of Ethiopia. Pacific Science Review B: Humanities and Social Sciences. 2016;2(1):37-42\n'},{id:"B57",body:'Hagan J, Hughes R, Smith J. Case study 12_Designing gender-sensitive sanitation for floating villages. In: Towards Incusive WASH Sharing Evidence and Experience from the Field. WASH. 2012\n'},{id:"B58",body:'Biran A. Enabling Technologies for Handwashing with Soap: A Case Study on the Tippy-Tap in Uganda [Internet]. Water and Sanitation Program; 2011. Available from: https://www.wsp.org/sites/wsp.org/files/publications/uganda-tippy-tap-hwws.pdf [cited May 1, 2018]\n'},{id:"B59",body:'Routray P, Torondel B, Clasen T, Schmidt W-P, et al. PLoS One. 2017;12(5):e0178042. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5443550/ [cited May 1, 2018]\n'},{id:"B60",body:'UNICEF. Water sanitation and hygiene. The Case for Support [Internet]. 2015. Available from: https://www.unicef.org\n\n'},{id:"B61",body:'National Statistical Office, ICF International. Malawi Demographic and Health Survey 2015–16 [Internet]. Zomba, Malawi, and Rockville, Maryland, USA: NSO and ICF International; 2016. Available from: http://www.dhsprogram.com/pubs/pdf/PR73/PR73.pdf [cited Jun 14, 2016]\n'},{id:"B62",body:'Hunter PR, AM MD, Carter RC. Water supply and health. PLoS Medicine. 2010;7(11):e1000361. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2976720/ [cited 2018 May 1]\n'},{id:"B63",body:'Wet SD. Identifying Community Needs. Saarbrücken: Scholars Press; 2015. 56p\n'},{id:"B64",body:'De Weerdt J. Moving out of poverty in Tanzania: Evidence from Kagera. Journal of Development Studies. 2010;46(2):331-349\n'},{id:"B65",body:'Tiwari S. Moving up the Ladder: Poverty Reduction and Social Mobility in Nepal [Internet]. The World Bank Group. 2016. Available from: http://documents.worldbank.org/curated/en/171641467117954924/pdf/106652-REVISED-WP-Moving-Up-the-Ladder-Executive-Summary.pdf [cited Ap. 29, 2018]\n'},{id:"B66",body:'White S, Kuper H, Itimu-Phiri A, Holm R, Biran A. A qualitative study of barriers to accessing water, sanitation and hygiene for disabled people in Malawi. PLoS One. 2016;11(5):e0155043\n'},{id:"B67",body:'Cameroon: Experts Warn of Disease Outbreaks from Poor Menstrual Hygiene; 2015\n'},{id:"B68",body:'WaterAid. Beyond Political Commitment to Sanitation: Navigating Incentives for Prioritisation and Course Correction in Ethiopia, India, and Indonesia [Internet]. WaterAid; 2016. Available from: https://www.google.com/url? [cited Ap. 30, 2018]\n'},{id:"B69",body:'Fox AM, Balarajan Y, Cheng C, Reich MR. Measuring political commitment and opportunities to advance food and nutrition security: Piloting a rapid assessment tool. Health Policy and Planning. 2015;30(5):566-578\n'},{id:"B70",body:'Nutrition C for FS and A. Hazard Analysis Critical Control Point (HACCP)—HACCP Principles & Application Guidelines [Internet]. 2012. Available from: https://www.fda.gov/Food/GuidanceRegulation/HACCP/ucm2006801.htm [cited Jan 11, 2018]\n'},{id:"B71",body:'Joshi S. Community participation and ownership of sanitation and hygiene in Western Nepal [thesis]. Diak South, Jar venpaa Unit, Nepal: Diaconia University of Applied Sciences; 2011. Available from: https://www.theseus.fi/bitstream/handle/10024/35741/Joshi_Sudip.pdf [cited Ap. 30, 2018]\n'},{id:"B72",body:'Weiss K. One Month in a Floating Village. UC Davis College of Engineering, Cambodia; 2016\n'},{id:"B73",body:'Madon S, Malecela MN, Mashoto K, Donohue R, Mubyazi G, Michael E. The role of community participation for sustainable integrated neglected tropical diseases and water, sanitation and hygiene intervention programs: A pilot project in Tanzania. Social Science & Medicine. 2018;202:28-37\n'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Save Kumwenda",address:"skumwenda@poly.ac.mw",affiliation:'
Department of Environmental Health, University of Malawi, The Polytechnic, Blantyre, Malawi
'}],corrections:null},book:{id:"6682",type:"book",title:"The Relevance of Hygiene to Health in Developing Countries",subtitle:null,fullTitle:"The Relevance of Hygiene to Health in Developing Countries",slug:"the-relevance-of-hygiene-to-health-in-developing-countries",publishedDate:"April 3rd 2019",bookSignature:"Natasha Potgieter and Afsatou Ndama Traore Hoffman",coverURL:"https://cdn.intechopen.com/books/images_new/6682.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-78985-804-4",printIsbn:"978-1-78985-803-7",pdfIsbn:"978-1-83962-106-2",reviewType:"peer-reviewed",numberOfWosCitations:22,isAvailableForWebshopOrdering:!0,editors:[{id:"55305",title:"Prof.",name:"Natasha",middleName:null,surname:"Potgieter",slug:"natasha-potgieter",fullName:"Natasha Potgieter"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"230460",title:"Prof.",name:"Afsatou N.",middleName:null,surname:"Traore",slug:"afsatou-n.-traore",fullName:"Afsatou N. Traore"},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1335"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},chapters:[{id:"65992",type:"chapter",title:"Introductory Chapter: Perspectives on Hygiene",slug:"introductory-chapter-perspectives-on-hygiene",totalDownloads:707,totalCrossrefCites:0,signatures:"Natasha Potgieter and Afsatou Ndama Traore Hoffman",reviewType:"peer-reviewed",authors:[{id:"55305",title:"Prof.",name:"Natasha",middleName:null,surname:"Potgieter",fullName:"Natasha Potgieter",slug:"natasha-potgieter"}]},{id:"63322",type:"chapter",title:"Challenges to Hygiene Improvement in Developing Countries",slug:"challenges-to-hygiene-improvement-in-developing-countries",totalDownloads:2606,totalCrossrefCites:7,signatures:"Save Kumwenda",reviewType:"peer-reviewed",authors:[{id:"233913",title:"Mr.",name:"Save",middleName:null,surname:"Kumwenda",fullName:"Save Kumwenda",slug:"save-kumwenda"}]},{id:"61814",type:"chapter",title:"Inequalities in Households’ Environmental Sanitation Practices in a Developing Nation’s City: The Example of Ile-Ife, Nigeria",slug:"inequalities-in-households-environmental-sanitation-practices-in-a-developing-nation-s-city-the-exam",totalDownloads:988,totalCrossrefCites:0,signatures:"Faniran Gbemiga and Ojo Deborah",reviewType:"peer-reviewed",authors:[{id:"232193",title:"Dr.",name:"Gbemiga",middleName:null,surname:"Faniran",fullName:"Gbemiga Faniran",slug:"gbemiga-faniran"},{id:"233650",title:"Mrs.",name:"Deborah",middleName:null,surname:"Ojo",fullName:"Deborah Ojo",slug:"deborah-ojo"}]},{id:"63180",type:"chapter",title:"Understanding the Hygiene Needs of People Living with HIV and AIDs in Southern African Developing Community (SADC) Countries",slug:"understanding-the-hygiene-needs-of-people-living-with-hiv-and-aids-in-southern-african-developing-co",totalDownloads:831,totalCrossrefCites:0,signatures:"Ephias M. Makaudze",reviewType:"peer-reviewed",authors:[{id:"234230",title:"Dr.",name:"Ephias",middleName:null,surname:"Makaudze",fullName:"Ephias Makaudze",slug:"ephias-makaudze"}]},{id:"63707",type:"chapter",title:"Drinking Water Treatment and Challenges in Developing Countries",slug:"drinking-water-treatment-and-challenges-in-developing-countries",totalDownloads:7903,totalCrossrefCites:13,signatures:"Josephine Treacy",reviewType:"peer-reviewed",authors:[{id:"238173",title:"Dr.",name:"Josephine",middleName:null,surname:"Treacy",fullName:"Josephine Treacy",slug:"josephine-treacy"}]},{id:"63191",type:"chapter",title:"Household Water Handling Practices in the Arid and Semi-Arid Lands in Kenya",slug:"household-water-handling-practices-in-the-arid-and-semi-arid-lands-in-kenya",totalDownloads:964,totalCrossrefCites:2,signatures:"Edith J. Kurui, George M. Ogendi, Wilkister N. Moturi\nand Dishon O. Nyawanga",reviewType:"peer-reviewed",authors:[{id:"78236",title:"Dr.",name:"Wilkister",middleName:null,surname:"Moturi",fullName:"Wilkister Moturi",slug:"wilkister-moturi"},{id:"234029",title:"M.Sc.",name:"Edith",middleName:"Jepchirchir",surname:"Kurui",fullName:"Edith Kurui",slug:"edith-kurui"},{id:"247927",title:"Dr.",name:"George",middleName:null,surname:"Ogendi",fullName:"George Ogendi",slug:"george-ogendi"},{id:"247930",title:"Mr.",name:"Dishon",middleName:null,surname:"Nyawanga",fullName:"Dishon Nyawanga",slug:"dishon-nyawanga"}]},{id:"65457",type:"chapter",title:"Water Quality Monitoring Infrastructure for Tackling Water-Borne Diseases in the State of Madhya Pradesh, India, and Its Implication on the Sustainable Development Goals (SDGs)",slug:"water-quality-monitoring-infrastructure-for-tackling-water-borne-diseases-in-the-state-of-madhya-pra",totalDownloads:856,totalCrossrefCites:2,signatures:"Abhishek Parsai and Varsha Rokade",reviewType:"peer-reviewed",authors:[{id:"232552",title:"Ph.D.",name:"Abhishek",middleName:null,surname:"Parsai",fullName:"Abhishek Parsai",slug:"abhishek-parsai"},{id:"232563",title:"Dr.",name:"Varsha",middleName:null,surname:"Rokade",fullName:"Varsha Rokade",slug:"varsha-rokade"}]}]},relatedBooks:[{type:"book",id:"10624",title:"Contemporary Developments and Perspectives in International Health Security",subtitle:"Volume 2",isOpenForSubmission:!1,hash:"edbc267908c2f140f991de15d99276df",slug:"contemporary-developments-and-perspectives-in-international-health-security-volume-2",bookSignature:"Stanislaw P. Stawicki, Thomas J. Papadimos, Sagar C. Galwankar, Andrew C. Miller and Michael S. Firstenberg",coverURL:"https://cdn.intechopen.com/books/images_new/10624.jpg",editedByType:"Edited by",editors:[{id:"181694",title:"Dr.",name:"Stanislaw P.",surname:"Stawicki",slug:"stanislaw-p.-stawicki",fullName:"Stanislaw P. Stawicki"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"},chapters:[{id:"78352",title:"Introductory Chapter: International Health Security in the Era of COVID-19",slug:"introductory-chapter-international-health-security-in-the-era-of-covid-19",signatures:"Stanislaw P. Stawicki, Thomas J. Papadimos, Sagar C. Galwankar, Ricardo Izurieta, Andrew C. Miller and Michael S. Firstenberg",authors:[{id:"181694",title:"Dr.",name:"Stanislaw P.",middleName:null,surname:"Stawicki",fullName:"Stanislaw P. Stawicki",slug:"stanislaw-p.-stawicki"},{id:"422540",title:"Dr.",name:"Thomas J.",middleName:null,surname:"Papadimos",fullName:"Thomas J. Papadimos",slug:"thomas-j.-papadimos"},{id:"422541",title:"Dr.",name:"Sagar C.",middleName:null,surname:"Galwankar",fullName:"Sagar C. Galwankar",slug:"sagar-c.-galwankar"},{id:"422542",title:"Dr.",name:"Ricardo",middleName:null,surname:"Izurieta",fullName:"Ricardo Izurieta",slug:"ricardo-izurieta"},{id:"422543",title:"Dr.",name:"Andrew C.",middleName:null,surname:"Miller",fullName:"Andrew C. Miller",slug:"andrew-c.-miller"},{id:"422544",title:"Dr.",name:"Michael S.",middleName:null,surname:"Firstenberg",fullName:"Michael S. Firstenberg",slug:"michael-s.-firstenberg"}]},{id:"75954",title:"Which Plagues are Coming Next?",slug:"which-plagues-are-coming-next-",signatures:"Ricardo Izurieta, Adriana Campos, Jeegan Parikh and Tatiana Gardellini",authors:[{id:"336849",title:"Prof.",name:"Ricardo",middleName:null,surname:"Izurieta",fullName:"Ricardo Izurieta",slug:"ricardo-izurieta"},{id:"336851",title:"MSc.",name:"Adriana",middleName:null,surname:"Campos",fullName:"Adriana Campos",slug:"adriana-campos"},{id:"336852",title:"Dr.",name:"Jeegan",middleName:null,surname:"Parikh",fullName:"Jeegan Parikh",slug:"jeegan-parikh"},{id:"336859",title:null,name:"Tatiana",middleName:null,surname:"Gardellini Guevara",fullName:"Tatiana Gardellini Guevara",slug:"tatiana-gardellini-guevara"}]},{id:"76312",title:"Reflections on Climate Change and Public Health in Africa in an Era of Global Pandemic",slug:"reflections-on-climate-change-and-public-health-in-africa-in-an-era-of-global-pandemic",signatures:"Edlyne Eze Anugwom",authors:[{id:"293469",title:null,name:"Edlyne Eze",middleName:null,surname:"Anugwom",fullName:"Edlyne Eze Anugwom",slug:"edlyne-eze-anugwom"}]},{id:"75171",title:"Improving International Health Security in Resource-Scarce Regions: Leveraging upon the Initial Success of Combating COVID-19 to Fight Emerging Health Threats",slug:"improving-international-health-security-in-resource-scarce-regions-leveraging-upon-the-initial-succe",signatures:"Daniel Lawer Egbenya",authors:[{id:"331483",title:"Ph.D.",name:"Daniel Lawer",middleName:null,surname:"Egbenya",fullName:"Daniel Lawer Egbenya",slug:"daniel-lawer-egbenya"}]},{id:"75731",title:"Inclusion Policies and Territorial Welfare Networks between Society, Work and the Economy at the Times of Covid 19",slug:"inclusion-policies-and-territorial-welfare-networks-between-society-work-and-the-economy-at-the-time",signatures:"Romano Benini",authors:[{id:"343222",title:"Prof.",name:"Romano",middleName:null,surname:"Benini",fullName:"Romano Benini",slug:"romano-benini"}]},{id:"73634",title:"Supply Chain Management and Restart of Economy in Post COVID-19",slug:"supply-chain-management-and-restart-of-economy-in-post-covid-19",signatures:"Venkataramanaiah Saddikuti, Sagar Galwankar and Akilesh Sai Saddikuti Venkat",authors:[{id:"292211",title:"Associate Prof.",name:"Venkataramanaiah",middleName:null,surname:"Saddikuti",fullName:"Venkataramanaiah Saddikuti",slug:"venkataramanaiah-saddikuti"},{id:"293168",title:"Dr.",name:"Sagar C.",middleName:null,surname:"Galwankar",fullName:"Sagar C. Galwankar",slug:"sagar-c.-galwankar"},{id:"321650",title:"Mr.",name:"Akilesh Sai",middleName:null,surname:"S V",fullName:"Akilesh Sai S V",slug:"akilesh-sai-s-v"}]},{id:"75488",title:"Management of Blood Supply and Blood Demand to Ensure International Health Security",slug:"management-of-blood-supply-and-blood-demand-to-ensure-international-health-security",signatures:"Amar Ibrahim Omer Yahia",authors:[{id:"336945",title:"Dr.",name:"Amar",middleName:"Ibrahim Omer",surname:"Yahia",fullName:"Amar Yahia",slug:"amar-yahia"}]},{id:"75726",title:"Timely Detection of SARS-CoV-2 in Limited Resource Settings: The Role of the Laboratory in Zimbabwe",slug:"timely-detection-of-sars-cov-2-in-limited-resource-settings-the-role-of-the-laboratory-in-zimbabwe",signatures:"Joyce Namulondo, Muchaneta Mugabe, Zinyowera Sekessai, Prisca Chikwanda, Phibeon Munyaradzi Mangwendeza, Raiva Simbi, Barbara Manyame, Anafi Mataka, Allen Matubu, Justen Manase, Anderson Chimusoro and Alex Gasasira",authors:[{id:"242299",title:"Dr.",name:"Justen",middleName:null,surname:"Manasa",fullName:"Justen Manasa",slug:"justen-manasa"},{id:"336600",title:"Ms.",name:"Joyce",middleName:null,surname:"Namulondo",fullName:"Joyce Namulondo",slug:"joyce-namulondo"},{id:"337156",title:"Dr.",name:"Anderson",middleName:null,surname:"Chimusoro",fullName:"Anderson Chimusoro",slug:"anderson-chimusoro"},{id:"337157",title:"Dr.",name:"Muchaneta",middleName:null,surname:"Mugabe",fullName:"Muchaneta Mugabe",slug:"muchaneta-mugabe"},{id:"337161",title:"Dr.",name:"Alex",middleName:null,surname:"Gasasira",fullName:"Alex Gasasira",slug:"alex-gasasira"},{id:"345477",title:"Dr.",name:"Mtapuri-Zinyowera",middleName:null,surname:"Sekesai",fullName:"Mtapuri-Zinyowera Sekesai",slug:"mtapuri-zinyowera-sekesai"},{id:"345478",title:"Mrs.",name:"Prisca",middleName:null,surname:"Chikwanda",fullName:"Prisca Chikwanda",slug:"prisca-chikwanda"},{id:"345479",title:"Dr.",name:"Raiva",middleName:null,surname:"Simbi",fullName:"Raiva Simbi",slug:"raiva-simbi"},{id:"345480",title:"Mrs.",name:"Barbara",middleName:null,surname:"Manyame",fullName:"Barbara Manyame",slug:"barbara-manyame"},{id:"345481",title:"Mr.",name:"Anafi",middleName:null,surname:"Mataka",fullName:"Anafi Mataka",slug:"anafi-mataka"},{id:"345482",title:"Mr.",name:"Allen",middleName:null,surname:"Matubu",fullName:"Allen Matubu",slug:"allen-matubu"},{id:"345483",title:"Dr.",name:"Phibeon",middleName:"Munyaradzi",surname:"Mangwendeza",fullName:"Phibeon Mangwendeza",slug:"phibeon-mangwendeza"}]},{id:"75646",title:"Neurological Complications in COVID-19: Implications on International Health Security and Possible Interventions of Phytochemicals",slug:"neurological-complications-in-covid-19-implications-on-international-health-security-and-possible-in",signatures:"Johnson Olaleye Oladele, Oluwaseun Titilope Oladele, Oyedotun M. Oyeleke and Adenike T. Oladiji",authors:[{id:"335880",title:"Dr.",name:"Johnson Olaleye",middleName:null,surname:"Oladele",fullName:"Johnson Olaleye Oladele",slug:"johnson-olaleye-oladele"},{id:"342648",title:"Mrs.",name:"Oluwaseun Titilope",middleName:null,surname:"Oladele",fullName:"Oluwaseun Titilope Oladele",slug:"oluwaseun-titilope-oladele"},{id:"342649",title:"Prof.",name:"Adenike T.",middleName:null,surname:"Oladiji",fullName:"Adenike T. Oladiji",slug:"adenike-t.-oladiji"},{id:"346531",title:"Dr.",name:"Oyedotun M.",middleName:null,surname:"Oyeleke",fullName:"Oyedotun M. Oyeleke",slug:"oyedotun-m.-oyeleke"}]},{id:"75520",title:"Autistic Spectrum Disorder in the Context of Pandemic by Covid-19: Caring for Children and Caregivers",slug:"autistic-spectrum-disorder-in-the-context-of-pandemic-by-covid-19-caring-for-children-and-caregivers",signatures:"José Vilelas",authors:[{id:"343636",title:"Associate Prof.",name:"José",middleName:"Manuel",surname:"Vilelas",fullName:"José Vilelas",slug:"jose-vilelas"}]},{id:"75095",title:"COVID-19 Pandemic and Mental Health of Nurses: Impact on International Health Security",slug:"covid-19-pandemic-and-mental-health-of-nurses-impact-on-international-health-security",signatures:"Gonca Ustun",authors:[{id:"335954",title:"Dr.",name:"Gonca",middleName:null,surname:"Ustun",fullName:"Gonca Ustun",slug:"gonca-ustun"}]},{id:"75851",title:"Significance of Diet and Behavior During Pandemic Situation According to Ayurveda",slug:"significance-of-diet-and-behavior-during-pandemic-situation-according-to-ayurveda",signatures:"Gaurav Sawarkar and Punam Sawarkar",authors:[{id:"335966",title:"Dr.",name:"Gaurav",middleName:null,surname:"Sawarkar",fullName:"Gaurav Sawarkar",slug:"gaurav-sawarkar"},{id:"335978",title:"Dr.",name:"Punam",middleName:null,surname:"Sawarkar",fullName:"Punam Sawarkar",slug:"punam-sawarkar"}]}]}],publishedBooks:[{type:"book",id:"6682",title:"The Relevance of Hygiene to Health in Developing Countries",subtitle:null,isOpenForSubmission:!1,hash:"c6bce9af9756cd41e5d336fa8945b2ea",slug:"the-relevance-of-hygiene-to-health-in-developing-countries",bookSignature:"Natasha Potgieter and Afsatou Ndama Traore Hoffman",coverURL:"https://cdn.intechopen.com/books/images_new/6682.jpg",editedByType:"Edited by",editors:[{id:"55305",title:"Prof.",name:"Natasha",surname:"Potgieter",slug:"natasha-potgieter",fullName:"Natasha Potgieter"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10624",title:"Contemporary Developments and Perspectives in International Health Security",subtitle:"Volume 2",isOpenForSubmission:!1,hash:"edbc267908c2f140f991de15d99276df",slug:"contemporary-developments-and-perspectives-in-international-health-security-volume-2",bookSignature:"Stanislaw P. Stawicki, Thomas J. Papadimos, Sagar C. Galwankar, Andrew C. Miller and Michael S. Firstenberg",coverURL:"https://cdn.intechopen.com/books/images_new/10624.jpg",editedByType:"Edited by",editors:[{id:"181694",title:"Dr.",name:"Stanislaw P.",surname:"Stawicki",slug:"stanislaw-p.-stawicki",fullName:"Stanislaw P. Stawicki"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6938",title:"Elections",subtitle:"A Global Perspective",isOpenForSubmission:!1,hash:"4a122ebf3b961d2c46bbfc8def2916fe",slug:"elections-a-global-perspective",bookSignature:"Ryan M. Yonk",coverURL:"https://cdn.intechopen.com/books/images_new/6938.jpg",editedByType:"Edited by",editors:[{id:"196259",title:"Dr.",name:"Ryan Merlin",surname:"Yonk",slug:"ryan-merlin-yonk",fullName:"Ryan Merlin Yonk"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],publishedBooksByAuthor:[{type:"book",id:"6682",title:"The Relevance of Hygiene to Health in Developing Countries",subtitle:null,isOpenForSubmission:!1,hash:"c6bce9af9756cd41e5d336fa8945b2ea",slug:"the-relevance-of-hygiene-to-health-in-developing-countries",bookSignature:"Natasha Potgieter and Afsatou Ndama Traore Hoffman",coverURL:"https://cdn.intechopen.com/books/images_new/6682.jpg",editedByType:"Edited by",editors:[{id:"55305",title:"Prof.",name:"Natasha",surname:"Potgieter",slug:"natasha-potgieter",fullName:"Natasha Potgieter"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},onlineFirst:{chapter:{type:"chapter",id:"79449",title:"Life-Threatening Cardiac Arrhythmias during Anesthesia and Surgery",doi:"10.5772/intechopen.101371",slug:"life-threatening-cardiac-arrhythmias-during-anesthesia-and-surgery",body:'
1. Introduction
1.1 Definition of cardiac arrhythmias
Accelerated, slowed, or irregular heart rates caused by abnormalities in the electrical impulses of the myocardium.
Cardiac arrhythmias are very common in the general population and are a significant cause of morbidity and mortality of both cardiac and noncardiac surgical procedures during the perioperative period. While the incidence of perioperative arrhythmias is extremely high (the Multicenter Study of General Anesthesia reported a 70.2% incidence of Brady and tachyarrhythmias in 17,201 patients having general anesthesia for a variety of surgical procedures), only 1.6% of these required clinically significant management [1, 2, 3]. For cardiac surgery, the patients are more prone to develop arrhythmias with a reported incidence of greater than 90%, while incidence for patients undergoing non-cardiac surgery is lower and varies from 16.3 to 61.7% [4, 5, 6]. Patients with pre-existing cardiac disease for cardiac surgery are more prone to develop perioperative rhythm disturbances. It is obvious that arrhythmias that occur during surgery are clinically important as it can evolve to life-threatening malignant arrhythmias with severe hemodynamic instability and cardiovascular collapse, necessitating prompt initiation of adequate cardiopulmonary resuscitation (CPR) and defibrillation or electrical cardioversion. Hence, a thorough understanding and prompt diagnosis and intervention are critical for the anesthesiologist in order to reduce severe perioperative adverse outcomes.
An understanding of normal cardiac physiology is essential before rhythm disturbances can be understood. The normal cardiac electrical conduction system is responsible for the contraction of the heart muscle and is represented on the electrocardiogram.
Normal cardiac conduction begins with cardiac impulses coming from the sinoatrial node and travels to both atria. The atria depolarizes and generates the P wave. From here, the impulse propagates to the atrioventricular node, then reaches the his bundle and Purkinje fibers transforming into conduction, causing ventricular contraction and generates the QRS wave [6]. The resting sinus heart rate in adults is usually between 60 and 100 beats/min.
In the heart, electrical stimulation is created by a sequence of ion fluxes through specialized channels in the cardiomyocytes that generate action potential and lead to a coordinated cardiac contraction in systole. Each action potential corresponds to one beat of the heart and the inherent frequency of these cells is essential for maintaining proper rate control. Antiarrhythmic drugs act by modifying this action potential, which results from the alteration of ion channels (Table 1).
Class
Actions
Drugs (examples)
I
Sodium channel blockade
IA
~moderate
Quinidine, procainamide
IB
~weak
Lidocaine, mexiletine
IC
~strong
Flecainide, propafenone
II
β blockade
Propranolol, esmolol, sotalol
III
Potassium (K+) channel blocker
Amiodarone, ibutilide
IV
Calcium (Ca2+) channel blocker
Diltiazem, verapamil
Table 1.
Choice of antiarrhythmic therapies based on Vaughan-Williams classification (classes I–IV).
Five phases of cardiac action potential (as illustrated in Figure 1):
Phase 4: resting potential at –90 mV with minor depolarization from –90 mV to –70 mV; the passive outflow of potassium.
Phase 0: rapid depolarization from –70 mV to +50 mV; inward voltage-gated sodium channels.
Phase 1: minor repolarization; outward voltage-gated potassium channels.
Phase 2: plateau at +50 mV; outward voltage-gated potassium channels and inward voltage-gated calcium channels.
Phase 3: repolarization from +50 mV to –90 mV; outward voltage-gated potassium channels.
Figure 1.
Cardiac action potential.
Damage to the normal conduction system of the heart can lead to rhythm disturbances which can be either benign or more serious in nature depending on the hemodynamic consequence of the arrhythmia and the possibility of evolving into a lethal arrhythmia.
Bradyarrhythmias result from decreased intrinsic pacemaker function or blocks in conduction, principally within the AV-node or the His-Purkinje system. Most tachyarrhythmias are caused by re-entry, some result from enhanced normal automaticity or from abnormal mechanisms of automaticity.
2. Mechanism of intraoperative arrhythmias
The principal mechanisms of Brady and tachyarrhythmias which are observed in clinical practice are as follows [5]:
Injury to the cardiac conduction system.
Re-entry: a mechanism that may precipitate a wide variety of supraventricular and ventricular arrhythmias, implying the presence of a pathologic circuit of an electrical impulse around a functional or anatomic loop.
Automaticity: Abnormal depolarization of atrial or ventricular muscle cells during periods of the action potential can lead to arrhythmias.
Mutations in ion channels.
Ectopic foci.
3. Contributing factors and causes of arrhythmias during anesthesia for surgery
Although the incidence of intraoperative arrhythmias is extremely high, the majority of such arrhythmias are benign and self-limiting. They require no emergency treatment and respond well to pharmacologic interventions or both. However, in certain patients, some arrhythmias may pose an immediate threat to life by causing profound hemodynamic instability and require urgent clinical attention.
There are several factors likely to contribute to the generation of intraoperative arrhythmias, which can be classified according to patient, anesthesia, and procedures (Table 2) [5, 7]. Identifying the causes mainly responsible for intraoperative arrhythmias is prudent before instituting specific therapy or intervention.
Patient-related
Anesthesia related
Surgical related
Pre-existing cardiac disease, thyrotoxicosis, central nervous system disease (e.g., subarachnoid hemorrhage)
Direct laryngoscopy and intubation
Cardiac surgery (intracardiac surgical manipulation)
Insufficient level of anesthesia
Surgical manipulation during non-cardiac surgery (e.g., traction to the intestine, oculocardiac reflex). Neurosurgical causes, dental surgery, and laparoscopic surgery
Elderly
Local anesthesia (central neuraxial blockade is associated with pharmacological sympathectomy)
Contributing factors and causes of intraoperative arrhythmias.
Patients with pre-existing heart disease (e.g., myocardial ischemia) have a much higher incidence of arrhythmias intraoperatively. Intracranial pathology such as subarachnoid hemorrhage and raised intracranial pressure can result in ECG abnormalities because of stimulation of the autonomic nervous system.
Airway manipulation most often associated with hemodynamic disturbances is a well-described cause of intraoperative arrhythmias [4, 7, 8]. During anesthesia, arrhythmias can be produced in the presence of a variety of triggering agents and clinical situations such as light plane of anesthesia with hypertension and tachycardia, hypoxemia, and hypercarbia.
Vital organs, such as the brain, heart, and kidneys, must be perfused adequately during general anesthesia and surgery. Most of the anesthetic agents have direct myocardial depressant effects which result in reduced cardiac contractility and sympathetic stimulation of the peripheral vasculature. The net effect is a fall in cardiac output with a fall in perfusing pressure of vital organs secondary to vascular vasodilation. Conversely, tachycardia can have detrimental effects in patients susceptible to ischemia due to reduced myocardial filling time. Even relatively minor fluctuations in cardiovascular and hemodynamic parameters due to arrhythmias can have a significant incidence of various complications, including cardiovascular events, renal failure, infection, and cerebral infarction, particularly among the elderly co-morbid patients undergoing elective and emergency surgery. The use of halothane during induction in children as well as maintenance of anesthesia has been largely superseded by sevoflurane, which is safer. Electrolyte imbalances, abnormal blood gases, and direct cardiac stimulation via catheters influence the occurrence of arrhythmia and conduction abnormalities. The anesthesiologists should be aware of all the drugs used and able to manage the consequences accordingly [8, 9].
Surgical manipulation and cardiopulmonary bypass during cardiac surgery may precipitate arrhythmias. Vagal stimulation in surgical procedures such as during carotid surgery and peritoneal traction produces bradycardia, conduction block, or even asystole. Dental surgery causes profound stimulation of the autonomic nervous system. Thoracic surgery is associated with an incidence of atrial fibrillation.
4. Anesthetic agents and adjuvants related to arrhythmias
Prolonged cardiac repolarization (represented as QT interval on ECG) induced by various anesthetic agents and adjuvant drugs may trigger the appearance of torsade de pointes (TdP), which in some patients degenerate towards malignant ventricular arrhythmias and sudden cardiac arrest [6, 7, 10]. The duration of QT interval, QT corrected for heart rate (QTc), JT interval, QT dispersion (QTd), QT variability index, and transmular dispersion of repolarization (TDR) are the commonly used ECG markers to check for the possibility of various degrees of TdP under different conditions [11]. All volatile anesthetics, especially isoflurane and desflurane cause QTC prolongation, while sevoflurane demonstrated no effects on TDR. Propofol is generally considered to be non-torsadogenic. The sympathomimetic properties of ketamine may promote the incidents of TdP [11]. Most opioids have no effect on QTc when used at clinically relevant doses. Succinylcholine has been shown to increase QTc, especially when used in conjunction with thiopental while most nondepolarizing muscle relaxants have no effect on the QT interval. Sugammadex at therapeutic doses has no effect on QTc whereas anticholinesterase-anticholinergic antagonism of neuromuscular blockade with neostigmine and glycopyrrolate or atropine causes clinically significant QTc prolongation. The commonly used local anesthetic agents are relatively safe; nevertheless, extensive central neuraxial blocks may increase the duration of QTc. Several antiemetic drugs, such as droperidol, domperidone, and most 5-HT3 antagonists, produce a significant prolongation of QT. The FDA’s black box warning of fatal arrhythmias associated with the administration of droperidol leads to a decrease in the use of this medication in recent years. Midazolam seems to have no effect on QTc and TDR. Although dexmedetomidine may cause mild prolongation of QT interval, it is unlikely to cause TdP. It should also be prudent to use dexmedetomidine with caution, especially in patients with bradyarrhythmias tendencies where the risk of QT prolongation is increased [12, 13, 14, 15].
5. Diagnostic evaluation
During surgery, it is not always possible to get 12-lead ECG done. The anesthesiologists would have to make the diagnosis by looking at the continuous ECG monitor in the operating room. Changing the sweep speed on the ECG monitor (from 50 to 25 mm/s) may help with the identification of arrhythmias and their management. Lead II and V5 are superior for arrhythmia detection and diagnosis. All available leads are displayed on the intraoperative monitor if arrhythmia develops and cannot be readily diagnosed. For non-cardiac surgery, 12-lead ECG can be obtained as soon as feasible [9, 16].
The blood pressure, arterial oxygen saturation, and temperature also need to be monitored. More advanced monitoring such as invasive arterial pressure, pulmonary artery catheterization, and transoesophageal echocardiography can provide additional clues when assessing the patient for causes of cardiovascular collapse. End-tidal carbon dioxide may help with the effectiveness of chest compressions during cardiopulmonary resuscitation. Estimation of serum electrolytes for verification of renal function is important in patients on medications for arrhythmias.
Adequate precautions should be taken during surgery to prevent the development of intraoperative arrhythmias:
Surgical manipulations which can precipitate arrhythmias should be kept to a minimum.
Adequate depth of anesthesia may prevent or control intraoperative arrhythmias.
Hypoxia, hypotension, hypovolemia, hypothermia should be prevented during surgery.
Whenever an arrhythmia develops in the intraoperative period, the anesthesiologists should first be able to eliminate the possible causes of arrhythmia before instituting specific interventions. Attempts to correct them should be made while continuing to evaluate the arrhythmia.
6. Specific intra-operative arrhythmias
6.1 Antiarrhythmic drugs
Patients requiring oral antiarrhythmic should continue the medication until the time of surgery. Specific cardiologist consultation is advised for patients who require pacing-cardioverter devices to suppress or terminate tachyarrhythmias. With life-threatening circulatory compromise, prompt pacing or electroversion is required. Obvious electrolyte imbalance should be corrected, and management provided for underlying heart disease. Specific antiarrhythmic agents are used to suppress arrhythmias and prevent recurrences (Table 3).
Drug
Action
Dose
Adenosine
AV nodal blockade
6–12 mg
Amiodarone
Class III antiarrhythmic
Bolus 150 mg over 10 min; repeat, if necessary, maintenance of 1 mg/min for 6 hours, then 0.5 mg/min Total dose over 24 h ≤2.4 g
Digoxin
Indirect vagomimetic and slows conduction through AV node
0.5–1.0 mg loading (dose 1: 50%; 25% at 4 hourly intervals; then 0.125–0.25 mg daily) Digoxin levels must be monitored for toxicity (therapeutic blood level: 0.8–2.0 ng/mL; if >3 ng/ml is indicative of toxicity)
Diltiazem
Ca channel antagonist
20 mg × 1 min (0.25 mg/kg) 0.125 mg/kg
Esmolol
Ultrashort-acting β-blocker
150–500 μg/kg × 1 min. 50–200 μg/kg/min
Isoproterenol
β-agonist
2–20 μg/min (0.02–0.15 μg/kg/min)
Lidocaine
Na channel action decreasing duration of action potential
1.0–1.5 mg/kg; 1–4 mg/min (20–50 μg/kg/min)
Propranolol
β-blocker
0.5–3 mg (10–30 μg/kg) q 2 min to max 6–10 mg
verapamil
Ca channel antagonist
5–10 mg. Repeat bolus if needed (maximum dose 30 mg)
Procainamide
Class Ia antiarrhythmic
20–50 mg/min or 100 mg every 5 min until arrhythmia is controlled, QRS prolonged by 50% of original width, hypotension occurs, or total cumulative dose of 17 mg/kg
Sotalol
Class III antiarrhythmic
75 mg over 5 h
Table 3.
The main intravenous agents useful in management of intraoperative arrhythmias.
The administration of antiarrhythmic drugs may paradoxically aggravate the arrhythmias that are being treated or cause new rhythm disorders. This is known as proarrhythmia generally occurs when the dosage of drugs does not exceed the therapeutic range [17]. Proarrhythmia is now considered omnipresent with all antiarrhythmic medications. Care should be taken when using antiarrhythmic drugs in patients with structural heart disease, as they are at higher risk of proarrhythmia with antiarrhythmic medications. These patients, such as heart failure or cardiomyopathy are not candidates for Class IC or Class III antiarrhythmics other than amiodarone or sotalol.
Antiarrhythmic agents, in general, have a narrow therapeutic index. As a result, they are often susceptible to drug interactions with anesthetic agents and can cause significant adverse effects (Table 4).
Antiarrhythmic drugs
Interaction with anesthetic agents
adenosine
Vasodilation with isoflurane and central neuraxial block
Bronchoconstriction with neostigmine
Asystole with neostigmine, dexmedetomidine, and opioids
Antagonism with aminophylline
digoxin
Bradycardia is potentiated by halothane and succinylcholine
Caution when using calcium and diuretics (digoxin toxicity)
β blocker
Myocardial depression with halothane
Bronchoconstriction with neostigmine and atracurium
quinidine
Prolongs the effects of neuromuscular blocking agents
procainamide
Antagonizes neostigmine
calcium channel blocker
Bradycardia and myocardial depression with halogenated agents and dantrolene
Potentiates neuromuscular blockers
lidocaine
Potentiates the sympathetic blockade of opioids
Table 4.
Antiarrhythmics and its interaction with anesthetics agents.
6.2 Pacing and cardiac electroversion
Both cardiac pacing and electroversion provide a more prompt therapeutic effect and easier dose titration (i.e., pacing mode, rate, current) than with drugs [8, 18]. They have advantages over drugs for the management of intraoperative arrhythmias.
Pacing is considered in patients with symptomatic bradycardia when a pulse is present but not responded to atropine or second-line drugs (e.g., adrenaline and dopamine) [19]. Temporary cardiac pacing is used in cardiac surgery to increase heart rate, suppress bradycardia dependent tachycardia, overdrive escape rhythms, suppress atrial or ventricular extrasystoles, and terminate re-entrant SVT or atrial flutter. Transcutaneous pacing is used if invasive pacing is not feasible or is impractical.
Cardiac electroversion includes cardioversion (synchronized shocks) or defibrillation (nonsynchronized shocks) of hemodynamically unstable patients, which use high-energy capacitor discharges to simultaneously depolarize all excitable myocardium to terminate arrhythmias. It is highly effective and avoids the potential complications of drug therapy [20]. Defibrillation or unsynchronized cardioversion is indicated in any patients with pulseless ventricular tachycardia or ventricular fibrillation whereas synchronized cardioversion is utilized for the treatment of persistently unstable tachyarrhythmias in patients without loss of pulse. In synchronized cardioversion, the direct current electrical discharge is synchronized with the R or S wave of the QRS complex, avoiding the energy delivery near the apex of T wave, which coincides with a vulnerable period of induction of ventricular fibrillation. The recent use of biphasic cardioversion has shown that less energy is required to convert an arrhythmia to a sinus rhythm. It results in fewer delivered shocks to the patient, less cumulative energy delivered, and less myocardial tissue damage than is found with higher voltage shocks.
6.3 Management of arrhythmias during anesthesia and surgery
Cardiac arrhythmias may not always require treatment. However, the distinction between benign and malignant arrhythmias which carry the risk of sudden death is fundamental [21]. Figure 2 provides an algorithm for the evaluation and management of rhythm disturbances.
Figure 2.
Management of arrhythmias developed during anesthesia and surgery.
Arrhythmias are broadly classified as bradyarrhythmia and tachyarrhythmia (Table 5).
Bradyarrhythmia
Tachyarrhythmia
Sinus arrhythmia
Conduction defects
Sinus arrhythmia
Supraventricular arrhythmias
Ventricular arrhythmias
Sinus bradycardia
AV-blocks
First degree AV-block
Second degree AV-block
Third degree AV-block
Intraventricular blocks
Right bundle branch block (RBBB) or Left bundle branch block (LBBB)
Fascicular block.
Left anterior hemiblock (LAHB)
Left posterior hemiblock (LPHB)
Bifascicular block
Trifascicular block
Sinus tachycardia
Premature atrial contraction
Paroxysmal supraventricular tachycardia
Atrial flutter
Atrial fibrillation
Premature ventricular contractions (PVCs)
Ventricular tachycardia (VT)
Ventricular fibrillation
Torsade de pointes
Table 5.
Classification of bradyarrhythmia and tachyarrhythmia.
Strategies for clinical care of a patient with bradyarrhythmia (Figure 3A) and tachyarrhythmia (Figure 3B).
Figure 3.
Algorithm for (A) bradyarrhythmia. Algorithm for (B) tachyarrhythmias. VT: ventricular tachycardia.
6.4 Bradyarrhythmia
6.4.1 Conduction defects
AV conduction block can occur in the settings of intrinsic cardiac disease, acute myocardial ischemia, general anesthetics, electrolyte abnormalities, and excessive vagal tone. In cardiac surgery, high-grade AV block is not so uncommon complication and thus, a temporary epicardial pacing system is necessary. AV block is classified as first, second, and third-degree (complete). First-degree AV block is generally benign, often needs no treatment apart from careful observation for progression to a higher degree of the block that requires prompt treatment. The second-degree AV block is divided into Mobitz type I and II. In Mobitz type I, the block is often transient and asymptomatic. In Mobitz type II, the block is often symptomatic and has a less favorable prognosis because there is a potential risk of progression to third-degree heart block. Pacing is required if there is severe bradycardia with hemodynamic insufficiency. Third-degree AV block is characterized by electrical instability and may evolve towards asystole. There is no apparent relationship exists between the P waves and QRS complexes. Pacing is typically required because no conduction to ventricles occurs with atrial activity more rapid than ventricular activity (approximately 20–40 beats/min). These bradyarrhythmia (Mobitz type II and third-degree heart block) are not likely to be responsive to atropine and should be treated with transcutaneous pacing or isoproterenol infusion acting as a “chemical pacemaker” while the patient is prepared for transvenous pacing.
Intraventricular conduction defects are generally classified as LBBB, RBBB, or Hemiblock. Intraventricular blocks may be of a His bundle branch block pattern, a fascicular block pattern, or both and result from significant slowing or interruption of conduction. They are frequently seen in those with and without cardiac disease. In the vast majority of cases, RBBB may be a normal variant with little or no impact on cardiovascular prognosis. LBBB is a more serious conduction disturbance and is always associated with significant heart disease. In the presence of LBBB, acute myocardial infarction is difficult to diagnose. When the LBBB occurs in myocardial infarction, a complete heart block may develop. The anatomical or functional block in a fascicle causes a fascicular block. The left anterior hemiblock is common, while the left posterior hemiblock is uncommon. The combination of RBBB with left anterior or posterior hemiblock is called bifascicular block. Trifascicular block refers to a block of both the left and right bundles or to first- or second-degree AV block with additional bifascicular block. Patients with bifascicular and trifascicular blocks are at risk of a slow progression to an advanced or complete AV block.
6.5 Tachyarrhythmia
Tachyarrhythmias are classified into two categories (narrow complex supraventricular tachycardia and wide complex tachycardia), based on the appearance of QRS complex, heart rate, and regularity.
6.5.1 Supraventricular arrhythmias
6.5.1.1 Premature atrial contractions (PACs)
PACs are a common kind of arrhythmia characterized by early (premature) ectopic beats originating in the atria, which may be seen in patients with heart and chronic lung diseases, sepsis, shock, use of volatile agents, sympathetic stimulation, and excessive alcohol, nicotine, or caffeine. PAC is usually hemodynamically insignificant and self-limiting. But when they are in excess or compromise the cardiovascular function, β-blockers, digitalis or calcium channel blockers can be used after excluding the underlying causes.
PSVT is due to the rapid electrical discharge from an ectopic atrial focus, causing regular and consecutive atrial extrasystoles or may be caused by reentry in the AV node by the accessory pathway (AVNRT). It occurs most commonly in normal individuals, who may show no clinical evidence of heart disease. Less common causes of PSVT are rheumatic valvular heart disease, pulmonary embolism, cardiac surgery, thyrotoxicosis, and coronary artery disease. PSVT is characterized by rapid regular atrial rhythm at a rate of 160–220 beats/min, usually with a narrow QRS complex and lacking the P wave. It is typically rapid in onset and conclusion. The majority of patients who develop intraoperative PSVT maintain hemodynamic stability and do not require electrical direct current (DC) cardioversion. For this reason, heart rate control is the mainstay of the therapy that does not require immediate cardioversion [19]. PSVT can be confused with sinus tachycardia, atrial fibrillation, atrial flutter, and ventricular tachycardia. Carotid sinus massage can abruptly terminate the arrhythmia by activation of baroreceptors in the carotid sinus, resulting in increased vagal activity and transient AV nodal conduction block. This aids differentiation between PSVT, atrial flutter, and fibrillation. The Valsalva maneuver can also be used. If these vagal maneuvers are unsuccessful, then rapid intravenous adenosine in a dose of 6–12 mg is the drug of choice for terminating the re-entrant variety of PSVT arrhythmia. Adenosine slows the sinoatrial and AV nodal conduction and prolongs refractoriness, which is very effective in terminating PSVT. Its ultrashort duration of action (10 s) and very rapid onset of action (15–30 s) make it desirable over other intravenous drugs. However, atrial flutter and atrial fibrillation do not respond to adenosine. Other intravenous drugs that are useful for terminating PSVT are verapamil, diltiazem, and β-blockers. Intravenous digoxin is not clinically useful in the acute control of PSVT because of its delayed peak effect and a narrow therapeutic index. DC cardioversion is indicated for PSVT unresponsive to drug therapy or PSVT associated hemodynamic deterioration. Radiofrequency ablation is the preferred approach for patients with persistent symptomatic re-entry PSVT.
6.5.1.3 Atrial flutter
Atrial flutter is due to electrical impulse re-entry into the atria, often giving an atrial rate of 250–350 beats/min with a ventricular rate of 150 beats/min. It is usually associated with varying degrees of AV block, manifesting 2:1–4:1 AV conduction. The rapid P waves create a classic saw tooth appearance on ECG (best seen in leads II, III, aVF, and V1) and are called flutter waves (F waves). Normal T waves are lost in F waves. Atrial flutter often occurs in association with other arrhythmias such as AF. It usually signifies the presence of underlying severe heart disease and exacerbation of a chronic condition such as pulmonary disease, thyrotoxicosis, or after cardiac surgery. In many instances, treatment of the underlying disease process restores sinus rhythm. Intraoperative management of atrial flutter depends on the hemodynamic stability of the patient. Synchronized cardioversion using a low energy current (50–100 J) is the treatment of choice if the hemodynamic deterioration is present. If vital signs are stable, intravenous amiodarone, diltiazem or verapamil may convert the flutter to normal sinus rhythm.
6.5.1.4 Atrial fibrillation (AF)
AF is much commoner than an atrial flutter, and is one of the most common of all arrhythmias, especially in the elderly population [20, 22]. It accounts for more than 90% of supraventricular arrhythmia in the perioperative setting. AF has an irregularly irregular rhythm. The absence of P waves and variable QRS complexes on ECG is diagnostic of AF. AF is due to excessively rapid and disorganized atrial electrical activation without effective atrial contraction at a higher ventricular rate. The loss of atrial contraction may lead to a decrease in cardiac output and blood pressure that is often hemodynamically clinically significant. Other complications of AF include heart failure, pulmonary and systemic thromboembolism, and a significant risk of cerebrovascular events. Patients with ischemic heart disease, rheumatic heart disease, hypertension, thyrotoxicosis, and pneumonia are more prone to develop AF. The immediate intraoperative management of AF should begin with an assessment of hemodynamic status and correction of precipitating factors. The onset of AF or faster rates of chronic AF during the intraoperative period may be precipitated by acid-base and electrolyte abnormalities, hypovolemia, myocardial ischemia, sepsis, and surgical manipulation in the thoracic cavity. The goal of management is directed towards the control of ventricular response rate with pharmacological agents that slow AV node conduction. IV β-blockers or calcium channel blockers produce rapid control of rate. In the acute setting, the usefulness of digoxin is limited due to slow onset and low efficacy in high adrenergic states such as surgery. Amiodarone is a good choice for rate and rhythm control in patients with AF in the operating room. This agent also suppresses atrial ectopy and thus, recurrent AF and improves the success rate of electrical cardioversion. In cardiovascular compromised patients, synchronized DC cardioversion at 100–200 J (biphasic) is the most reliable method of converting AF to sinus rhythm. However, it should not be used in AF of more than 48-h duration without at least 3 weeks of anticoagulation, attempts to restore sinus rhythm may increase the risk of atrial blood clot formation and systemic thromboembolism.
6.5.2 Ventricular arrhythmias
Ventricular arrhythmias during anesthesia are more common in patients with underlying cardiac disease. Their occurrence must be considered life-threatening.
6.5.2.1 Ventricular extrasystole or premature ventricular contractions (PVCs)
PVCs are commonly seen during anesthesia and can be caused by multiple factors such as electrolyte and acid-base disorders, hypoxia, hypercarbia, hypothermia, anesthetic agents, sympathomimetic drugs, and very commonly direct laryngoscopy and tracheal intubation. They are also frequently observed during cardiac and thoracic surgical procedures. PVCs are ectopic beats arising from below the AV node and give rise to a wide and bizarre QRS complex. PVCs can be unifocal, multifocal, or they can alternate with sinus beats in every second (bigeminy) or every third (trigeminy) beat pattern. The management of PVCs should focus on the correction of underlying problems. Asymptomatic or healthy patients generally do not require any treatment. Frequent PVCs, multifocal PVCs, and PVCs occurring on the T wave should be considered a potentially serious event as they can precede runs of life-threatening ventricular tachycardia or fibrillation and require prompt treatment. The immediate availability of a defibrillator is paramount in the event of a deterioration in the rhythm. Lidocaine is the drug of choice. Amiodarone is also helpful. Propanolol, procainamide, and quinidine are other drugs that can be given to abolish PVCs. However, these anti-arrhythmic drugs (classes I and III) may have proarrhythmic effects, particularly in patients with underlying heart disease [23]. Early and continuous vigilance is necessary throughout therapy. It is important to ensure that serum electrolytes (especially potassium) are kept well within the normal range. Cardiac function should be optimized and cardiac ischemia should be managed aggressively. The drugs should be prescribed only if the overall effect is clearly beneficial. Furthermore, the Cardiac Arrhythmia Suppression Trial (CAST) shows that proarrhythmic death can occur even when PVCs are apparently eliminated. Occasionally, PVCs are induced when there is severe bradycardia. Atropine, isoproterenol, or pacing may be effective to abolish the PVCs by speeding up the SA node.
6.5.2.2 Ventricular tachycardia (VT)
VT is a severe, potentially life-threatening arrhythmia as the rhythm can degenerate into ventricular fibrillation, requiring emergent treatment. The ECG shows a rapid ventricular rhythm with broad abnormal QRS complexes. The ratio of P and QRS has no fixed relationship because of atrioventricular dissociation. Like other forms of arrhythmias, the correction of precipitating factors assumes great importance. It can be categorized into non-sustained and sustained ventricular tachycardia [24].
Non-sustained VT (NSVT) is defined as 3 or more PVCs that occur at a rate of more than 120 beats/min and lasting less than 30s without hemodynamic compromise. These arrhythmias are routinely seen in the absence of cardiac disease and may not require drug therapy. However, NSVT should be monitored carefully, as it can generate into a non-perfusing rhythm.
Sustained VT presents with a broad QRS complex that may be monomorphic or polymorphic. Timely termination of VT is desirable even if it is well-tolerated. Amiodarone is the first-line recommended therapy for patients with VT. The alternative pharmacological therapy includes lidocaine and procainamide. Patients may show signs of inadequate perfusion with or without a pulse. Pulseless VT should be treated immediately with defibrillation and initiation of cardiopulmonary resuscitation according to Advanced Cardiac Life Support (ACLS) algorithm, whereas VT with a pulse should be treated with synchronized cardioversion.
6.5.2.3 Ventricular fibrillation (VF)
This arrhythmia is characterized by very rapid, chaotic, grossly irregular, and disorganized broad complexes on the ECG with no mechanical effect, resulting either from rapid discharges of impulses from one or more ventricular foci or from multiple wandering re-enters circuits in the ventricles. On the ECG, the QRS is absent. It is a serious, life-threatening rhythm due to lack or no cardiac output during the arrhythmia. Clinically, pulses will be impalpable and there will be an acute drop in oxygen saturation on pulse oximetry.
VF during anesthesia and surgery is a critical event. The common causes are myocardial ischemia, hypoxia, hypothermia, metabolic electrolyte imbalance, and drug effects. Management includes prompt initiation of cardiopulmonary resuscitation. External defibrillation is the only effective method to convert VF to a viable rhythm. The most important factor affecting survival in patients experiencing VF is time to defibrillation. Survival is best if defibrillation occurs within 3–5 min of cardiac arrest.
As with any pulseless arrest, contributing factors must be investigated and addressed. When VF is refractory to electrical treatment, IV administration of adrenaline 1 mg or amiodarone 150–300 mg may improve the response to electrical defibrillation. Adjunctive therapy with amiodarone, lidocaine, or magnesium may be indicated. A precordial thump is occasionally effective in the termination of VF but should only be attempted if a defibrillator is not immediately available [25]. Standard ACLS algorithms should be followed for electrical, pharmacological, and adjunct therapy.
6.5.2.4 Torsades de pointes (TdP)
It is an atypical polymorphic form of VT characterized by a constantly changing/twisting QRS axis around the baseline. A non-uniform delay in repolarization is the underlying electrophysiological derangement, manifested as prolonged QT interval on ECG. Tdp is usually short in duration and spontaneously reverts to sinus rhythm. However, rapidly recurring episodes may degenerate into VF and cardiac arrest [26]. The management of Tdp depends on hemodynamic stability and is initially aimed at correction of the precipitating factors and use of intravenous magnesium as cellular membrane stabilizer:
Single episode and hemodynamically stable: intravenous magnesium sulfate is the first-line therapy and helps to prevent recurrent arrhythmias.
Multiple self-terminating episodes and hemodynamically stable: intravenous magnesium and consider temporary transvenous overdrive atrial pacing and/or intravenous isoproterenol infusion, to reduce the RR interval and repolarization time.
Hemodynamic instability: prompt synchronized electrical cardioversion, and intravenous magnesium.
Pulseless arrhythmia: Follow VF treatment approach. Intravenous magnesium should be administered. Avoid amiodarone since it has a proarrhythmic effect because of the additional prolongation of the QTc interval but administer intravenous lidocaine instead.
Lidocaine is the preferred antiarrhythmic drug for TdP, though there is a lack of evidence to support its use. Other antiarrhythmic drugs such as amiodarone, procainamide, beta-blockers further prolong the QT interval and therefore worsen the condition. β-blockers will slow down the heart rate, increasing the risk of TdP.
6.5.2.5 Pulseless electrical activity (PEA)
PEA, previously known as electromechanical dissociation, is a life-threatening, non-shockable cardiac rhythm. It occurs when the electrical activity of the heart persists but does not usually follow sufficient ventricular response to produce a sufficient cardiac output to generate a pulse and supply blood to the organs in the body. While the absence of a pulse confirms a clinical diagnosis of cardiac arrest, PEA can only be differentiated from other causes of cardiac arrest by ECG. This means that PEA includes any pulseless waveform except for VF, VT, or asystole. PEA is often caused by a profound cardiovascular insult which weakens the cardiac contraction and is usually exacerbated by worsening acidosis, hypoxia, and increasing vagal tone (Table 6). Further compromise of the inotropic state of the cardiac muscle leads to inadequate mechanical activity, despite the presence of electrical activity and ultimately causing degeneration of the rhythm and death of the patient. Overall, the prognosis of PEA patients is poor and still shows a high mortality rate despite optimum CPR.
4Hs
4Ts
Hypoxia
Toxicity
Hypovolemia
Tamponade (cardiac)
Hypothermia/hyperthermia
Tension pneumothorax
Hypokalemia/hyperkalemia (electrolyte disorders) and hydrogen ions (acidosis)
Thromboembolism (coronary or pulmonary)
Table 6.
Factors contributing to the etiology of PEA that is widely thought as 4Hs and 4Ts include as following.
Prompt and good quality CPR according to ACLS guidelines to maintain cardiac output until the PEA can be corrected is the first step in the management of PEA, while potential underlying causes are identified and addressed [27]. Once a diagnosis is made, specific therapy to treat the cause should be commenced immediately. This process may involve the decompression of pneumothorax, pericardial drain for tamponade, fluids infusion for hypovolemia, correction of body temperature for hypothermia, administration of thrombolytics pulmonary embolism, and early coronary angiography with percutaneous coronary intervention (PCI) in patients with myocardial infarction. Where it is not possible to determine and/or reverse the underlying cause of PEA, the treatment of PEA is similar to that of asystole. The mainstay of drug therapy for PEA arrest is intravenous adrenaline 1 mg every 3–5 min. The routine use of sodium bicarbonate is not recommended, except in special situations (e.g., severe metabolic acidosis or hyperkalemia). Atropine is generally no longer recommended for PEA as it has not been shown to have a therapeutic benefit. Defibrillators cannot be used to correct this rhythm, as the problem lies in the response of the myocardial tissue to electrical impulses. Although PEA and asystole are often considered fatal arrhythmias, PEA has a slightly better outcome than asystole. Previous data by the National Registry of Cardiopulmonary Resuscitation in 2003 revealed that 10% of hospital patients whose initial rhythm is PEA survive with good neurological outcomes [28].
7. Post resuscitation care
Resuscitation of an intraoperative cardiac arrest victim does not end with ROSC and must be tailored to the needs of the individual patient.
Following ROSC after cardiac arrest, many patients suffer from post-cardiac arrest syndrome, which is a high inflammatory state characterized by brain injury, myocardial dysfunction, systemic ischemia and reperfusion injury, and persistent precipitating pathology [29]. The severity of this syndrome varies according to the duration and cause of cardiac arrest. Management of these patients is challenging and requires a structured approach including restoration of adequate hemodynamics and organ perfusion, optimizing ventilation, treatment of electrolyte abnormalities, glycemic control targeted temperature management, and multimodal prognostication to improve outcomes. Specific therapy is determined by the etiology of arrest and initiating treatment to prevent recurrence [30].
The flow diagram is designed as a step-by-step guide to critical arrhythmias management in the operating room, as shown in Figure 4 [26, 31].
Figure 4.
Summary of management of critical arrhythmias at any time in the operating room [26, 29]. CPR: cardiopulmonary resuscitation; OR: operating room; ROSC: return of spontaneous circulation.
8. Conclusions
Cardiac arrhythmias can occur in all stages of anesthesia and surgical procedures. They are relatively frequent and continue to be an important source of morbidity and mortality among surgical patients. Most arrhythmias are benign, but some can progress to malignant arrhythmias and necessitate an urgent response. A thorough understanding of the arrhythmias, timely diagnosis as well as performing an early intervention with appropriate therapy enables a proactive approach to patient management and is life-saving for patients.
Conflict of interest
The authors declare no conflict of interest.
\n',keywords:"arrhythmias, anesthesia, surgery, life-threatening, intraoperatively",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/79449.pdf",chapterXML:"https://mts.intechopen.com/source/xml/79449.xml",downloadPdfUrl:"/chapter/pdf-download/79449",previewPdfUrl:"/chapter/pdf-preview/79449",totalDownloads:156,totalViews:0,totalCrossrefCites:0,dateSubmitted:"July 4th 2021",dateReviewed:"October 24th 2021",datePrePublished:"November 25th 2021",datePublished:"March 9th 2022",dateFinished:"November 25th 2021",readingETA:"0",abstract:"Life-threatening arrhythmias are frequently encountered during anesthesia for cardiac or non-cardiac surgery. They result in a significant cause of morbidity and mortality, particularly in elderly patients. Predisposing factors like electrolytes abnormalities, pre-existing cardiac disease, intubation procedure, anesthetic medications, and various surgical stimulation need to be determined. Early diagnosis and commencement of an appropriate treatment protocol may be lifesaving. Treatment usually involves correction of the underlying causes, cardiac electroversion, and the use of one or more antiarrhythmic agents. Although ventricular tachycardia, ventricular fibrillation, torsade de pointes, and pulseless electrical activity are considered malignant arrhythmias that can lead to cardiac arrest, other types of Brady and tachyarrhythmias are also included in this chapter to enable adopting a more objective approach in the management of arrhythmias intraoperatively, avoiding risks of inappropriate management strategies.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/79449",risUrl:"/chapter/ris/79449",signatures:"Zuraini Md. Noor",book:{id:"10704",type:"book",title:"Cardiac Arrhythmias",subtitle:"Translational Approach from Pathophysiology to Advanced Care",fullTitle:"Cardiac Arrhythmias - Translational Approach from Pathophysiology to Advanced Care",slug:"cardiac-arrhythmias-translational-approach-from-pathophysiology-to-advanced-care",publishedDate:"March 9th 2022",bookSignature:"Endre Zima",coverURL:"https://cdn.intechopen.com/books/images_new/10704.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83969-506-3",printIsbn:"978-1-83969-505-6",pdfIsbn:"978-1-83969-507-0",isAvailableForWebshopOrdering:!0,editors:[{id:"201263",title:"Dr.",name:"Endre",middleName:null,surname:"Zima",slug:"endre-zima",fullName:"Endre Zima"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"353513",title:"Dr.",name:"Zuraini",middleName:null,surname:"Md. Noor",fullName:"Zuraini Md. Noor",slug:"zuraini-md.-noor",email:"drzuraini@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_1_2",title:"1.1 Definition of cardiac arrhythmias",level:"2"},{id:"sec_3",title:"2. Mechanism of intraoperative arrhythmias",level:"1"},{id:"sec_4",title:"3. Contributing factors and causes of arrhythmias during anesthesia for surgery",level:"1"},{id:"sec_5",title:"4. Anesthetic agents and adjuvants related to arrhythmias",level:"1"},{id:"sec_6",title:"5. Diagnostic evaluation",level:"1"},{id:"sec_7",title:"6. Specific intra-operative arrhythmias",level:"1"},{id:"sec_7_2",title:"6.1 Antiarrhythmic drugs",level:"2"},{id:"sec_8_2",title:"6.2 Pacing and cardiac electroversion",level:"2"},{id:"sec_9_2",title:"6.3 Management of arrhythmias during anesthesia and surgery",level:"2"},{id:"sec_10_2",title:"6.4 Bradyarrhythmia",level:"2"},{id:"sec_10_3",title:"6.4.1 Conduction defects",level:"3"},{id:"sec_12_2",title:"6.5 Tachyarrhythmia",level:"2"},{id:"sec_12_3",title:"6.5.1 Supraventricular arrhythmias",level:"3"},{id:"sec_12_4",title:"6.5.1.1 Premature atrial contractions (PACs)",level:"4"},{id:"sec_13_4",title:"6.5.1.2 Paroxysmal supraventricular tachycardia (PSVT)",level:"4"},{id:"sec_14_4",title:"6.5.1.3 Atrial flutter",level:"4"},{id:"sec_15_4",title:"6.5.1.4 Atrial fibrillation (AF)",level:"4"},{id:"sec_17_3",title:"Table 6.",level:"3"},{id:"sec_17_4",title:"6.5.2.1 Ventricular extrasystole or premature ventricular contractions (PVCs)",level:"4"},{id:"sec_18_4",title:"6.5.2.2 Ventricular tachycardia (VT)",level:"4"},{id:"sec_19_4",title:"6.5.2.3 Ventricular fibrillation (VF)",level:"4"},{id:"sec_20_4",title:"6.5.2.4 Torsades de pointes (TdP)",level:"4"},{id:"sec_21_4",title:"Table 6.",level:"4"},{id:"sec_25",title:"7. Post resuscitation care",level:"1"},{id:"sec_26",title:"8. Conclusions",level:"1"},{id:"sec_30",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'Forrest JB, Cahalan MK, Rehder K, Goldsmith CH, Levy WJ, Strunin L, et al. Multicenter study of general anaesthesia II. Results. Anesthesiology. 1990;72:262-268'},{id:"B2",body:'Forrest J, Rehder K, Cahalan M, Goldsmith C. Multicenter study of general anaesthesia III. Predictors of severe perioperative adverse outcomes. Anesthesiology. 1992;76:3-15'},{id:"B3",body:'Katz R, Bigger T. Cardiac arrhythmias during anaesthesia and operation. Anesthesiology. 1970;33(2):193-194'},{id:"B4",body:'Dua N, Kumra VP. Management of perioperative arrhythmias. Indian Journal of Anaesthesia. 2007;51(4):310-323'},{id:"B5",body:'Altinbas A, Tas N, Bektas O. Perioperative arrhythmias. Middle Black Sea Journal of Health Science. 2017;3(3):41-48. DOI: 10.19127/mbsjohs.353187'},{id:"B6",body:'Kennedy A, Finlay D, Guldenring D, Bond R, Moran K, McLaughlin J. The cardiac conduction system: Generation and conduction of cardiac impulse. Critical Care Nursing Clinics of North America. 2016;28(3):269-279. DOI: 10.1016/j.cnc.2016.04.001'},{id:"B7",body:'Methangkool E, Howard-Quijano K, Mahajan A. Cardiac dysrhythmias. Understanding mechanisms, drug treatments, and novel therapies. Advances in Anesthesia. 2018;36:181-199. DOI: 10.1016/j.aan.2018.07.008'},{id:"B8",body:'Toprak V, Yentur A, Sakarya M. Anaesthetic management of severe bradycardia during general anaesthesia using temporary cardiac pacing. British Journal of Anaesthesia. 2002;89(4):655-657. DOI: 10.1093/bja/aef240'},{id:"B9",body:'Feely T. Management of perioperative arrythmias. Journal of Cardiothoracic and Vascular Anesthesia. 1997;11(2):10-15'},{id:"B10",body:'Owczuk R, Wujtewicz MA, Zienciuk-Krajka A, Lasinska-Kowara M, Piankowski A, Wujtewicz M. The influence of anaesthesia on cardiac repolarization. Minerva Anestesiologica. 2012;78(4):483-495'},{id:"B11",body:'Staikou C, Stamelos M, Stavroulakis E. Impact of anaesthetic drugs and adjuvants on ECG markers of torsadogenicity. British Journal of Anaesthesia. 2014;112(2):217-230. DOI: 10.1093/bja/aet412'},{id:"B12",body:'Hunter J, Sharma P, Rathi S. Long QT syndrome. Continuing Education in Anaesthesia, Critical Care and Pain. 2008;8(2):67-70. DOI: 10.1093/bjaceaccp/mkn003'},{id:"B13",body:'Noronha D, Mauricio S, Rodrigues I. Long QT syndrome and anaesthesia. Anaesthesia Tutorial of The Week. 2021;449:8 Available from: https://resources.wfsahq.org/atotw/long-qt-syndrome-and-anaesthesia/'},{id:"B14",body:'Niimi N, Yuki K, Zaleski K. Long QT syndrome and perioperative torsade de pointes: What the anaesthesiologist should know. Journal of Cardiothoracic and Vascular Anaesthesia. 2020;00:1-17. DOI: 10.1053/j.jvca.2020.12.011'},{id:"B15",body:'Fazio G, Vernuccio F, Grutta G, Lo RG. Drugs to be avoided in patients with long QT syndrome: Focus on the anaesthesiologist management. World Journal of Cardiology. 2013;5(4):87-93. DOI: 10.4330/wjc.v5.i4.87'},{id:"B16",body:'Kabade S, Shankar B, Venkatesh Y. Perioperative cardiac arrhythmias: An approach. Journal of Evolution of Medical and Dental Sciences. 2014;37(3):9633-9647. DOI: 10.14260/jemds/2014/3247'},{id:"B17",body:'Kwon CH, Kim S-H. Intraoperative management of critical arrhythmia. Korean Journal of Anaesthesiology. 2017;70(2):120-126. DOI: 10.4097/kjae.2017.70.2.120'},{id:"B18",body:'Part 5:Electrical therapies. Automated external defibrillators, defibrillation, cardioversion and pacing. Circulation American Heart Association. 2005;112:IV-35-IV-46. DOI: 10.1161/CIRCULATIONAHA.105.166554'},{id:"B19",body:'Stewart A, Greaves K, Bromilow J. Supraventricular tacharrhythmias and their management in the perioperative period. Continuing Education in Anaesthesia, Critical Care & Pain. 2015;15(2):90-97. DOI: 10.1093/bjaceaccp/mku018'},{id:"B20",body:'Parida S, Thangaswamy C. Cardiac tachyarrhythmias and anaesthesia: General principles and focus on atrial fibrillation. Indian Journal of Anaesthesia. 2017;61:712-720. DOI: 10.4103/ija.IJA_383_17'},{id:"B21",body:'Part 7:Adult advanced cardiovascular life support. Circulation American Heart Association. 2015;132:(suppl. 2):S444-S464. DOI: 10.1161/CIR.0000000000000261'},{id:"B22",body:'Nathanson MH, Gajraj NM. The peri-operative management of atrial fibrillation. Anaesthesia. 1998;53:665-676'},{id:"B23",body:'Dan G-A, Martinez-Rubio A, Agewall S, Boriani G, Borggrefe M, Gaita F, et al. Antiarrhythmic drugs-clinical use and clinical decision making: A consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group on Cardiovascular Pharmacology, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and International Society of Cardiovascular Pharmacotherapy. European Society of Cardiology (ESC). 2018;20:731-732. DOI: 10.1093/europace/eux373'},{id:"B24",body:'Lorentz MN, Vianna B. Cardiac dysrhythmias and anaesthesia. Revista Brasileira de Anestesiologia. 2011;61(6):798-813'},{id:"B25",body:'Hines R, Marschall K. Stoelting’s. Abnormalities of cardiac conduction and cardiac rhythm. Anaesthesia and Co-existing Disease. 7th ed. Philadelphia, PA: Elsevier; 2018. pp. 151-200'},{id:"B26",body:'Hutchins D. Perioperative Cardiac Arrhythmias: Part Two. Ventricular Dysrhythmias. Anaesthesia Tutorial of the Week 285. 2013. Available from: https://resources.wfsahq.org/atotw/peri-operative-cardiac-arrhythmias-part-two-ventricular-dysrhythmias-anaesthesia-tutorial-of-the-week-285/'},{id:"B27",body:'Myerburg R, Halperin H, Egan D, Boineau R, Chugh S, Gillis A, et al. Pulseless electrical activity: Definition, causes, mechanisms, management, and research priorities for the next decade: Report From a National Heart, Lung, and Blood Institute Workshop. Circulation AHA. 2013;128(23):2532-2541. DOI: 10.1161/CIRCULATIONAHA.113.004490'},{id:"B28",body:'Peberdy MA, Kaye W, Ornato J, Larkin G, Nadkarni V, Elizabeth M, et al. Cardiopulmonary resuscitation of adults in the hospital: A report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation Journal. 2003;58:297-308'},{id:"B29",body:'Walker A, Johnson N. Critical care of the post-cardiac arrest patient. Cardiology Clinics. 2018;36(3):419-428. DOI: 10.1016/j.ccl.2018.03.009'},{id:"B30",body:'Ben-Jacob TK, Moitra VK, O’Connor MF. Intraoperative advanced cardiac life support (ACLS) [Uptodate.com]. 2021. Available from: https://www.uptodate.com/contents/intraoperative-advanced-cardiac-life-support [Accessed: September 18, 2021]'},{id:"B31",body:'Horvath B. Malignant arrhythmia and cardiac arrest in the operating room. [Internet]. 2021. Available from: https://emedicine.medscape.com/article/2500081-overview [Accessed: August 24, 2021]'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Zuraini Md. Noor",address:"drzuraini@gmail.com",affiliation:'
Hospital Serdang, Selangor, Malaysia
'}],corrections:null},book:{id:"10704",type:"book",title:"Cardiac Arrhythmias",subtitle:"Translational Approach from Pathophysiology to Advanced Care",fullTitle:"Cardiac Arrhythmias - Translational Approach from Pathophysiology to Advanced Care",slug:"cardiac-arrhythmias-translational-approach-from-pathophysiology-to-advanced-care",publishedDate:"March 9th 2022",bookSignature:"Endre Zima",coverURL:"https://cdn.intechopen.com/books/images_new/10704.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83969-506-3",printIsbn:"978-1-83969-505-6",pdfIsbn:"978-1-83969-507-0",isAvailableForWebshopOrdering:!0,editors:[{id:"201263",title:"Dr.",name:"Endre",middleName:null,surname:"Zima",slug:"endre-zima",fullName:"Endre Zima"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},profile:{item:{id:"285502",title:"Associate Prof.",name:"Firas",middleName:null,surname:"Abdulrazzak",email:"firas_habeb2000@yahoo.com",fullName:"Firas Abdulrazzak",slug:"firas-abdulrazzak",position:null,biography:null,institutionString:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",totalCites:0,totalChapterViews:"0",outsideEditionCount:0,totalAuthoredChapters:"1",totalEditedBooks:"0",personalWebsiteURL:null,twitterURL:null,linkedinURL:null,institution:null},booksEdited:[],chaptersAuthored:[{id:"66164",title:"Behavior of X-Ray Analysis of Carbon Nanotubes",slug:"behavior-of-x-ray-analysis-of-carbon-nanotubes",abstract:"Carbon nanotubes with a variety of types occupied an amazing position compared to other nanomaterials due to rarer and specific physical and chemical properties. The behavior of graphite or graphite nanotubes theoretically and experimentally encourages their use in huge applications such as industries, fields of energy, and the environment. Many attempts are being made to get more of these benefits by a better understanding of the nature of carbon nanotubes. One of the ways to achieve this aim is by enhancing the acquaintance of characterization such as spectroscopy analysis and image microscopy. In this chapter, we are concerned with using X-ray as a source to produce clear imaginations for a tubular structure. Thus, the common ways that use X-ray as a source to interact with carbon nanotubes will be reviewed with details of characterization such as XRD, XRF, XPS, and EDX techniques.",signatures:"Firas Habeb Abdulrazzak, Ayad Fadel Alkiam and Falah Hasan Hussein",authors:[{id:"285502",title:"Associate Prof.",name:"Firas",surname:"Abdulrazzak",fullName:"Firas Abdulrazzak",slug:"firas-abdulrazzak",email:"firas_habeb2000@yahoo.com"}],book:{id:"7640",title:"Perspective of Carbon Nanotubes",slug:"perspective-of-carbon-nanotubes",productType:{id:"1",title:"Edited Volume"}}}],collaborators:[{id:"41703",title:"Dr.",name:"Mohamed",surname:"Berber",slug:"mohamed-berber",fullName:"Mohamed Berber",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41703/images/system/41703.png",biography:"Dr. Mohamed Reda BERBER has obtained his PhD from Tokushima University, Japan, followed by a fellowship at Kyushu University. Also, he was awarded with a doctoral Fellowship from I2CNER, Japan. Currently, he is an associate professor at Chemistry Department, Faculty of Science, Tanta University.\r\nDr. BERBER carried out a scientific research for more than 21 years and has contributed in several areas of polymers research and technology. He authored, co-authored and edited five academic books, published 41 academic papers, and presented 89 conference papers. Dr. BERBER is internationally recognized for his work in chemistry and his recent results of PEFCs were highlighted in NATURE. He was recently awarded with the Presidential Medal of Excellence of First Grade from the president of Egypt and also with the State Encouragement Award of scientific research development 2017.",institutionString:"Tanta University",institution:{name:"Zewail City of Science and Technology",institutionURL:null,country:{name:"Egypt"}}},{id:"208314",title:"Associate Prof.",name:"Norihiro",surname:"Shimoi",slug:"norihiro-shimoi",fullName:"Norihiro Shimoi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Tohoku University",institutionURL:null,country:{name:"Japan"}}},{id:"272217",title:"Dr.",name:"Arti",surname:"Rushi",slug:"arti-rushi",fullName:"Arti Rushi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272217/images/system/272217.jpg",biography:"Arti Dinkarrao Rushi is currently an assistant professor in the Department of Electronics and Telecommunication Engineering, Maharashtra Institute of Technology, Aurangabad (MS), India. Her areas of interest include nanotechnology, electrochemical sensors, functionalized materials, macrocyclic compounds, and the application of sensors for environment protection. She has published thirty-nine research papers in various international journals, books, and conferences.",institutionString:"Maharashtra Institute of Technology",institution:{name:"Maharashtra Institute of Technology - Art, Design and Technology University",institutionURL:null,country:{name:"India"}}},{id:"281779",title:"Prof.",name:"Mohamed",surname:"Mustafa",slug:"mohamed-mustafa",fullName:"Mohamed Mustafa",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"283229",title:"Dr.",name:"Inas",surname:"Hafez",slug:"inas-hafez",fullName:"Inas Hafez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"285875",title:"Dr.",name:"Marianna V.",surname:"Kharlamova",slug:"marianna-v.-kharlamova",fullName:"Marianna V. Kharlamova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/285875/images/system/285875.jpg",biography:"Dr. Marianna V. Kharlamova holds a Ph.D. degree in Physics (Spectroscopy) from the University of Vienna (Vienna, Austria) and a Ph.D. in Chemistry (Inorganic Chemistry, Solid State Chemistry) from Lomonosov Moscow State University (Moscow, Russia). She graduated from Lomonosov Moscow State University with an MSc degree in Chemistry and a BSc degree in Materials Science. She is currently working as a Senior Postdoc at the Institute of Materials Chemistry, Vienna University of Technology (Vienna, Austria), and Moscow Institute of Physics and Technology (Dolgoprudny, Russia). Her research interests include the electronic properties of carbon nanomaterials, including carbon nanotubes, and spectroscopic investigations of the physical and chemical properties of carbon nanomaterials. In particular, she uses Raman spectroscopy for the investigations of carbon nanomaterials. She co-authored 3 books, 6 book chapters (two chapters were published by IntechOpen), and 55 peer-reviewed research articles (including 4 reviews). Among them, 2 books and 50 research articles are dedicated to Raman spectroscopy investigations of carbon nanomaterials.",institutionString:"Vienna University of Technology",institution:{name:"TU Wien",institutionURL:null,country:{name:"Austria"}}},{id:"293763",title:"Prof.",name:"Dominik",surname:"Eder",slug:"dominik-eder",fullName:"Dominik Eder",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"294686",title:"Dr.",name:"Kunal",surname:"Datta",slug:"kunal-datta",fullName:"Kunal Datta",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294686/images/system/294686.jpg",biography:"Kunal Datta is currently an assistant professor in the Industrial Automation Division, Deen Dayal Upadhayay Kaushal Kendra (DDUKK), Dr. Babasaheb Ambedkar Marathwada University, Aurangabad (MS), India. He has fifteen years of research experience in instrumentation, automation, and electrochemical sensors (based on functional nanomaterials, namely single-walled nanotubes, porphyrins, organic conducting polymers, and nanoparticles). His research focuses on the real-time measurement of inorganic/organic air pollutants from the environment, the development of technical didactic tools, and industrial robotics. He has published fifty-four research papers in various international journals, books, and conferences.",institutionString:"Dr. Babasaheb Ambedkar Marathwada University",institution:{name:"Dr. Babasaheb Ambedkar Marathwada University",institutionURL:null,country:{name:"India"}}},{id:"294687",title:"Dr.",name:"Prasanta",surname:"Ghosh",slug:"prasanta-ghosh",fullName:"Prasanta Ghosh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294687/images/system/294687.jpg",biography:"Prasanta Kumar Ghosh is currently an assistant professor in the School of Physics, Dr. Vishwanath Karad MIT World Peace University (MIT-WPU), Pune (MS), India. He is an active researcher in the broad area of organic/inorganic functional materials, including organic field-effect transistors, inorganic/organic hybrids, and advanced sensors based on organic matter and SHI Irradiation. He has fifteen years of experience in the field of nanomaterials, microdevices, and instrumentation. He provides industrial and research solutions with low-cost automation and indigenous instrumentation. He has published fifty-two research papers in various international journals, books, and conferences.",institutionString:"School of Physics, MIT-World Peace University (MIT-WPU)",institution:null},{id:"294688",title:"Prof.",name:"Mahendra",surname:"Shirsat",slug:"mahendra-shirsat",fullName:"Mahendra Shirsat",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null}]},generic:{page:{slug:"open-access-funding-funders-list",title:"List of Funders by Country",intro:"
If your research is financed through any of the below-mentioned funders, please consult their Open Access policies or grant ‘terms and conditions’ to explore ways to cover your publication costs (also accessible by clicking on the link in their title).
\n\n
IMPORTANT: You must be a member or grantee of the listed funders in order to apply for their Open Access publication funds. Do not attempt to contact the funders if this is not the case.
",metaTitle:"List of Funders by Country",metaDescription:"If your research is financed through any of the below-mentioned funders, please consult their Open Access policies or grant ‘terms and conditions’ to explore ways to cover your publication costs (also accessible by clicking on the link in their title).",metaKeywords:null,canonicalURL:"/page/open-access-funding-funders-list",contentRaw:'[{"type":"htmlEditorComponent","content":"
UK Research and Innovation (former Research Councils UK (RCUK) - including AHRC, BBSRC, ESRC, EPSRC, MRC, NERC, STFC.) Processing charges for books/book chapters can be covered through RCUK block grants which are allocated to most universities in the UK, which then handle the OA publication funding requests. It is at the discretion of the university whether it will approve the request.)
UK Research and Innovation (former Research Councils UK (RCUK) - including AHRC, BBSRC, ESRC, EPSRC, MRC, NERC, STFC.) Processing charges for books/book chapters can be covered through RCUK block grants which are allocated to most universities in the UK, which then handle the OA publication funding requests. It is at the discretion of the university whether it will approve the request.)
Wellcome Trust (Funding available only to Wellcome-funded researchers/grantees)
\n
\n'}]},successStories:{items:[]},authorsAndEditors:{filterParams:{mdrv:"www.intechopen.com"},profiles:[{id:"6700",title:"Dr.",name:"Abbass A.",middleName:null,surname:"Hashim",slug:"abbass-a.-hashim",fullName:"Abbass A. Hashim",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/6700/images/1864_n.jpg",biography:"Currently I am carrying out research in several areas of interest, mainly covering work on chemical and bio-sensors, semiconductor thin film device fabrication and characterisation.\nAt the moment I have very strong interest in radiation environmental pollution and bacteriology treatment. The teams of researchers are working very hard to bring novel results in this field. I am also a member of the team in charge for the supervision of Ph.D. students in the fields of development of silicon based planar waveguide sensor devices, study of inelastic electron tunnelling in planar tunnelling nanostructures for sensing applications and development of organotellurium(IV) compounds for semiconductor applications. I am a specialist in data analysis techniques and nanosurface structure. I have served as the editor for many books, been a member of the editorial board in science journals, have published many papers and hold many patents.",institutionString:null,institution:{name:"Sheffield Hallam University",country:{name:"United Kingdom"}}},{id:"54525",title:"Prof.",name:"Abdul Latif",middleName:null,surname:"Ahmad",slug:"abdul-latif-ahmad",fullName:"Abdul Latif Ahmad",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"20567",title:"Prof.",name:"Ado",middleName:null,surname:"Jorio",slug:"ado-jorio",fullName:"Ado Jorio",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidade Federal de Minas Gerais",country:{name:"Brazil"}}},{id:"47940",title:"Dr.",name:"Alberto",middleName:null,surname:"Mantovani",slug:"alberto-mantovani",fullName:"Alberto Mantovani",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"12392",title:"Mr.",name:"Alex",middleName:null,surname:"Lazinica",slug:"alex-lazinica",fullName:"Alex Lazinica",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/12392/images/7282_n.png",biography:"Alex Lazinica is the founder and CEO of IntechOpen. After obtaining a Master's degree in Mechanical Engineering, he continued his PhD studies in Robotics at the Vienna University of Technology. Here he worked as a robotic researcher with the university's Intelligent Manufacturing Systems Group as well as a guest researcher at various European universities, including the Swiss Federal Institute of Technology Lausanne (EPFL). During this time he published more than 20 scientific papers, gave presentations, served as a reviewer for major robotic journals and conferences and most importantly he co-founded and built the International Journal of Advanced Robotic Systems- world's first Open Access journal in the field of robotics. Starting this journal was a pivotal point in his career, since it was a pathway to founding IntechOpen - Open Access publisher focused on addressing academic researchers needs. Alex is a personification of IntechOpen key values being trusted, open and entrepreneurial. Today his focus is on defining the growth and development strategy for the company.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"19816",title:"Prof.",name:"Alexander",middleName:null,surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/19816/images/1607_n.jpg",biography:"Alexander I. Kokorin: born: 1947, Moscow; DSc., PhD; Principal Research Fellow (Research Professor) of Department of Kinetics and Catalysis, N. Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow.\r\nArea of research interests: physical chemistry of complex-organized molecular and nanosized systems, including polymer-metal complexes; the surface of doped oxide semiconductors. He is an expert in structural, absorptive, catalytic and photocatalytic properties, in structural organization and dynamic features of ionic liquids, in magnetic interactions between paramagnetic centers. The author or co-author of 3 books, over 200 articles and reviews in scientific journals and books. He is an actual member of the International EPR/ESR Society, European Society on Quantum Solar Energy Conversion, Moscow House of Scientists, of the Board of Moscow Physical Society.",institutionString:null,institution:{name:"Semenov Institute of Chemical Physics",country:{name:"Russia"}}},{id:"62389",title:"PhD.",name:"Ali Demir",middleName:null,surname:"Sezer",slug:"ali-demir-sezer",fullName:"Ali Demir Sezer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62389/images/3413_n.jpg",biography:"Dr. Ali Demir Sezer has a Ph.D. from Pharmaceutical Biotechnology at the Faculty of Pharmacy, University of Marmara (Turkey). He is the member of many Pharmaceutical Associations and acts as a reviewer of scientific journals and European projects under different research areas such as: drug delivery systems, nanotechnology and pharmaceutical biotechnology. Dr. Sezer is the author of many scientific publications in peer-reviewed journals and poster communications. Focus of his research activity is drug delivery, physico-chemical characterization and biological evaluation of biopolymers micro and nanoparticles as modified drug delivery system, and colloidal drug carriers (liposomes, nanoparticles etc.).",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"61051",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"100762",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"St David's Medical Center",country:{name:"United States of America"}}},{id:"107416",title:"Dr.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Texas Cardiac Arrhythmia",country:{name:"United States of America"}}},{id:"64434",title:"Dr.",name:"Angkoon",middleName:null,surname:"Phinyomark",slug:"angkoon-phinyomark",fullName:"Angkoon Phinyomark",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/64434/images/2619_n.jpg",biography:"My name is Angkoon Phinyomark. I received a B.Eng. degree in Computer Engineering with First Class Honors in 2008 from Prince of Songkla University, Songkhla, Thailand, where I received a Ph.D. degree in Electrical Engineering. My research interests are primarily in the area of biomedical signal processing and classification notably EMG (electromyography signal), EOG (electrooculography signal), and EEG (electroencephalography signal), image analysis notably breast cancer analysis and optical coherence tomography, and rehabilitation engineering. I became a student member of IEEE in 2008. During October 2011-March 2012, I had worked at School of Computer Science and Electronic Engineering, University of Essex, Colchester, Essex, United Kingdom. In addition, during a B.Eng. I had been a visiting research student at Faculty of Computer Science, University of Murcia, Murcia, Spain for three months.\n\nI have published over 40 papers during 5 years in refereed journals, books, and conference proceedings in the areas of electro-physiological signals processing and classification, notably EMG and EOG signals, fractal analysis, wavelet analysis, texture analysis, feature extraction and machine learning algorithms, and assistive and rehabilitative devices. I have several computer programming language certificates, i.e. Sun Certified Programmer for the Java 2 Platform 1.4 (SCJP), Microsoft Certified Professional Developer, Web Developer (MCPD), Microsoft Certified Technology Specialist, .NET Framework 2.0 Web (MCTS). I am a Reviewer for several refereed journals and international conferences, such as IEEE Transactions on Biomedical Engineering, IEEE Transactions on Industrial Electronics, Optic Letters, Measurement Science Review, and also a member of the International Advisory Committee for 2012 IEEE Business Engineering and Industrial Applications and 2012 IEEE Symposium on Business, Engineering and Industrial Applications.",institutionString:null,institution:{name:"Joseph Fourier University",country:{name:"France"}}},{id:"55578",title:"Dr.",name:"Antonio",middleName:null,surname:"Jurado-Navas",slug:"antonio-jurado-navas",fullName:"Antonio Jurado-Navas",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",biography:"Antonio Jurado-Navas received the M.S. degree (2002) and the Ph.D. degree (2009) in Telecommunication Engineering, both from the University of Málaga (Spain). He first worked as a consultant at Vodafone-Spain. From 2004 to 2011, he was a Research Assistant with the Communications Engineering Department at the University of Málaga. In 2011, he became an Assistant Professor in the same department. From 2012 to 2015, he was with Ericsson Spain, where he was working on geo-location\ntools for third generation mobile networks. Since 2015, he is a Marie-Curie fellow at the Denmark Technical University. His current research interests include the areas of mobile communication systems and channel modeling in addition to atmospheric optical communications, adaptive optics and statistics",institutionString:null,institution:{name:"University of Malaga",country:{name:"Spain"}}}],filtersByRegion:[{group:"region",caption:"North America",value:1,count:6597},{group:"region",caption:"Middle and South America",value:2,count:5902},{group:"region",caption:"Africa",value:3,count:2400},{group:"region",caption:"Asia",value:4,count:12537},{group:"region",caption:"Australia and Oceania",value:5,count:1006},{group:"region",caption:"Europe",value:6,count:17560}],offset:12,limit:12,total:132762},chapterEmbeded:{data:{}},editorApplication:{success:null,errors:{}},ofsBooks:{filterParams:{hasNoEditors:"1",sort:"dateEndThirdStepPublish",topicId:"8"},books:[{type:"book",id:"12073",title:"Solvents",subtitle:null,isOpenForSubmission:!0,hash:"d31c0b4deb8e2005ddefc42a4be8e451",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/12073.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12074",title:"Updates on Titanium Dioxide",subtitle:null,isOpenForSubmission:!0,hash:"8642ed95890654474416a163e3236afb",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/12074.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12075",title:"Arsenic",subtitle:null,isOpenForSubmission:!0,hash:"a1156f4143737baa68f568837f9edc94",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/12075.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12076",title:"Ruthenium",subtitle:null,isOpenForSubmission:!0,hash:"08bd1ab70c296e319165eb763b112e00",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/12076.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12077",title:"Heavy Metals",subtitle:null,isOpenForSubmission:!0,hash:"bcf87da8936c737e7fdd61cdc825128e",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/12077.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12079",title:"Heterocycles",subtitle:null,isOpenForSubmission:!0,hash:"fcadb070d3dbdf21157b1290d9880c3e",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/12079.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12080",title:"Density Functional Theory",subtitle:null,isOpenForSubmission:!0,hash:"fcd6287912c74f409babc8937c6d0fd1",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/12080.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12290",title:"Electrochemiluminescence",subtitle:null,isOpenForSubmission:!0,hash:"7a3bf39f9a3f87b0697d6855ab2d695b",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/12290.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12293",title:"Cobalt",subtitle:null,isOpenForSubmission:!0,hash:"c841e0833d63ee0f5962a22defe6d0b0",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/12293.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12295",title:"Noble Gases",subtitle:null,isOpenForSubmission:!0,hash:"ef0dbba5426cbb55e8b0150ff3642aae",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/12295.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12297",title:"Electrophile",subtitle:null,isOpenForSubmission:!0,hash:"ed99712e2d3a8ea85b8732d969e15ebd",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/12297.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"12299",title:"Benzene",subtitle:null,isOpenForSubmission:!0,hash:"e0fdce171959cc4ddc167e1f658121f3",slug:null,bookSignature:"",coverURL:"https://cdn.intechopen.com/books/images_new/12299.jpg",editedByType:null,editors:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],filtersByTopic:[{group:"topic",caption:"Agricultural and Biological Sciences",value:5,count:42},{group:"topic",caption:"Biochemistry, Genetics and Molecular Biology",value:6,count:12},{group:"topic",caption:"Business, Management and Economics",value:7,count:7},{group:"topic",caption:"Chemistry",value:8,count:17},{group:"topic",caption:"Computer and Information Science",value:9,count:18},{group:"topic",caption:"Earth and Planetary Sciences",value:10,count:18},{group:"topic",caption:"Engineering",value:11,count:46},{group:"topic",caption:"Environmental Sciences",value:12,count:7},{group:"topic",caption:"Immunology and Microbiology",value:13,count:11},{group:"topic",caption:"Materials Science",value:14,count:14},{group:"topic",caption:"Mathematics",value:15,count:6},{group:"topic",caption:"Medicine",value:16,count:107},{group:"topic",caption:"Nanotechnology and Nanomaterials",value:17,count:2},{group:"topic",caption:"Neuroscience",value:18,count:7},{group:"topic",caption:"Pharmacology, Toxicology and Pharmaceutical Science",value:19,count:11},{group:"topic",caption:"Physics",value:20,count:4},{group:"topic",caption:"Psychology",value:21,count:8},{group:"topic",caption:"Robotics",value:22,count:2},{group:"topic",caption:"Social Sciences",value:23,count:32},{group:"topic",caption:"Technology",value:24,count:1},{group:"topic",caption:"Veterinary Medicine and Science",value:25,count:2}],offset:12,limit:12,total:17},popularBooks:{featuredBooks:[],offset:0,limit:12,total:null},hotBookTopics:{hotBooks:[],offset:0,limit:12,total:null},publish:{},publishingProposal:{success:null,errors:{}},books:{featuredBooks:[],latestBooks:[]},subject:{topic:{id:"842",title:"Biodiversity",slug:"biodiversity",parent:{id:"126",title:"Ecology",slug:"environmental-sciences-ecology"},numberOfBooks:3,numberOfSeries:0,numberOfAuthorsAndEditors:192,numberOfWosCitations:395,numberOfCrossrefCitations:98,numberOfDimensionsCitations:434,videoUrl:null,fallbackUrl:null,description:null},booksByTopicFilter:{topicId:"842",sort:"-publishedDate",limit:12,offset:0},booksByTopicCollection:[{type:"book",id:"1364",title:"The Dynamical Processes of Biodiversity",subtitle:"Case Studies of Evolution and Spatial Distribution",isOpenForSubmission:!1,hash:"c91392a64dfd9abd2532f68ea7ac3e21",slug:"the-dynamical-processes-of-biodiversity-case-studies-of-evolution-and-spatial-distribution",bookSignature:"Oscar Grillo and Gianfranco Venora",coverURL:"https://cdn.intechopen.com/books/images_new/1364.jpg",editedByType:"Edited by",editors:[{id:"51992",title:"PhD.",name:"Oscar",middleName:null,surname:"Grillo",slug:"oscar-grillo",fullName:"Oscar Grillo"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1366",title:"Biodiversity Loss in a Changing Planet",subtitle:null,isOpenForSubmission:!1,hash:"d325a1437cd12bf8823408657080ee8a",slug:"biodiversity-loss-in-a-changing-planet",bookSignature:"Oscar Grillo and Gianfranco Venora",coverURL:"https://cdn.intechopen.com/books/images_new/1366.jpg",editedByType:"Edited by",editors:[{id:"51992",title:"PhD.",name:"Oscar",middleName:null,surname:"Grillo",slug:"oscar-grillo",fullName:"Oscar Grillo"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"17",title:"Herbicides and Environment",subtitle:null,isOpenForSubmission:!1,hash:null,slug:"herbicides-and-environment",bookSignature:"Andreas Kortekamp",coverURL:"https://cdn.intechopen.com/books/images_new/17.jpg",editedByType:"Edited by",editors:[{id:"14108",title:"Dr.",name:"Andreas",middleName:null,surname:"Kortekamp",slug:"andreas-kortekamp",fullName:"Andreas Kortekamp"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:3,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"12592",doi:"10.5772/12877",title:"Effects of Herbicide Glyphosate and Glyphosate-Based Formulations on Aquatic Ecosystems",slug:"effects-of-herbicide-glyphosate-and-glyphosate-based-formulations-on-aquatic-ecosystems",totalDownloads:5691,totalCrossrefCites:9,totalDimensionsCites:64,abstract:null,book:{id:"17",slug:"herbicides-and-environment",title:"Herbicides and Environment",fullTitle:"Herbicides and Environment"},signatures:"Gonzalo Luis Pérez, María Solange Vera and Leandro Miranda",authors:[{id:"13369",title:"Dr.",name:"Gonzalo Luis",middleName:null,surname:"Pérez",slug:"gonzalo-luis-perez",fullName:"Gonzalo Luis Pérez"},{id:"14902",title:"Dr.",name:"María Solange",middleName:null,surname:"Vera",slug:"maria-solange-vera",fullName:"María Solange Vera"},{id:"14903",title:"Dr.",name:"Leandro",middleName:null,surname:"Miranda",slug:"leandro-miranda",fullName:"Leandro Miranda"}]},{id:"12591",doi:"10.5772/13620",title:"Impacts of Biochar (Black Carbon) Additions on the Sorption and Efficacy of Herbicides",slug:"impacts-of-biochar-black-carbon-additions-on-the-sorption-and-efficacy-of-herbicides",totalDownloads:3966,totalCrossrefCites:3,totalDimensionsCites:44,abstract:null,book:{id:"17",slug:"herbicides-and-environment",title:"Herbicides and Environment",fullTitle:"Herbicides and Environment"},signatures:"Alegría Cabrera Mesa and Kurt Spokas",authors:[{id:"13745",title:"Dr.",name:"Kurt",middleName:null,surname:"Spokas",slug:"kurt-spokas",fullName:"Kurt Spokas"},{id:"23738",title:"Dr.",name:"Alegría",middleName:null,surname:"Cabrera Mesa",slug:"alegria-cabrera-mesa",fullName:"Alegría Cabrera Mesa"}]},{id:"23614",doi:"10.5772/23881",title:"Modern Methods of Estimating Biodiversity from Presence-Absence Surveys",slug:"modern-methods-of-estimating-biodiversity-from-presence-absence-surveys",totalDownloads:3285,totalCrossrefCites:0,totalDimensionsCites:22,abstract:null,book:{id:"1366",slug:"biodiversity-loss-in-a-changing-planet",title:"Biodiversity Loss in a Changing Planet",fullTitle:"Biodiversity Loss in a Changing Planet"},signatures:"Robert M. Dorazio, Nicholas J. Gotelli and Aaron M. Ellison",authors:[{id:"54270",title:"Dr.",name:"Robert",middleName:"M.",surname:"Dorazio",slug:"robert-dorazio",fullName:"Robert Dorazio"},{id:"60808",title:"Dr.",name:"Nicholas",middleName:null,surname:"Gotelli",slug:"nicholas-gotelli",fullName:"Nicholas Gotelli"},{id:"60809",title:"Dr.",name:"Aaron",middleName:null,surname:"Ellison",slug:"aaron-ellison",fullName:"Aaron Ellison"}]},{id:"24420",doi:"10.5772/23378",title:"Biodiversity of Trichoderma in Neotropics",slug:"biodiversity-of-trichoderma-in-neotropics",totalDownloads:4229,totalCrossrefCites:9,totalDimensionsCites:21,abstract:null,book:{id:"1364",slug:"the-dynamical-processes-of-biodiversity-case-studies-of-evolution-and-spatial-distribution",title:"The Dynamical Processes of Biodiversity",fullTitle:"The Dynamical Processes of Biodiversity - Case Studies of Evolution and Spatial Distribution"},signatures:"Lilliana Hoyos-Carvajal and John Bissett",authors:[{id:"51840",title:"Prof.",name:"Lilliana",middleName:"MarÃa",surname:"Hoyos-Carvajal",slug:"lilliana-hoyos-carvajal",fullName:"Lilliana Hoyos-Carvajal"},{id:"98558",title:"Dr.",name:"John",middleName:null,surname:"Bissett",slug:"john-bissett",fullName:"John Bissett"}]},{id:"24409",doi:"10.5772/23789",title:"The Origin of Diversity in Begonia: Genome Dynamism, Population Processes and Phylogenetic Patterns",slug:"the-origin-of-diversity-in-begonia-genome-dynamism-population-processes-and-phylogenetic-patterns",totalDownloads:4323,totalCrossrefCites:7,totalDimensionsCites:21,abstract:null,book:{id:"1364",slug:"the-dynamical-processes-of-biodiversity-case-studies-of-evolution-and-spatial-distribution",title:"The Dynamical Processes of Biodiversity",fullTitle:"The Dynamical Processes of Biodiversity - Case Studies of Evolution and Spatial Distribution"},signatures:"A. Dewitte, A.D. Twyford, D.C. Thomas, C.A. Kidner and J. Van Huylenbroeck",authors:[{id:"53763",title:"Dr.",name:"Angelo",middleName:null,surname:"Dewitte",slug:"angelo-dewitte",fullName:"Angelo Dewitte"},{id:"59917",title:"Mr",name:"Alex",middleName:null,surname:"Twyford",slug:"alex-twyford",fullName:"Alex Twyford"},{id:"59918",title:"Dr.",name:"Johan",middleName:null,surname:"Van Huylenbroeck",slug:"johan-van-huylenbroeck",fullName:"Johan Van Huylenbroeck"},{id:"84615",title:"Dr.",name:"Catherine",middleName:null,surname:"Kidner",slug:"catherine-kidner",fullName:"Catherine Kidner"},{id:"84617",title:"Dr.",name:"Daniel",middleName:null,surname:"Thomas",slug:"daniel-thomas",fullName:"Daniel Thomas"}]}],mostDownloadedChaptersLast30Days:[{id:"23611",title:"Limited Bio-Diversity and Other Defects of the Immune System in the Inhabitants of the Islands of St Kilda, Scotland",slug:"limited-bio-diversity-and-other-defects-of-the-immune-system-in-the-inhabitants-of-the-islands-of-st",totalDownloads:3614,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"1366",slug:"biodiversity-loss-in-a-changing-planet",title:"Biodiversity Loss in a Changing Planet",fullTitle:"Biodiversity Loss in a Changing Planet"},signatures:"Peter Stride",authors:[{id:"62425",title:"Dr.",name:"Peter",middleName:null,surname:"Stride",slug:"peter-stride",fullName:"Peter Stride"}]},{id:"24417",title:"Aquatic Fungi",slug:"aquatic-fungi",totalDownloads:9081,totalCrossrefCites:1,totalDimensionsCites:5,abstract:null,book:{id:"1364",slug:"the-dynamical-processes-of-biodiversity-case-studies-of-evolution-and-spatial-distribution",title:"The Dynamical Processes of Biodiversity",fullTitle:"The Dynamical Processes of Biodiversity - Case Studies of Evolution and Spatial Distribution"},signatures:"Wurzbacher Christian, Kerr Janice and Grossart Hans-Peter",authors:[{id:"50261",title:"Dr.",name:"Hans-Peter",middleName:null,surname:"Grossart",slug:"hans-peter-grossart",fullName:"Hans-Peter Grossart"},{id:"50283",title:"Mr.",name:"Christian",middleName:null,surname:"Wurzbacher",slug:"christian-wurzbacher",fullName:"Christian Wurzbacher"},{id:"86366",title:"Dr.",name:"Janice",middleName:"Laraine",surname:"Kerr",slug:"janice-kerr",fullName:"Janice Kerr"}]},{id:"24414",title:"Spatial Patterns of Phytodiversity - Assessing Vegetation Using (Dis) Similarity Measures",slug:"spatial-patterns-of-phytodiversity-assessing-vegetation-using-dis-similarity-measures",totalDownloads:2492,totalCrossrefCites:1,totalDimensionsCites:2,abstract:null,book:{id:"1364",slug:"the-dynamical-processes-of-biodiversity-case-studies-of-evolution-and-spatial-distribution",title:"The Dynamical Processes of Biodiversity",fullTitle:"The Dynamical Processes of Biodiversity - Case Studies of Evolution and Spatial Distribution"},signatures:"S. Babar, A. Giriraj, C. S. Reddy, G. Jurasinski, A. Jentsch and S. Sudhakar",authors:[{id:"60160",title:"Dr",name:"Giriraj",middleName:null,surname:"A.",slug:"giriraj-a.",fullName:"Giriraj A."},{id:"108958",title:"Dr.",name:"Shilpa",middleName:null,surname:"G.",slug:"shilpa-g.",fullName:"Shilpa G."},{id:"108961",title:"Dr.",name:"Reddy",middleName:null,surname:"C.S.",slug:"reddy-c.s.",fullName:"Reddy C.S."},{id:"108962",title:"Dr.",name:"Jurasinski",middleName:null,surname:"G.",slug:"jurasinski-g.",fullName:"Jurasinski G."},{id:"108964",title:"Prof.",name:"Anke",middleName:null,surname:"Jentsch",slug:"anke-jentsch",fullName:"Anke Jentsch"},{id:"108967",title:"Dr.",name:"Sudhakar",middleName:null,surname:"S.",slug:"sudhakar-s.",fullName:"Sudhakar S."}]},{id:"23610",title:"Provision of Natural Habitat for Biodiversity: Quantifying Recent Trends in New Zealand",slug:"provision-of-natural-habitat-for-biodiversity-quantifying-recent-trends-in-new-zealand",totalDownloads:2131,totalCrossrefCites:0,totalDimensionsCites:3,abstract:null,book:{id:"1366",slug:"biodiversity-loss-in-a-changing-planet",title:"Biodiversity Loss in a Changing Planet",fullTitle:"Biodiversity Loss in a Changing Planet"},signatures:"Anne-Gaelle E. Ausseil, John R. Dymond and Emily S. Weeks",authors:[{id:"60671",title:"Dr.",name:"John",middleName:null,surname:"Dymond",slug:"john-dymond",fullName:"John Dymond"},{id:"60673",title:"Dr.",name:"Anne-Gaelle",middleName:"Elsa",surname:"Ausseil",slug:"anne-gaelle-ausseil",fullName:"Anne-Gaelle Ausseil"},{id:"60674",title:"Ms.",name:"Emily",middleName:null,surname:"Weeks",slug:"emily-weeks",fullName:"Emily Weeks"}]},{id:"12592",title:"Effects of Herbicide Glyphosate and Glyphosate-Based Formulations on Aquatic Ecosystems",slug:"effects-of-herbicide-glyphosate-and-glyphosate-based-formulations-on-aquatic-ecosystems",totalDownloads:5693,totalCrossrefCites:9,totalDimensionsCites:64,abstract:null,book:{id:"17",slug:"herbicides-and-environment",title:"Herbicides and Environment",fullTitle:"Herbicides and Environment"},signatures:"Gonzalo Luis Pérez, María Solange Vera and Leandro Miranda",authors:[{id:"13369",title:"Dr.",name:"Gonzalo Luis",middleName:null,surname:"Pérez",slug:"gonzalo-luis-perez",fullName:"Gonzalo Luis Pérez"},{id:"14902",title:"Dr.",name:"María Solange",middleName:null,surname:"Vera",slug:"maria-solange-vera",fullName:"María Solange Vera"},{id:"14903",title:"Dr.",name:"Leandro",middleName:null,surname:"Miranda",slug:"leandro-miranda",fullName:"Leandro Miranda"}]}],onlineFirstChaptersFilter:{topicId:"842",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[],lsSeriesList:[],hsSeriesList:[],sshSeriesList:[],testimonialsList:[]},series:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"May 18th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:27,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:49,paginationItems:[{id:"80495",title:"Iron in Cell Metabolism and Disease",doi:"10.5772/intechopen.101908",signatures:"Eeka Prabhakar",slug:"iron-in-cell-metabolism-and-disease",totalDownloads:1,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Iron Metabolism - Iron a Double‐Edged Sword",coverURL:"https://cdn.intechopen.com/books/images_new/10842.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"81799",title:"Cross Talk of Purinergic and Immune Signaling: Implication in Inflammatory and Pathogenic Diseases",doi:"10.5772/intechopen.104978",signatures:"Richa Rai",slug:"cross-talk-of-purinergic-and-immune-signaling-implication-in-inflammatory-and-pathogenic-diseases",totalDownloads:7,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Purinergic System",coverURL:"https://cdn.intechopen.com/books/images_new/10801.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"81764",title:"Involvement of the Purinergic System in Cell Death in Models of Retinopathies",doi:"10.5772/intechopen.103935",signatures:"Douglas Penaforte Cruz, Marinna Garcia Repossi and Lucianne Fragel Madeira",slug:"involvement-of-the-purinergic-system-in-cell-death-in-models-of-retinopathies",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Purinergic System",coverURL:"https://cdn.intechopen.com/books/images_new/10801.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"81756",title:"Alteration of Cytokines Level and Oxidative Stress Parameters in COVID-19",doi:"10.5772/intechopen.104950",signatures:"Marija Petrusevska, Emilija Atanasovska, Dragica Zendelovska, Aleksandar Eftimov and Katerina Spasovska",slug:"alteration-of-cytokines-level-and-oxidative-stress-parameters-in-covid-19",totalDownloads:8,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chemokines Updates",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",subseries:{id:"18",title:"Proteomics"}}}]},overviewPagePublishedBooks:{paginationCount:27,paginationItems:[{type:"book",id:"7006",title:"Biochemistry and Health Benefits of Fatty Acids",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7006.jpg",slug:"biochemistry-and-health-benefits-of-fatty-acids",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Viduranga Waisundara",hash:"c93a00abd68b5eba67e5e719f67fd20b",volumeInSeries:1,fullTitle:"Biochemistry and Health Benefits of Fatty Acids",editors:[{id:"194281",title:"Dr.",name:"Viduranga Y.",middleName:null,surname:"Waisundara",slug:"viduranga-y.-waisundara",fullName:"Viduranga Y. Waisundara",profilePictureURL:"https://mts.intechopen.com/storage/users/194281/images/system/194281.jpg",biography:"Dr. Viduranga Waisundara obtained her Ph.D. in Food Science and Technology from the Department of Chemistry, National University of Singapore, in 2010. She was a lecturer at Temasek Polytechnic, Singapore from July 2009 to March 2013. She relocated to her motherland of Sri Lanka and spearheaded the Functional Food Product Development Project at the National Institute of Fundamental Studies from April 2013 to October 2016. She was a senior lecturer on a temporary basis at the Department of Food Technology, Faculty of Technology, Rajarata University of Sri Lanka. She is currently Deputy Principal of the Australian College of Business and Technology – Kandy Campus, Sri Lanka. She is also the Global Harmonization Initiative (GHI) Ambassador to Sri Lanka.",institutionString:"Australian College of Business & Technology",institution:null}]},{type:"book",id:"6820",title:"Keratin",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6820.jpg",slug:"keratin",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Miroslav Blumenberg",hash:"6def75cd4b6b5324a02b6dc0359896d0",volumeInSeries:2,fullTitle:"Keratin",editors:[{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}}]},{type:"book",id:"7978",title:"Vitamin A",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7978.jpg",slug:"vitamin-a",publishedDate:"May 15th 2019",editedByType:"Edited by",bookSignature:"Leila Queiroz Zepka, Veridiana Vera de Rosso and Eduardo Jacob-Lopes",hash:"dad04a658ab9e3d851d23705980a688b",volumeInSeries:3,fullTitle:"Vitamin A",editors:[{id:"261969",title:"Dr.",name:"Leila",middleName:null,surname:"Queiroz Zepka",slug:"leila-queiroz-zepka",fullName:"Leila Queiroz Zepka",profilePictureURL:"https://mts.intechopen.com/storage/users/261969/images/system/261969.png",biography:"Prof. Dr. Leila Queiroz Zepka is currently an associate professor in the Department of Food Technology and Science, Federal University of Santa Maria, Brazil. She has more than fifteen years of teaching and research experience. She has published more than 550 scientific publications/communications, including 15 books, 50 book chapters, 100 original research papers, 380 research communications in national and international conferences, and 12 patents. She is a member of the editorial board of five journals and acts as a reviewer for several national and international journals. Her research interests include microalgal biotechnology with an emphasis on microalgae-based products.",institutionString:"Universidade Federal de Santa Maria",institution:{name:"Universidade Federal de Santa Maria",institutionURL:null,country:{name:"Brazil"}}}]},{type:"book",id:"7953",title:"Bioluminescence",subtitle:"Analytical Applications and Basic Biology",coverURL:"https://cdn.intechopen.com/books/images_new/7953.jpg",slug:"bioluminescence-analytical-applications-and-basic-biology",publishedDate:"September 25th 2019",editedByType:"Edited by",bookSignature:"Hirobumi Suzuki",hash:"3a8efa00b71abea11bf01973dc589979",volumeInSeries:4,fullTitle:"Bioluminescence - Analytical Applications and Basic Biology",editors:[{id:"185746",title:"Dr.",name:"Hirobumi",middleName:null,surname:"Suzuki",slug:"hirobumi-suzuki",fullName:"Hirobumi Suzuki",profilePictureURL:"https://mts.intechopen.com/storage/users/185746/images/system/185746.png",biography:"Dr. Hirobumi Suzuki received his Ph.D. in 1997 from Tokyo Metropolitan University, Japan, where he studied firefly phylogeny and the evolution of mating systems. He is especially interested in the genetic differentiation pattern and speciation process that correlate to the flashing pattern and mating behavior of some fireflies in Japan. He then worked for Olympus Corporation, a Japanese manufacturer of optics and imaging products, where he was involved in the development of luminescence technology and produced a bioluminescence microscope that is currently being used for gene expression analysis in chronobiology, neurobiology, and developmental biology. Dr. Suzuki currently serves as a visiting researcher at Kogakuin University, Japan, and also a vice president of the Japan Firefly Society.",institutionString:"Kogakuin University",institution:null}]}]},openForSubmissionBooks:{},onlineFirstChapters:{},subseriesFiltersForOFChapters:[],publishedBooks:{},subseriesFiltersForPublishedBooks:[],publicationYearFilters:[],authors:{paginationCount:148,paginationItems:[{id:"165328",title:"Dr.",name:"Vahid",middleName:null,surname:"Asadpour",slug:"vahid-asadpour",fullName:"Vahid Asadpour",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/165328/images/system/165328.jpg",biography:"Vahid Asadpour, MS, Ph.D., is currently with the Department of Research and Evaluation, Kaiser Permanente Southern California. He has both an MS and Ph.D. in Biomedical Engineering. He was previously a research scientist at the University of California Los Angeles (UCLA) and visiting professor and researcher at the University of North Dakota. He is currently working in artificial intelligence and its applications in medical signal processing. In addition, he is using digital signal processing in medical imaging and speech processing. Dr. Asadpour has developed brain-computer interfacing algorithms and has published books, book chapters, and several journal and conference papers in this field and other areas of intelligent signal processing. He has also designed medical devices, including a laser Doppler monitoring system.",institutionString:"Kaiser Permanente Southern California",institution:null},{id:"169608",title:"Prof.",name:"Marian",middleName:null,surname:"Găiceanu",slug:"marian-gaiceanu",fullName:"Marian Găiceanu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/169608/images/system/169608.png",biography:"Prof. Dr. Marian Gaiceanu graduated from the Naval and Electrical Engineering Faculty, Dunarea de Jos University of Galati, Romania, in 1997. He received a Ph.D. (Magna Cum Laude) in Electrical Engineering in 2002. Since 2017, Dr. Gaiceanu has been a Ph.D. supervisor for students in Electrical Engineering. He has been employed at Dunarea de Jos University of Galati since 1996, where he is currently a professor. Dr. Gaiceanu is a member of the National Council for Attesting Titles, Diplomas and Certificates, an expert of the Executive Agency for Higher Education, Research Funding, and a member of the Senate of the Dunarea de Jos University of Galati. He has been the head of the Integrated Energy Conversion Systems and Advanced Control of Complex Processes Research Center, Romania, since 2016. He has conducted several projects in power converter systems for electrical drives, power quality, PEM and SOFC fuel cell power converters for utilities, electric vehicles, and marine applications with the Department of Regulation and Control, SIEI S.pA. (2002–2004) and the Polytechnic University of Turin, Italy (2002–2004, 2006–2007). He is a member of the Institute of Electrical and Electronics Engineers (IEEE) and cofounder-member of the IEEE Power Electronics Romanian Chapter. He is a guest editor at Energies and an academic book editor for IntechOpen. He is also a member of the editorial boards of the Journal of Electrical Engineering, Electronics, Control and Computer Science and Sustainability. Dr. Gaiceanu has been General Chairman of the IEEE International Symposium on Electrical and Electronics Engineering in the last six editions.",institutionString:'"Dunarea de Jos" University of Galati',institution:{name:'"Dunarea de Jos" University of Galati',country:{name:"Romania"}}},{id:"4519",title:"Prof.",name:"Jaydip",middleName:null,surname:"Sen",slug:"jaydip-sen",fullName:"Jaydip Sen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/4519/images/system/4519.jpeg",biography:"Jaydip Sen is associated with Praxis Business School, Kolkata, India, as a professor in the Department of Data Science. His research areas include security and privacy issues in computing and communication, intrusion detection systems, machine learning, deep learning, and artificial intelligence in the financial domain. He has more than 200 publications in reputed international journals, refereed conference proceedings, and 20 book chapters in books published by internationally renowned publishing houses, such as Springer, CRC press, IGI Global, etc. Currently, he is serving on the editorial board of the prestigious journal Frontiers in Communications and Networks and in the technical program committees of a number of high-ranked international conferences organized by the IEEE, USA, and the ACM, USA. He has been listed among the top 2% of scientists in the world for the last three consecutive years, 2019 to 2021 as per studies conducted by the Stanford University, USA.",institutionString:"Praxis Business School",institution:null},{id:"320071",title:"Dr.",name:"Sidra",middleName:null,surname:"Mehtab",slug:"sidra-mehtab",fullName:"Sidra Mehtab",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00002v6KHoQAM/Profile_Picture_1584512086360",biography:"Sidra Mehtab has completed her BS with honors in Physics from Calcutta University, India in 2018. She has done MS in Data Science and Analytics from Maulana Abul Kalam Azad University of Technology (MAKAUT), Kolkata, India in 2020. Her research areas include Econometrics, Time Series Analysis, Machine Learning, Deep Learning, Artificial Intelligence, and Computer and Network Security with a particular focus on Cyber Security Analytics. Ms. Mehtab has published seven papers in international conferences and one of her papers has been accepted for publication in a reputable international journal. She has won the best paper awards in two prestigious international conferences – BAICONF 2019, and ICADCML 2021, organized in the Indian Institute of Management, Bangalore, India in December 2019, and SOA University, Bhubaneswar, India in January 2021. Besides, Ms. Mehtab has also published two book chapters in two books. Seven of her book chapters will be published in a volume shortly in 2021 by Cambridge Scholars’ Press, UK. Currently, she is working as the joint editor of two edited volumes on Time Series Analysis and Forecasting to be published in the first half of 2021 by an international house. Currently, she is working as a Data Scientist with an MNC in Delhi, India.",institutionString:"NSHM College of Management and Technology",institution:null},{id:"226240",title:"Dr.",name:"Andri Irfan",middleName:null,surname:"Rifai",slug:"andri-irfan-rifai",fullName:"Andri Irfan Rifai",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/226240/images/7412_n.jpg",biography:"Andri IRFAN is a Senior Lecturer of Civil Engineering and Planning. He completed the PhD at the Universitas Indonesia & Universidade do Minho with Sandwich Program Scholarship from the Directorate General of Higher Education and LPDP scholarship. He has been teaching for more than 19 years and much active to applied his knowledge in the project construction in Indonesia. His research interest ranges from pavement management system to advanced data mining techniques for transportation engineering. He has published more than 50 papers in journals and 2 books.",institutionString:null,institution:{name:"Universitas Internasional Batam",country:{name:"Indonesia"}}},{id:"314576",title:"Dr.",name:"Ibai",middleName:null,surname:"Laña",slug:"ibai-lana",fullName:"Ibai Laña",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314576/images/system/314576.jpg",biography:"Dr. Ibai Laña works at TECNALIA as a data analyst. He received his Ph.D. in Artificial Intelligence from the University of the Basque Country (UPV/EHU), Spain, in 2018. He is currently a senior researcher at TECNALIA. His research interests fall within the intersection of intelligent transportation systems, machine learning, traffic data analysis, and data science. He has dealt with urban traffic forecasting problems, applying machine learning models and evolutionary algorithms. He has experience in origin-destination matrix estimation or point of interest and trajectory detection. Working with large volumes of data has given him a good command of big data processing tools and NoSQL databases. He has also been a visiting scholar at the Knowledge Engineering and Discovery Research Institute, Auckland University of Technology.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"314575",title:"Dr.",name:"Jesus",middleName:null,surname:"L. Lobo",slug:"jesus-l.-lobo",fullName:"Jesus L. Lobo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314575/images/system/314575.png",biography:"Dr. Jesús López is currently based in Bilbao (Spain) working at TECNALIA as Artificial Intelligence Research Scientist. In most cases, a project idea or a new research line needs to be investigated to see if it is good enough to take into production or to focus on it. That is exactly what he does, diving into Machine Learning algorithms and technologies to help TECNALIA to decide whether something is great in theory or will actually impact on the product or processes of its projects. So, he is expert at framing experiments, developing hypotheses, and proving whether they’re true or not, in order to investigate fundamental problems with a longer time horizon. He is also able to design and develop PoCs and system prototypes in simulation. He has participated in several national and internacional R&D projects.\n\nAs another relevant part of his everyday research work, he usually publishes his findings in reputed scientific refereed journals and international conferences, occasionally acting as reviewer and Programme Commitee member. Concretely, since 2018 he has published 9 JCR (8 Q1) journal papers, 9 conference papers (e.g. ECML PKDD 2021), and he has co-edited a book. He is also active in popular science writing data science stories for reputed blogs (KDNuggets, TowardsDataScience, Naukas). Besides, he has recently embarked on mentoring programmes as mentor, and has also worked as data science trainer.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"103779",title:"Prof.",name:"Yalcin",middleName:null,surname:"Isler",slug:"yalcin-isler",fullName:"Yalcin Isler",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRyQ8QAK/Profile_Picture_1628834958734",biography:"Yalcin Isler (1971 - Burdur / Turkey) received the B.Sc. degree in the Department of Electrical and Electronics Engineering from Anadolu University, Eskisehir, Turkey, in 1993, the M.Sc. degree from the Department of Electronics and Communication Engineering, Suleyman Demirel University, Isparta, Turkey, in 1996, the Ph.D. degree from the Department of Electrical and Electronics Engineering, Dokuz Eylul University, Izmir, Turkey, in 2009, and the Competence of Associate Professorship from the Turkish Interuniversity Council in 2019.\n\nHe was Lecturer at Burdur Vocational School in Suleyman Demirel University (1993-2000, Burdur / Turkey), Software Engineer (2000-2002, Izmir / Turkey), Research Assistant in Bulent Ecevit University (2002-2003, Zonguldak / Turkey), Research Assistant in Dokuz Eylul University (2003-2010, Izmir / Turkey), Assistant Professor at the Department of Electrical and Electronics Engineering in Bulent Ecevit University (2010-2012, Zonguldak / Turkey), Assistant Professor at the Department of Biomedical Engineering in Izmir Katip Celebi University (2012-2019, Izmir / Turkey). He is an Associate Professor at the Department of Biomedical Engineering at Izmir Katip Celebi University, Izmir / Turkey, since 2019. In addition to academics, he has also founded Islerya Medical and Information Technologies Company, Izmir / Turkey, since 2017.\n\nHis main research interests cover biomedical signal processing, pattern recognition, medical device design, programming, and embedded systems. He has many scientific papers and participated in several projects in these study fields. He was an IEEE Student Member (2009-2011) and IEEE Member (2011-2014) and has been IEEE Senior Member since 2014.",institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"339677",title:"Dr.",name:"Mrinmoy",middleName:null,surname:"Roy",slug:"mrinmoy-roy",fullName:"Mrinmoy Roy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/339677/images/16768_n.jpg",biography:"An accomplished Sales & Marketing professional with 12 years of cross-functional experience in well-known organisations such as CIPLA, LUPIN, GLENMARK, ASTRAZENECA across different segment of Sales & Marketing, International Business, Institutional Business, Product Management, Strategic Marketing of HIV, Oncology, Derma, Respiratory, Anti-Diabetic, Nutraceutical & Stomatological Product Portfolio and Generic as well as Chronic Critical Care Portfolio. A First Class MBA in International Business & Strategic Marketing, B.Pharm, D.Pharm, Google Certified Digital Marketing Professional. Qualified PhD Candidate in Operations and Management with special focus on Artificial Intelligence and Machine Learning adoption, analysis and use in Healthcare, Hospital & Pharma Domain. Seasoned with diverse therapy area of Pharmaceutical Sales & Marketing ranging from generating revenue through generating prescriptions, launching new products, and making them big brands with continuous strategy execution at the Physician and Patients level. Moved from Sales to Marketing and Business Development for 3.5 years in South East Asian Market operating from Manila, Philippines. Came back to India and handled and developed Brands such as Gluconorm, Lupisulin, Supracal, Absolut Woman, Hemozink, Fabiflu (For COVID 19), and many more. In my previous assignment I used to develop and execute strategies on Sales & Marketing, Commercialization & Business Development for Institution and Corporate Hospital Business portfolio of Oncology Therapy Area for AstraZeneca Pharma India Ltd. Being a Research Scholar and Student of ‘Operations Research & Management: Artificial Intelligence’ I published several pioneer research papers and book chapters on the same in Internationally reputed journals and Books indexed in Scopus, Springer and Ei Compendex, Google Scholar etc. Currently, I am launching PGDM Pharmaceutical Management Program in IIHMR Bangalore and spearheading the course curriculum and structure of the same. I am interested in Collaboration for Healthcare Innovation, Pharma AI Innovation, Future trend in Marketing and Management with incubation on Healthcare, Healthcare IT startups, AI-ML Modelling and Healthcare Algorithm based training module development. I am also an affiliated member of the Institute of Management Consultant of India, looking forward to Healthcare, Healthcare IT and Innovation, Pharma and Hospital Management Consulting works.",institutionString:null,institution:{name:"Lovely Professional University",country:{name:"India"}}},{id:"1063",title:"Prof.",name:"Constantin",middleName:null,surname:"Volosencu",slug:"constantin-volosencu",fullName:"Constantin Volosencu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/1063/images/system/1063.png",biography:"Prof. Dr. Constantin Voloşencu graduated as an engineer from\nPolitehnica University of Timișoara, Romania, where he also\nobtained a doctorate degree. He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. He has developed automation equipment for machine tools, spooling\nmachines, high-power ultrasound processes, and more.",institutionString:"Polytechnic University of Timişoara",institution:{name:"Polytechnic University of Timişoara",country:{name:"Romania"}}},{id:"221364",title:"Dr.",name:"Eneko",middleName:null,surname:"Osaba",slug:"eneko-osaba",fullName:"Eneko Osaba",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/221364/images/system/221364.jpg",biography:"Dr. Eneko Osaba works at TECNALIA as a senior researcher. He obtained his Ph.D. in Artificial Intelligence in 2015. He has participated in more than twenty-five local and European research projects, and in the publication of more than 130 papers. He has performed several stays at universities in the United Kingdom, Italy, and Malta. Dr. Osaba has served as a program committee member in more than forty international conferences and participated in organizing activities in more than ten international conferences. He is a member of the editorial board of the International Journal of Artificial Intelligence, Data in Brief, and Journal of Advanced Transportation. He is also a guest editor for the Journal of Computational Science, Neurocomputing, Swarm, and Evolutionary Computation and IEEE ITS Magazine.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"275829",title:"Dr.",name:"Esther",middleName:null,surname:"Villar-Rodriguez",slug:"esther-villar-rodriguez",fullName:"Esther Villar-Rodriguez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/275829/images/system/275829.jpg",biography:"Dr. Esther Villar obtained a Ph.D. in Information and Communication Technologies from the University of Alcalá, Spain, in 2015. She obtained a degree in Computer Science from the University of Deusto, Spain, in 2010, and an MSc in Computer Languages and Systems from the National University of Distance Education, Spain, in 2012. Her areas of interest and knowledge include natural language processing (NLP), detection of impersonation in social networks, semantic web, and machine learning. Dr. Esther Villar made several contributions at conferences and publishing in various journals in those fields. Currently, she is working within the OPTIMA (Optimization Modeling & Analytics) business of TECNALIA’s ICT Division as a data scientist in projects related to the prediction and optimization of management and industrial processes (resource planning, energy efficiency, etc).",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49813/images/system/49813.png",biography:"Prof. Dr. Javier Del Ser received his first PhD in Telecommunication Engineering (Cum Laude) from the University of Navarra, Spain, in 2006, and a second PhD in Computational Intelligence (Summa Cum Laude) from the University of Alcala, Spain, in 2013. He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. He is a Senior Member of the IEEE, and a recipient of the Biscay Talent prize for his academic career.",institutionString:"Tecnalia Research & Innovation",institution:null},{id:"278948",title:"Dr.",name:"Carlos Pedro",middleName:null,surname:"Gonçalves",slug:"carlos-pedro-goncalves",fullName:"Carlos Pedro Gonçalves",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRcmyQAC/Profile_Picture_1564224512145",biography:'Carlos Pedro Gonçalves (PhD) is an Associate Professor at Lusophone University of Humanities and Technologies and a researcher on Complexity Sciences, Quantum Technologies, Artificial Intelligence, Strategic Studies, Studies in Intelligence and Security, FinTech and Financial Risk Modeling. He is also a progammer with programming experience in:\n\nA) Quantum Computing using Qiskit Python module and IBM Quantum Experience Platform, with software developed on the simulation of Quantum Artificial Neural Networks and Quantum Cybersecurity;\n\nB) Artificial Intelligence and Machine learning programming in Python;\n\nC) Artificial Intelligence, Multiagent Systems Modeling and System Dynamics Modeling in Netlogo, with models developed in the areas of Chaos Theory, Econophysics, Artificial Intelligence, Classical and Quantum Complex Systems Science, with the Econophysics models having been cited worldwide and incorporated in PhD programs by different Universities.\n\nReceived an Arctic Code Vault Contributor status by GitHub, due to having developed open source software preserved in the \\"Arctic Code Vault\\" for future generations (https://archiveprogram.github.com/arctic-vault/), with the Strategy Analyzer A.I. module for decision making support (based on his PhD thesis, used in his Classes on Decision Making and in Strategic Intelligence Consulting Activities) and QNeural Python Quantum Neural Network simulator also preserved in the \\"Arctic Code Vault\\", for access to these software modules see: https://github.com/cpgoncalves. He is also a peer reviewer with outsanding review status from Elsevier journals, including Physica A, Neurocomputing and Engineering Applications of Artificial Intelligence. Science CV available at: https://www.cienciavitae.pt//pt/8E1C-A8B3-78C5 and ORCID: https://orcid.org/0000-0002-0298-3974',institutionString:"University of Lisbon",institution:{name:"Universidade Lusófona",country:{name:"Portugal"}}},{id:"241400",title:"Prof.",name:"Mohammed",middleName:null,surname:"Bsiss",slug:"mohammed-bsiss",fullName:"Mohammed Bsiss",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241400/images/8062_n.jpg",biography:null,institutionString:null,institution:null},{id:"276128",title:"Dr.",name:"Hira",middleName:null,surname:"Fatima",slug:"hira-fatima",fullName:"Hira Fatima",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/276128/images/14420_n.jpg",biography:"Dr. Hira Fatima\nAssistant Professor\nDepartment of Mathematics\nInstitute of Applied Science\nMangalayatan University, Aligarh\nMobile: no : 8532041179\nhirafatima2014@gmal.com\n\nDr. Hira Fatima has received his Ph.D. degree in pure Mathematics from Aligarh Muslim University, Aligarh India. Currently working as an Assistant Professor in the Department of Mathematics, Institute of Applied Science, Mangalayatan University, Aligarh. She taught so many courses of Mathematics of UG and PG level. Her research Area of Expertise is Functional Analysis & Sequence Spaces. She has been working on Ideal Convergence of double sequence. She has published 17 research papers in National and International Journals including Cogent Mathematics, Filomat, Journal of Intelligent and Fuzzy Systems, Advances in Difference Equations, Journal of Mathematical Analysis, Journal of Mathematical & Computer Science etc. She has also reviewed few research papers for the and international journals. She is a member of Indian Mathematical Society.",institutionString:null,institution:null},{id:"414880",title:"Dr.",name:"Maryam",middleName:null,surname:"Vatankhah",slug:"maryam-vatankhah",fullName:"Maryam Vatankhah",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Borough of Manhattan Community College",country:{name:"United States of America"}}},{id:"414879",title:"Prof.",name:"Mohammad-Reza",middleName:null,surname:"Akbarzadeh-Totonchi",slug:"mohammad-reza-akbarzadeh-totonchi",fullName:"Mohammad-Reza Akbarzadeh-Totonchi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Ferdowsi University of Mashhad",country:{name:"Iran"}}},{id:"414878",title:"Prof.",name:"Reza",middleName:null,surname:"Fazel-Rezai",slug:"reza-fazel-rezai",fullName:"Reza Fazel-Rezai",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"American Public University System",country:{name:"United States of America"}}},{id:"302698",title:"Dr.",name:"Yao",middleName:null,surname:"Shan",slug:"yao-shan",fullName:"Yao Shan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Dalian University of Technology",country:{name:"China"}}},{id:"125911",title:"Prof.",name:"Jia-Ching",middleName:null,surname:"Wang",slug:"jia-ching-wang",fullName:"Jia-Ching Wang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Central University",country:{name:"Taiwan"}}},{id:"357085",title:"Mr.",name:"P. Mohan",middleName:null,surname:"Anand",slug:"p.-mohan-anand",fullName:"P. Mohan Anand",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"356696",title:"Ph.D. Student",name:"P.V.",middleName:null,surname:"Sai Charan",slug:"p.v.-sai-charan",fullName:"P.V. Sai Charan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"357086",title:"Prof.",name:"Sandeep K.",middleName:null,surname:"Shukla",slug:"sandeep-k.-shukla",fullName:"Sandeep K. Shukla",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"356823",title:"MSc.",name:"Seonghee",middleName:null,surname:"Min",slug:"seonghee-min",fullName:"Seonghee Min",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Daegu University",country:{name:"Korea, South"}}},{id:"353307",title:"Prof.",name:"Yoosoo",middleName:null,surname:"Oh",slug:"yoosoo-oh",fullName:"Yoosoo Oh",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:"Yoosoo Oh received his Bachelor's degree in the Department of Electronics and Engineering from Kyungpook National University in 2002. He obtained his Master’s degree in the Department of Information and Communications from Gwangju Institute of Science and Technology (GIST) in 2003. In 2010, he received his Ph.D. degree in the School of Information and Mechatronics from GIST. In the meantime, he was an executed team leader at Culture Technology Institute, GIST, 2010-2012. In 2011, he worked at Lancaster University, the UK as a visiting scholar. In September 2012, he joined Daegu University, where he is currently an associate professor in the School of ICT Conver, Daegu University. Also, he served as the Board of Directors of KSIIS since 2019, and HCI Korea since 2016. From 2017~2019, he worked as a center director of the Mixed Reality Convergence Research Center at Daegu University. From 2015-2017, He worked as a director in the Enterprise Supporting Office of LINC Project Group, Daegu University. His research interests include Activity Fusion & Reasoning, Machine Learning, Context-aware Middleware, Human-Computer Interaction, etc.",institutionString:null,institution:{name:"Daegu Gyeongbuk Institute of Science and Technology",country:{name:"Korea, South"}}},{id:"262719",title:"Dr.",name:"Esma",middleName:null,surname:"Ergüner Özkoç",slug:"esma-erguner-ozkoc",fullName:"Esma Ergüner Özkoç",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Başkent University",country:{name:"Turkey"}}},{id:"346530",title:"Dr.",name:"Ibrahim",middleName:null,surname:"Kaya",slug:"ibrahim-kaya",fullName:"Ibrahim Kaya",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"419199",title:"Dr.",name:"Qun",middleName:null,surname:"Yang",slug:"qun-yang",fullName:"Qun Yang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Auckland",country:{name:"New Zealand"}}},{id:"351158",title:"Prof.",name:"David W.",middleName:null,surname:"Anderson",slug:"david-w.-anderson",fullName:"David W. Anderson",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Calgary",country:{name:"Canada"}}}]}},subseries:{item:{id:"5",type:"subseries",title:"Parasitic Infectious Diseases",keywords:"Blood Borne Parasites, Intestinal Parasites, Protozoa, Helminths, Arthropods, Water Born Parasites, Epidemiology, Molecular Biology, Systematics, Genomics, Proteomics, Ecology",scope:"Parasitic diseases have evolved alongside their human hosts. In many cases, these diseases have adapted so well that they have developed efficient resilience methods in the human host and can live in the host for years. Others, particularly some blood parasites, can cause very acute diseases and are responsible for millions of deaths yearly. Many parasitic diseases are classified as neglected tropical diseases because they have received minimal funding over recent years and, in many cases, are under-reported despite the critical role they play in morbidity and mortality among human and animal hosts. The current topic, Parasitic Infectious Diseases, in the Infectious Diseases Series aims to publish studies on the systematics, epidemiology, molecular biology, genomics, pathogenesis, genetics, and clinical significance of parasitic diseases from blood borne to intestinal parasites as well as zoonotic parasites. We hope to cover all aspects of parasitic diseases to provide current and relevant research data on these very important diseases. In the current atmosphere of the Coronavirus pandemic, communities around the world, particularly those in different underdeveloped areas, are faced with the growing challenges of the high burden of parasitic diseases. At the same time, they are faced with the Covid-19 pandemic leading to what some authors have called potential syndemics that might worsen the outcome of such infections. Therefore, it is important to conduct studies that examine parasitic infections in the context of the coronavirus pandemic for the benefit of all communities to help foster more informed decisions for the betterment of human and animal health.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/5.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11401,editor:{id:"67907",title:"Dr.",name:"Amidou",middleName:null,surname:"Samie",slug:"amidou-samie",fullName:"Amidou Samie",profilePictureURL:"https://mts.intechopen.com/storage/users/67907/images/system/67907.jpg",biography:"Dr. Amidou Samie is an Associate Professor of Microbiology at the University of Venda, in South Africa, where he graduated for his PhD in May 2008. He joined the Department of Microbiology the same year and has been giving lectures on topics covering parasitology, immunology, molecular biology and industrial microbiology. He is currently a rated researcher by the National Research Foundation of South Africa at category C2. He has published widely in the field of infectious diseases and has overseen several MSc’s and PhDs. His research activities mostly cover topics on infectious diseases from epidemiology to control. His particular interest lies in the study of intestinal protozoan parasites and opportunistic infections among HIV patients as well as the potential impact of childhood diarrhoea on growth and child development. He also conducts research on water-borne diseases and water quality and is involved in the evaluation of point-of-use water treatment technologies using silver and copper nanoparticles in collaboration with the University of Virginia, USA. He also studies the use of medicinal plants for the control of infectious diseases as well as antimicrobial drug resistance.",institutionString:null,institution:{name:"University of Venda",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null,series:{id:"6",title:"Infectious Diseases",doi:"10.5772/intechopen.71852",issn:"2631-6188"},editorialBoard:[{id:"188881",title:"Dr.",name:"Fernando José",middleName:null,surname:"Andrade-Narváez",slug:"fernando-jose-andrade-narvaez",fullName:"Fernando José Andrade-Narváez",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRIV7QAO/Profile_Picture_1628834308121",institutionString:null,institution:{name:"Autonomous University of Yucatán",institutionURL:null,country:{name:"Mexico"}}},{id:"269120",title:"Dr.",name:"Rajeev",middleName:"K.",surname:"Tyagi",slug:"rajeev-tyagi",fullName:"Rajeev Tyagi",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRaBqQAK/Profile_Picture_1644331884726",institutionString:"CSIR - Institute of Microbial Technology, India",institution:null},{id:"336849",title:"Prof.",name:"Ricardo",middleName:null,surname:"Izurieta",slug:"ricardo-izurieta",fullName:"Ricardo Izurieta",profilePictureURL:"https://mts.intechopen.com/storage/users/293169/images/system/293169.png",institutionString:null,institution:{name:"University of South Florida",institutionURL:null,country:{name:"United States of America"}}}]},onlineFirstChapters:{paginationCount:1,paginationItems:[{id:"81813",title:"Schistosomiasis: Discovery of New Molecules for Disease Treatment and Vaccine Development",doi:"10.5772/intechopen.104738",signatures:"Andressa Barban do Patrocinio",slug:"schistosomiasis-discovery-of-new-molecules-for-disease-treatment-and-vaccine-development",totalDownloads:3,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"New Horizons for Schistosomiasis Research",coverURL:"https://cdn.intechopen.com/books/images_new/10829.jpg",subseries:{id:"5",title:"Parasitic Infectious Diseases"}}}]},publishedBooks:{paginationCount:7,paginationItems:[{type:"book",id:"7102",title:"Pneumonia",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7102.jpg",slug:"pneumonia",publishedDate:"May 11th 2022",editedByType:"Edited by",bookSignature:"Nima Rezaei",hash:"9fd70142814192dcec58a176749f1b60",volumeInSeries:13,fullTitle:"Pneumonia",editors:[{id:"116250",title:"Dr.",name:"Nima",middleName:null,surname:"Rezaei",slug:"nima-rezaei",fullName:"Nima Rezaei",profilePictureURL:"https://mts.intechopen.com/storage/users/116250/images/system/116250.jpg",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",institutionURL:null,country:{name:"Iran"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"9615",title:"Chikungunya Virus",subtitle:"A Growing Global Public Health Threat",coverURL:"https://cdn.intechopen.com/books/images_new/9615.jpg",slug:"chikungunya-virus-a-growing-global-public-health-threat",publishedDate:"February 9th 2022",editedByType:"Edited by",bookSignature:"Jean Engohang-Ndong",hash:"c960d94a63867dd12a8ab15176a3ff06",volumeInSeries:12,fullTitle:"Chikungunya Virus - A Growing Global Public Health Threat",editors:[{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",institutionString:"Kent State University",institution:{name:"Kent State University",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"9619",title:"Epstein-Barr Virus",subtitle:"New Trends",coverURL:"https://cdn.intechopen.com/books/images_new/9619.jpg",slug:"epstein-barr-virus-new-trends",publishedDate:"December 22nd 2021",editedByType:"Edited by",bookSignature:"Emmanuel Drouet",hash:"a2128c53becb6064589570cbe8d976f8",volumeInSeries:11,fullTitle:"Epstein-Barr Virus - New Trends",editors:[{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",institutionString:null,institution:{name:"Grenoble Alpes University",institutionURL:null,country:{name:"France"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"9613",title:"Dengue Fever in a One Health Perspective",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/9613.jpg",slug:"dengue-fever-in-a-one-health-perspective",publishedDate:"October 28th 2020",editedByType:"Edited by",bookSignature:"Márcia Aparecida Sperança",hash:"77ecce8195c11092230b4156df6d83ff",volumeInSeries:7,fullTitle:"Dengue Fever in a One Health Perspective",editors:[{id:"176579",title:"Ph.D.",name:"Márcia Aparecida",middleName:null,surname:"Sperança",slug:"marcia-aparecida-speranca",fullName:"Márcia Aparecida Sperança",profilePictureURL:"https://mts.intechopen.com/storage/users/176579/images/system/176579.jpg",institutionString:"Federal University of ABC",institution:{name:"Universidade Federal do ABC",institutionURL:null,country:{name:"Brazil"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7887",title:"Hepatitis B and C",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7887.jpg",slug:"hepatitis-b-and-c",publishedDate:"April 8th 2020",editedByType:"Edited by",bookSignature:"Luis Rodrigo",hash:"8dd6dab483cf505d83caddaeaf497f2c",volumeInSeries:5,fullTitle:"Hepatitis B and C",editors:[{id:"73208",title:"Prof.",name:"Luis",middleName:null,surname:"Rodrigo",slug:"luis-rodrigo",fullName:"Luis Rodrigo",profilePictureURL:"https://mts.intechopen.com/storage/users/73208/images/system/73208.jpg",institutionString:"University of Oviedo",institution:{name:"University of Oviedo",institutionURL:null,country:{name:"Spain"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7064",title:"Current Perspectives in Human Papillomavirus",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7064.jpg",slug:"current-perspectives-in-human-papillomavirus",publishedDate:"May 2nd 2019",editedByType:"Edited by",bookSignature:"Shailendra K. Saxena",hash:"d92a4085627bab25ddc7942fbf44cf05",volumeInSeries:2,fullTitle:"Current Perspectives in Human Papillomavirus",editors:[{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"6667",title:"Influenza",subtitle:"Therapeutics and Challenges",coverURL:"https://cdn.intechopen.com/books/images_new/6667.jpg",slug:"influenza-therapeutics-and-challenges",publishedDate:"September 19th 2018",editedByType:"Edited by",bookSignature:"Shailendra K. Saxena",hash:"105e347b2d5dbbe6b593aceffa051efa",volumeInSeries:1,fullTitle:"Influenza - Therapeutics and Challenges",editors:[{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},testimonialsList:[{id:"8",text:"I work with IntechOpen for a number of reasons: their professionalism, their mission in support of Open Access publishing, and the quality of their peer-reviewed publications, but also because they believe in equality.",author:{id:"202192",name:"Catrin",surname:"Rutland",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",slug:"catrin-rutland",institution:{id:"134",name:"University of Nottingham",country:{id:null,name:"United Kingdom"}}}},{id:"27",text:"The opportunity to work with a prestigious publisher allows for the possibility to collaborate with more research groups interested in animal nutrition, leading to the development of new feeding strategies and food valuation while being more sustainable with the environment, allowing more readers to learn about the subject.",author:{id:"175967",name:"Manuel",surname:"Gonzalez Ronquillo",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/175967/images/system/175967.png",slug:"manuel-gonzalez-ronquillo",institution:{id:"6221",name:"Universidad Autónoma del Estado de México",country:{id:null,name:"Mexico"}}}},{id:"18",text:"It was great publishing with IntechOpen, the process was straightforward and I had support all along.",author:{id:"71579",name:"Berend",surname:"Olivier",institutionString:"Utrecht University",profilePictureURL:"https://mts.intechopen.com/storage/users/71579/images/system/71579.jpg",slug:"berend-olivier",institution:{id:"253",name:"Utrecht University",country:{id:null,name:"Netherlands"}}}}]},submityourwork:{pteSeriesList:[],lsSeriesList:[],hsSeriesList:[],sshSeriesList:[],subseriesList:[],annualVolumeBook:{},thematicCollection:[],selectedSeries:null,selectedSubseries:null},seriesLanding:{item:null},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"profile.detail",path:"/profiles/285502",hash:"",query:{},params:{id:"285502"},fullPath:"/profiles/285502",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()