Occurrences after mating
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"2583",leadTitle:null,fullTitle:"Sepsis - An Ongoing and Significant Challenge",title:"Sepsis",subtitle:"An Ongoing and Significant Challenge",reviewType:"peer-reviewed",abstract:"Sepsis is the major cause of death in non-cardiologic intensive care units around the world. Every year, billions of dollars are consumed in the treatment of sepsis and in research to understand its complex pathophysiology and therefore obtain future therapeutic opportunities. Despite the efforts of the scientists and medical practitioners, the mortality rates are still high and the incidence of sepsis is increasing. In this book we provide an update on several aspects of sepsis. Starting from the history of the disease and finishing with treatment of sepsis-associated organ dysfunctions, this book offers a wide scope of well-written and complete reviews concerning pathophysiological and therapeutic characteristics of sepsis. We hope that the work of the authors will provide a significant forum of discussion on the topic, and increase the awareness of the healthcare team regarding the important aspects of early recognition and treatment of this severe condition.",isbn:null,printIsbn:"978-953-51-0780-4",pdfIsbn:"978-953-51-7032-7",doi:"10.5772/2958",price:139,priceEur:155,priceUsd:179,slug:"sepsis-an-ongoing-and-significant-challenge",numberOfPages:422,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"85121c8c358a97497c254ca2832be903",bookSignature:"Luciano Azevedo",publishedDate:"October 3rd 2012",coverURL:"https://cdn.intechopen.com/books/images_new/2583.jpg",numberOfDownloads:88596,numberOfWosCitations:35,numberOfCrossrefCitations:27,numberOfCrossrefCitationsByBook:2,numberOfDimensionsCitations:64,numberOfDimensionsCitationsByBook:3,hasAltmetrics:1,numberOfTotalCitations:126,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"December 7th 2011",dateEndSecondStepPublish:"January 11th 2012",dateEndThirdStepPublish:"April 16th 2012",dateEndFourthStepPublish:"July 15th 2012",dateEndFifthStepPublish:"August 14th 2012",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"72846",title:"Prof.",name:"Luciano",middleName:null,surname:"Azevedo",slug:"luciano-azevedo",fullName:"Luciano Azevedo",profilePictureURL:"https://mts.intechopen.com/storage/users/72846/images/3578_n.jpg",biography:"Dr. Luciano Azevedo obtained his medical degree from Federal University of Paraíba, Brazil, in 1996. After deciding to study critical care, he moved to São Paulo where he finished medical residencies in Internal Medicine and Critical Care Medicine at the University of São Paulo in 1998 and 1999, respectively. By this time, he was completely absorbed by the study of sepsis and this led him to complete his PhD in this area at the University of São Paulo in 2004. Nowadays, he is a professor at the Emergency Medicine Department at the University of São Paulo and the coordinator of the Intensive Care and Anesthesiology Experimental Laboratory at the Instituto Sirio-Libanes de Ensino e Pesquisa in São Paulo. 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Currently China has the largest herd (around 8 million), followed by the United States (7 million), Mexico (a little more than 6 million) and Brazil (a little less than 6 million). Together, these four countries have close to 45% of the world\'s equine population [1].
The horse population\'s growth rate has been either constant or decreasing in most of the countries, with only some regions in Central America, Asia and Europe keeping positive growth rates (Figure 1). From 2003 to 2007, Puerto Rico presented the highest growth rate (45.4%), while the biggest Decrease was in Benin, Africa (-12.9%) (Figure 2).
Growth rate of horse population in the world from 1997 to 2007 (Source [
Countries with higher and lower equine population growth rates from 2003 to 2007
The world\'s export trade of live horses is concentrated in Europe and America, together representing 84% (58% and 26% respectively) of 2.1 billion dollars moved around yearly [2]. According to this source, the United States were the main exporter (148,472 animals, representing 48.8% of the world trade), raising around 474 million, in average $ 3,200 per animal.
Similar to the exportation, the world trade of live horses in relation to imports is highly supported by Europe (49.8% of the world trade), followed by Asia (26%) and Mexico (82,854), Canada (63,240) and Italy (46,333) are the main importers in number of animals, although the highest global expenditure in this aspect occurred in the United Kingdom (U.S. $ 498 million), UAE ($ 236 million) and Ireland (U.S. $ 233 million), representing together 46% of annual turnover - [2].
The expression "improvement of equine species," according to [3] dates back to the French articles about horses and donkeys in the
Only decades later, after Darwin’s evolution theory introduced the concept of selection is that the improvement of native populations emerged to counterbalance the situation, and effectively replace the desire to keep local types. Later, and gradually, the management of purebred animals predominated over crossbreeding, ending in the Thoroughbred Studbook’s creation (first worldwide). It was a very important step for the use of animal production techniques in the 19th century [4]. According to the author, these techniques required precise identification procedures records of races held at different times and places in order to relate them to the same horse. The Stud Book, from the animal lineage certification, not only made it possible to relate the own horse performance information, but also their relatives. This fact prepared the way for the pedigree selection and progeny tests.
In addition, until the beginning of last century, horses were the focuses of experimental tests of inheritage theories. In this sense, historically the main concepts introduced by the horses, especially by the Thoroughbred breed, were [4]: performance selection in a purebred, introducing of a precise method for identifying an animal and its relatives, thinking about the male and female roles in the herd and the widespread use of planned matings.
Currently, although research in several countries are published every year in the literature involving some kinds of horse breeding study, few of them have ongoing consistent selection program. It means, in a way that most of research results in this area don’t generate practical application and therefore it adds little to the species’ development.
In most cases, this fact occurs because the breeders don’t show interest in using the research results and not because of the research quality. The studies, depending on the availability and quality of information, usually do not consider the breeders’ interests. Thus, in most countries there is wide gap between research institutes / universities and breeder associations. This gap is particularly due to the fact that more than in other species, horse breeders consider other breeders as potential competitors and give little importance to joint actions needed in breeding programs.
On the other hand, closer relation in Japan, Canada and some European countries, have allowed major advances in horse breeding. In Germany, for example, a country that stands out for jumping and dressage competitions and export of horses, the opinion, awareness and cooperation among breeders gave associations set guidelines that would meet not only their needs, and those of the research institutes / universities, but also the interest of the country. So the Breeders\' Associations, supported by these institutions, publishes annually a Sire Handbook containing productive traits considered of general interest. This liaison has been very productive, resulting in19 gold, 8 silver and 12 bronze medals only in the last two Olympics taking into account dressage disciplines, jumping and eventing.
Comparing to other farm animal species, there are some advantages and difficulties specifically related to researches on horse breeding, when quantitative genetics principles are used.
The advantages are fundamentally the amount of performance information and pedigree extension.
The depth of the genealogy in most breeds is high
Traditionally, horse breeders associations consider the "pedigree" as a key factor to select their animals, so that in most of them, herd control is efficient. This fact goes back to the world\'s first Stud Book opening in 1791 (General Stud Book) for Thoroughbred animals. It was the basis for the other
Most of the breeds that were studied based on breeding, it is possible to track the animal’s genealogy back to the fourth or fifth generation (depending on when the breeders’ association’s started), so that genetic evaluations in this aspect are efficient.
Economic important traits can generally be measured in both genders.
In most of the breeds, especially the ones for some kinds of performance, the possibility of measuring both genders generates a greater information and knowledge volume about the behavior of traits in the population, what enables more efficient genetic evaluations. Racing, jumping, dressage, barrel, performances meets three classical disciplines: dressage, cross country and jumping. It is a form held in three days.
On the other hand, even in breeds (or strains within a breed) where the breeding economic interest is the production of animals only for the conformation, not for performance, both genders can be evaluated.
Economic important traits can usually be measured repeatedly in short time periods.
In horses it is possible to get repeated performance in relatively short time periods in a large portion of the population, while that doesn’t happen with some domestic species, where economic important traits aren’t repeated in the animal life (weight at weaning, weight at the year), or require a relatively long time to repeat (milk production, weight of the fleece).
In this sense, considering that the average number of starts per horse in Thoroughbred race season 2007/2008 was 6.5 [6], in a year is possible to get reasonable performance information (position, awards, time) about the horses. Although this average represents a new performance every two months, there are animals that race every 15 days, or even during the same week.
On the other hand, certain difficulties related to equine species and others due to various issues have been some of the major problems when research on horse breeding is done
Low reproductive rates
Since the early ancestors emerged from 55 to 60 million years ago, horses are adapting in order to develop a reproduction model that ensures survivability in the wild, adopting different reproductive strategies to ensure that their progeny are born in the appropriate time of year [7]. However, domestication has strongly influenced reproductive performance, with selection pressure on fertility being either small or null, and mating usually dictated by the functional performance of the animals [8].
Thus, considering that reproductive traits usually have low heritability estimate [8], and have been selected on horses by an indirect way, genetic alterations in order to enhance characteristics of this nature are evidently neither fast nor simple, especially in a species with a long generation interval such as the equine’s (see item "High ranges of generation and delivery").
Hence, horses have low reproductive performance when compared to other farm animal species. The birth rate ranges from 59% [9, 8] to 74% [10, 7] the higher percentages being usually found in tests involving a small number of mares. Table 1 illustrates the result of 42,750 matings done with 7,278 Thoroughbred mares. It was observed that birthrates for males and females were 49.26% and 50.74%, respectively, whereas abortion and stillborn foals were 1.41% and 2.02%, respectively. It was also recorded that 9.07% of coverings were classified as empty, whereas 23.7% of matings did not show any latter records to track success.
Occurrence | Number of observations and % |
Male | (29.35%) |
Female | 12,927 (30.23%) |
Abortion | 603 (1.41%) |
Empty | 3,878 (9.07%) |
Without information | 9,864 (7.23%) |
Stillborn | 866 (2.02%) |
Not mated | 1,945 ( 4.54%) |
Mated with another breed | 135 (0.31%) |
Occurrences after mating
This relatively low fertility is described in different races, countries and purposes, and may be related to hormonal dysfunction, genital infections in mares, parasitic infestations and inadequate handling practices before the breeding season [11]. These factors are even more imposing in the case of animals used in sports, since they have very different handling from those that are exclusively used in breeding [12]. Furthermore, maintenance of older mares and stallions due to their progeny’s superior sporting performance can decrease the rate of conception in the herd, as the rate decreases progressively with increasing age [13]. Table 2 describes this aspect, illustrating the conception and apparent fertility rates (defined by [14] as the ratio of the total number of mares that conceived by the total number of mated mares and as mares that delivered living foals by the number of mated mares, respectively) according to parturition order.
Parturition Order | N | Conception rate (%) | Apparent fertility rate (%) |
1 | 5.531 | 75 | 71 |
2 | 4.534 | 73 | 68 |
3 | 3.655 | 71 | 68 |
4 | 2.794 | 69 | 67 |
5 | 2.155 | 67 | 65 |
6 | 1.560 | 64 | 61 |
7 | 1.070 | 62 | 59 |
8 | 777 | 59 | 56 |
9 | 513 | 56 | 54 |
10 | 329 | 54 | 52 |
11 | 171 | 48 | 47 |
12 | 92 | 48 | 46 |
"/> 13 | 79 | 41 | 38 |
Number of observations (N), conception rates and apparent fertility according to the parturition order of Thoroughbred mares.
Additionally, in some breeds (Thoroughbred, Quarter Horse, Standardbred, etc.), the existence of the so-called Racing Year In the southern hemisphere, an interval of 12 months between July 1st and June 31st. In northern hemisphere countries, begins on January 1st and ends in December 31st.
Percentage of Thoroughbred foal births by month in Brazil
With that objective, the breeding season, that usually lasts for 4 to 5 months, usually starts in August 15th in the southern hemisphere (or February 15th in the northern hemisphere). However, the percentage of mares that naturally ovulate in this period is quite low, since mares are seasonal poliestric, with the onset of the natural breeding season in spring, associated with increases in photoperiod, temperature and food availability [7]
In this sense, [15] found in Thoroughbred horses raised in Ireland (Northern Hemisphere), that the change of the beginning of the breeding season from February 15th to April 15th (hence delaying the beginning of the racing year by the same amount - January 1 to March 1), would better accommodate the natural reproductive cycle of females and could potentially increase the pregnancy rate by approximately 10% (Figure 4). Similar gains were likely to occur in countries in the southern hemisphere if the beginning of the breeding season changed from August 15th to October 15th, consecutively postponing the beginning of the racing year from July 1st to September 1st. Following this guidance, Australia postponed the beginning of the national racing year to August 1st (breeding season between September and December), mitigating the problem, although [13] considers the best breeding season in that country to be between November and February.
Figure 5 helps to understand the idea suggested by [13], as it represents the photoperiod in the southern hemisphere according to the latitude. It is observed that photoperiods are longer between October and February and higher percentages of ovulating mares are expected, favoring successful coverings.
Percentage of mares ovulating by month in the northern hemisphere (adapted from [
Photoperiods for different degrees south latitude (adapted from [
high generation and parturition intervals
Generation interval represents the time needed to replace the next generation, and the shorter it is, the greater the expected annual gene change rate. Thus, considering that in horses this interval varies from 8 to 12 years, overall genetic changes due to selection tend to be slower when compared to cattle (4-6 years), sheep (3-5 years) pigs (1.5 to 2 years) and birds (1 to 1.5 years). Sportive breeds, in which reproductive technologies are not permitted, typically show higher ranges as the superior performance animals, especially females, usually start into reproduction after the end of their competitive life.
The generation intervals of some equine breeds are described in Table 3.
Andalusian | 10.1 | [17] |
Thoroughbred | 7.10 | [18] |
Icelandic Toeler | 9.7 | [14] |
Friesian | 9.6 | [19] |
Hanoverian | 8.4 | [20] |
Mangalarga | 9.5 | [21] |
Arabian | 9.7 | [22] |
Lusitano | 10.5 | [23] |
Mangalarga Marchador | 8.9 | [24] |
Generation intervals from a few equine breeds
The parturition interval is the amount of time between two consecutive parturitions, including the time from the parturition until the appearance of the first heat, from the first heat to the conception and finally the duration of pregnancy. It is an important component when estimating the herds’ reproductive efficiency, with great influence on the economic return and breeding, due to its effects on the generation interval and selection intensity to be applied.
Among the domestic species, the mare has the capacity to provide fertile estrus a few days after birth, the so called foal heat. The main advantage of this phenomenon seems to be the maintenance of a 12 months foaling interval [25]. According to these authors, due to the enrollment of horses in sport activities, there is great pressure in order to have as many pregnant mares as possible in the breeding season. In this sense, efforts are made to cover mares in the foal heat. Considering the average pregnancy lasting around 11 months (see topics below) and the possibility of new pregnancy in the close postpartum days, a 12 months foaling interval would be obtained [25]. Thus, most breeders seek to take the opportunity of the foal heat, being aware that during this heat mares ovulate quickly, conception rates are lower and early embryonic mortality rate is higher [8].
There is a great variation among the equine foaling intervals, depending on the breed and breeding purposes, although most studies point values greater than 365 days (Table 4).
Halflinger | 468 | [26] |
Thoroughbred | 490 | [8] |
Marwari | 535 | [27] |
Kathiawari | 567 | [27] |
Mangalarga Marchador | 548 | [24] |
Arabian | 387 | [7] |
Foaling intervals in some equine breeds
Relatively long gestation period and low number of offspring per parturition
Although the duration of a pregnancy isn’t directly associated with a breeding farm’s production costs, its study may be extremely important in the preparation of breeding plans.
The gestation period can be defined as the time between fertilization of egg and the fetus’ delivery. According to [28], the average duration of a mare’s pregnancy is typically 340 days, ranging from 300 to 400 days. This wide time range until the birth of the foals indicates that mares may be highly susceptible to both internal and external factors afecting the duration of the pregnancy [29]. The ages of mare and stallion, year and month of birth, breeding season, foal sex, breed and nutritional status are factors that should be considered in the study of the pregnancy’s duration [28].
Studies focusing the stallion used on coverings also deserve special attention when studying the pregnancy period in mares. The pregnancy’s duration for females mated with specific stallions may be a criterion when choosing the stallion. This is because when a mare is bred late in a breeding season, yet the owner wants to mate her during this season, choosing a stallion associated with shorter pregnancy durations may be profitable [28].
Working with horses in the northern hemisphere [30] observed that the mating season was the most important factor affecting the duration of pregnancy in mares. According to these authors, the pregnancies that derived from mating during the period from December to May were 10.4 days longer than those derived from mating from June to November.
Studying Arab mares in Egypt, [31] observed that pregnancies with longer durations were the ones that ended in the winter, suggesting that the mares seem to be able to adapt the length of the gestation so the births happen in spring, which may be important for the survival of the species in the wild.
Carthusian | 332 | [32] |
Thoroughbred/Quarter Horse | 341 | [33] |
Andalusian | 336 | [34] |
Standardbred | 349 | [35] |
Mangalarga Marchador | 327 | [24] |
Arabian | 334 | [7] |
Criollo | 335 | [36] |
Freiberger | 336 | [37] |
Gestation periods in some equine breeds
Regardless of the discrepancy between studies and breeds, mares have a relatively long gestation period compared to other domestic species such as cattle (270-290 days), goats (145-151 days), sheep (144-152 days), pigs (112-115 days) and buffalo (298-317 days). Furthermore, as a uniparous species, twins (or multiple) are rare in mares, incidence varying from 0.5 to 1.6% of parturitions [38], so that the annual availability of animals for selection is comparatively small.
Use of reproductive technologies
Although reproductive technologies (artificial insemination and embryo transfer) make possible different practical advantages such as lower disease and injury transmission, long-term storage of genetic material, easier transportation, earlier onset of reproduction in females and, in the case of embryo transfer, reproduction during the sports career, in the context of animal breeding they are usually considered additional tools to optimize breeding programs [5].
The commercial impact of these techniques in horses varies greatly. For example, in Thoroughbred horses meant for racing, the use of artificial insemination Indeed, in exceptional cases may occur insemination as set forth in Article 25 of the Rules of the Association of Breeders and Owners Horse Racing - Stud Book.
On the other hand, according to the International Embryo Transfer Society (IETS) the higher number of embryo transfers occur in the United States, Argentina and Brazil, in order of importance, countries which together represent over 90% of the activities in this area worldwide. In 2005, 5,700 embryos were transferred in Brazil, none frozen, while across Europe only 711 transfers were done in horses [39].
In this context, it is observed that, although several countries present a prominent role in the worldwide scenario with respect to the use of these reproductive biotechniques, especially embryo transfer, there are few studies about their impact (generation interval, accuracy, selective intensity, inbreeding) on horses breeding programs. Research in this subject would be important to understand the direction that has been given to these tools in different countries and monitor their actual benefit for the horse population.
Knowledge of interesting traits’ economic values
A fundamental requirement for any breeding scheme aiming the improvement of quantitative traits is the establishment of the breeding objectives, involving the relative values of genetic change for all desirable features included in the breeding program. Typically, these values are expressed in monetary terms as weights to be applied to each feature of economic importance [40].
However, few scientific studies have been performed in order to obtain economic weights for traits involved in horse selection programs, were a combination of empirical experience, some biological factors and intuition of designers prevail. There are a few reasons for that.
It’s often very difficult to determine, in horses, the value of one unit of expression for a given trait in relation to the animal’s total value. Economically quantifying units for traits such as speed, dressage, jumping, etc., is far more complex than attributing values to liters of milk, kilos of meat or wool.
The long period of time between mating and expressig the traits of interest in the progeny, besides the difficulties in determining an appropriate function for profitability, provide part of this deficiency. Moreover, according to recent authors, another problem arises from the fact that not always the relative economic weights are linear in a breeding program. Thus, the amount of increase in the genotype for certain character can be strongly dependent on the values of other genetic traits. For example, in horses with outstanding ability to jump, the additional genetic values affecting their training capability is almost neglected, whereas in animals with a low ability to jump, a genotype corresponding to training characteristics can greatly increase its value.
Diversity of goals within certain breeds
There are equine breeds that are commonly selected by breeder in only one direction, as is the case of the Thoroughbred, where the objective is basically to obtain animals with superior performance in races. In Quarter horses, in addition to races, performance in work tests and conformation may also be targets of breeders since the race is subdivided amongst these strains.
Moreover, in breeds in which animals are involved in a wide variety of uses (work on farms, horseback riding, trekking, exhibitions, equine therapy, equestrian tourism, unskilled riding sports, etc.) breeders seek very different traits, depending on the purpose of raising the animal, hindering the implementation of breeding programs that cover all segments. Brazilian breeds such as the Mangalarga and the Mangalarga Marchador fall into this category.
In these cases, studies involving quantitative and molecular aspects of traits that can meet the desire for the greater proportion of breeders can result in meaningful contributions to selection of reproductive, behavioral, immunological and other traits.
Corrosive ingestion is a medical emergency that is especially prevalent in developing countries such as Thailand [1, 2, 3, 4, 5, 6, 7, 8, 9]. Since 2020, the COVID-19 has had an enormous impact on many sectors worldwide, and it had affected the trend of rising incidence and severity of diseases [10]. However, the actual incidence should not be precise as the tip of the iceberg phenomenon is probably under-report [4, 8]. Currently, various studies on this topic are still being developed for medical knowledge to the achievement goal of the best practice. Perforation and stricture are complications of corrosive ingestion which are currently being researched and which are discussed in this chapter.
Caustic injuries are caused by the ingestion of substances with acid or base properties. Acids cause coagulation necrosis, and alkalis cause liquefaction necrosis. Corrosive ingestion in children is usually accidental. In adults, it might be related to suicide. Therefore, it is a public health concern with mental and socioeconomic aspects [1, 2, 6, 11].
Morbidity with mortality rates of corrosive injuries are high [12, 13]. Airway assessment and prompt management are priorities in emergency settings, especially in severe cases [2, 13, 14]. Extensive burns can cause the fragile esophageal wall to become perforated. Physicians must evaluate this condition as soon as possible. Stricture is another complication that physicians need to evaluate. Post-corrosive esophageal strictures cause patients to suffer and are difficult to treat [2, 3, 4, 9, 12, 15, 16, 17, 18, 19].
Caustic substances with pH less than two or more than 12 are especially destructive. Form, concentration, amount of ingestion, and contact duration also affect the results. Acidic substances generate coagulation necrosis which creates eschar formation. Eschar can limit the penetration of injuries [16]. On the other hand, alkaline substances melt the tissue protein and initiate liquefactive necrosis with saponification that can penetrate deeper into the esophageal wall [17].
Perforation occurs in the acute stage of severe esophageal injuries. As a consequence of perforation, stricture follows during the recovery stage. Tissue injuries after corrosive ingestion go through three phases. Phase 1 is characterized by cell necrosis and thrombosis, 48–72 hours after the event. Next, in Phase 2, there is mucosal sloughing with ulceration of the esophageal wall plus fibroblast colonization and granulation. This phase continues for 14 days from the Phase 1, and the esophagus is friable during this phase. Finally, in Phase 3, the healing process starts in the third week and usually continues 3–6 months [3, 20, 21].
When patients arrive at the emergency department, stabilization of the patient is the most important target for this stage [21]. Signs and symptoms that often occur in corrosive ingested patients include burning of the oral cavity, drooling, nausea, and vomiting. Upper gastrointestinal bleeding can be found in severe cases, indicating substance injuries to the alimentary tract. Respiratory trauma can result in hoarseness, difficulty to breathe, stridor, and airway compromise. Esophagus perforation can be expressed as mediastinitis, chest wall emphysema, and pneumothorax, depending on time and severity.
Physicians should first examine the airway, especially for signs of aspiration or laryngeal injury. Physical examination and history taking should be done for details of the corrosive substance, the volume, timing before admission, pre-hospital treatment, and cause of ingestion. The patient should be given nil per os (NPO) and adequate resuscitation. Nasogastric tube intubation, gastric lavage, administration of emetic drugs, and neutralizing agents are not recommended because reflux of these agents into the esophagus could result in further damage [1, 8, 21]. Intravenous broad-spectrum antibiotics may benefit a patient with high-grade esophageal injuries. The investigation by chest and abdominal radiography should be evaluated. In cases of attempted suicide, the patient should be evaluated by the psychiatric department [1, 3, 4, 9, 22, 23].
The initial evaluation of the severity of a caustic injury provides important information. Esophagogastroduodenoscopy (EGD) is recommended for grading esophageal injuries following the Zargar classification (Table 1). Zargar classification can assist prognosis and guide clinical management [16]. The EGD should be done as soon as possible within 24–48 hours. Performing endoscopy after 48 hours is not recommended because the tissue injuries go through Phase 2 when they should not be subjected to an unwanted event [16, 21]. For patients with Zargar grade 1 and 2a, an oral diet may be given. Patients with Zargar grade 2b and 3a can start an oral diet once they can swallow saliva. Esophagectomy should be performed on patients with Zargar grade 3b injuries.
Zargar classification | Description |
---|---|
Grade 0 | Normal finding on endoscopic examination |
Grade 1 | Edema and hyperemia of the mucosa |
Grade 2a | Friability, blisters, exudates, hemorrhages, whitish membrane, erosions, and superficial ulceration |
Grade 2b | Grade 2a plus deep discrete or circumferential ulceration |
Grade 3a | Small scattered areas of multiple ulceration and areas of necrosis with brown-black or grayish discoloration |
Grade 3b | Extensive necrosis |
Zargar classification of corrosive esophageal injury.
The method for assessing the degree of esophageal damage by computed tomography (CT) with scoring was recently established as a noninvasive modality [24]. Nowadays, the use of CT scans of the chest and abdomen is increasing. CT can assist prognosis after ingestion, but it is still inconclusive [25, 26, 27]. CT also provides extraesophageal information regarding anatomies such as the mediastinum, lung, and pleural cavity, which endoscopies do not (Table 2).
Score | Endoscopic score [16] | Computerized tomography score [24] |
---|---|---|
0 | Grade 0; Normal | Normal |
I | Grade 1; Edema and hyperemia of the mucosa | No definite swelling of esophagus wall (<3 mm, within normal limit) |
II | Grade 2a; Friability, blisters, exudates, hemorrhages, whitish membrane, erosion, and superficial ulceration | Edematous wall thickening (>3 mm) without periesophageal soft tissue infiltration |
Grade 2b; Grade 2a plus deep discrete or circumferential ulceration | ||
III | Grade 3a; Small scattered areas of multiple ulceration and areas of necrosis with brown-black or grayish discoloration | Edematous wall thickening with periesophageal soft tissue infiltration pulse well-demarcated tissue interface |
Grade 3b; Extensive necrosis | ||
VI | Grade 4; Perforation | Edematous wall thickening with periesophageal soft tissue infiltration plus blurring of tissue interface or localized fluid collection around the esophagus or the descending aorta |
Endoscopic score and computerized tomography score of corrosive esophageal injury.
Although an endoscopy is an important tool for initial evaluation, contraindications are suspected perforation, oral cavity necrosis, and airway injury with compromised respiration. CT scans can safely provide details about esophageal transmural necrosis consisting of esophageal wall blurring, peri-esophageal fat stranding, and no enhancement of esophageal wall after administration of intravenous contrast [24]. Recent studies reported that unnecessary esophagectomy following endoscopic evaluation of patients with Zargar grade 3b could have been avoided if CT had been used [28, 29, 30].
Both CT and endoscopy have distinctive advantages. CT is minimally invasive with high sensitivity and specificity [24, 25, 27, 28, 29, 30]. Intra-luminal evaluation by endoscopy reveals subtle details of the esophageal mucosa and degrees of damage [31]. The combination of CT and endoscopy is especially useful for examining patients with Zargar 3b injuries [8, 30, 31].
As the esophagus is healing following ingestion of a corrosive substance, the possibility of stricture should be assessed. Post-corrosive esophageal stricture is a complication that produces suffering for victims [9, 15, 17]. Esophageal dilation is a therapeutic intervention of choice to perform at the onset of stricture. If left until later, the procedure becomes more difficult, decreasing the success and increasing adverse events [21, 32, 33, 34, 35, 36]. Esophageal dilatation can be performed repeatedly according to schedule and using various dilators such as Maloney-Hurst, Savary-Gilliard, and Balloon dilator under the endoscopy, fluoroscopy, or both. Alternative methods for post-corrosive esophageal stricture such as esophageal stenting [21, 37, 38], intralesional steroids [21, 39, 40, 41, 42, 43], and, Mitomycin-C [21, 44, 45, 46, 47, 48] have been published with various outcomes. These options might supplement dilation with better results. In cases of severe stricture, failure to dilate, or refractory strictures, surgery might be necessary (Figure 1) [4, 18, 19, 49, 50, 51, 52, 53, 54].
The treatment options for post-corrosive esophageal stricture. (A) Severe post-corrosive esophageal stricture; (B) Savary-Gilliard dilator; (C) endoscopic balloon dilation; (D) esophagectomy with open right thoracotomy; (E) esophagectomy with video-assisted thoracoscopic surgery (VATS); (F) reconstruction with cervical anastomosis after esophagectomy; (G, H) right side colonic conduit for esophageal replacement; and (I) subcutaneous colon interposition.
Post-corrosive esophageal stricture should highly consider inpatient with Zargar grade 2b and 3a [4, 5, 8, 9, 16, 55]. Although various treatment strategies have been developed, none of them can provide outstanding results. Stricture prevention would be the ideal method. Corticosteroids reduce inflammation, but the benefit is inconclusive. Steroids cause severe adverse side effects such as esophageal candidiasis, gastric ulcer, ethmoiditis, osteomyelitis, and osteoporosis [56, 57, 58]. Recent studies have demonstrated that omeprazole with proton pump inhibitor activity could enhance healing, reduce stricture, and reduce the short-term risk of developing esophageal stricture in patients with 2b and 3a corrosive injuries [9, 59, 60, 61]. However, further studies of omeprazole are needed to corroborate these findings (Figure 2).
Schematic diagram of corrosive ingestion in esophageal injury.
Corrosive ingestion is a serious medical emergency that is a global problem, especially in several developing countries. When patients arrive at the emergency department, stabilization of the patient is initially the most important target. Airway assessment and prompt management are the priorities for emergency settings, especially in severe cases. Any intervention that might cause substance reflux into the esophagus resulting in further damage is not recommended. Current methods for assessing the degree of esophageal damage are early endoscopy for Zargar classification and CT scan, which focuses on ruling out perforation. Post-corrosive esophageal stricture can be a consequent complication with poor treatment outcomes, and stricture prevention is an interesting idea.
The author declares no conflict of interest.
Special thanks to Michael Jan Everts for assistance in editing the English version of this chapter.
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Jansen",authors:[{id:"25232",title:"Prof.",name:"Sukumaran",middleName:null,surname:"Anil",slug:"sukumaran-anil",fullName:"Sukumaran Anil"},{id:"28373",title:"Prof.",name:"John",middleName:null,surname:"Jansen",slug:"john-jansen",fullName:"John Jansen"},{id:"77058",title:"Dr.",name:"Seham",middleName:null,surname:"Alyafei",slug:"seham-alyafei",fullName:"Seham Alyafei"},{id:"82073",title:"Dr.",name:"Subhash",middleName:null,surname:"Narayanan",slug:"subhash-narayanan",fullName:"Subhash Narayanan"}]},{id:"18415",doi:"10.5772/16936",title:"Osseointegration and Bioscience of Implant Surfaces - Current Concepts at Bone-Implant Interface",slug:"osseointegration-and-bioscience-of-implant-surfaces-current-concepts-at-bone-implant-interface",totalDownloads:12502,totalCrossrefCites:16,totalDimensionsCites:42,abstract:null,book:{id:"179",slug:"implant-dentistry-a-rapidly-evolving-practice",title:"Implant Dentistry",fullTitle:"Implant Dentistry - A Rapidly Evolving Practice"},signatures:"Mustafa Ramazanoglu and Yoshiki Oshida",authors:[{id:"26726",title:"Prof.",name:"Yoshiki",middleName:null,surname:"Oshida",slug:"yoshiki-oshida",fullName:"Yoshiki Oshida"},{id:"29841",title:"Prof.",name:"Mustafa",middleName:null,surname:"Ramazanoglu",slug:"mustafa-ramazanoglu",fullName:"Mustafa Ramazanoglu"}]},{id:"18426",doi:"10.5772/18746",title:"Factors Affecting the Success of Dental Implants",slug:"factors-affecting-the-success-of-dental-implants",totalDownloads:17474,totalCrossrefCites:9,totalDimensionsCites:35,abstract:null,book:{id:"179",slug:"implant-dentistry-a-rapidly-evolving-practice",title:"Implant Dentistry",fullTitle:"Implant Dentistry - A Rapidly Evolving Practice"},signatures:"Carlos Nelson Elias",authors:[{id:"32438",title:"Prof.",name:"Carlos",middleName:null,surname:"Elias",slug:"carlos-elias",fullName:"Carlos Elias"}]},{id:"18414",doi:"10.5772/17512",title:"Dental Implant Surfaces – Physicochemical Properties, Biological Performance, and Trends",slug:"dental-implant-surfaces-physicochemical-properties-biological-performance-and-trends",totalDownloads:13080,totalCrossrefCites:5,totalDimensionsCites:30,abstract:null,book:{id:"179",slug:"implant-dentistry-a-rapidly-evolving-practice",title:"Implant Dentistry",fullTitle:"Implant Dentistry - A Rapidly Evolving Practice"},signatures:"Ahmed M. Ballo, Omar Omar, Wei Xia and Anders Palmquist",authors:[{id:"19042",title:"Dr.",name:"Wei",middleName:null,surname:"Xia",slug:"wei-xia",fullName:"Wei Xia"},{id:"28549",title:"Dr.",name:"Ahmed",middleName:"M.",surname:"Ballo",slug:"ahmed-ballo",fullName:"Ahmed Ballo"},{id:"81291",title:"Dr.",name:"Omar",middleName:null,surname:"Omar",slug:"omar-omar",fullName:"Omar Omar"},{id:"81292",title:"Dr.",name:"Anders",middleName:null,surname:"Palmquist",slug:"anders-palmquist",fullName:"Anders Palmquist"}]},{id:"18417",doi:"10.5772/18309",title:"Implant Stability - Measuring Devices and Randomized Clinical Trial for ISQ Value Change Pattern Measured from Two Different Directions by Magnetic RFA",slug:"implant-stability-measuring-devices-and-randomized-clinical-trial-for-isq-value-change-pattern-measu",totalDownloads:13176,totalCrossrefCites:8,totalDimensionsCites:19,abstract:null,book:{id:"179",slug:"implant-dentistry-a-rapidly-evolving-practice",title:"Implant Dentistry",fullTitle:"Implant Dentistry - A Rapidly Evolving Practice"},signatures:"Jong-Chul Park, Jung-Woo Lee, Soung-Min Kim and Jong-Ho Lee",authors:[{id:"31057",title:"Prof.",name:"Jong-Ho",middleName:null,surname:"Lee",slug:"jong-ho-lee",fullName:"Jong-Ho Lee"},{id:"48351",title:"Prof.",name:"Jong-Chul",middleName:null,surname:"Park",slug:"jong-chul-park",fullName:"Jong-Chul Park"},{id:"83313",title:"Dr.",name:"JungWoo",middleName:null,surname:"Lee",slug:"jungwoo-lee",fullName:"JungWoo Lee"}]}],mostDownloadedChaptersLast30Days:[{id:"18432",title:"Clinical Complications of Dental Implants",slug:"clinical-complications-of-dental-implants",totalDownloads:56478,totalCrossrefCites:2,totalDimensionsCites:5,abstract:null,book:{id:"179",slug:"implant-dentistry-a-rapidly-evolving-practice",title:"Implant Dentistry",fullTitle:"Implant Dentistry - A Rapidly Evolving Practice"},signatures:"Su-Gwan Kim",authors:[{id:"27797",title:"Prof.",name:"Su-Gwan",middleName:null,surname:"Kim",slug:"su-gwan-kim",fullName:"Su-Gwan Kim"}]},{id:"47927",title:"Miniscrew Applications in Orthodontics",slug:"miniscrew-applications-in-orthodontics",totalDownloads:4697,totalCrossrefCites:0,totalDimensionsCites:2,abstract:null,book:{id:"4548",slug:"current-concepts-in-dental-implantology",title:"Current Concepts in Dental Implantology",fullTitle:"Current Concepts in Dental Implantology"},signatures:"Fatma Deniz Uzuner and Belma Işık Aslan",authors:[{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan"},{id:"172009",title:"Dr.",name:"Fatma Deniz",middleName:null,surname:"Uzuner",slug:"fatma-deniz-uzuner",fullName:"Fatma Deniz Uzuner"}]},{id:"50308",title:"Antibiotics in Implant Dentistry",slug:"antibiotics-in-implant-dentistry",totalDownloads:2369,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Antibiotics have been recommended either as an extended treatment for several days or as a single antibiotic prophylaxis dose since the development of dental implant osseointegration technique in the 1970s. It is also performed as part of surgical protocol during the peri-operative phase in the treatment of peri-implantitis. To date, there is a lack of scientific evidence regarding the additive effect of antibiotics in the treatment of dental implant. This has thus left the clinician with inconclusive recommendations, leading to increase antibiotic prescription. With this increase, the development of antibiotic resistance is becoming a threat to modern healthcare that requires revisiting of current indications and implementation of rational treatment strategies. Therefore, more studies are needed to assess the benefit of antibiotic prescription and whether it is safe to refrain from its use.",book:{id:"5185",slug:"dental-implantology-and-biomaterial",title:"Dental Implantology and Biomaterial",fullTitle:"Dental Implantology and Biomaterial"},signatures:"Dalia Khalil, Bodil Lund and Margareta Hultin",authors:[{id:"179031",title:"Dr.",name:"Dalia",middleName:null,surname:"Khalil",slug:"dalia-khalil",fullName:"Dalia Khalil"},{id:"185113",title:"Dr.",name:"Bodil",middleName:null,surname:"Lund",slug:"bodil-lund",fullName:"Bodil Lund"},{id:"185114",title:"Dr.",name:"Margareta",middleName:null,surname:"Hultin",slug:"margareta-hultin",fullName:"Margareta Hultin"}]},{id:"47915",title:"Rationale for Dental Implants",slug:"rationale-for-dental-implants",totalDownloads:3076,totalCrossrefCites:0,totalDimensionsCites:2,abstract:null,book:{id:"4548",slug:"current-concepts-in-dental-implantology",title:"Current Concepts in Dental Implantology",fullTitle:"Current Concepts in Dental Implantology"},signatures:"Ilser Turkyilmaz and Gokce Soganci",authors:[{id:"171984",title:"Associate Prof.",name:"Ilser",middleName:null,surname:"Turkyilmaz",slug:"ilser-turkyilmaz",fullName:"Ilser Turkyilmaz"}]},{id:"18430",title:"An Important Dilemma in Treatment Planning: Implant or Endodontic Therapy?",slug:"an-important-dilemma-in-treatment-planning-implant-or-endodontic-therapy-",totalDownloads:6264,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"179",slug:"implant-dentistry-a-rapidly-evolving-practice",title:"Implant Dentistry",fullTitle:"Implant Dentistry - A Rapidly Evolving Practice"},signatures:"Funda Kont Cobankara and Sema Belli",authors:[{id:"28846",title:"Dr.",name:"Funda",middleName:null,surname:"Kont Çobankara",slug:"funda-kont-cobankara",fullName:"Funda Kont Çobankara"},{id:"75862",title:"Prof.",name:"Sema",middleName:null,surname:"Belli",slug:"sema-belli",fullName:"Sema Belli"}]}],onlineFirstChaptersFilter:{topicId:"998",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81595",title:"Prosthetic Concepts in Dental Implantology",slug:"prosthetic-concepts-in-dental-implantology",totalDownloads:25,totalDimensionsCites:0,doi:"10.5772/intechopen.104725",abstract:"This chapter will address evidence-based prosthetic concepts in dental implantology as well as clinical evidence with focus on appropriate logic and technical skills. Those prosthetic factors are as just important as surgical factors, and long-term success can only be achieved if both of those factors are considered, respected, and strictly followed from planning to prosthetic phase of treatment. This chapter will deal with materials selection for prosthetic part, shape, size, and design of supracrestal parts of abutments and their influence on soft tissue and bone stability around dental implants. Furthermore, one of most important decisions is about choosing the proper way of retention: screw- vs. cement-retained restorations, and it will be discussed in detail. Additionally, emergence profile and its function in soft tissues adaptation and adhesion to different prosthetic materials also have important role in long-term success of dental implant restorations.",book:{id:"10808",title:"Current Concepts in Dental Implantology - From Science to Clinical Research",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg"},signatures:"Ivica Pelivan"},{id:"80500",title:"Novel Dental Implants with Herbal Composites: A Review",slug:"novel-dental-implants-with-herbal-composites-a-review",totalDownloads:49,totalDimensionsCites:0,doi:"10.5772/intechopen.101489",abstract:"Missing a permanent tooth is a miserable condition faced by a common man. A tooth decay, periodontitis, mechanical trauma, or any systemic complications lead to such a complication. These bone defects when left untreated lead to severe resorption of the alveolar bone. A proper dental filling with an appropriate bone substitute material could prevent such resorption and paves a way for subsequent implant placement. Dental implants are considered as the prime option by dentists to replace a single tooth or prevent bone resorption. A variety of bone substitutes are available differ in origin, consistency, particle size, porosity, and resorption characteristics. Herbal composites in dentistry fabricated using biphospho-calcium phosphate, casein, chitosan, and certain herbal extracts of Cassia occidentalis, Terminalia arjuna bark, Myristica fragans also were reported to possess a higher ossification property, osteogenic property and were able to repair bone defects. C. occidentalis was reported to stimulate mineralization of the bone and osteoblastic differentiation through the activation of the PI3K-Akt/MAPKs pathway in MC3T3-E1 cells of mice. This implant proved better osteoconductivity and bioactivity compared to pure HAP and other BCP ratios. Terminalia Arjuna was also worked in the incorporation in the graft to enhance the osteogenic property of the implant and gave good results. Another implant bone graft was synthesized containing BCP, biocompatible casein, and the extracts of Myristica fragans and subjected to in vitro investigations and the results revealed the deposition of apatite on the graft after immersing in SBF and also the ALP activity was high when treated with MG-63 cells, NIH-3 T3, and Saos 2 cell lines. This study indicates that the inclusion of plant extract enhances the osteogenic property of the graft. Thus, these novel dental implants incorporated with herbal composites evaluated by researchers revealed an enhanced bone healing, accelerates osseointegration, inhibits osteopenia, and inhibits inflammation. This application of herbal composite inclusion in dentistry and its applications has a greater potential to improve the success rate of dental implants and allows the implications of biotechnology in implant dentistry.",book:{id:"10808",title:"Current Concepts in Dental Implantology - From Science to Clinical Research",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg"},signatures:"Gopathy Sridevi and Seshadri Srividya"},{id:"78320",title:"Implant-Retained Maxillary and Mandibular Overdentures - A Solution for Completely Edentulous Patients",slug:"implant-retained-maxillary-and-mandibular-overdentures-a-solution-for-completely-edentulous-patients",totalDownloads:66,totalDimensionsCites:0,doi:"10.5772/intechopen.99575",abstract:"The main goal of modern removable prosthodontics is to restore the normal appearance, function, esthetics and speech in each completely edentulous patient. However, if all teeth are missing in a patient, it becomes very complicated to achieve it using traditional protocols. Therefore, implants were introduced into removable prosthodontics to ensure better retention and stability of the conventional dentures. In case of a large amount of bone missing in the jaw it is necessary to ensure the functioning of the dentures constructing various additional stabilizing and retentive prosthodontic solutions on the osseointegrated implants. Numerous types of attachment systems have been used recently for relating implant-retained overdentures to underlying implants: basically splinting (various bar shape designs) and non-splinting attachments (various ball type attachment, magnet attachment, telescopic coping systems). Indications for their use depend on the surgical and prosthodontic factors such as the number and position of the implants, the amount of free intermaxillary space and the type and size of the overdentures. Different indications, types of the overdentures and the attachment systems will be discussed in this chapter.",book:{id:"10808",title:"Current Concepts in Dental Implantology - From Science to Clinical Research",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg"},signatures:"Dubravka Knezović Zlatarić, Robert Ćelić and Hrvoje Pezo"},{id:"79724",title:"Implant Stability Quotient (ISQ): A Reliable Guide for Implant Treatment",slug:"implant-stability-quotient-isq-a-reliable-guide-for-implant-treatment",totalDownloads:60,totalDimensionsCites:0,doi:"10.5772/intechopen.101359",abstract:"Implant stability is a prerequisite for successful dental implants and osseointegration. To determine the status of implant stability, continuous monitoring in an objective and qualitative manner is important. To measure implant stability two different stages are there: Primary and secondary. Primary implant stability at placement is a mechanical phenomenon that is related to the local bone quality and quantity, the type of implant and placement technique used. Primary stability is checked from mechanical engagement with cortical bone. Secondary stability is developed from regeneration and remodeling of the bone and tissue around the implant after insertion and affected by the primary stability, bone formation and remodeling. Implant stability is essential for the time of functional loading. Classical benchmark methods to measure implant stability were radiographs or microscopic analysis, removal torque, push-through and pull-through but due to lack of feasibility, time consumption and ethical reasons other methods have been propounded over period of time like measurement of implant torque, model analysis and most important ISQ which has the ability to monitor osseointegration and the life expectancy of an implant. ISQ is a valuable diagnostic and clinical tool that has far-reaching consequences on implant dentistry and this article throws light on advanced and reliable methods of assessing ISQ.",book:{id:"10808",title:"Current Concepts in Dental Implantology - From Science to Clinical Research",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg"},signatures:"Gaurav Gupta"},{id:"79817",title:"Peri-Implant Soft Tissue Augmentation",slug:"peri-implant-soft-tissue-augmentation",totalDownloads:128,totalDimensionsCites:0,doi:"10.5772/intechopen.101336",abstract:"The peri-implant soft tissue (PIS) augmentation procedure has become an integral part of implant-prosthetic rehabilitation. Minimal width of keratinized mucosa (KM) of 2 mm is deemed necessary to facilitate oral hygiene maintenance around the implant and provide hard and soft peri-implant tissue stability. PIS thickness of at least 2 mm is recommended to achieve the esthetic appearance and prevent recessions around implant prosthetic rehabilitation. The autogenous soft tissue grafts can be divided into two groups based on their histological composition—free gingival graft (FGG) and connective tissue graft (CTG). FGG graft is used mainly to increase the width of keratinized mucosa while CTG augment the thickness of PIS. Both grafts are harvested from the same anatomical region—the palate. Alternatively, they can be harvested from the maxillary tuberosity. Soft tissue grafts can be also harvested as pedicle grafts, in case when the soft tissue graft remains attached to the donor site by one side preserving the blood supply from the donor region. Clinically this will result in less shrinkage of the graft postoperatively, improving the outcome of the augmentation procedure. To bypass the drawback connected with FGG or CTG harvesting, substitutional soft tissue grafts have been developed.",book:{id:"10808",title:"Current Concepts in Dental Implantology - From Science to Clinical Research",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg"},signatures:"Marko Blašković and Dorotea Blašković"},{id:"79611",title:"Growth Factors and Dental Implantology",slug:"growth-factors-and-dental-implantology",totalDownloads:103,totalDimensionsCites:0,doi:"10.5772/intechopen.101082",abstract:"Normal healing procedure of bone involves various sequential events to develop bone and bridge the bone -to- bone gap. When this healing occurs with a metal (titanium) fixture on one side, it is called as osseointegration. After extensive studies on this topic, it is found that this procedure occurs in presence of various biologic constituents that are spontaneously released at the site. Thus, to accelerate normal healing after implant placement and make results more predictable, it has been proposed to use these autologous factors in the osteotomy site. Since it is the beginning of a new revolution in dental implantology, right now it is essential to analyze all possible combinations of host conditions, bone quality and quantity and bio factors being used. This can definitely be a boon for the patients with compromised systemic or local conditions.",book:{id:"10808",title:"Current Concepts in Dental Implantology - From Science to Clinical Research",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg"},signatures:"Deeksha Gupta"}],onlineFirstChaptersTotal:17},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:318,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:106,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:15,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. 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Completed the Course Medical Mycology, the Centraalbureau voor Schimmelcultures (CBS), Fungal Biodiversity Centre, Netherlands (2006). International Union of Microbiological Societies (IUMS) Fellow, and International Emerging Infectious Diseases (IEID) Fellow, Centers for Diseases Control and Prevention (CDC), Atlanta, USA. Diploma of Dermatological Scientist, Japanese Society for Investigative Dermatology. Ph.D. of Juntendo University, Japan. Bachelor’s and Master’s degree, Medicine, West China University of Medical Sciences. Chair of Sichuan Medical Association Dermatology Committee. General Secretary of The 19th Annual Meeting of Chinese Society of Dermatology and the Asia Pacific Society for Medical Mycology (2013). In charge of the Annual Medical Mycology Course over 20-years authorized by National Continue Medical Education Committee of China. Member of the board of directors of the Asia-Pacific Society for Medical Mycology (APSMM). Associate editor of Mycopathologia. Vice-chief of the editorial board of Chinses Journal of Mycology, China. Board Member and Chair of Mycology Group of Chinese Society of Dermatology.",institutionString:null,institution:{name:"Sichuan University",institutionURL:null,country:{name:"China"}}},editorTwo:null,editorThree:null},{id:"5",title:"Parasitic Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/5.jpg",isOpenForSubmission:!0,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. 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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. 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