\r\n\tWith the discovery of more unconventional heavier crude and alternative hydrocarbon sources, primary upgrading or cracking of the oil into lighter liquid fuel is critical. With increasing concern for environmental sustainability, the regulations on fuel specifications are becoming more stringent. Processing and treating crude oil into a cleaner oil with better quality is equally important. Hence, there has been a relentless and continuous effort to develop new crude upgrading and treating technologies, such as various catalytic systems for more economical and better system performance, as well as cleaner and higher-quality oil.
\r\n\r\n\tThis edited book aims to provide the reader with an overview of the state-of-the-art technologies of crude oil downstream processing which include the primary and secondary upgrading or treating processes covering desulfurization, denitrogenation, demetallation, and evidence-based developments in this area.
",isbn:"978-1-80356-681-8",printIsbn:"978-1-80356-680-1",pdfIsbn:"978-1-80356-682-5",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"808b0ddfb3b92e0636ae44a83ef7dbd9",bookSignature:"Dr. Ching Thian Tye",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11542.jpg",keywords:"Crude Oil Properties, Hydrocracking, Catalytic Cracking, Coking, Visbreaking, Thermal Cracking, Hydroprocessing, Hydrodesulfurization, Desulfurization, Denitrogenation, Demetallation, Dearomatization",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 22nd 2022",dateEndSecondStepPublish:"April 19th 2022",dateEndThirdStepPublish:"June 18th 2022",dateEndFourthStepPublish:"September 6th 2022",dateEndFifthStepPublish:"November 5th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Associate professor at the School of Chemical Engineering in Universiti Sains Malaysia and dedicated researcher in fuel-related catalytic process and chemical reaction engineering. 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Ocular toxoplasmosis is one of the most common cause of posterior uveitis caused by an intracellular parasite, toxoplasma gondii [2, 3].
1952, Helenor Campbell Wilder (later Helenor Campbell Wilder Foerster) confirmed the growing suspicion that toxoplasma gondii was a cause of uveitis in otherwise healthy adults by identifying the presence of both trophozoites and brachyzoites in enucleated eyes, that suffered severe intraocular inflammation [4].
Retinitis is the most common manifestation of ocular toxoplasmosis with vitritis. Factors that may influence visual prognosis include severity of the inflammation, size of the lesion and site of the inflammation. Also, progression to complications such as a neovascularization, vitreomacular traction, retinal detachment, glaucoma and cataract renders worse visual prognosis. Multimodal imaging can assist in meticulously evaluating and studying the extent of intraocular damage imposed by toxoplasma inflammation. Laboratory testing of intraocular fluid has been widely studied and employed, including PCR testing and detection of intraocular antibodies using Goldmann-Witmer coefficient (GWC), to enable more precise diagnosis Ocular toxoplasmosis has a self-limiting nature, treatment can help rapid control of inflammation specially if the retinitis involves the posterior pole. Treatment includes different combinations of antimicrobials; none have can prevent recurrences, but some combinations have shown more effective reduction in the size of the retinal lesion in comparison to other combinations or no treatment [5].
Toxoplasma exists in 3 infectious forms including sporozoites, which are contained within oocysts, tachyzoites and bradyzoites, which reside in tissue cysts. Oocysts are produced only in cat intestines and become infectious when defecated by cats. Tachyzoites are the fastest replicating form and responsible for systemic dissemination and active tissue infection in intermediate hosts. Tachyzoites can enter almost any type of host cell and multiply until the host cell is filled with parasites. Lysis of the host cell results in tachyzoite release followed by reentry into a new host cell. As a result of this cycle, multifocal tissue necrosis may occur. The host usually limits this phase of infection, then the parasite enters the dormant form, named bradyzoites, and gets isolated in tissue cysts. Cysts may contain hundreds of bradyzoites. These cysts usually cause no host reaction and may remain dormant throughout the life of the host [6].
The infection may be acquired or congenital by vertical transmission to the fetus. However, reports have supported the view that acquired infections might be a more important cause of ocular diseases than congenital [7, 8, 9].
Acquired infection occurs by consumption of raw meat containing cysts or ingestion of water or food contaminated by oocytes [9, 10]. Once the active parasite has invaded the body, it will spread via the blood stream, and due to a high affinity for cerebro- and retinovascular endothelial cells, can become established within the retina [10]. Following invasion of the parasite into the eye, the tachyzoite remains latent in the cyst under the control of the immune response of host [11, 12, 13]. In event of trigger of cyst rupture, the tachyzoite is converted to bradyzoite, and the inflammatory response is activated [5, 14].
Congenital- transplacental transmission occurs in 40–70%, while acquired ocular involvement was reported in 1–21% [15]. However, each entity has significantly different clinical manifestation. A study conduct in southern Brazil reported lower prevalence of ocular toxoplasmosis in children been 5.1% below the age of 13 and 21.3% above the age of 13, concluding that ocular toxoplasmosis is a sequela of postnatal rather than congenital infection [7].
Ocular lesions are the most frequent manifestations of congenital toxoplasmosis [16, 17]. Vertical transmission of toxoplasmosis occurs during primary infection in pregnant women, and generally the maternal disease goes unnoticed. When pregnant women become infected in the first trimester, the frequency of fetal infection goes up to 15–20%, in the second up to 25%, and in the third up to 65–70%. The most compromised fetuses are those who are infected earlier [1, 18, 19].
Besides retinochoroiditis, other ocular manifestations of congenital toxoplasmosis are described, such as microphthalmia, optic nerve atrophy, and abnormalities of the iris, cataract, and strabismus [17, 20, 21, 22, 23, 24].
However, typical presentation in the retina is an atrophic hyperpigmented scarred macular lesion that is described as ‘wagon-wheel’ lesion caused by congenital toxoplasmosis. It shows a central area composed of glial and pigmented material connected by pigmented strands to a peripheral ring of pigment at the edge of the lesion Figure 1. A study designed to detect ocular involvement in infants with congenital toxoplasma reported that ocular involvement occurred in 70.4% of the cases, with mean age of active lesion at 1.4 months. Bilateral involvement occurred in 15.7% of the patients, mainly involving the papillomacular bundle in 76.3%. The retinochoroiditis lesions were active in 15.7% of the eyes and had healed in 84.3% [25].
Colored image (left) and fundus fluorescein angiography (right) of atrophic pigmented congenital toxoplasma ‘wagon wheel’ macular scar.
It is worth mentioning that new lesions continue to appear well after the age of 5 years, likely with severe visual impairments. Therefore, screening of women for toxoplasmosis before pregnancy is advisable [26].
A significant reduction in prevalence and severity of the disease has been attributed to prenatal and neonatal treatment maintained throughout the first year of life [27, 28, 29].
Acquired ocular toxoplasmosis commonly manifests in the second through fourth decades [10, 30]. Approximately 10% of otherwise healthy individuals who contract the infection report nonspecific symptoms, such as fatigue, fever and myalgias. Cervical lymphadenopathy [31].
Though floaters with altered vision may be the most common symptom of toxoplasma retinitis, however, clinical presentation ranges a wide spectrum.
Anterior uveitis is a common finding, with mutton-fat keratic precipitates, fibrin, cells and flare, iris nodules and posterior synechiae [32]. Raised intraocular pressure has been reported in (30%–38%) of the cases [33, 34].
This usually manifests as active focal necrotizing retinitis, at the edge of an old, pigmented scar with overlying vitritis Figure 2. Bosch-Driessen et al. reported 72% of the patients had pre-existing retinochoroidal scars, indicating prior subclinical disease. The pigmented scar has been described to harbor the cysts that remain dormant until the cyst ruptures with release of organisms into the surrounding retina inducing adjacent retinitis [10].
Colored image of a supranasal peripapillary pigmented scar (yellow arrow) with adjacent area of active retinitis (white arrow).
Toxoplasma retinitis may occasionally manifest without an adjacent scar Figure 3. It is known that tissue cysts can exist in normal-appearing retina. The retina may be infected at the time of an initial systemic infection, but without clinically apparent lesions at the time [32].
Colored image of superior macular toxoplasma retinitis lesion (white arrow) without adjacent scar.
The focus of retinitis is of necrotizing nature and usually involves the full thickness of the retina, although occasional limited involvement of either inner or outer retina occurs, as described by Friedmann and Knox. Depending upon the thickness of involved retina, the overlying vitreous and underlying choroid are variably involved [30].
Large, full-thickness lesions tend to incite more severe vitritis, producing the classic ‘headlight in the fog’ sign. Optical coherence tomography (OCT) of active lesions can detect the level of retinal involvement, severity of choroiditis, as well as monitoring the regression of the lesion with treatment Figures 4 and 5. On regression of the retinitis, a pigmented scar that is smaller than the actual size of the retinitis forms.
OCT line scan through full thickness retinitis seen between the two white arrows with compete loss of architecture of inner retinal layers, with a small deep retinal infiltrate (orange arrow) and adjacent mild subretinal fluid. Dense localized overlying vitreous infiltration overlying the area of retinitis.
OCT line scan through active toxoplasma retinitis seen between the white arrows in the photo on the left with underlying choroidal involvement exhibiting a hyporeflective elevated appearance. Healed lesion in the photo on the right between yellow arrows shows resolved retinitis with thinned retina, decreased thickness of the choroid with increased choroidal transmission.
Punctate outer retinal toxoplasma (PORT) was first described in 1985 by Doft and Gass [35]. They elucidated the outer variation of punctate toxoplasmosis that primarily affects the outer retinal layers of the macular area. This entity usually presents in younger, immunocompetent patients [35, 36]. These can be either a single or several deep retinal infiltrates that may extend as far as the inner plexiform layer (IPL). The underlying retinal pigment epithelium is interrupted with variable involvements of the Bruch’s membrane and choroid. These lesions have been detected in the same eye with typical retinal toxoplasma lesions as in Figures 6 and 7 or in eyes with no previous toxoplasma lesions [37]. PORT lesions resolve slowly, leaving an atrophic chorioretinal scar and frequently recur in adjacent areas of the macula [38].
Autofluorescence showing foveal hypoautofluorescent toxoplasma lesion with an active edge, and two nasal PORT lesions (white arrow).
Inflammatory vascular involvement in acute toxoplasma retinochoroiditis constitutes an invariable clinical sign of the disease and was reported in (100%) of cases in a previous study [39].
During the acute phase of toxoplasmic retinochoroiditis, perivasculitis with arterial involvement in the form of multiple small periarterial plaques, previously described as Kyreiles plaques [40], may occur, whereas that of the vein may show scattered infiltration of the wall, sheathing, or both Figure 8. Obstruction of a branch of the central retinal artery and vein as well as choroidal vascular occlusion have also been reported to occur [41, 42, 43, 44, 45].
Small Kyreilles plaques along the retinal artery (white arrow) adjacent to patch of toxoplasma retinitis with perivenular infiltrates (yellow arrow).
The pathogenesis of vasculitis, was previously explained to be, is secondary to a reaction between local antigens and circulating antibody, and the beads seen along the vessels represent cuffs of mononuclear cells [46, 47].
Inflammation of the retinal vessels can occur in close proximity to the area of retinitis. The intensity of the vascular involvement was reported to be more prominent were the vessel traverses the active lesion. Vasculitis may also present away from the actual focus of inflammation Figure 9 and involve vessels in all four quadrants [39].
Fundus fluorescein angiography (FFA) in the left image, exhibiting superior old hypofluorescent scar with adjacent active retinitis (white arrow) and supranasal active satellite lesion (yellow arrow). Perivenular leakage in the image on the right is evident supratemporally and infratemporally (white arrow) away from the actual foci of active retinitis.
Occasionally, vascular occlusion may occur when thick focal retinitis engulfs the course of retinal vessels, leaving a permanent area of retinal ischemia [43] Figure 10. Retinal vascular occlusion has been reported to be 5% [39].
Supratemporal thick toxoplasma retinitis along the supratemporal vessels (white arrow in the left side image) with occluded vessels distal to the lesion (yellow arrow). FFA performed after healing of the retinitis (right image), demonstrating an atrophic patch at previous site of retinitis (orange arrow) with occluded supratemporal vessels and a large area of retinal ischemia (red arrows).
Optic nerve involvement may be due to parasitic invasion or reactive inflammation [48, 49, 50, 51]. Eckert et al., reported optic nerve changes in 5% of the cases. In 35% of the cases, retinitis was juxtapapillary Figure 11. In pure papillitis, the parasite affects the optic disc directly, causing a swollen papilla with sheathing of the peripapillary veins and there may be no concurrent active retinochoroiditis lesion [50]. Optic nerve involvement may induce severe visual field defects as well as loss of color vision [6]. Neuroretinitis has also been described as a unique presentation of ocular toxoplasmosis [51, 52].
Multicolored images (left side photo of superior peripapillary lesion (yellow arrow). OCT line scans through superior peripapillary lesion exhibiting almost full thickness retinitis with overlying localized dense vitritis (yellow arrow) in right side photo.
Macular oedema has been reported in 12% of toxoplasma cases [10]. Subretinal fluid accumulation (SRF) of variable severity, adjacent to area of retinochoroiditis involving the macula, has been described Figure 12. This was explained by. Khairallah, as the disrupted outer blood retinal barrier, secondary to the adjacent inflammatory process. Ultimately the fluid regresses as the retinitis heals [53].
Full thickness retinitis in OCT line scan indicated by the white arrow with adjacent foveal SRF.
Cystoid macular oedema (CME) may occur in active ocular toxoplasmosis with different phenotypes. Ouyang et al. reported that 7.5% of the cases presented with CME, while 2.5% presented with a huge outer retinal cyst (HORC). Interestingly, the same study reported that 3.5% of the cases showed cystoid degeneration in the inner retina next to the retinal vessels without other any retinal/choroidal abnormality in the macula [54].
HORC was described to be intraretinal cyst with a membranous structure bordering the outer border of that cyst Figure 13. Ouyang et al., hypothesized that this structure represents the tissue between ELM and the inner boundary of the RPE (i.e., photoreceptor layer), which further suggests that the lesion represents an intraretinal rather than a subretinal fluid accumulation. With regression of the fluid, the membranous structure resumes its anatomical location in the macular layer architecture [55].
Toxoplasma lesions healing starts to be appreciated as the vitritis regresses and the toxoplasma lesion starts to show more defined borders, because cicatrization occurs from the periphery towards the center, with variable pigmentary hyperplasia [32].
OCT is a sensitivity tool that has been used to study toxoplasma lesions in the active and healed stage [55, 56]. In the acute stage, retinal necrosis is detected by OCT as hypereflective disorganized thickening of the neurosensory retina. Underlying RPE clumping and disruption of the ELM and photoreceptors is seen. Choroidal inflammation may occasionally occur, and is detected by OCT appearing, hyporeflectivite thickening and, confined underneath area of retinitis. Overlying toxoplasma retinitis lesions, hyperreflective vitreous aggregates settling over inflamed retinal surface has also been reported [55].
As the retinitis starts to heal, the OCT scans show the hyperreflective area of retinitis, within the neurosensory retina starts to decrease in thickness with regressing of any adjacent SRF or CME. The RPE clumping starts to be more obvious and may show localized heaping which is likely the commencement of the pigmentary scar. As the hyperreflectivity of the retinitis recedes, degenerative cystoid spaces occasionally develop that resolves as healing reaches a final stage. The posterior hyaloid starts to get thicker, may exerts vitroemacular traction, which occasionally may spontaneously be released, with the separation of the posterior hyaloid from the macular surface Figure 14.
OCT scan through the fovea demonstrating toxoplasma necrotizing retinitis evolving from the active stage into an atrophic healed scar tissue. A: Full thickness retinitis. B: The retinitis has resolved remarkably with evolution of small deep residual area foveally with overlying appearance of the thick posterior hyaloid. C: Decreased size of the residual deep hyperreflective material with adjacent degenerative cystoid spaces and vitreofovel tangential traction. D: As healing progresses, the posterior hyaloid detaches completely with release of the vitreofoveal traction. E: Complete resolution of the retinitis with atrophic appearance of the inner layers, resolved degenerative cyst and disrupted outer foveal layers.
Occasionally, when retinitis is severe and recalcitrant to treatment, upon eventually evolving into the healing stage, the retinal layers exhibit severe, disorganization, thinning, with a fibrotic appearance, that may be laminated and splitted. Severe vitreomacular traction in such cases, can progress to retinal detachment Figure 15.
55-year-old female patient with neglected toxoplasma retinitis a and B: Colored and OCT images respectively, exhibit large active retinitis involving all the macular area, with overlying dense vitritis. C and D multicolored and OCT images respectively, demonstrate photos after complete healing of the retinitis. D shows OCT image denoting complete disruption of the inner macular layers been replaced with laminated and split fibrosed tissue with focal area of traction parafoveally.
Reported complications of ocular toxoplasmosis include isolated retinal tear (6%), retinal detachment, which is usually rhegmatogenous and/or tractional (6%), pre-retinal membrane (7%), choroidal neovascularization (<1%), vitreous hemorrhage (2%), optic atrophy (4%) and cataract (5%–13%) [10, 57].
Atypical manifestations include exceptionally large, multifocal, bilateral, diffuse retinal involvement or panophthalmitis. Elderly, AIDS, immunocompromised individual, or even rarely younger, immunocompetent patients as well [58] are likely to have specific defects in immune response that render them more at risk for atypical forms of toxoplasmosis [59]. This extensive toxoplasma retinitis presents similarly to necrotizing herpetic retinopathies, with large confluent full thickness areas of retinitis involving the peripheral retina and posterior pole. The thick, more densely yellow-white appearance of the lesion borders with a distinct, smooth contoured edge; and lack of hemorrhage, may distinguish these lesions from viral retinitis [60].
Following an episode of toxoplasmic retinochoroiditis, the risk of recurrence is reportedly higher during the first year than during subsequent years: 29–32% of recurrences occur within 1 year, and 53–57% within 2 years [10, 32, 61].
Reasons for recurrences are not usually identified. They may arise from senescent changes in tissue cysts, with an accompanying release of parasites or antigens or as a result of trauma, hormonal fluctuations or even, transient immune responses of humoral or cellular nature [62]. Patients who are relatively young at the first presentation are at increased risk of recurrence compared to older patients who have been independently confirmed [63]. A larger retinal parasite load in younger patients is one explanation that Holland et al. offered for this observation [64]. In AIDS patients, recurrence is the rule in the absence of long-term antiparasitic therapy [65].
Pregnancy and cataract surgery have both been associated with an increased risk of reactivation [62, 66]. Bosch-Driessen and associates [10], reported that 9% of women with ocular toxoplasmosis developed recurrences during pregnancy. It has been hypothesized that this relationship is attributable to hormonal or immunological changes that occur during pregnancy [67].
There is substantial variation in the severity of intraocular toxoplasma inflammation, attributable to multiple host- and disease-related factors.
Individuals less than 60 years showed significantly higher incidence of having lesions less than1 disc area (DA) as compared to those above the age of 60, showing lesions more than 1DA in size with P = 0.02. The same study reported that larger lesions were associated with more severe vitreous humor inflammation [57]. Patients with AIDS develop extensive disease and frequently reactivate, if treatment is discontinued [68].
Diagnosis of ocular toxoplasmosis starts at the point where the classic retinal manifestation is highly suggestive of the disease. However, in many instances the clinical findings cannot be sufficient to confirm a diagnosis, especially in the atypical form of presentation and thus laboratory investigations are necessary.
Ocular disease in the context of the presence of serum IgG and IgM antibodies against Toxoplasma gondii measured by screening tests such as the enzyme-linked immunosorbent assay (ELISA) or CLIA (Chemiluminescence immune assay) is compatible with acute or recent infection with toxoplasma supporting the diagnosis [69], yet can never be confirmatory, unless a definitive test like the dye test (Sabin-Feldman), IFAT (indirect fluorescent antibody test), immunoblot, and ISAGA (immunoglobulin-M immunosorbent agglutination assay) is performed. Nonetheless, these methods are performed only by specialized laboratories, they are complex and costly [70].
If retinitis develops within a year of an acquired systemic infection, anti-toxoplasma IgM should be detectable, but the variable rate of decline of this Ig isotype also limits the usefulness of such testing. The only exception is during pregnancy, when maternal IgM may herald acute infection of both the mother and foetus triggering urgent consultation with the obstetrician and neonatologist [71].
Since seropositivity is prevalent in most communities, the positive predictive value of IgG is low, and a positive IgG cannot be interpreted as indicative of active toxoplasmic infection. However, a rise in titer of specific IgG antibodies over a 3-week period has been used as an indicator of recent infection [72].
In immunosuppressed subjects, positive serological tests indicate infection, however, negative tests do not exclude previous or concurrent infections [73].
Levels of antibodies in aqueous humor and their relationship to serum antibodies may help in establishing the diagnosis of ocular toxoplasmosis [74, 75]. The Goldmann-Witmer coefficient (GWC) has been proposed as a valuable index of intraocular antibody production in active toxoplasmic retinochoroiditis in the immunocompetent subject [76].
(GWC) is calculated as the proportion of specific immunoglobulin (Ig)G in ocular fluid versus serum samples. It is determined as follows (anti-Toxoplasma IgG in aqueous humor/total IgG in aqueous humor)/(anti-Toxoplasma IgG in serum/total IgG in serum). Although a ratio over one should indicate intraocular antibody production, this also occurs in healthy controls, and therefore a ratio of at least three is often preferred for certain diagnosis [77].
The polymerase chain reaction (PCR) is an in-vitro method for exponentially replicating nucleic acids. PCR allows the detection and analysis of infinitesimal quantities of DNA. PCR of intraocular fluid has been extensively used to diagnosis infectious uveitis [78].
PCR testing of ocular sample can be useful in presumed toxoplasmosis in patients older than 50, in cases with inflammation (Tyndall ≥1/2+, panuveitis), area of retinochoroiditis>3 DA, and when ocular sampling performed within 1 week of presentation after onset of symptoms and up to 4 months [79, 80].
GWC testing is of better sensitivity than real time PCR, and is the preferred diagnostic procedure in ocular toxoplasmosis, especially if the testing is carried out in younger patients with quiet eyes and with smaller sized chorioretinal lesions [79].
Real time PCR confirmed the clinical diagnosis of toxoplasmosis in 62.5% of the cases, while the GWC confirmed in 87.5% [79]. Other studies reported that for 25 patients who suffered from ocular toxoplasmosis, the GWC was positive in 90%, while PCR testing was positive in just 36% [80]. Also, Labalette et al., noted the aqueous PCR was positive in 60% when lesions were larger than three-disc areas, but in only 25% when lesions were smaller. Overall, GWC was more likely positive than PCR (i.e., 89% vs. 44%) in this group [81]. Also, the rates of positive PCR are high in aqueous humor, obtained from HIV-infected or elderly subjects presenting toxoplasma retinitis [82].
No drug has been proven to cure infection [5], therefore, the aim of antibiotic treatment is to reduce the duration and severity of symptoms of acute intraocular inflammation, the risk of permanent visual impairment (by reducing the size of the eventual retinochoroidal scar), and the risk of recurrent episodes [83].
In immunocompetent individuals, toxoplasma retinochoroiditis typically resolves over a period of 1 to 2 months [84].
Previous reports indicated that toxoplasma treatment was employed if dense vitritis developed, retinitis is located close to the optic nerve, papillomacular area, or close proximity of lesions to major retinal vessels or if decreased vision occurs [5]. However, Holland reported the results of a survey from1991 to 2001, where members of the AUS showed a shift in management over 10 years, were in favor of treatment of both mild and severe disease [85].
Treatment of active ocular toxoplasmosis in immunocompromised individuals regardless of the severity is the recommended practice with less debate [85].
Several antimicrobial drug combinations are used to treat ocular toxoplasmosis.
Classic therapy is a combination of pyrimethamine 25 mg–50 mg daily orally with folinic acid 5 mg every other day and sulfadiazine 1 g four times daily orally with systemic corticosteroid [84]. Pyrimethamine side effects include gastrointestinal and dermatological manifestations as well as hematological adverse events, including leukopenia and thrombocytopenia, that mandate monitoring of the blood picture regularly throughout the treatment course. 26% of the patients on this regimen were reported to discontinue treatment due to complications from the drugs [5].
The alternate treatment regimen is trimethoprim-sulfamethoxazole 160 mg–800 mg twice daily orally with systemic corticosteroid, which is a well-tolerated combination although sulfonamide-related reactions may occur. The common side effects include mild gastrointestinal symptoms and mild maculopapular rash. However, this regimen is relatively well tolerated with side effects requiring discontinuation in 4% of patients [5].
Both pyrimethamine and sulfadiazine, as well as trimethoprim-sulfamethoxazole, have a similar mechanism of action, inhibiting tetrahydrofolate synthesis, thereby impacting nucleic acid synthesis of toxoplasma gondii. No reported difference in treatment results was reported when the classic or alternate treatment was used, however, treatment with classic therapy showed a greater reduction in the size of the retinal lesion than patients receiving other treatments or no treatment [5]. Other reports comparing these two regiments showed different results and concluded that drug efficacies in terms of reduction in retinal lesion size and improvement in visual acuity were similar. Reduction in the size of the lesion was comparable between the two treatment groups been 59% for trimethoprim-sulfamethoxazole and 61% for classic therapy, and there was no significant difference in post-treatment visual acuity. Therefore, trimethoprim/sulfamethoxazole seems to be an acceptable alternative for the treatment of ocular toxoplasmosis [86, 87].
Clindamycin 300 mg orally four times daily [84], is often added to triple therapy, which is then referred to as ‘quadruple therapy’. Animal studies showed that clindamycin reduced numbers of tissue cysts [86]. However, experience has shown that it does not prevent recurrent disease in human beings [88]. Pseudomembranous colitis is a well-recognized potential complication of clindamycin, as well as diarrhea. Clindamycin continues to be the most popular supplemental agent for treatment of patients with severe or persistent disease.
Opremcak and associates reported a series of 16 patients who were treated for toxoplasmic retinochoroiditis with trimethoprim (160 mg)/sulfamethoxazole (800 mg). Four were treated with trimethoprim/sulfamethoxazole alone, four were treated with trimethoprim/sulfamethoxazole and clindamycin, and eight were treated with trimethoprim/ sulfamethoxazole, clindamycin and oral prednisone. They concluded that trimethoprim/sulfamethoxazole accelerated the rate of resolution of toxoplasmic retinochoroiditis and improved the visual outcomes of their patients, although the study was uncontrolled [89].
Atovaquone 750 mg three/four times daily orally or azithromycin 250 mg daily orally are two antiparasitic agents used for treatment of toxoplasma. However, these agents do not appear to prevent recurrent toxoplasmic retinochoroiditis in the human host convincing activity against encysted parasites in experiment systems [90, 91]. Atovaquone was well tolerated but reactivation was reported by Winterhalter et al., in 44% of the cases within an interval averaging 39 months. [92]. Azithromycin in treatment of ocular toxoplasmosis has shown regression of the retinitis within 1 month in 64% of the patients, however, 27% experienced recurrence within the first year of follow-up, thus debating the effectiveness in decreasing recurrences [91]. The effective potency of this drug with no reported side effects that needed stopping the drug while used in treatment of ocular toxoplasma has been reported [92].
Recent research suggests that there is widespread variation for se of steroids in clinical practice for treating ocular toxoplasmosis. In a cross-sectional survey of uveitis specialists, 17% used oral corticosteroids in the treatment of ocular toxoplasmosis in immunocompetent patients, regardless of clinical findings. The other clinicians used corticosteroids for specific indications, such as severe vitreous inflammatory reaction (71%), decreased vision (59%), proximity of the lesions to the fovea or optic disc (35%), and for large lesions (5%) [93].
Oral corticosteroids are used during the active phase to reduce the retinal inflammation and thus further collateral tissue damage and also to prevent blood-retinal barrier breakdown. Furthermore, it can also reduce toxoplasma scarring. Steroids are usually started from 1 to 3 days after starting antiparasitic agent and continued for approximately 1 month. Indications for stopping therapy earlier include substantial improvement in the lesion appearance (“hardening” of lesion margins), substantial reduction of inflammatory reactions, marked improvement in vision, and adverse drug effects. Occasionally, antiparasitic agents are continued at least 2 days after stopping corticosteroids [84]. Oral corticosteroids are not used in immunocompromised individuals to treat ocular toxoplasma, thereby reducing the risk of further suppression of host defenses. Clinical series have shown that the signs of ocular toxoplasmosis, including inflammatory signs, can respond rapidly to antiparasitic therapy alone in immunocompromised patients [68, 94, 95].
Trimethoprim and sulfamethoxazole may be used in the prevention of recurrent attacks of ocular toxoplasmosis. Silveira et al. found that trimethoprim-sulfamethoxazole (160 mg–800 mg), taken orally every 3 days for 20 months, significantly reduced the risk of recurrent toxoplasmic retinochoroiditis from 23.8% in untreated control subjects to 6.6% [96].
The investigators suggested a role for such preventive treatment in patients with a history of frequent and severe recurrences or with toxoplasmic scars adjacent to the fovea where any reactivation can result in profound vision loss.
The rationale behind prophylactic treatment is the fact that recurrence rates decrease with duration of infection, even without treatment. If the frequency of recurrences decreases over time, it may be useful immediately after acquired infections to suppress recurrences during the period of greatest risk [96].
Recurrences of toxoplasmic retinochoroiditis may occur following LASIK and phacoemulsification with posterior chamber intraocular lens implantation [64, 97]. It is therefore recommended that prophylactic treatment be given to patients 2 days prior to surgery and to be continued for a period of 1 week.
Intravitreal clindamycin (1 mg) and dexamethasone (400 μg) have been used, injections can be repeated at 2-week intervals, based on a 5.6-day half-life of intravitreal clindamycin.
Soheilian et al. reported the results of treating patients with ocular toxoplasmosis involving or threatening macula or optic nerve, or adjacent to a large vessel and/or associated with severe vitritis with intravitreal treatment versus oral treatment using pyrimethamine and sulfadiazine plus prednisolone [98].
The mean number of injections in the intravitreal clindamycin was 1.6. Mean reduction in lesion size, increase in visual acuity and decrease in vitreous inflammation were not significantly different between groups, however, significantly reduction in size of lesions in IgM-positive patients who received classic treatment versus those who received intravitreal treatment was reported. This can be explained by the fact that a patient with acquired toxoplasmosis confronts a systemic infection that is treated better with systemic therapy.
The authors stressed that intravitreal clindamycin is a better alternative for pregnant and pediatric patients. Furthermore, the results of this study cannot be generalized to immunocompromised patients, monocular cases, and eyes with lesions inside the fovea (500 um). However, acquired toxoplasmosis confront systemic infection and, therefore, may benefit from systemic therapyas well, rather than just intravitreal injections [99].
Bosch-Driessen and associates, reported that seven (9%) of 82 women with ocular toxoplasmosis developed recurrences during pregnancy [10]. Some reported, recurrent toxoplasma retinochoroiditis in a pregnant woman poses minimal risk to the fetus, and treatment is not indicated for the sole purpose of preventing vertical transmission [100]. However, other studies stressed that infection by toxoplasma will need treatment using spiramycin 1 g orally every 8 hours if a seronegative pregnant patient gets infected up to 18 weeks into the pregnancy or within the 6 months prior to pregnancy [71]. Intravitreal clindamycin can be a reasonable choice of treatment in pregnant mothers.
Vitreoretinal surgery may be indicated in cases of persistent vitreous opacities, tractional or rhegmatogenous retinal detachment. In the setting of severe refractory vitritis precluding fundus examination, pars plana vitrectomy may be used for both diagnostic and therapeutic purposes [85].
Retinal detachment was reported in 11.4% of the cases. 75% underwent pars plana vitrectomy and 25% underwent laser retinopexy. 50% presented with recurrent RD requiring scleral buckle. At final follow-up, all patients who underwent surgical repair had attached retinas; with severe vision loss of 20/200 or worse [101].
Cataract surgery with intraocular lens implantation is often indicated in cases of significant lens opacification, after resolution of inflammation.
Ocular toxoplasmosis presents in a myriad of manifestations in the eye with variable complications and can be vision depleting. Multimodal imaging is useful in carefully monitoring treatment response, detecting, regression or progression of toxoplasma lesions and also show complications such as vitreomacular traction, CNVs or even subtle SRF, that cannot be clinically detected early. Molecular biological advances have improved the ability for diagnosis. Though current treatment modalities are effective in healing active disease yet does not effectively prevent recurrence. Further studies could be dedicated to developing antimicrobials that can help eradicate the disease.
Al Watany Eye Hospital Cairo Egypt, the hospital I have worked at and learnt a lot over the years. The hospital is very supportive of research work and all the images included in this chapter were either captured in the hospital or were in the patient’s electronic medical record. Retinal imaging team WEH dedicated hard work.
I have no financial disclosures or conflict of interest.
‘Special thanks to my dear Mother
Hydroxyapatite (HAp, Ca10(PO4)6(OH)2) is one of the most usual forms of calcium phosphate and has the similar chemical composition to the mineral phase of bone tissues. Thus, HAp has attracted the interest of the scientific community in the medicine field, material science, and tissue engineering areas in many years. However, due to the special characteristics of this material, HAp is also studied for various applications including fluorescent lamps, fuel cells, and adsorption of harmful metals, as well as catalysts [1]. TiO2 material was concerned almost 48 years ago. For the first time in 1969, the possibility of solar photoelectrolysis of TiO2 was demonstrated; the powdered TiO2 was studied in the 1980s and TiO2 film photocatalysis in the 1990s [2]. TiO2 photocatalysis (in particles or films) has gained much attention because the material has high stability, low cost, and nontoxicity and can be easily fabricated by many processes including precipitation, hydrothermal, sol-gel, plasma, etc. The research onTiO2/hydroxyapatite photocatalytic materials may derive from researches on TiO2/hydroxyapatite composites in medical industry. To achieve biocompatibility, osteoconduction, and osseointegration, the surface of titanium or its alloy, which is used as a permanent implant material, must be modified by developing hydroxyapatite (HAp, Ca10(PO4)6(OH)2) coating on the surface [3, 4, 5, 6, 7, 8, 9]. By inserting TiO2 inner layer between HAp coating and Ti substrate, the adhesion strength of the coating and the substrate increases [10]. The addition of TiO2 inner layer is expected to reduce a thermal expansion mismatch of the layers, to improve the bonding strength between the HAp layer and Ti substrate, to prevent the corrosion of the Ti substrate, as well as to obtain an abundance of surface hydroxyl and superoxide radical groups, sequentially, to achieve a surface free of cracks and a high adhesion of the modified surface to the substrate [7, 11, 12, 13]. The reactions of photocatalysis occur on the surface of TiO2; thus, both the surface properties and the mass transfer of the pollutant and degraded products onto the substrate affect to its photocatalytic activity. HAp, which is known as a material having a large surface area and high adsorption ability, may play the role of a transparent or semitransparent to allow UV and visible radiation to pass through it. In fact, there are numerous materials having larger surface area and higher adsorption ability such as silica gel, zeolite, activated carbon, etc. However, besides these general properties, HAp material was investigated as a support for photocatalysis due to the generation of active superoxide anion radicals (O2˙−) under UV irradiation [14]; thus, the TiO2/HAp photocatalysts have gained the interest of many scientists. In this chapter, the role of hydroxyapatite in TiO2/HAp photocatalytic materials will be analyzed and evaluated to supply a clear view of the composites.
\nAdsorption of biological, organic-chemical molecules on the HAp surface is generally influenced by its physicochemical properties including crystallite size, pore structure, morphology of particles, or coatings [15] which directly depend on the synthesis methods. The synthesis methods of HAp particles include solid-state reaction; sol-gel, plasma, and hydrothermal technique; layer hydrolysis of other calcium phosphate salts; etc. [16, 17, 18], while those of HAp coating include sol-gel, chemical vapor deposition, pulsed laser deposition, RF magnetron sputtering, spray pyrolysis, etc. [7, 19, 20]. The choice of a specific method depends on the purpose of research which is synthesis, characteristics, or application of pure HAp or those of TiO2/HAp composites.
\nThe adsorption property of HAp in the photocatalytic TiO2/HAp composites has been reported in many researches. Nonami et al. [21] soaked TiO2 powder in a simulated physiological solution containing phosphate ions for periods of about 1 h at 37°C. The apatite film with a thickness of approximately 0.7 μm has formed on the approximately 0.3 μm thick TiO2 layer. The crystals have a plate-like shape, measuring approximately 0.1–0.5 μm in length and 2–10 nm in thickness. This composite material may adsorb contaminants without exposure to light, and the contaminants are decomposed by TiO2 photocatalyst on exposure to light. As a result, the photocatalytic TiO2/HAp composites can be used to pure the air or play the role of the antimicrobial and antifungal coating with HAp absorber.
\nOther literatures show that the photocatalytic TiO2/HAp materials not only absorb organic contaminants such as viruses, bacteria, etc. but also decompose these compounds by the photocatalytic process. Hirakura et al. [22] presented that lysozyme (LSZ) and bovine serum albumin (BSA) can be monomolecularly absorbed on HAp by using two types of fibrous crystals elongated in the c-axis. HAp-nanostructured crystals doping TiO2 anatase can selectively remove of the specific proteins by the absorbing and decomposing under UV irradiation. Thus, the photocatalytic activity for the decomposition of proteins could be controlled with the adsorption on the surface of the nanostructured HAp crystals. The adsorption of BSA on TiO2/HAp composite was also presented in the publication of Katayama et al. [23]. The research explained that the adsorption of the acidic protein BSA occurred at Ca2+ sites of the HAp component which contained a large number of pores supporting to the physical adsorption.
\nRyu et al. [24] fabricated the TiO2-β-TCP nanocomposite photocatalytic thin films by aerosol deposition. The aerosol-deposition films almost fully covered the substrate (glass) and are not porous but extremely rough microstructure. The deposited films maintained good adhesion with the substrate, and the film’s pencil hardness was over 9H. The aerosol-deposition TiO2-40 wt% β-TCP composite film has two different phases distinctly: white regions of β-TCP and dark regions of TiO2, 5–50 nm-sized TiO2 nanocrystallites with nanoscaled β-TCP crystallites formed by the collision of the accelerated particles with high kinetic energy during deposition. The films consisting of nano-sized TiO2 photocatalytic crystallites with a dispersion of β-TCP adsorbent crystalline phase show the high photocatalytic activity under both UV and dark conditions due to adsorption effect of β-TCP.
\nThe adsorption role of the HAp layer in Ag-TiO2/HAp/Al2O3 bioceramic composite membrane was also evaluated in the report of Ma et al. [25]. This composite membrane, which was fabricated by a facile two-step approach, involves sol–gel process and calcination was a microporous membrane structure with average 0.8 m pore size, which comprised of Ag-TiO2/HAp composite layer with a thickness of 10 m overlaid on α-Al2O3 disk support. HAp component acted as a highly efficient bacterial adsorbent, while Ag-TiO2 provided powerful photocatalytic attack toward
Xie et al. [26] fabricated TiO2/HAp composite with mosaic structure via a facile route without any structure-directing agent. The result proved the increased photocatalytic activity of the composite results from the combination of adsorption capacity of HAp and the high photocatalytic activity of TiO2.
\nOther reports also concerned to the adsorption properties of HAp in the HAp/TiO2 composites, especially in atmospheric environment [27, 28, 29]. Komazaki et al. [27] collected NO(x) by an annular diffusion scrubber coated with a mixture of TiO2 and HAp. The research shows that HAp plays the role of adsorption material, while TiO2 produces reactive oxygen species under ultraviolet light (UV) illumination such as super oxide (O2−), hydroxyl radical (OH°), and peroxyhydroxyl radical (HO2°), by which nitric oxide is oxidized to nitrogen dioxide and is further oxidized to nitric acid.
\nOzeki et al. [28] fabricated TiO2/HAp thin film by sputtering on glass using a radio-frequency magnetron. The film has a higher decomposition rate of formaldehyde gas than either the TiO2 or the HAp film alone. However, in the bacterial survival test, survival of cells on the TiO2/HAp thin film is higher than that on the TiO2 film, which indicates that the TiO2/HAp thin film has a lower bactericidal effect than the pure TiO2 film.
\nLiu et al. [29] synthesized HAp-modified N-TiO2 by a facile wet-chemical method and evaluated its photocatalytic activity by the decomposition of gaseous acetone under visible-light irradiation. The results demonstrated that 10%-HAp-N-TiO2 sample shows the best photocatalytic activity and the remarkable photocatalytic activity may arise from the synergism between adsorption on HAp and photoactivity by TiO2 which generated oxygen-reactive species diffusing and reacting with the molecules located on the HAp.
\nMasato Wakamura et al. have many publications on the field [30, 31, 32]. The authors evaluated the adsorption behaviors of proteins onto photocatalytic Ti4+-doped calcium hydroxyapatite (TiHAp) particles which was synthesized by the coprecipitation method using Ca(NO3)2, Ti(SO4)2, H3PO4, and NH4OH original materials [31]. The result showed that all the adsorption isotherms of bovine serum albumin (BSA), myoglobin (MGB), and lysozyme (LSZ) from 1 × 10−4 mol/dm3 KCl solution were Langmuir type. Generally, the saturated amounts of adsorbed protein value on the TiHAp were much higher than CaHAp.
\nBeside the role as an adsorption material in the photocatalytic TiO2/HAp composites, some recent researches have investigated that hydroxyapatite promotes photocatalytic degradation because it can play the role of a support for photocatalysts. The activity of HAp is caused by the generation of active superoxide anion radicals (O2˙−) due to a change in the electronic state of the surface PO43− group under UV irradiation [14].
\nHu et al. [33] proved the promotion role of HAp to TiO2 in photocatalytic degradation by using experimental observations and kinetic modeling. The derived kinetic parameters including reaction rate constant, Langmuir adsorption constant, apparent activation energy, etc. confirm that the activity of TiO2/HAp composite is more effective than that of TiO2. A negative effect of HAp on the photo absorption ability of the TiO2/HAp composite is characterized by UV-vis reflectance spectra. The existence of superior chemisorption between HAp and the organic molecules leads to a better performance of TiO2/HAp for photocatalytic degradation.
\nMohamed et al. [34] determined photocatalytic activities of Pd-TiO2-hydroxyapatite nanoparticles, which are synthesized by a template-ultrasonic-assisted method, by photocatalytic removal of cyanide under visible-light irradiation (Scheme 1). Scheme 1 shows that the vacancies formed on the surface of the excited PO43− group in visible illumination will lead to the formation of O2˙− and will attack the surrounding organic molecules adsorbed on HAp.
\nPhotocatalytic mechanism of cyanide degradation by Pd-TiO2-HAp [
The research [34] investigated that the amount of hydroxyl radials formed in the Pd-TiO2-hydroxyapatite nanoparticle was higher than those of Pd-TiO2 and TiO2 nanoparticles. The absorption of radiation in the visible-light region, the small recombination rate of the electron-hole pair, as well as the high surface area of HAp material are the promoted impacts of hydroxyapatite in the photocatalytic TiO2/HAp composites.
\nThe recombination rate of the electron-hole pair is also concerned in another publication [35]. Zhang et al. [35] demonstrated the increased photocatalytic performance of TiO2 nanoparticles which was supported on electrically polarized HAp films. The separation of photogenerated electrons and holes in TiO2 nanoparticles is promoted by the internal polarization of the HAp support, and consequently, the recombination of charge carriers is mitigated. It can be concluded that the materials with large internal polarization can be used in strategies for enhancing quantum efficiency of photocatalysts.
\nThe surface area of HAp material was concerned in the research of Kobayashi et al. [36]. The TiO2/HAp photocatalytic coating was deposited by gas tunnel-type plasma spraying using powders with nano-sized grains. The photocatalytic reaction occurs on powder surface; as the grain size becomes smaller, the specific surface area becomes larger, and the degradation efficiency of organic pollutants also increases.
\nThe promoted impact of hydroxyapatite in the photocatalytic TiO2/HAp composites was presented in the report of Liu et al. [37]. The photocatalytic activities of Ag-TiO2-HAp powders synthesized by a facile wet-chemical strategy were evaluated by photocatalytic oxidation decomposition of acetone in air under visible-light illumination. The high photocatalytic activity of the Ag-TiO2-HAP hybrids could be attributed to its strong absorption in the visible-light region, low recombination rate of the electron-hole pair, and large BET-specific surface area.
\nAramendia et al. [38] studied on the TiO2/natural phosphate material synthesized by sol-gel process and tested the photocatalytic activity in the photo-oxidation process of propan-2-ol. The results show that the presence of natural phosphate makes a retardation of TiO2 crystallization and creates a certain interaction with titanium.
\nNishikawa et al. [39] indicated that the difference in photocatalytic activity of the materials containing HAp and without HAp may be originated from the properties of the electronic state that forms the valence band of HAp-containing PO4 group.
\nLi et al. [40] synthesized Ti-substituted hydroxyapatite (TiHAp) by the coprecipitation method. The adsorption and photocatalytic degradation of bisphenol A (BPA, an environmental endocrine disrupting chemical) over TiHAp and P25 TiO2 photocatalysts were studied using liquid chromatography-mass spectrometry. The results indicated that the adsorption of BPA on TiHAp and TiO2 obeyed the Langmuir adsorption equation, and the adsorption capacity and photocatalytic degradation activity of BPA of TiHAp material were much higher than those of TiO2. To explain for the results, the authors presented that the zeta potentials of TiHAp, and TiO2 did not show significant difference when the pH was about seven, suggesting that the surface charge was not the reason for the different adsorption capacities of the particles. In addition, the specific surface area and average pore diameter of TiHAp and TiO2 were comparable, so these would not lead to the different adsorption capacities either. In fact, TiHAp material is produced from a substitution of some Ca sites in HAp by Ti, which resulted in multiple Ti-OH groups on the TiHAp surface. Large amounts of phosphates and hydroxyls in the crystal lattice of TiHAp can adsorb the hydroxyls of BPA by hydrogen bonding.
\nThe bandgap of TiO2/HAp materials were mentioned in some publications because it decides the energy separation between valence and conduction bands, the quantum effect, as well as the effect of visible-light utilization, etc. The bandgap of HAp was reported in [41] to be 3.95 eV by photoluminescence measurement; meanwhile, in other reports, the bandgap of HAp was calculated to be around 4.51–5.4 eV [42, 43]. The bandgap of TiO2/HAp composites calculated by UV-vis diffuse reflectance spectra was between 3.06 and 3.08 eV while that of pure TiO2 was broader (3.12 eV) [44]. However, the bandgap of Ti-substituted hydroxyapatite evaluated by both experimental and theoretical methods was 3.65 eV [45]. Masato Wakamura et al. determined the effect of Ti substitution in HAp synthesized by the coprecipitation method on the bandgap which was compared with that of a typical anatase-TiO2 photocatalytic powder. The experimentally obtained optical bandgap energies of TiHAp, HAp, and TiO2 powder measured by diffuse reflectance spectroscopy were 3.65, >6, and 3.27 eV, respectively. The authors explained the increase of bandgap in TiHAp due to hybridizing of Ti 3d orbital with O 2p orbital and forming an internal state in the HAp bandgap, consequently, causing the absorption-edge lowering of TiHAp. Researching on the acetaldehyde gas decomposition of TiHAp by UV with VIS irradiation, the authors investigated the increase of activity comparing with when UV irradiation alone was used. Linh et al. [46] also indicated the shift of bandgap of TiO2/HAp material synthesized by the hydrothermal process containing TiO(OH)2 and HAp gels. The binding energy values of Ca 2p, P 2p, and O1s levels are related to hydroxyapatite phase, whereas those of Ti 2p levels corresponded with the characterization of titanium (IV) in TiO2. The experimental bandgap of TiO2/HAp material calculated by the DRS measurement was 3.6 eV, while those of pure HAp and TiO2 were 5.3 and 3.2 eV, respectively. The shifts may relate oxidation states of titanium in the annealing process of TiO(OH)2/HAp gel. The increase of bandgap may affect the absorption ability of radiation in the visible-light region; consequently, in some cases, it is a demoted impact which reduces the photocatalytic activity of TiO2/HAp composites.
\nIn the photocatalytic TiO2/HAp composites, HAp plays the role of an adsorption of contaminations which is generally influenced by the physicochemical properties of HAp material. On the other hand, the promoted impacts of hydroxyapatite in the composites are experimentally collected in the specific cases including the absorption of radiation in the visible-light region, the small recombination rate of the electron-hole pair, and the high surface area of HAp component. However, the role of HAp in TiO2/hydroxyapatite photocatalytic materials has been continuously researched and evaluated to obtain the best composite in the photocatalytic field, as well as in other applications.
\nThis work is supported by Basic Science Research Programs (No. 2015R1D1A1A01056983) through the NRF, Korea, funded by the Ministry of Education and (No. 2018R1A2B6002194) by the Ministry of Science and ICT.
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Adenoviruses are excellent vectors for delivering genes or vaccine antigens to the target host tissues and are being tested in several vaccine and gene therapy studies. Adenovirus-based vectors offer several advantages over other viral vectors such as broad range of tissue tropism, well-characterized genome, ease of genetic manipulation including acceptance of large transgene DNA insertions, inherent adjuvant properties, ability to induce robust transgene-specific T cell and antibody responses, non-replicative nature in host, and ease of production at large scale. However, several studies have highlighted major drawbacks to using adenovirus as vaccine and gene therapy vectors. These include pre-existing immunity in humans, inflammatory responses, sequestering of the vector to liver and spleen, and immunodominance of the vector genes over transgenes. In the same vein, recently discovered protein sequence homology and heterologous immunity between adenoviruses and hepatitis C virus have significant implications in the use of adenoviral vectors for vaccine development, especially for hepatitis C virus. This chapter focuses on the current scope and challenges in using adenoviral vector-based vaccines and gene therapies.",book:{id:"7286",slug:"adenoviruses",title:"Adenoviruses",fullTitle:"Adenoviruses"},signatures:"Shakti Singh, Rakesh Kumar and Babita Agrawal",authors:null},{id:"33318",doi:"10.5772/33285",title:"Baculovirus Enhancins and Their Role in Viral Pathogenicity",slug:"baculovirus-enhancins-and-their-role-in-viral-pathogenicity",totalDownloads:2436,totalCrossrefCites:1,totalDimensionsCites:13,abstract:null,book:{id:"1775",slug:"molecular-virology",title:"Molecular Virology",fullTitle:"Molecular Virology"},signatures:"James M. 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Remarkable results have been obtained by combining cryo-EM, X-ray analysis and bioinformatics in structural studies of these nano-machines. In this review we will describe results of structural studies of phages that uncover their organisation in different conformations, thus facilitating our understanding of the functional mechanisms in supramolecular assemblies and helping us understand the usage of phages in medical treatments. Currently, antibiotic resistance is an enormous challenge that we face. The tailed phages could be used in place of antibiotics due to their high specificity to host cells, but more knowledge of their organisation and function is required.",book:{id:"6910",slug:"bacteriophages-perspectives-and-future",title:"Bacteriophages",fullTitle:"Bacteriophages - Perspectives and Future"},signatures:"Helen E. White and Elena V. Orlova",authors:[{id:"101052",title:"Prof.",name:"Elena",middleName:null,surname:"Orlova",slug:"elena-orlova",fullName:"Elena Orlova"},{id:"262804",title:"Dr.",name:"Helen",middleName:null,surname:"White",slug:"helen-white",fullName:"Helen White"}]},{id:"58406",doi:"10.5772/intechopen.72660",title:"A Historical Review of Ebola Outbreaks",slug:"a-historical-review-of-ebola-outbreaks",totalDownloads:1573,totalCrossrefCites:2,totalDimensionsCites:8,abstract:"Ebola Virus Disease (EVD) is a severe, often fatal illness in humans caused by the Ebola virus. Since the first case was identified in 1976, there have been 36 documented outbreaks with the worst and most publicized recorded in 2014 which ravaged three West African Countries, Guinea, Liberia and Serial Leone. The West African outbreak recorded 28,616 human cases, 11,310 deaths (CFR: 57–59%) and left about 17,000 survivors, many of whom have to grapple with Post-Ebola syndrome. Historically, ZEBOV has the highest virulence. Providing a historical perspective which highlights key challenges and progress made toward detecting and responding to EVD is a key to charting a path towards stronger resilience against the disease. There have been remarkable shifts in diagnostics, at risk populations, impact on health systems and response approaches. The health sector continues to gain global experiences about EVD which has shaped preparedness, prevention, detection, diagnostics, response, and recovery strategies. This has brought about the need for stronger collaboration between international organizations and seemingly Ebola endemic countries in the areas of improving disease surveillance, strengthening health systems, development and establishment of early warning systems, improving the capacity of local laboratories and trainings for health workers.",book:{id:"6294",slug:"advances-in-ebola-control",title:"Advances in Ebola Control",fullTitle:"Advances in Ebola Control"},signatures:"Kasangye Kangoy Aurelie, Mutangala Muloye Guy, Ngoyi Fuamba\nBona, Kaya Mulumbati Charles, Avevor Patrick Mawupemor and Li\nShixue",authors:[{id:"214449",title:"Ph.D. Student",name:"Kasangye Kangoy",middleName:null,surname:"Aurelie",slug:"kasangye-kangoy-aurelie",fullName:"Kasangye Kangoy Aurelie"},{id:"215908",title:"Dr.",name:"Mutangala Muloye",middleName:null,surname:"Guy",slug:"mutangala-muloye-guy",fullName:"Mutangala Muloye Guy"},{id:"215909",title:"Dr.",name:"Ngoyi Fuamba",middleName:null,surname:"Bona",slug:"ngoyi-fuamba-bona",fullName:"Ngoyi Fuamba Bona"},{id:"215910",title:"Dr.",name:"Kaya Mulumbati",middleName:null,surname:"Charles",slug:"kaya-mulumbati-charles",fullName:"Kaya Mulumbati Charles"},{id:"215911",title:"Mr.",name:"Patrick",middleName:"Mawupemor",surname:"Avevor",slug:"patrick-avevor",fullName:"Patrick Avevor"},{id:"215912",title:"Prof.",name:"Li",middleName:null,surname:"Shixue",slug:"li-shixue",fullName:"Li Shixue"}]},{id:"45876",doi:"10.5772/56976",title:"Genetic Engineering of Baculoviruses",slug:"genetic-engineering-of-baculoviruses",totalDownloads:3841,totalCrossrefCites:2,totalDimensionsCites:8,abstract:null,book:{id:"3505",slug:"current-issues-in-molecular-virology-viral-genetics-and-biotechnological-applications",title:"Current Issues in Molecular Virology",fullTitle:"Current Issues in Molecular Virology - Viral Genetics and Biotechnological Applications"},signatures:"Santiago Haase, Leticia Ferrelli, Matías Luis Pidre and Víctor\nRomanowski",authors:[{id:"163273",title:"Mr.",name:"Santiago",middleName:null,surname:"Haase",slug:"santiago-haase",fullName:"Santiago Haase"}]}],mostDownloadedChaptersLast30Days:[{id:"62883",title:"Adenoviral Vector-Based Vaccines and Gene Therapies: Current Status and Future Prospects",slug:"adenoviral-vector-based-vaccines-and-gene-therapies-current-status-and-future-prospects",totalDownloads:4966,totalCrossrefCites:16,totalDimensionsCites:30,abstract:"Adenoviruses are one of the most genetically diverse DNA viruses and cause non-life-threatening infections in the ocular, respiratory, or gastrointestinal epithelium of a diverse range of hosts. Adenoviruses are excellent vectors for delivering genes or vaccine antigens to the target host tissues and are being tested in several vaccine and gene therapy studies. Adenovirus-based vectors offer several advantages over other viral vectors such as broad range of tissue tropism, well-characterized genome, ease of genetic manipulation including acceptance of large transgene DNA insertions, inherent adjuvant properties, ability to induce robust transgene-specific T cell and antibody responses, non-replicative nature in host, and ease of production at large scale. However, several studies have highlighted major drawbacks to using adenovirus as vaccine and gene therapy vectors. These include pre-existing immunity in humans, inflammatory responses, sequestering of the vector to liver and spleen, and immunodominance of the vector genes over transgenes. In the same vein, recently discovered protein sequence homology and heterologous immunity between adenoviruses and hepatitis C virus have significant implications in the use of adenoviral vectors for vaccine development, especially for hepatitis C virus. This chapter focuses on the current scope and challenges in using adenoviral vector-based vaccines and gene therapies.",book:{id:"7286",slug:"adenoviruses",title:"Adenoviruses",fullTitle:"Adenoviruses"},signatures:"Shakti Singh, Rakesh Kumar and Babita Agrawal",authors:null},{id:"66740",title:"Bacteriophages: Their Structural Organisation and Function",slug:"bacteriophages-their-structural-organisation-and-function",totalDownloads:1983,totalCrossrefCites:5,totalDimensionsCites:11,abstract:"Viruses are infectious particles that exist in a huge variety of forms and infect practically all living systems: animals, plants, insects and bacteria. Viruses that infect and use bacterial resources are classified as bacteriophages (or phages) and represent the most abundant life form on Earth. A phage can be described as a specific type of nano-machine that is able to recognise its environment, find a host cell, start infection, self-assemble and safeguard its genome until the next cycle of replication is initiated. Remarkable results have been obtained by combining cryo-EM, X-ray analysis and bioinformatics in structural studies of these nano-machines. In this review we will describe results of structural studies of phages that uncover their organisation in different conformations, thus facilitating our understanding of the functional mechanisms in supramolecular assemblies and helping us understand the usage of phages in medical treatments. Currently, antibiotic resistance is an enormous challenge that we face. The tailed phages could be used in place of antibiotics due to their high specificity to host cells, but more knowledge of their organisation and function is required.",book:{id:"6910",slug:"bacteriophages-perspectives-and-future",title:"Bacteriophages",fullTitle:"Bacteriophages - Perspectives and Future"},signatures:"Helen E. White and Elena V. 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Bandeira and José Antonio Suárez",authors:[{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales"}]},{id:"67876",title:"The Unusual Linear Plasmid Generating Systems of Prokaryotes",slug:"the-unusual-linear-plasmid-generating-systems-of-prokaryotes",totalDownloads:1201,totalCrossrefCites:0,totalDimensionsCites:2,abstract:"Linear DNA is vulnerable to exonuclease degradation and suffers from genetic loss due to the end replication problem. Eukaryotes overcome these problems by locating repetitive telomere sequences at the end of each chromosome. In humans and other vertebrates this noncoding terminal sequence is repeated between hundreds and thousands of times, ensuring important genetic information is protected. In most prokaryotes, the end-replication problem is solved by utilizing circular DNA molecules as chromosomes. However, some phage and bacteria do store genetic information in linear constructs, and the ends of these structures form either invertrons or hairpin telomeres. Hairpin telomere formation is catalyzed by a protelomerase, a unique protein that modifies DNA by a two-step transesterification reaction, proceeding via a covalent protein bound intermediate. The specifics of this mechanism are largely unknown and conflicting data suggests variations occur between different systems. These proteins, and the DNA constructs they produce, have valuable applications in the biotechnology industry. They are also an essential component of some human pathogens, an increased understanding of how they operate is therefore of fundamental importance. Although this review will focus on phage encoded protelomerase, protelomerases found from Agrobacterium and Borellia will be discussed in terms of mechanism of action.",book:{id:"6910",slug:"bacteriophages-perspectives-and-future",title:"Bacteriophages",fullTitle:"Bacteriophages - Perspectives and Future"},signatures:"Sophie E. Knott, Sarah A. Milsom and Paul J. 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The severity of GBS can range from mild impairment with fast recovery to complete paralysis including severe respiratory or autonomic failure. Recovery may take months and even years and may be incomplete despite disease modifying treatment with IVIG or plasma exchange. Therefore, optimal supportive care and effective rehabilitation remain crucial. Multidisciplinary rehabilitation is recommended but may be challenging in the acute phase because of limited patient participation due to profound muscle weakness and severe pain. Inactive denervated muscles will inevitably undergo rapid degeneration resulting in wasting, weakness, and contractures as major long-term complications in severely affected patients. In this chapter, the current evidence of rehabilitation on the short- and long-term motor function in GBS is reviewed, including newly obtained experiences with neuromuscular electrical stimulation (NMES). Rehabilitation remains an area lacking well designed and controlled clinical studies and thus a clear lack of evidence-based guidelines.",book:{id:"8990",slug:"current-concepts-in-zika-research",title:"Current Concepts in Zika Research",fullTitle:"Current Concepts in Zika Research"},signatures:"Thomas Harbo and Henning Andersen",authors:[{id:"310593",title:"M.D.",name:"Thomas",middleName:null,surname:"Harbo",slug:"thomas-harbo",fullName:"Thomas Harbo"},{id:"318823",title:"Prof.",name:"Henning",middleName:null,surname:"Andersen",slug:"henning-andersen",fullName:"Henning Andersen"}]}],onlineFirstChaptersFilter:{topicId:"427",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:318,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:106,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:15,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"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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",coverUrl:"https://cdn.intechopen.com/series/covers/23.jpg",latestPublicationDate:"June 25th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:0,editor:{id:"280770",title:"Dr.",name:"Katherine K.M.",middleName:null,surname:"Stavropoulos",slug:"katherine-k.m.-stavropoulos",fullName:"Katherine K.M. Stavropoulos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRdFuQAK/Profile_Picture_2022-05-24T09:03:48.jpg",biography:"Katherine Stavropoulos received her BA in Psychology from Trinity College, in Connecticut, USA. Dr. Stavropoulos received her Ph.D. in Experimental Psychology from the University of California, San Diego. She completed her postdoctoral work at the Yale Child Study Center with Dr. James McPartland. Dr. Stavropoulos’ doctoral dissertation explored neural correlates of reward anticipation to social versus nonsocial stimuli in children with and without autism spectrum disorders (ASD). She has been a faculty member at the University of California, Riverside in the School of Education since 2016. Her research focuses on translational studies to explore the reward system in ASD, as well as how anxiety contributes to social challenges in ASD. She also investigates how behavioral interventions affect neural activity, behavior, and school performance in children with ASD. She is also involved in the diagnosis of children with ASD and is a licensed clinical psychologist in California. She is the Assistant Director of the SEARCH Center at UCR and is a Faculty member in the Graduate Program in Neuroscience.",institutionString:null,institution:{name:"University of California, Riverside",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:2,paginationItems:[{id:"89",title:"Education",coverUrl:"https://cdn.intechopen.com/series_topics/covers/89.jpg",isOpenForSubmission:!1,editor:{id:"260066",title:"Associate Prof.",name:"Michail",middleName:null,surname:"Kalogiannakis",slug:"michail-kalogiannakis",fullName:"Michail Kalogiannakis",profilePictureURL:"https://mts.intechopen.com/storage/users/260066/images/system/260066.jpg",biography:"Michail Kalogiannakis is an Associate Professor of the Department of Preschool Education, University of Crete, and an Associate Tutor at School of Humanities at the Hellenic Open University. He graduated from the Physics Department of the University of Crete and continued his post-graduate studies at the University Paris 7-Denis Diderot (D.E.A. in Didactic of Physics), University Paris 5-René Descartes-Sorbonne (D.E.A. in Science Education) and received his Ph.D. degree at the University Paris 5-René Descartes-Sorbonne (PhD in Science Education). His research interests include science education in early childhood, science teaching and learning, e-learning, the use of ICT in science education, games simulations, and mobile learning. 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His research focuses on biochemistry, biophysics, genetics, molecular biology, and molecular medicine with specialization in the fields of drug design, protein structure-function, protein folding, prions, microRNA, pseudogenes, molecular cancer, epigenetics, metabolites, proteomics, genomics, protein expression, and characterization by spectroscopic and calorimetric methods.",institutionString:"University of Health Sciences",institution:null},{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",biography:"Hiroyuki Kagechika received his bachelor’s degree and Ph.D. in Pharmaceutical Sciences from the University of Tokyo, Japan, where he served as an associate professor until 2004. 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He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a Principal Investigator and Scientist at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via machine-learning-based analyses of exosomal signatures. Dr. Paul has published in more than fifty peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award, a senior member of the Institute of Electrical and Electronics Engineers (IEEE), and an editorial board member for several international journals.",institutionString:"University of California Los Angeles",institution:{name:"University of California Los Angeles",country:{name:"United States of America"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals. He is currently working on the protective activity of phenolic compounds in disorders associated with oxidative stress and inflammation.",institutionString:null,institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Dr.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329248",title:"Dr.",name:"Md. Faheem",middleName:null,surname:"Haider",slug:"md.-faheem-haider",fullName:"Md. Faheem Haider",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329248/images/system/329248.jpg",biography:"Dr. Md. Faheem Haider completed his BPharm in 2012 at Integral University, Lucknow, India. In 2014, he completed his MPharm with specialization in Pharmaceutics at Babasaheb Bhimrao Ambedkar University, Lucknow, India. He received his Ph.D. degree from Jamia Hamdard University, New Delhi, India, in 2018. He was selected for the GPAT six times and his best All India Rank was 34. Currently, he is an assistant professor at Integral University. Previously he was an assistant professor at IIMT University, Meerut, India. He has experience teaching DPharm, Pharm.D, BPharm, and MPharm students. He has more than five publications in reputed journals to his credit. Dr. Faheem’s research area is the development and characterization of nanoformulation for the delivery of drugs to various organs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/system/329795.png",biography:"Dr. Mohd Aftab Siddiqui is an assistant professor in the Faculty of Pharmacy, Integral University, Lucknow, India, where he obtained a Ph.D. in Pharmacology in 2020. He also obtained a BPharm and MPharm from the same university in 2013 and 2015, respectively. His area of research is the pharmacological screening of herbal drugs/natural products in liver cancer and cardiac diseases. He is a member of many professional bodies and has guided many MPharm and PharmD research projects. Dr. Siddiqui has many national and international publications and one German patent to his credit.",institutionString:"Integral University",institution:null},{id:"255360",title:"Dr.",name:"Usama",middleName:null,surname:"Ahmad",slug:"usama-ahmad",fullName:"Usama Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255360/images/system/255360.png",biography:"Dr. Usama Ahmad holds a specialization in Pharmaceutics from Amity University, Lucknow, India. He received his Ph.D. from Integral University, Lucknow, India, with his work titled ‘Development and evaluation of silymarin nanoformulation for hepatic carcinoma’. Currently, he is an Assistant Professor of Pharmaceutics, at the Faculty of Pharmacy, Integral University. He has been teaching PharmD, BPharm, and MPharm students and conducting research in the novel drug delivery domain. From 2013 to 2014 he worked on a research project funded by SERB-DST, Government of India. He has a rich publication record with more than twenty-four original journal articles, two edited books, four book chapters, and several scientific articles to his credit. He is a member of the American Association for Cancer Research, the International Association for the Study of Lung Cancer, and the British Society for Nanomedicine. Dr. Ahmad’s research focus is on the development of nanoformulations to facilitate the delivery of drugs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"333824",title:"Dr.",name:"Ahmad Farouk",middleName:null,surname:"Musa",slug:"ahmad-farouk-musa",fullName:"Ahmad Farouk Musa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333824/images/22684_n.jpg",biography:"Dato’ Dr Ahmad Farouk Musa\nMD, MMED (Surgery) (Mal), Fellowship in Cardiothoracic Surgery (Monash Health, Aust), Graduate Certificate in Higher Education (Aust), Academy of Medicine (Mal)\n\n\n\nDato’ Dr Ahmad Farouk Musa obtained his Doctor of Medicine from USM in 1992. He then obtained his Master of Medicine in Surgery from the same university in the year 2000 before subspecialising in Cardiothoracic Surgery at Institut Jantung Negara (IJN), Kuala Lumpur from 2002 until 2005. He then completed his Fellowship in Cardiothoracic Surgery at Monash Health, Melbourne, Australia in 2008. He has served in the Malaysian army as a Medical Officer with the rank of Captain upon completing his Internship before joining USM as a trainee lecturer. He is now serving as an academic and researcher at Monash University Malaysia. He is a life-member of the Malaysian Association of Thoracic & Cardiovascular Surgery (MATCVS) and a committee member of the MATCVS Database. He is also a life-member of the College of Surgeons, Academy of Medicine of Malaysia; a life-member of Malaysian Medical Association (MMA), and a life-member of Islamic Medical Association of Malaysia (IMAM). Recently he was appointed as an Interim Chairperson of Examination & Assessment Subcommittee of the UiTM-IJN Cardiothoracic Surgery Postgraduate Program. As an academic, he has published numerous research papers and book chapters. He has also been appointed to review many scientific manuscripts by established journals such as the British Medical Journal (BMJ). He has presented his research works at numerous local and international conferences such as the European Association for Cardiothoracic Surgery (EACTS) and the European Society of Cardiovascular Surgery (ESCVS), to name a few. He has also won many awards for his research presentations at meetings and conferences like the prestigious International Invention, Innovation & Technology Exhibition (ITEX); Design, Research and Innovation Exhibition, the National Conference on Medical Sciences and the Annual Scientific Meetings of the Malaysian Association for Thoracic and Cardiovascular Surgery. He was awarded the Darjah Setia Pangkuan Negeri (DSPN) by the Governor of Penang in July, 2015.",institutionString:null,institution:{name:"Monash University Malaysia",country:{name:"Malaysia"}}},{id:"30568",title:"Prof.",name:"Madhu",middleName:null,surname:"Khullar",slug:"madhu-khullar",fullName:"Madhu Khullar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/30568/images/system/30568.jpg",biography:"Dr. Madhu Khullar is a Professor of Experimental Medicine and Biotechnology at the Post Graduate Institute of Medical Education and Research, Chandigarh, India. She completed her Post Doctorate in hypertension research at the Henry Ford Hospital, Detroit, USA in 1985. She is an editor and reviewer of several international journals, and a fellow and member of several cardiovascular research societies. Dr. Khullar has a keen research interest in genetics of hypertension, and is currently studying pharmacogenetics of hypertension.",institutionString:"Post Graduate Institute of Medical Education and Research",institution:{name:"Post Graduate Institute of Medical Education and Research",country:{name:"India"}}},{id:"223233",title:"Prof.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/223233/images/system/223233.png",biography:"Xianquan Zhan received his MD and Ph.D. in Preventive Medicine at West China University of Medical Sciences. He received his post-doctoral training in oncology and cancer proteomics at the Central South University, China, and the University of Tennessee Health Science Center (UTHSC), USA. He worked at UTHSC and the Cleveland Clinic in 2001–2012 and achieved the rank of associate professor at UTHSC. Currently, he is a full professor at Central South University and Shandong First Medical University, and an advisor to MS/PhD students and postdoctoral fellows. He is also a fellow of the Royal Society of Medicine and European Association for Predictive Preventive Personalized Medicine (EPMA), a national representative of EPMA, and a member of the American Society of Clinical Oncology (ASCO) and the American Association for the Advancement of Sciences (AAAS). He is also the editor in chief of International Journal of Chronic Diseases & Therapy, an associate editor of EPMA Journal, Frontiers in Endocrinology, and BMC Medical Genomics, and a guest editor of Mass Spectrometry Reviews, Frontiers in Endocrinology, EPMA Journal, and Oxidative Medicine and Cellular Longevity. He has published more than 148 articles, 28 book chapters, 6 books, and 2 US patents in the field of clinical proteomics and biomarkers.",institutionString:"Shandong First Medical University",institution:{name:"Affiliated Hospital of Shandong Academy of Medical Sciences",country:{name:"China"}}}]}},subseries:{item:{id:"4",type:"subseries",title:"Fungal Infectious Diseases",keywords:"Emerging Fungal Pathogens, Invasive Infections, Epidemiology, Cell Membrane, Fungal Virulence, Diagnosis, Treatment",scope:"Fungi are ubiquitous and there are almost no non-pathogenic fungi. Fungal infectious illness prevalence and prognosis are determined by the exposure between fungi and host, host immunological state, fungal virulence, and early and accurate diagnosis and treatment. \r\nPatients with both congenital and acquired immunodeficiency are more likely to be infected with opportunistic mycosis. Fungal infectious disease outbreaks are common during the post- disaster rebuilding era, which is characterised by high population density, migration, and poor health and medical conditions.\r\nSystemic or local fungal infection is mainly associated with the fungi directly inhaled or inoculated in the environment during the disaster. The most common fungal infection pathways are human to human (anthropophilic), animal to human (zoophilic), and environment to human (soilophile). Diseases are common as a result of widespread exposure to pathogenic fungus dispersed into the environment. \r\nFungi that are both common and emerging are intertwined. In Southeast Asia, for example, Talaromyces marneffei is an important pathogenic thermally dimorphic fungus that causes systemic mycosis. Widespread fungal infections with complicated and variable clinical manifestations, such as Candida auris infection resistant to several antifungal medicines, Covid-19 associated with Trichoderma, and terbinafine resistant dermatophytosis in India, are among the most serious disorders. \r\nInappropriate local or systemic use of glucocorticoids, as well as their immunosuppressive effects, may lead to changes in fungal infection spectrum and clinical characteristics. Hematogenous candidiasis is a worrisome issue that affects people all over the world, particularly ICU patients. CARD9 deficiency and fungal infection have been major issues in recent years. Invasive aspergillosis is associated with a significant death rate. Special attention should be given to endemic fungal infections, identification of important clinical fungal infections advanced in yeasts, filamentous fungal infections, skin mycobiome and fungal genomes, and immunity to fungal infections.\r\nIn addition, endemic fungal diseases or uncommon fungal infections caused by Mucor irregularis, dermatophytosis, Malassezia, cryptococcosis, chromoblastomycosis, coccidiosis, blastomycosis, histoplasmosis, sporotrichosis, and other fungi, should be monitored. \r\nThis topic includes the research progress on the etiology and pathogenesis of fungal infections, new methods of isolation and identification, rapid detection, drug sensitivity testing, new antifungal drugs, schemes and case series reports. It will provide significant opportunities and support for scientists, clinical doctors, mycologists, antifungal drug researchers, public health practitioners, and epidemiologists from all over the world to share new research, ideas and solutions to promote the development and progress of medical mycology.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/4.jpg",hasOnlineFirst:!0,hasPublishedBooks:!1,annualVolume:11400,editor:{id:"174134",title:"Dr.",name:"Yuping",middleName:null,surname:"Ran",slug:"yuping-ran",fullName:"Yuping Ran",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS9d6QAC/Profile_Picture_1630330675373",biography:"Dr. Yuping Ran, Professor, Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China. Completed the Course Medical Mycology, the Centraalbureau voor Schimmelcultures (CBS), Fungal Biodiversity Centre, Netherlands (2006). 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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. 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Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. 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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. 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