The characteristics of drylands in Ethiopia.
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In Middle Ages, it was thought that people who have religious and sexual unwanted thoughts were taken over by the devil and to be punished by burning. In the seventeenth century, Shakespeare defined a character called Lady Macbeth; she had contamination obsession and hand washing compulsion. In the nineteenth century, Esquirol mentioned from a case report named Matmazel F. Matmazel F was rubbing her fingers and washing her hands constantly because she was thinking that she might be infected with something, and she could not stop herself. Morel used the term of “obsession” first time in 1866. In the twentieth century, Janet stated that the sense of incompleteness is the base of obsessive-compulsive disorder. Janet handled this disorder under the title of psikasteni and exhibited that rituals could be improved by behavioral technics. S. Freud also stated the psychodynamic basis of the disorder [1].
There are two basic classification systems in psychiatric disorders as the Diagnostic and Statistical Manual (DSM) and the International Classification of Diseases (ICD). Obsessive-compulsive disorder (OCD) has been included in ICD-5 first time among adult mental disorders in 1939, but for children OCD has been included in DSM-II among childhood mental disorders in 1968 and in ICD-9 in 1978 [2, 3, 4]. In DSM-IV, differences in childhood OCD patients “like they could not know their obsessions and compulsions” are extremely unreasonable were highlighted [5]. While obsessive-compulsive disorder (OCD) is present under the category of anxiety disorders in DSM-IV TR, it is classified under “Obsessive Compulsive Disorder and Related Disorders” in DSM 5 and hoarding compulsions separated from OCD in DSM 5 into a new disorder, as “Hoarding Disorder.” But in the ICD 10 classification system, OCD is located under “neurotic, stress-related, and somatoform disorders” [6, 7, 8].
Obsessive compulsive disorder and related disorders include:
Obsessive-compulsive disorder (OCD)
Body dysmorphic disorder
Hoarding disorder
Trichotillomania
Excoriation (skin-picking) disorder
Substance-/medication-induced obsessive-compulsive and related disorder
Obsessive-compulsive and related disorder due to another medical condition
Other specified obsessive-compulsive and related disorders and unspecified obsessive-compulsive and related disorders [8]
OCD is a disorder that is characterized by the presence of obsessions and/or compulsions [8]. Obsessions are intrusive and unwanted thoughts, urges, or images which are recurrent and persistently experienced and caused anxiety or distress. Patients usually try to ignore or suppress these thoughts, urges, or images or try to neutralize them. Compulsions are behaviors or mental acts which are repetitive and performed in response to an obsession or applied as rigid rules. These behaviors or mental acts are performed in order to prevent or reduce anxiety and distress or feared event or situations. These behaviors or mental acts are unrelated with feared events in reality. For this to be diagnosed, it should take a lot of time, for example, more than 1 h per day and cause clinically significant distress or impairment in functioning like social, occupational, or other important areas. Symptoms of OCD must not be related with any substance’s physiological effects, medical conditions, or mental disorders. In DSM 5 diagnostic criteria, OCD could be specified as if with good or fair insight, with poor insight, and with absent insight/delusional beliefs or tic related [8]. Although there is no different diagnostic system for children and adolescents than the adults, it has been stated that young children may not be able to articulate the purposes of their compulsive behaviors or cognitive actions [8]. Children usually have less insight about the irrationality of their obsessions and compulsions. And at some developmental stages of children, it is hard to distinguish some normative behaviors from OCD. At this point, behavior’s impact in child or adolescent’s functioning is important; normative behaviors usually do not affect functioning [9].
The etiology of OCD is certainly unknown, but multiple factors like genetic, biological, cognitive, and behavioral are found effective [10]. Also it involves interactions between genetic and environmental factors [11]. Environmental factors such as traumatic life events and stress were found to be effective in 50% of OCD cases [12, 13]. In a twin study, OCD concordance was found approximately 90% in identical twins and 47% in dizygotic twins [14]. And in a twin study, genetic factors were found related with OCD symptoms [15]. In early onset OCD patients, OCD may be almost twice as high through the relatives as late onset OCD patients. This shows that familiarity in early onset OCD patients is higher [16].
OCD is a neuropsychiatric disorder, and basal ganglia dysfunction has been associated with obsessive-compulsive symptoms. In literature there are some studies that found association between OCD and neurological disorders like epilepsy, brain injury, Tourette’s syndrome, and Sydenham’s chorea [16, 17, 18, 19]. Repetitive behaviors in a patient with Sydenham cores were first described by Sir William Osler. During the course of Sydenham’s chorea, usually obsessive-compulsive symptoms occur [18, 20]. In literature it was reported that immunologically based group A beta-hemolytic streptococcal infection is an another etiological factor. This disorder is called as Pediatric Autoimmune Neuropsychiatric Diseases Associated to Streptococcal Infections (PANDAS). This disorder leads to an autoimmune inflammation in the striatum and other brain areas and shows some neurologic symptoms like hyperactivity, choreiform movements, and tics. In addition to these, in a certain period, increase of obsessive-compulsive symptoms is observed. This makes researchers to think that Tourette’s syndrome, Sydenham’s chorea, and OCD have a common etiology [21]. OCD’s neural basis is thought to include the circuits of the orbitofrontal cortex, striatum, and thalamus and the neurotransmitters as serotonin, dopamine, glutamate, and gamma-amino-butyric acid [22, 23].
In recent neuroimaging studies, amygdala and prefrontal cortex’s role has been found important in mechanism of regulating emotional responses like fear and anxiety [24]. Some evidences showed that there is a reward dysfunction in OCD [25]. Similar to addictive behaviors, compulsive behaviors that cause relief from anxiety and have a rewarding effect were hypothesized. Reward process has been associated with ventral striatal orbitofrontal circuitry and in neuroimaging studies; it was shown that OCD patients had an altered metabolism in this area frequently, and this results supported the hypothesis [26].
As psychoanalytic theory, unresolved oedipal complexes cause anxiety, and this takes place a factor in OCD etiology. According to this theory, as a result of encountering anxiety, people have a regression to anal period, and some defense mechanisms are commonly used like isolation, doing-undoing, reaction formation, and displacement [27].
There is a little evidence about the cognitive mechanisms of OCD; it is thought that these mechanisms are similar in adults and children. According to cognitive theory, the basis of obsessions is catastrophic interpretation of unwanted and distressing thoughts, impulses, and images. Obsessions are creating anxiety, and by rituals, ruminations, or avoidances, this anxiety is tried to be reduced. For obsession treatment these misinterpretations must be corrected. Also in a study, maternal cognitive biases are found more relevant with younger children’s OCD severity; personal cognitive biases are more relevant in adolescents [28].
People with OCD seek medical help when their daily functionality is seriously compromised or they experience severe anxiety, and it has been reported that these individuals start seeking professional help after an average of 7 years from the onset of these symptoms. It was found that adolescents with OCD often hide their symptoms and delay seeking help due to several reasons such as inability to recognize their symptoms as disease manifestations, embarrassment, fear of being stigmatized by other people, and believing that what they experience is transient [29, 30]. Furthermore, because adolescents hide their symptoms, it is difficult to determine the actual prevalence of the disorder, and when they seek professional help, they may be misdiagnosed as depression or anxiety disorder due to not mentioning their symptoms [31].
In the past few decades, knowledge of OCD has increased, but studies were mostly done in adult population and less studied in children. Although the first study about the prevalence of OCD in children was reported in 1970, there are few population-based studies presented about the prevalence of OCD in children and adolescents recently [32]. The prevalence of OCD in children and adolescents has been reported between 0.5 and 3% [33, 34]. In a recent study, in 16 European countries, median prevalence of OCD was found 0.7% [35].
It is predicted that OCD is the fourth frequent psychiatric disorder after phobies, substance use disorder, and depression. Studies in different countries and cultures show that OCD prevalence is independent from cultures [27]. Previous epidemiological and clinical studies show that OCD is more frequent among males prior to adolescence and during childhood, the difference between the sexes diminishes to a similar rate as the age advances, and the prevalence rate does not differ between sexes during adolescence and adulthood, and the rates are equal in both sexes at this time [36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46]. Although it was reported in the literature as early as 2 years of age, OCD usually begins at late childhood and early adolescence in youth. Age at onset of the OCD is averagely 10 years old, but age of diagnosis is around 13 years old [47]. Childhood-onset OCD’s onset age is approximately 8–11 years old in boys and 11–13 in girls [48].
OCD has adverse effects on family, school, and social lives of children and adolescents [49, 50]. The age of onset has significance in terms of the disease progression. Several studies have detected that OCD often starts at late adolescence and early adulthood period [51, 52]. Studies with adolescents showed that OCD development risk is higher at late adolescence than early adolescence [53]. It is very important to detect OCD at its early stage, because studies indicate that 50% of the adult patients develop the disease during childhood or adolescence [47, 54, 55, 56].
It is generally considered that in children obsessive thoughts are less common compared to adults; solely compulsive behaviors in the absence of obsessive thoughts are more frequent, while solely obsessive thinking is less common [45]. However, there are studies in literature showing that all children with compulsive aspect of the disease also have accompanying obsessions [57]. Some studies have reported that unlike adults, children may add their families in their rituals, and they cannot describe triggering factors and stressors as well as adults [42].
According to literature, the most common obsessions among children and adolescents include “fear of contamination, dirt, contracting disease”; “fear of aggressiveness, doing harm-receiving harm”; and “need for symmetry, order and precision”, while the most common compulsions are “grooming,” “repeating, and checking” [36, 37, 58, 59]. A study including 44 adolescents, 43 early onset adults, and 45 late onset adult OCD patients reported that religious and sexual obsessions are more common in adolescents than in adult patients, obsessions about contamination are more common in adolescents, and grooming compulsions are more frequent in early onset adults than adolescent patients [60]. Onset of OCD is rare before 6 years old. But in cases that began before 6 years old, symptoms usually began with rituals or hand washing and checking [27]. Childhood OCD in boys is 1.5–2 times more than girls [61]. In boys disorder is more severe, and neurological symptoms and comorbidities are more common [27].
Studies that involved children and adolescents diagnosed with OCD reported the frequency of poor insight with the range of 20–45%. Poor insight in children and adolescents with OCD is associated with severity of symptoms and loss of functionality and has a great influence on duration and success of treatment [62, 63]. Poor insight in OCD causes patients not to recognize their symptoms as a problem and results in reduced treatment motivation and treatment success. Therefore OCD patients with poor insight may be misdiagnosed or may not seek treatment [62, 64].
The Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) is mostly using tool and often referring as the “gold standard” measurement for assessment of pediatric OCD. It involves two subscales for Obsessions Severity and Compulsions Severity, and total score is estimating with these two subscales [65, 66]. Also there are some other assessment tools like the Children’s Florida Obsessive Compulsive Inventory (C-FOCI), Leyton Obsessional Inventory-Child Version, the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Version (ADIS-C/P) which could be used for OCD assessment in pediatric population [67, 68, 69].
Among children with OCD, 85% of patients have at least one, and 21–75% have at least two or more additional psychiatric diseases [70, 71, 72, 73]. The most commonly reported accompanying diagnoses include anxiety disorder and depression [71, 72, 74]. Several studies involving children and adolescents have reported that attention deficit hyperactivity disorder, Tourette’s disorder, oppositional defiant disorder, and generalized anxiety disorder are frequent comorbidities [75, 76, 77, 78]. In addition to these accompanying disorders, eating disorders, especially anorexia nervosa, can be frequently observed concurrently with OCD in females [79]. Other studies have found association between early onset OCD and somatoform disorders, tic disorder, impulse control disorder, and high resistance to treatment [80, 81, 82, 83].
There are many diagnoses that can be confused with OCD. For example, some anxiety disorders must be considered like generalized anxiety disorder, specific phobia, and social anxiety disorder. In generalized anxiety disorder, recurrent thoughts are usually about real-life concerns as finances and family, but in OCD these thoughts are irrational. Anxiety of patients with specific phobia is more limited with specific objects or situations, and they do not have rituals or compulsions. In social anxiety disorder, fear is limited with social situations. Major depression can be confused with OCD, but obsessions in major depression are usually appropriate with patients’ mood, not intrusive or distressing and not related with compulsive behaviors. Some disorders that are under the category of OCD and related disorders like body dysmorphic disorder, trichotillomania, and hoarding disorder can interfere with OCD. In body dysmorphic disorder, obsessions and compulsions are only with physical appearance; in trichotillomania there are no obsessions, and compulsive behaviors are only hair pulling. Hoarding disorder patients have difficulty in discarding or parting with possessions. In consequence objects extremely accumulate, but in OCD obsessions are not typically related with dispose of objects. Although obsessions and compulsions in anorexia nervosa are limited to body image or weight, this disorder can be confused with OCD. Tic disorders also can be misdiagnosed as OCD. Tics are not related with neutralizing obsessions, and tics are less complex than compulsions. Not only OCD but also psychotic disorder patients can have irrational thoughts or delusional beliefs. But OCD patients do not have other psychotic symptoms and recognize that the intrusive thoughts are a product of their own mind. Obsessive-compulsive personality disorder does not have specific obsessions or compulsions but have a resistant perfectionist or controller personality structure. OCD can be confused with some medical conditions because of the results of compulsions like eczema, rashes, and constipation [8, 9, 84].
Cognitive behavioral therapy (CBT) is recommended for the first-line treatment in mild to moderate OCD, but in moderate to severe OCD cases, it is recommended to support CBT with medication [85].
CBT is a kind of psychotherapy which is developed on the basis of learning theories in psychology and the principles of cognitive psychology. The purpose of this therapy is to change emotions and incompatible behaviors by using psychotherapeutic methods based on these principles [86]. Behavioral therapies began to be used in the treatment of emotional and behavioral problems of young people in the 1950s. These behavioral approaches are based on the theories of Thorndike, Watson, and Bandura, and classical and operant conditioning have been used to treat behavioral disorders seen in infants and children. Cognitive therapies were developed by Aaron Beck in the 1970s and started to be used in the treatment of child and adolescent cases in the 1980s [87].
According to CBT, the mental condition of a person is the result of the mutual interaction of the environment, relationships, the biological structure, emotions, cognition, and behaviors. Psychotherapeutic methods can only be applied to cognition and behaviors of a person [86]. According to learning theory, compulsions reduce distress that triggered by obsession so that negative reinforcement occurs over time (Figure 1) [88].
The obsessive-compulsive cycle used by Piacentini et al. [
In the CBT, children and adolescents learn to confront with their fears step by step. By learning how to behave against what the OCD tells them, they would understand that their fears do not reflect reality [90]. According to cognitive theory, cognitive processes determine the feelings and behaviors of people. Cognitive processes provide one’s interpretation of the external world, surrounding events, own life, and relations with other people. When the basic assumptions and beliefs involved in the cognitive structure that determines the person’s view of the world and its interpretations are distorted or functionally improper, a person begins to experience problems [91]. Hence, problems that disturb the person are not due to the events and experiences themselves but due to perception and evaluation of the events and experiences [92]. Instead of these problematic forms of interpretation, cognitive therapy tries to reveal more compatible and appropriate perception and evaluation structures for a situation [93]. Additionally, cognitive therapy emphasizes that improper cognitive structures are an important factor in emerging and maintaining mental disorders. The basic cognitive features of OCD are an overestimation of thoughts and feelings, exaggerated sense of responsibility, perfectionism about controls of thoughts and behaviors, and catastrophic interpretation of possible outcomes of thoughts and impulses, and these features lead to misinterpretations [21]. Cognitive therapy firstly tries to establish connections among emotion, behavior, and thought [94]. According to the cognitive theory, cognition is examined in two sets: automatic thoughts and schemes (Figure 2) [86].
Cognition structure [
Cognitive therapy deals with automatic thoughts. These thoughts are spontaneous and located in the stream of mind. Also, they are cognitions that are mostly specific to environment and situation that accompanied to moments of emotional distress. Contrary to emotions automatic thoughts are rarely noticed. These thoughts could be verbal or imaginary. There are unsaid intermediate beliefs, rules, and assumptions regulating one’s behavior underlying automatic thoughts. These are permanent rules and anticipations about the behavior of himself/herself and others, their life, and things that happened to them. Nonfunctional intermediate beliefs lead the therapist to core beliefs that are the deepest cognitive structures. Core beliefs consist of people’s early life experiences and their identification with the people around them. These beliefs are reinforced by similar experiences and learnings by time [95]. According to Piaget, the child enters the concrete operational stage around the age of 7–8. Most of the children at the concrete operational stage have the logical processes to take advantage of the cognitive debate. There may be difficulties in cognitive therapy in children who have not reached the concrete operational stage [95]. Children and teenagers often apply to therapy by caregiver’s decision. So the first thing to do by the therapists is to introduce themselves and to explain to the child who they are, what they do, and how they can help [93].
The most effective behavioral techniques are a combination of exposure and response prevention. Exposure to anxiety-producing stimulus is advised to a person, and decrease of anxiety is expected after repeated practices. During exposure, the person must prevent rituals and avoidance behaviors. At this stage, response prevention is used. Practices can be in real or imaginary ways. A list should be made of the anxiety-inducing stimuli before practice. Practice starts with easy tasks in the list, and the difficulty of the tasks is increased step by step [27, 96].
CBT session consists of symptom control, review, and getting feedback of homework done; determines the agenda items; configures session content; and determines the new homework, [97]. CBT usually continue 10–14 weeks, with weekly sessions taking 45–90 min [98]. Among the basic principles of the CBT, the first step is psychoeducation. In psychoeducation session, the incidence and prevalence of OCD, age-dependent normal obsessive-compulsive behaviors, OCD’s symptoms and disorder’s nature in child and adolescent age group, OCD’s mechanism, and the impact of factors like developmental level and temperament are given. Also in this session, knowledge of underlying reasons of OCD and basis of cognitive and behavioral therapy, especially exposure and response prevention, and social learning theory, when the medical treatment is needed, are given.
The second step is the diagnostic assessment. There must be a detailed assessment of child’s/adolescent’s problem and history of coping methods and medical, developmental, family, and school features. Social and cultural characteristics must be considered. Different sources of information such as the clinical interview, parents, questionnaires, and information from school must be integrated. Specific OCD symptoms and comorbidities should be asked. A formulation should be made including protective, precipitating, predisposing, and maintaining factors linked to child/adolescent’s situation. The decision should be given about whether an additional medical treatment is necessary. A family assessment involving the capacity to support the child/adolescent of the family should be undertaken. Which family members have become involved in rituals, avoidance behaviors, and obsessions and family functioning must be questioned.
In the third step, emotions, behaviors, and cognitions should be assessed. Anxiety should be explained and normalized in ordinary fear-inducing situations. Furthermore, thoughts, feelings, and behaviors should be assessed. Detailed list of obsessive ideas and rituals should be done by standardized instruments. Insight level should be questioned. A list of triggers to obsessional fears and compulsive behaviors/rituals and avoided situations should be generated. Cognitive and behavioral rituals used to reduce discomfort should be identified. By using scales appropriate for the age such as “fear thermometer” or “SUDS ratings” anxiety levels should be rated, and child/adolescent should rate how difficult to resist OCD symptoms. For exposure and response prevention, targets should be identified.
The next step is intervention stage. At this step, OCD and intervention rationale should be explained. OCD could be explained by age-appropriate metaphors. With positive reinforcement like praise, awards, and “certificates of achievement,” engagement to therapy should be increased. OCD symptoms are tried to be externalized by giving a nickname to OCD, using “boss back OCD” strategy, being child/adolescent’s ally in fighting OCD and figuring out strategies for fighting OCD. Constructive self-talk might be helpful for coping, and cognitive reconstruction would be useful for unhelpful assumptions underlying the obsessions. In the exposure trials, a child/an adolescent creates a hierarchic list of anxiety situations. Mutually agreed targets are chosen from the list, and those targets are worked together. A direct exposure method is implemented on the agreed targets, and enough exposure time is allowed for habituation. In this process, anxiety levels are rated. Graded exposure including imaginal exposure, exposure to cartoons or images of the feared trigger, is used in the session [99]. The exposure trial is continued until distress ratings decrease by 50% [100]. By agreeing on realizable daily homework tasks, chances of success are maximized.
For ritual prevention, a plan will be made as delaying, shortening, doing differently or performing the ritual slowly. Also, self-monitoring and recording rituals are a part of the exposure process. During response prevention, child’s/adolescent’s anxiety is measured by the fear thermometer. Then relapse prevention is used. The distinction between “lapse” and “relapse” is explained to child/adolescent and parents. For any future OCD symptoms, a rehearsal is made for remembering and using CBT techniques. Family members are included in the intervention as “coaches” for supporting children during exercises, and it is important to work with the school [99]. When CBT is implemented, escape, avoidance, and security search behaviors must be considered because these behaviors are the factors leading to anxiety [101].
Child/adolescent is trained for some anxiety management strategies like breathing and relaxation techniques [102]. CBT could be implemented in groups. Studies show that group CBT programs are more comfortable for patient children because of seeing other children with the same problem [90]. The developmental characteristics as a level of autonomy and dependence of the child should also be considered when CBT is applied [101]. The level of language development during therapy can cause problems. They may not express their feelings verbally. For this reason, first of all, emotional words and concepts should be studied with comics, pictures, heroes, and narratives [93]. And cognitive behavioral play therapy can be applied while working with very young children [101].
In OCD’s pharmacological treatment, fluoxetine, sertraline, and fluvoxamine as selective serotonin reuptake inhibitor (SSRI) and clomipramine as nonselective serotonin reuptake inhibitor have the approval of US Food and Drug Administration for child and adolescents. Which serotonergic drug is the first choice is unknown. But clomipramine’s effect was found superior than SSRIs [103]. Clomipramine is considered as the gold standard medication in pharmacological treatment of OCD; however, 46–74% of adolescent OCD patients have been reported to benefit from this drug [104]. Studies indicate that selective serotonin reuptake inhibitors (SSRIs) are superior to placebo for treatment of childhood OCD [103].
Some supportive strategies can be applied in case SSRI treatment is not adequate. These supportive methods include options like addition of CBT, risperidone, clonazepam, clomipramine, aripiprazole, or memantine to the treatment [105, 106]. Medication augmentation is recommended for cases which have moderate impairment persists in at least one functioning area despite adequate monotherapy. Treatment resistance can be described as failing ≥2 adequate SSRI monotherapy treatment, 1 SSRI and a clomipramine trial, and failure of adequately delivered CBT [85].
In augmentation strategy especially clomipramine and the atypical antipsychotics are commonly used [107, 108]. And also some other drugs like stimulants, gabapentin, sumatriptan, pindolol, inositol, opiates, St. John’s wort, N-acetyl cysteine, memantine, and riluzole, without evidence-based results, have also been tried [109].
Adding clomipramine to an SSRI (often fluvoxamine at low doses like 25–75 mg/day) could be a useful augmentation strategy. But practitioner must be careful about adding clomipramine to fluvoxamine or to other CYP-450 2D6 inhibitors like fluoxetine or paroxetine to prevent potentially toxic serum clomipramine levels which would cause cardiological side effects and must follow up with electrocardiography. In augmentation therapy, mostly atypical antipsychotics are chosen. This strategy can improve oppositional behaviors which are caused by increased anxiety level [85]. Riluzole is a “glutamatergic modulator” which effects on glutamate release and increases the level of α-amino-3- hydroxy-5-methyl-4-isoxazolepropionic acid trafficking and amino acid transporters that stimulates neuroglia [110]. Riluzole has FDA indication only in amyotrophic lateral sclerosis, but there are no indications for childhood conditions. Recently, riluzole was studied in a few open-label trials for generalized anxiety disorder, major depressive disorder, bipolar depression, and OCD in adults, and these results showed riluzole’s beneficial effects, and it was well tolerated [111]. In an open-label trial of riluzole of childhood OCD, four of six patients’ OCD symptoms had improved significantly. In this study riluzole was well tolerated, and there were no any side effects seen in children [112].
In a study that includes 17 children and adolescents between aged 8 and 18 years with a primary diagnosis of OCD, effectiveness of D-cycloserine (DCS)-augmented CBT for children and adolescents was investigated. Results of this study showed DCS-augmented exposure, and response prevention produced significant improvements in OCD severity relative to a placebo control in severe and difficult-to-treat pediatric OCD [113]. Lamotrigine is an antiepileptic drug and also a mood stabilizer that decreases extreme glutamate release [114, 115]. Thus Lamotrigine could be a good augmentation agent in refractory OCD cases. Except those studies, there is a case report that aripiprazole was used with clomipramine, which showed remarkable improvement [116].
OCD is an important psychiatric disorder in childhood and adolescence. At this age OCD is common, but the diagnosis is often missed. For this reason OCD usually shows chronic progress and serious loss of function. OCD could be confused with other diseases, or comorbidities could be seen. These conditions make it difficult to treat the disease. Although the disease has not completely recovered by the treatment, symptoms can be improved, or functionality may improve somewhat.
OCD could not be as well-defined as adults. Therefore more clinical studies are needed. These studies lead to a better understanding for etiology, treatment, and course of OCD. With the new treatment approaches, OCD could be treated at early age period, and chronicity could be preventable. Thus the incidence of OCD in adulthood may decrease, and it may increase patients’ quality of life.
The Food and Agricultural Organization (FAO) stated that “the major challenge threatening the dryland communities is degradation of the natural resource base, which is leading to soil and vegetation loss, fertility decline, water stress, drying of water resources, lakes and rivers. This degradation is being exacerbated by increasing climate variability and change, with profound impacts on the livelihoods of dryland communities” [1]. Despite the fact that Ethiopia’s contribution to global GHGs is about 0.04% [2], climate change poses significant challenges for agriculture in general and dryland agriculture in particular. In return, conventional agriculture in general and malpractice agriculture in particular have contributed to climate change by emitting greenhouse gases (GHGs) such as CO2, CH4 and N2O. In this case, a paradigm shift at all levels is needed in such a way that agriculture should be at the core of sustainable development and poverty-reduction efforts as well as those related to lower-carbon and climate-resilient growth [2, 3].
According to the Intergovernmental Panel on Climate Change [4, 5], in Ethiopia, over the past five decades, the temperature has been increasing annually at a rate of 0.2°C. This has already led to a decline in agricultural production, and cereal production is expected to decline still further (12%) under moderate global warming [6]. Furthermore, it has led to a decline in biodiversity, a shortage of food and an increases in human and livestock health problems, as well as rural-urban migration and dependency on external support. Factors exacerbating the impact of climate change in Ethiopia are rapid population growth, land degradation, widespread poverty, dependency on rain fed agriculture, lack of awareness by policy and decision-makers about climate change and lack of appropriate policies and legislation ([7, 8], National Meteorological Agency of Ethiopia [9]. More than 85% of the people in Ethiopia depend mainly on agriculture for their livelihoods. This will render them very vulnerable to climate variability and change. Consequently, a large number of people in Ethiopia are being affected chronically by drought and/or flooding, leading to deaths and loss of assets [10]. For instance in the period 1900–2019, there were 16 drought events that caused a total death of 402,367 people and a total affected population of 77,141,879 and resulted in total economic damage amounted to USD 1.5 billion [10]. This has obliged the country to make an appeal for international support. The problem is very serious in the arid and semi-arid areas, especially among the herders (Table 1) [12].
Dryland features | Descriptions |
---|---|
General characteristics |
|
Ecologies |
|
Resource |
|
Population |
|
Farming systems |
|
The livelihoods of pastoralists are highly dependent on natural resources and very sensitive to climate change, yet such events cannot be easily separated from other events such as land degradation and policy changes [12]. The study by Thomas
Despite all those challenges for agricultural development in the dryland agro-climatic zones in Ethiopia, agriculture has remained conventional and traditional in such environments. Those conventional and traditional agricultural developments, combined with the impacts of climate change and variability, are not sustainable, retard climate change mitigation and adaptation initiatives, and exacerbate food insecurity. Therefore, the core objectives of this review were to assess the contribution of such conventional agricultural developments to GHGs emissions from global and Ethiopian perspectives; to give directions on how these unsustainable forms of agriculture could be transformed into sustainable developments by applying climate-smart technologies and proper resource management strategies.
Greenhouse gases allow the penetration of incoming solar radiation but absorb the outgoing long wave radiation from the earth’s surface and re-radiate the absorbed radiation back to the surface of the earth and by doing so they have caused global warming and climate change [4, 5].
The emission of GHGs from anthropogenic activities such as industrial processes, land use change and agriculture are the main causes of climate change. As indicated in Figure 1, agriculture’s contribution to GHGs emissions is huge. It takes 14% of CO2, 47% of CH4 and 84% of N2O to make up the global share of GHGs emissions [2, 14, 16, 17, 18, 19]. These gases are the most persuasive GHGs that are emitted from unsustainable agricultural practices [20, 21, 22]. In Ethiopia, agriculture contributed 80% of total country’s GHGs emission. Of this, CH4, N2O and CO2 contributed 72%, 15% and 14% to aggregated emission respectively [23]. Agriculture includes cropland management; grazing land management/pasture improvement; management from agricultural organic soils; restoration of degraded lands; livestock management; manure/bio-solid management; and bioenergy production [2, 4, 19]. These practices can result in GHGs emissions such as CH4 from enteric fermentation and rice production, N2O emissions from soils, N2O and CH4 from manure management and biomass burning, and CO2 emissions and removals in agricultural soils. This in turn impacts agricultural developments by contributing to climate change.
Percentage global contribution of GHGs to climate change (Source: [
To soothe the impacts of climate change, countries should act now, act together and act differently to stabilize the fractions of greenhouse gases in the atmosphere at a level that would also stabilize the climate system. This will give sufficient time to allow ecosystems to adapt naturally to climate change, to ensure that food production is not threatened and to enable economic development to proceed in a sustainable manner [24]. As was dealt in Kyoto Protocol, in order to promote sustainable agricultural development, countries should promote sustainable forms of agriculture in light of climate change [25]. Based on the results of the International Food Policy Research Institute [26], climate change was supposed to have reduced net crop revenue by −28% to −79% in Central Africa, by −7% to −32% in West Africa, by −12% to −17% in Southern Africa, by −11% to −12% in East Africa and by −4% to −7% in North Africa. In Ethiopia, the study by Deressa [26] showed that a unit increase in temperature during summer and winter would reduce net revenue by $177.62 ha−1 and $464.71 ha−1, respectively. On the other hand, the marginal impact of increasing precipitation during spring would increase net revenue by $225.09 ha−1. How can agricultural GHGs emissions (Table 2) be reduced or sequestration enhanced while maintaining and even increasing food supply, particularly in dryland agriculture? As shown in Figure 2, this can be answered by adopting climate-compatible agricultural development strategies [29, 30].
Sub-sector in Agriculture | Main drivers | Emission in million tonnes of CO2e | ||
---|---|---|---|---|
2010 | 2020 | 2030 | ||
Forestry | Deforestation Forest degradation | 50 | 125 | 90 |
Livestock | Methane from enteric fermentation N2O from manure left on pastures | 65 | 146 | 125 |
Soil management | Crop production Fertilizer use Manure management | 12 | 5.8 | 60 |
Options of strategies and key issues in climate change-agricultural development nexus (Source: [
Climate-smart agriculture can be defined as agriculture that sustainably increases productivity, resilience (adaptation), reduces/removes GHGs (mitigation), and enhances achievement of national food security and development goals [2, 31, 32, 33]. Making agriculture climate-smart is one of the means to tackle climate change and its impacts which is the focus of Sustainable Development Goals (SDGs) (Goal 13) and complements SDGs 1 and 2. Agricultural development in drylands is a victim of climate change impacts. It is anticipated that higher temperatures could reduce crop yields by 10–20% in Sub-Saharan Africa by 2050. In return, unsustainable agricultural development is one of the causes of climate change as it is responsible for 10–12% of anthropogenic GHGs emissions each year and much more (30%) if human beings take into account the clearance of forests to make way for crops and livestock [34, 35]. Agricultural development must be effective in terms of food production, reducing GHGs emissions and helping farmers adapt to climate change [36, 37]. To build the resilience of drylands, it is essential to make agricultural land management practices more sustainable; improving grassland management so as to enhance carbon sequestration; reforestation and restoration of dryland forests; improving the efficiency and productivity of livestock by rearing improved breeds and transforming high emitter livestock (
Climate change requires environmental conservation and global partnerships that are related to two of the Millennium Development Goals (MDGs): ensure environmental sustainability and develop a global partnership for development [38]. These have been strongly strengthened in the SDGs under goals 15 and 17 [39]. Parry [40] stated that climate change is a binary development issue. In the first case, unsustainable development, in the past and present, is the root cause of climate change. In the The second case, sustainable development is certainly a necessary, and probably sufficient condition for overcoming this challenge (Figure 3). Portfolios of mitigation and adaptation strategies to unsustainable development will not result in the right co-benefits. Rather sustainable transformations are important for the case in point [41, 42]. For instance, Denmark has reduced GHGs emissions by 28% in 1990–2009 because of a 31% reduction in N2O emissions due to improved use of manure and a 40% reduction in the use of inorganic fertilizer in 1990–2000, with a further consensus to reduce GHGs emissions from agriculture by 50–70% without a decrease in food production [43]. Ethiopia has also planned to follow similar trends through its climate resilient green economy strategy. This creates a win-win situation between climate change and agricultural development [28, 44, 45].
The climate change and agricultural development relationships (negative signs before GHGs indicate emission reduction and the yellow arrows show negative impacts on each other & positive signs before GHGs indicate emission enhancement and the green arrows show win-win). The strategies that help to make such transformations are described in Sections 3.1 to 3.4 below.
Land degradation and human population growth in the drylands of Ethiopia, exacerbated by climate change such as severe droughts, have greatly impaired the country’s economic and social development and its food security status. It is clear that combating desertification and land degradation, and mitigating the effects of drought are the basis for accelerated sustainable development, poverty reduction and insuring food security in Ethiopia. This requires the realization of strong partnership building and commitment at regional and international levels. Cognizant of this fact, the Ethiopian Government was one of the pioneering governments to accept and endorse the Great Green Wall for the Sahel and Sahara Initiative (GGWSSI) and was ready for its implementation [46].
Drylands are characterized by low and highly variable precipitation and warm temperatures. Livestock grazing is the predominant type of land use, providing a livelihood for a considerable number of people [47]. Optimal rangeland management depends on (i) the current state of the vegetation; (ii) the observed rainfall; and (iii) optimizing the stocking density and rate to reduce emission of GHGs, particularly methane. The stocking density refers to the number of livestock per hectare of rangeland while the stocking rate refers to the ratio of livestock to available forage on the pasture in a given year [48].
The livestock population of Ethiopia, which reached more than 160 million heads in 2011 and more than 224 million heads in 2020 [49, 50], is the largest in Africa and the 10th in the world. It constitutes a large component of the Ethiopian agricultural sector and is well integrated with the farming systems in general and provides the sole means of subsistence for the herders in the lowlands in particular. More than 50% of Ethiopia’s land is utilized for grazing and browsing. Herders in the lowlands take the lion’s share of this figure. Even if the world share of non-CO2 emissions from the livestock sector of Ethiopia is the minimum as shown in Figure 4 [28, 51], sector-wise Ethiopia’s emission profile is dominated by emissions from agriculture contributing about 80% of the total. Whereas gas-wise it is dominated by CH4 contributing 80% of the total CO2 equivalent emissions in 1994 [52] and most of this contribution is from less productive livestock. Even in current times, cattle take more than 80% of the share of CH4 emission in Ethiopia [53, 54]. Based on IPCC [55] guidelines, methane emissions from enteric fermentation are estimated using equation 1 for eight major livestock subcategories in Ethiopia (Table 3). The livestock subcategories are donkeys, camels, cattle, goats, mules, sheep, horses and poultry. Livestock population data for each subcategory is from CSA [49, 50]. The emission factors attributed to each livestock subcategory for enteric fermentation are all IPCC default values ascribed for Ethiopian conditions. The methane emissions resulting from equation 1 are then multiplied by 21, the global warming potential for methane at 100 years in the atmosphere, to yield the carbon dioxide equivalent in tonnes of CO2e (Table 3). In order to optimize methane emissions while there is an increasing livestock population [50], there is a need to settle climate smart livestock production with proper rangeland management, improved feed and highly productive livestock breeds. If Ethiopia’s livestock production is climate-smart and reduces emissions by 38%, the emission from the eight livestock subcategories (Table 3) is less 16,929,022 tCO2e and 24,583,413 tCO2e than conventional livestock production in 2011 and 2020 respectively. The Ethiopian Climate-Resilient Green Economy strategy states that, in agriculture, higher livestock productivity has the potential to reduce 45 x 106 tonnes of CO2e emissions a year in 2030 [28]. Grazing lands are considered an important carbon sink-storing 10–30% of the global soil organic carbon. Improved grazing management on rangeland, such as species management, irrigation, rotational grazing, and fertilization, is expected to capture a significant amount of carbon. Studies indicated that there are potential soil carbon sequestration rates of 0.6 - 1.3 tCO2e ha−1yr−1 from these improved managements [57].
Global non-CO2 emission from the livestock sector (Ethiopia’s contribution Ethiopia is 0.065 Gt CO2-eq) (Source: [
Livestock categories | Default IPCC Emission factor (KgCH4/head/yr) for Ethiopia [55, 56] | Number of livestock in Ethiopia [50] | Methane emission/year( Tonnes) | Emission CO2e /year(tonnes) | |||
---|---|---|---|---|---|---|---|
Enteric fermentation | Manure management | Enteric fermentation | Manure management | Total | |||
a | B | c | d = ac/1000 | e = bc/1000 | f = d+e | g = 21*f | |
Donkeys | 10 | 0.9 | 6,209,665 | 62,097 | 5,589 | 67,685 | 1,421,392 |
Camels | 46 | 1.92 | 1,102,119 | 50,697 | 2,116 | 52,814 | 1,109,084 |
Cattle | 31 | 1 | 53,382,194 | 1,654,848 | 53,382 | 1,708,230 | 35,872,834 |
Goats | 5 | 0.17 | 22,786,946 | 113,935 | 3,874 | 117,809 | 2,473,979 |
Mules | 10 | 0.9 | 385,374 | 3,854 | 347 | 4,201 | 88,212 |
Sheep | 5 | 0.15 | 25,509,004 | 127,545 | 3,826 | 131,371 | 2,758,799 |
Horse | 18 | 0.9 | 2,028,233 | 36,508 | 1,825 | 38,334 | 805,006 |
Poultry | 0 | 0.02 | 49,286,932 | 0 | 986 | 986 | 20,701 |
Donkeys | 10 | 0.9 | 9,987,762 | 99,878 | 8,989 | 108,867 | 2,286,199 |
camels | 46 | 1.92 | 7,702,493 | 354,315 | 14,789 | 369,103 | 7,751,173 |
cattle | 31 | 1 | 65,354,090 | 2,025,977 | 65,354 | 2,091,331 | 43,917,948 |
Goats | 5 | 0.17 | 50,501,672 | 252,508 | 8,585 | 261,094 | 5,482,967 |
Mules | 10 | 0.9 | 357,603 | 3,576 | 322 | 3,898 | 81,855 |
Sheep | 5 | 0.15 | 39,894,394 | 199,472 | 5,984 | 205,456 | 4,314,579 |
Horse | 18 | 0.9 | 2,111,134 | 38,000 | 1,900 | 39,900 | 837,909 |
Poultry | 0 | 0.02 | 48,955,675 | 0 | 979 | 979 | 20,561 |
Methane emission in Ethiopia’s livestock sector.
Water and desertification are the most optimizing factors to foster economic, social and environmental development in the drylands and that the sustainable utilization of water resources is a priority at regional and national scales [58]. Climate change will have enormous effects on the hydrological cycles in drylands with less total rainfall, drier soils but with increased risks of floods from increased frequency and intensity of storm events [4]. There should be a need to enhance physical and economic water productivity. The former is defined as the ratio of the amount of agricultural output to the amount of water used and the latter is defined as the value derived per unit of water used [13].
The drylands of Ethiopia are characterized by scarce and unreliable rainfall. Due to this, within the context of dryland development, the Federal Constitution of Ethiopia in article 52(2d) provides legal provisions (“to administer land and other natural resources in accordance with Federal laws”) which provide a basis for regional governments to take an active role in formulating and implementing appropriate policies and programmes for water development in dryland areas (Figure 5). Rainwater harvesting is a centuries old practice by the Ethiopian pastoralists and it has continued to be implemented in the current Government’s efforts in soil and water conservation programmes to improve food security ([60], Tolossa
Impact matrix of water development in dry lands (Adapted from [
Adoption of improved approaches and good practices to water development can strengthen the contribution of dry lands to national economies, and reduce their drain on resources by enhancing resilience and reducing the need for food and other cash interventions during emergencies brought on by climate extremes such as floods and droughts. Improving water development and management, particularly through ecosystem-based approaches, enhances the productivity and sustainability of soil, water and vegetation resources so as to make dryland agricultural development initiatives as sustainable as possible. This improves the resilience of both human communities and ecosystems to climate change in the drylands [59, 61, 62].
Conservation agriculture (CA) is a concept for resource-saving agricultural crop production that strives to achieve acceptable profits together with high and sustained production levels while concurrently conserving the environment. CA is based on enhancing natural biological processes above and below the ground. Interventions such as mechanical soil tillage are reduced to an absolute minimum, and the use of external inputs such as agrochemicals and nutrients of mineral or organic origin is applied at an optimum level and in a way and quantity that does not interfere with, or disrupt, the biological processes. CA is characterized by three principles (Figure 6) which are linked to each other, namely: continuous minimum mechanical soil disturbance; permanent organic soil cover; and diversified crop rotations in the case of annual crops or plant associations in the case of perennial crops [64, 65, 66].
The three pillars of conservation agriculture (Source: [
Conventional tillage exposes the soil by deep cultivation and this in turn enhances CO2 emissions from the soil. More than 97% of the world’s food supply is produced on land that emits GHGs when intensively tilled, fertilized, and/or grazed by animals [67]. Conversion of 76% of the croplands in the USA, for example, to conservation tillage could sequester as much as 286–468 million metric tonnes (MMTs) CO2e over 30 years showing that conservation agriculture could become a net sink for carbon [68] and play an important mitigation and adaptation role in climate change effects [69, 70].
A global estimate of carbon sequestration from the conversion of conventional tillage to conservation tillage will be as high as 4900 MMT CO2e by 2020. Combining economics of fuel cost reductions and environmental benefits of conversion to conservation tillage are a positive first step for agriculture toward decreasing carbon emissions into the atmosphere [71]. In the same token, it was also calculated that, if 15% of the carbon in crop residues is converted to passive soil organic carbon (SOC), it may lead to a carbon sequestration rate of 200 MMT CO2e yr−1 when it is used with less intensive tillage. A change from conventional tillage to no-tillage has been found to sequester 4300–7100 kg of carbon ha−1yr−1 [72]. A traditional agricultural conservation practice in northern Ethiopia has been found to be effective for in-situ soil and water conservation, reducing runoff on average by 11% and soil loss by 36% [73]. This in turn could reduce GHG emissions from agricultural lands.
Agriculture can contribute to the mitigation of climate change by adopting practices that promote the stashing of CO2 as carbon in soil, crop biomass and trees, and by displacing the use of fossil fuels required for tillage, chemical manufacture, equipment manufacture, and grain handling operations [74, 75, 76]. In the Ethiopian case too, agricultural development as business as usual and contributing the largest share of Emission (Figure 7), without consideration of climate risks and opportunities, will lead to maladaptive practices weakening national resilience to climate change [78]. This is also emphasized with the Cancún Agreements that developing nations are, for the first time, officially encouraged to develop low-carbon development strategies.
All GHGs emission trend of Ethiopia by sector (Source: [
Plants are central in carbon, water and nitrogen cycles thereby necessitating the need for sustainable utilization of these resources with a view to contributing towards reducing the impact of climate change and variability. The ways in which these resources are used and managed, determine the future direction of climate change impacts in drylands [79]. Enhancing awareness on the importance of plant biodiversity and sustainable livelihoods in response to climate change and variability is vital in the fragile dryland ecosystem where there is direct dependence on natural resources for livelihood [80]. Adopting practices of adaptation and mitigation such as proper fire management, improved forest management, reforestation, reducing deforestation and forest degradation will enhance carbon sinks and help to minimize impacts of climate change. In addition to high temperature and changing rainfall patterns, the major threats affecting vegetation resources in drylands are the coping strategies put in place, such as firewood and charcoal sale, by community members during times of drought. These livelihood activities provide households with an alternative income source when livestock and crop production fail. But these activities become unsustainable as droughts become more frequent, leading to substantial deforestation and forest degradation. With expected future climate change and increasing drought risk (Figure 8), pressures on vegetation resources are likely to intensify, unless more sustainable alternative sources of fuel and income generating options are provided or put in place. Otherwise, the resulting deforestation and forest degradation will go on to diminish development efforts of local communities and make them vulnerable to climate change shocks [81, 82].
Repercussions of vegetation degradation and drought in drylands of Ethiopia and how to reverse it by managing the resources and use of technology.
Climate change is a global concern whereby developing countries are the most affected by its impacts. Every ecosystem is affected by climate change impacts and in particular drylands are more vulnerable. Dryland agriculture in Ethiopia is more susceptible to the impacts of climate change as the system is already fragile, degraded and unstable with low, erratic and unevenly distributed rainfall patterns. To optimize the productivity of dryland agriculture and enhance food security for the growing population, the practices of agriculture should be climate compatible which encompasses sustainable development, adaptation and mitigation strategies. To this end GHG emissions are reduced or sequestration enhanced while maintaining and even increasing food supply to attain food security. Indeed, there is a need to reduce forest degradation and deforestation, improve rangeland management, improve livestock feeds and rare drought resistant breeds, use drought resistant and short maturing crop varieties, improve soil and water management (including water harvesting and conservation agriculture).
Achieving success in dryland agriculture by overcoming the challenges of climate change requires a comprehensive approach of technical, institutional and financial innovations, so that both adaptation and mitigation strategies are consistent with efforts to safeguard food security, maintain ecosystem services, provide carbon sequestration and reduce emissions. The dryland agriculture in Ethiopia needs reform to attain much greater harmony with the natural and human environment and follow the principles of green economy and making synergies with other sectors. At the end of the day, it is possible to create climate-smart dryland agriculture that maintains livestock and crop productivity as well as reduces GHGs emissions and lessens the impact of climate change. Therefore, productive and ecologically sustainable agriculture with strongly reduced GHGs emissions is fundamental so as to reduce trade-offs in dryland agricultural development to fulfil food security, mitigate climate change and improve ecosystem degradation.
The author declares there are no conflicts of interest.
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\\n"}]'},components:[{type:"htmlEditorComponent",content:'1. IntechOpen partners with third-party companies to serve ads and/or collect certain information when you visit our website. These companies may collect non-personally identifiable information (not including your name, address, email address or telephone number) during your visit to IntechOpen's website.
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Large herbivores such as elephants and hippopotamus in particular are vulnerable to climate change due to their ecology, whereas other species are less vulnerable. Climate-related extreme events, coupled with other anthropogenic stressors, interact to influence changes in abundance and distribution of wildlife resources. Understanding the influence of these climatic factors on wildlife resources is vital for adaptive management and protection of biodiversity.",book:{id:"5934",slug:"selected-studies-in-biodiversity",title:"Selected Studies in Biodiversity",fullTitle:"Selected Studies in Biodiversity"},signatures:"Olga L. 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From 1964 to 1974, he worked as an Assistant in Biochemistry at the School of Medicine at the same university. From 1974 to 1976, he was a fellow of the National Institutes of Health (NIH) at the University of Connecticut, Health Center, USA. From 1985 to 2004, he served as a Full Professor of Biochemistry at the Universidad Nacional de La Plata. He is a member of the National Research Council (CONICET), Argentina, and the Argentine Society for Biochemistry and Molecular Biology (SAIB). His laboratory has been interested for many years in the lipid peroxidation of biological membranes from various tissues and different species. Dr. Catalá has directed twelve doctoral theses, published more than 100 papers in peer-reviewed journals, several chapters in books, and edited twelve books. He received awards at the 40th International Conference Biochemistry of Lipids 1999 in Dijon, France. He is the winner of the Bimbo Pan-American Nutrition, Food Science and Technology Award 2006 and 2012, South America, Human Nutrition, Professional Category. In 2006, he won the Bernardo Houssay award in pharmacology, in recognition of his meritorious works of research. Dr. Catalá belongs to the editorial board of several journals including Journal of Lipids; International Review of Biophysical Chemistry; Frontiers in Membrane Physiology and Biophysics; World Journal of Experimental Medicine and Biochemistry Research International; World Journal of Biological Chemistry, Diabetes, and the Pancreas; International Journal of Chronic Diseases & Therapy; and International Journal of Nutrition. 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He was head of this department from 1993 to 2003. His specializations are medicine, gastroenterology, clinical pharmacology, clinical nutrition, and dietetics. His research fields are biochemical pharmacological examinations in the human gastrointestinal (GI) mucosa, mechanisms of retinoids, drugs, capsaicin-sensitive afferent nerves, and innovative pharmacological, pharmaceutical, and nutritional (dietary) research in humans. He has published about 360 peer-reviewed papers, 197 book chapters, 692 abstracts, 19 monographs, and has edited 37 books. He has given about 1120 regular and review lectures. He has organized thirty-eight national and international congresses and symposia. He is the founder of the International Conference on Ulcer Research (ICUR); International Union of Pharmacology, Gastrointestinal Section (IUPHAR-GI); Brain-Gut Society symposiums, and gastrointestinal cytoprotective symposiums. He received the Andre Robert Award from IUPHAR-GI in 2014. 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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. 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He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. 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He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"322007",title:"Dr.",name:"Maria Elizbeth",middleName:null,surname:"Alvarez-Sánchez",slug:"maria-elizbeth-alvarez-sanchez",fullName:"Maria Elizbeth Alvarez-Sánchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",country:{name:"Mexico"}}},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}},{id:"338856",title:"Mrs.",name:"Nur Alvira",middleName:null,surname:"Pascawati",slug:"nur-alvira-pascawati",fullName:"Nur Alvira Pascawati",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universitas Respati Yogyakarta",country:{name:"Indonesia"}}},{id:"441116",title:"Dr.",name:"Jovanka M.",middleName:null,surname:"Voyich",slug:"jovanka-m.-voyich",fullName:"Jovanka M. Voyich",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Montana State University",country:{name:"United States of America"}}},{id:"330412",title:"Dr.",name:"Muhammad",middleName:null,surname:"Farhab",slug:"muhammad-farhab",fullName:"Muhammad Farhab",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}}]}},subseries:{item:{id:"12",type:"subseries",title:"Human Physiology",keywords:"Anatomy, Cells, Organs, Systems, Homeostasis, Functions",scope:"Human physiology is the scientific exploration of the various functions (physical, biochemical, and mechanical properties) of humans, their organs, and their constituent cells. The endocrine and nervous systems play important roles in maintaining homeostasis in the human body. Integration, which is the biological basis of physiology, is achieved through communication between the many overlapping functions of the human body's systems, which takes place through electrical and chemical means. Much of the basis of our knowledge of human physiology has been provided by animal experiments. Because of the close relationship between structure and function, studies in human physiology and anatomy seek to understand the mechanisms that help the human body function. 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His interest later turned to the molecular mechanism and attenuating strategy of sarcopenia (age-related muscle atrophy). His opinion is to attenuate sarcopenia by improving autophagic defects using nutrient- and pharmaceutical-based treatments.",institutionString:null,institution:{name:"Tokyo Institute of Technology",institutionURL:null,country:{name:"Japan"}}},editorTwo:{id:"331519",title:"Dr.",name:"Kotomi",middleName:null,surname:"Sakai",slug:"kotomi-sakai",fullName:"Kotomi Sakai",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000031QtFXQA0/Profile_Picture_1637053227318",biography:"Senior researcher Kotomi Sakai, Ph.D., MPH, works at the Research Organization of Science and Technology in Ritsumeikan University. She is a researcher in the geriatric rehabilitation and public health field. She received Ph.D. from Nihon University and MPH from St.Luke’s International University. Her main research interest is sarcopenia in older adults, especially its association with nutritional status. Additionally, to understand how to maintain and improve physical function in older adults, to conduct studies about the mechanism of sarcopenia and determine when possible interventions are needed.",institutionString:null,institution:{name:"Ritsumeikan University",institutionURL:null,country:{name:"Japan"}}},editorThree:null,series:{id:"10",title:"Physiology",doi:"10.5772/intechopen.72796",issn:"2631-8261"},editorialBoard:[{id:"213786",title:"Dr.",name:"Henrique P.",middleName:null,surname:"Neiva",slug:"henrique-p.-neiva",fullName:"Henrique P. 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