\r\n\tWe are living in a particularly challenging historical moment. People have learned that no matter how much they control their lives, their environment, and their relationships, everything can be changed instantly, at the fancy of a virus that does not respect age, nationality, ancestry, intelligence, or skills. People learned that the limitless power of science and technology was purely illusory, in the face of an absolute and overwhelming force of nature that was almost no longer recognized. After all, the balance of forces between Nature and science and technology was inevitably shaken and the certainties with which people built their lives were jeopardized by an unpredictable and constantly changing reality. Uncertainty is one of the biggest challenges we face today. Never, as today, people management can make such a difference in their future, both personally and professionally.
\r\n
\r\n\t \r\n\tCHROs need to decide where to focus their resources and attention, select their action priorities. This book will aim to provide the reader with a comprehensive overview of the new challenges of people management and provide keys to (re)think about the new/renewed challenges that the new times, the new “normals” place on those who manage people. From the strategic management of HR to people analytics and HR IT architecture and operation, through the new practices of remote work, this book aims to reflect on the future(s) of people management, illuminating trends and reflecting on potential risks or promising achievements.
",isbn:"978-1-80355-043-5",printIsbn:"978-1-80355-042-8",pdfIsbn:"978-1-80355-044-2",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,hash:"982c56a5fb4684d966f8f5e76b2638f5",bookSignature:"Prof. Diana Dias and Dr. Carla Magalhães",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11603.jpg",keywords:"HR Strategy, Strategic Workforce Planning, Employer Branding, Talent Ecosystem Management, Upskilling and Reskilling, Learning and Development, Performance Management, Rewards and Recognition, HR IT Architecture and Operation, Remote and Hybrid, HR Organization and Governance, HR Shared Services",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 22nd 2022",dateEndSecondStepPublish:"March 22nd 2022",dateEndThirdStepPublish:"May 21st 2022",dateEndFourthStepPublish:"August 9th 2022",dateEndFifthStepPublish:"October 8th 2022",remainingDaysToSecondStep:"2 months",secondStepPassed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Combining Psychology and Management Sciences, Dr. Dias chooses People Management as her field of teaching, learning, work, and research. She was Vice-rector for research, quality, and academic development in Laureate International Universities and also the European Representative in Laureate Research Council (Miami, FL-USA)As a consultant for higher education quality, she works with A3ES, EUA, UNESCO, and OECD. Nowadays she is Dean of two Faculties of Economic, Social and Business Sciences.",coeditorOneBiosketch:"Dr. Magalhães has more than 20 years of international experience in the Human Resources Management scientific field as a teacher, researcher, and consultor. An active member of several international projects, she took along her career several positions of academic, scientific, and pedagogical coordination.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"450553",title:"Prof.",name:"Diana",middleName:null,surname:"Dias",slug:"diana-dias",fullName:"Diana Dias",profilePictureURL:"https://mts.intechopen.com/storage/users/450553/images/system/450553.jpg",biography:"Diana Dias, graduated in Psychology, specializing in career management at the University of Porto. Her PhD in Educational Sciences dealing with the theme of academic integration in Higher Education culminated entirely in her experience and field work, not only as a teacher, but also as a researcher in the field of Academic Management in Higher Education. She is recognized by the Portuguese Psychologist Board as a specialist in Work and Organizational Psychology.\r\nIn 2022, she will present Aggregation Exams in Management and in 2017, it accumulates as the aggregation title already atributed at the University of Minho in the specialty of Learning Psychology.\r\nOver the course of his career, she has taken on various academic management positions, directing two Higher Schools and coordinating scientifically and pedagogically several Undergraduate, Masters and Postgraduate Degrees, with emphasis on the scientific design and coordination of the Degree and Doctorate Degree in Psychology, as well. as a Licentiate and Master's Degree in Human Resources Management. She was part of the Executive Committee of a Doctorate in Management and scientifically coordinated the Doctorate in Psychology. She was Pedagogical Director at ESAI – Higher School of Real Estate Activities, where she is also President of the Council for Quality Assurance. She was Dean for Research and Academic Innovation at the European University, after 5 years as Vice-Dean.\r\nFull professor at Universidade Lusófona, she is Dean of FCESE - Faculty of Economic, Social and Business Sciences at Universidade Lusófona do Porto and Strategic Director of the School of Economic Sciences and Organizations at Universidade Lusófona de Humanidades e Tecnologia (Lisbon).\r\nShe is also a researcher and member of the Scientific Council of CIPES-Center for Research on Higher Education Policies, classified as Excellent by the FCT.\r\nShe has a vast scientific work published in indexed scientific journals and is the author of several books in the areas of Management, Psychology and Education.\r\nConsultant in Higher Education policies, she has been working with several relevant national and international entities, namely, POCH, DGEEC, A3ES, CNE, USA, UNESCO and OECD.",institutionString:"Lusofona University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:null}],coeditorOne:{id:"452431",title:"Dr.",name:"Carla",middleName:null,surname:"Magalhães",slug:"carla-magalhaes",fullName:"Carla Magalhães",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003LeuV6QAJ/Profile_Picture_1643029510060",biography:"PhD in Business Sciences (specialization in Human Resources), by Minho University (Braga/Portugal), in partnership with Getúlio Vargas Foundation (Rio de Janeiro/Brazil). Master in Public Administration (specialization in Human Resources and Marketing), by Brazilian School of Public and Business Administration of Getulio Vargas Foundation (Rio de Janeiro). Associate Professor at Faculty of Social and Business Economic Sciences of Lusófona University (Porto/Portugal), where coordinates the 1st study cycle of Human Resources Management and Development and directs the Lifelong Training Unit. Invited Professor at the School of Economics and Management of Minho University. Researcher at the Center for Population, Economy and Society Studies (CEPESE) and an associate member of Transdisciplinary Research Center for Innovation & Entrepreneurship Ecosystems (TRIE), both in Portugal.",institutionString:"Lusofona University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:null},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"7",title:"Business, Management and Economics",slug:"business-management-and-economics"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"429339",firstName:"Jelena",lastName:"Vrdoljak",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/429339/images/20012_n.jpg",email:"jelena.v@intechopen.com",biography:"As an Author Service Manager, my responsibilities include monitoring and facilitating all publishing activities for authors and editors. 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\n
1. Introduction
\n
\nMucuna is a valuable genus of Leguminosae family; it has tremendous value in food and medicine. The genus Mucuna originated in Eastern India and China and then was transferred throughout tropical and subtropical regions of the world creating new populations [1]. Traditionally, Mucuna is known by different names including beans, buffalo beans, dopa bean, cowitch, kappikachhu and atmagupta. Out of 100 Mucuna species found worldwide, 8 species and 3 varieties of Mucuna are predominantly found in different localities of India [1, 2, 3, 4]. The Mucuna plant is an annual perennial climbing shrub with long vines having a length of 15–25 m with trifoliate leaves and yielding long inflorescences with purple or pale yellow flowers. They produce green or brown pods covered with rigid hair, which causes intense itching [5]. Pods contain four to six ellipsoidal-shaped seeds that are rich dark brown or blotched [6] varying from species to species. Mucuna seeds are a rich source of nutritional, antinutritional and phytochemical compounds containing l-dopa as a prime constituent [7]. The content of l-dopa varies between from species to species and locality to locality. Among them, M. pruriens is the most exploited species as a remedy against Parkinson’s disease [8]. Due to huge international and national trade price and scarcity of M. pruriens, other Mucuna species are reported to be adulterants for M. pruriens.\n
\n
Ancient reports of Ayurveda suggest that Mucuna seed powder contributes in reducing the risks of certain cardiovascular diseases and neurodegenerative disease and also as a remedy for snake bite. The seeds of Mucuna have gained increasing attention among food scientists, nutrition specialists and pharmaceutical expertise due to their rich source of antioxidant, phenolic, flavonoids, l-dopa, proteins, starch, micronutrients, dietary fiber and bioactive compounds that play a pronounced role in the traditional as well as modern medicine all over the world [9, 10]. The existing scenario shows ten reported Mucuna species that were studied recently by Pulikkalpura et al., from the Indian subcontinent [11], whereas Patil et al., also collected fourteen different species of Mucuna from various localities and further studied for their l-dopa content (anti-Parkinson’s activity) [6, 12].
\n
\nMucuna grows best under moist, warm conditions and in areas with plenteous rainfall. It can propagate in any type of soil but sandy lome soil is mostly favorable with pH of 5.5–7.5. Several researchers have investigated different species having typical characteristics like size and shape of bracts, leaflets and pods, color, thickness, density as well as number of seeds in pod and flower, respectively [6]. The evaluation of genetic-level studies of Mucuna species from India was also carried out using inter-simple sequence repeat markers and randomly amplified polymorphic DNA [13]. The seeds show tolerance against different abiotic stress including low soil fertility and acidic pH and also grow in wet soils (Duke, 1981). Similar to different species, Mucuna also has 2n = 2x = 22 number of chromosomes with genome size ranging between 1281 and 1361 Mbp/C [14]. Due to wild fluctuating climatic and geographical distribution, these species show gigantic diversity in phenotype in the Indian subcontinent. Corresponding to the family Leguminosae, it also has the ability of atmospheric nitrogen fixation. It is also grown for the potential utility in animal feed and human food due to its rich source of nutritional content [15, 16]. Thus, it was consumed universally for the treatment of Parkinson’s disease. Traditionally, in Ayurvedic science, Mucuna (velvet bean) plant is widely used to treat numerous diseases including parkinsonism [17, 18, 19, 20, 21] due to its l-dopa content as one of the principal constituents [9]. All parts of Mucuna have a great medicinal value in the ancient traditional medicinal system, and hence, it has a prodigious demand in the international and the Indian market [7, 22].
\n
\nMucuna is a superb source of protein and bioactive compounds that have increased consumption per capita after being considered as a functional food by the US [23]. The previous literature survey shows that the declining occurrence of numerous long-lasting disorders, namely neurological disorder, cardiovascular diseases, diabetes, obesity and cancer, has a positive correlation with the consumption of legume seeds [24]. Considering all the evident health profits, studying its bioactive compounds is of great importance. Among all the under-utilized Mucuna species, normally available and commonly used Mucuna pruriens seeds were studied enormously and have been reported in numerous of articles published till date. To avoid the burden on commonly available and used Mucuna Purience, various researchers are studying bioactive components and the use of other Mucuna species like M. imbracata, M. bracteata, M. monosperma, M. macrocarpa, M. sanjappae, M. atropurpurea, M. nigricans, M. gigantea, M. pruriens var hirsuta, M. laticifera, M. yadaviana, etc. in the treatment of various diseases [5, 6, 7, 9, 11, 12, 13, 14, 17, 20, 22, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34]. Phytochemistry, toxilogicalogycal and food potential on the Mucuna species under study in the world were described by Lorenzetti et al. [35].
\n
\n
\n
2. Bioactive compounds from various parts of Mucuna species
\n
\n
2.1 Bioactive compounds from seeds of Mucuna\n
\n
Seeds of Mucuna are commonly used part of the plant, which are a rich source of nutritional and anti-nutritional compounds like l-dopa (anti-Parkinson’s activity), antioxidants, phenolic, flavonoids, tannin, carbohydrates, starch, protein, micronutrients Sopanines and many more [9, 12, 26]. Antioxidant activities in this plant are mainly due to phenolic and various bioactive compounds present in the seed material [36, 37]. There are various extraction techniques, different solvents and processing methods that were used to extract the biologically active compounds from the seed of Mucuna [26, 31]. The prior study reports that M. macrocarpa, M. sanjappae and M. atropurpurea disclosed a higher level of l-dopa content, which also concludes that l-dopa content has a positive correlation to the protein content of seeds [12]. These high-yielding varieties of Mucuna can be commercially cultivated, which can thus serve to be a good option to lower the burden exerted on commonly used M. prurience variety [28]. LCMS analysis of four different species demonstrates the presence of diverse group of phenolics, alkaloids, flavonoids, different derivatives of gallic acid, l-dopa, catechin, alkaloids, quercetin, tannic acid, glycosides, saponins, tubastatin and a variety of amino acids in the seed extract [38]. Apart from that, it is also concluded that few anticancer compounds like Spergualin, sanggenon G, isopentenyl adenosine and spisulosine are also present in the seed extract [28, 38].
\n
\n
\n
2.2 Bioactive compounds from leaves and roots of Mucuna\n
\n
The root extract of Mucuna has various activities like stimulant, thermogenic, purgative, emollient, diuretic anthelmintic, emmenagogue and tonic; hence, they are used in the vitiated circumstances in Veda and Ayurveda [39]. l-Dopa content of leaves and roots is as much as 1% and 4–7% in Mucuna plant [40]. Mucuna plants release secondary chemical compounds called allelochemical in the form of l-3,4-dihydroxyphenylalanine (l-dopa) in the surrounding environment which show an impact on growth of nearby plants, either negatively or positively. These substances are produced through its roots, seeds or leaves [41]. These secondary chemical agents play a role in damaging root growth, terminating seedling growth, inhibiting plantlet growth or suppressing seed germination of other plants [42]. Plant-box bioassay explains that the secondary chemical compound produced from the root of Mucuna is l-dopa [40], which affects the cell and root of various plant seedlings [41]. Leaf extracts are used to treat various complications like Anticataleptic, antiepileptic, aphrodisiac, antimicrobial, tonic and ulcers are some applications in which Mucuna leaves were reported being used previously [8, 20, 43, 44].
\n
\n
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2.3 Bioactive compounds from callus of Mucuna\n
\n
Production of callus from Mucuna plant material is a new era in the advancement of biochemical engineering and industrial biotechnology, which has the potential to produce different biologically active agents from the explant [45, 46]. Their application in cost-effective industrially important product formation is helpful for humankind, which upshots effective drug formulations and upsurges the nutritional level of food [47, 48]. l-Dopa is a major component in different parts of Mucuna species [9]. This also helps in storing germplasm of endangered species, which in turn leads to regenerate new plantlets at any time. Production of callus from Mucuna species was done previously by the researcher at the lab scale [49]. An earlier study by Chattopadhyay et al. depicted the formation of callus culture of commonly used Mucuna pruriens [50]. Media containing various concentrations of media components affects biologically active chemicals and growth of the callus [51, 52]. The use of different elicitors and precursors are studied by Nandeo and Patel et al. [53, 54]. Implementation of precursor in the media of callus enhances the phenolic content as reported in prior studies. The percentage of phenolic is greater in callus culture than in seeds, which is very helpful for industrial production [55, 56].
\n
\n
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2.4 Bioactive compounds from cell suspension of Mucuna\n
\n
Reactive oxygen species (ROS) and reactive nitrogen species (RNS) are stress-producing free radicals, but at usual level perform an important part in the physiology of the body [57] to accommodate the massive demands for l-dopa and other secondary metabolites. In vitro production of biologically active compounds from suspension culture is predominantly studied before in Mucuna plant by Chattopadhyay et al. [50]. The use of mevalonic acid and its precursor gibberellic acid affect the growth. l-Dopa in callus exhibits a declining trend in fresh weight with a rise in concentration of l-dopa as shown by Desai et al. [52]. The comparative study of production of l-dopa from cell suspension culture and effect of elicitor on two different species like Mucuna pruriens L. and Mucuna prurita H were also done previously [58]. Large-scale production of phytochemicals and l-dopa was done from Mucuna pruriens L. Commercial production of the drugs (l-dopa), phenolic flavonoids and antioxidants using cell suspension cultures is in extensive practice nowadays.
\n
\n
\n
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3. Use of different bioactive compounds from Mucuna in various application
\n
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3.1 Antioxidant activity of Mucuna species
\n
Numerous studies on antioxidant activity and phytoconstituents content of Mucuna seeds, leaves and roots were performed previously [4, 7, 19, 30, 31, 59, 60, 61, 62]. Optimization of different solvents for the extraction of antioxidants was done by Aware and Patil et al. [9, 10, 26]. They concluded that depending on solubility of antioxidant compounds present in different species of Mucuna, concentration of antioxidants differs. Most commonly, ethanolic extract of Mucuna shows good antioxidant activity due to high phenolic content [43]. Some reports also conclude that water is a universal solvent, which shows significant quantity of phenolic, flavonoids and strong antioxidants that can scavenge free radicals using different assays. Diseases like neurodegenerative diseases, cardiovascular diseases, aging, cancer, rheumatoid arthritis and inflammation are caused by oxidative stresses, which are protected by ROS and RNS [60]. LCMS report of four different species of Mucuna determines the presence of various components like phenolic, flavonoids and bioactive compounds, which are responsible for production of reactive species [38].
\n
\n
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3.2 Antimicrobial activity of Mucuna species
\n
There are several compounds in Mucuna that contribute for the antimicrobial activity as reported in a previous study [38, 43]. These compounds are responsible for the treatment of various infectious diseases and ulcers [63]. The study on various plant pathogens suggests that methanolic extract of Mucuna pruriens seeds showed highest antimicrobial activity [64] from all used solvents. A similar type of study was done by Pujari et al., who concluded that methanol extract of seeds of Mucuna pruriens was found to impart the best inhibiting activity among all scrutinized pathogens as compared to ethanol and acetone solvents. But alcoholic extract of Mucuna pruriens (L.) leaves has significant antioxidant and antibacterial activity, which has strongly recommended the use of Mucuna leaves and seed extract in traditional as well as modern medicine [65].
\n
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3.3 Protective effect against snake venom
\n
Snakebite kills countless people annually since ancient days [66]. Various reports show the cross-reactivity between the enzyme of snake venom and protein from Mucuna, which determines the activity of Mucuna against snake venom [32, 67, 68, 69]. Betancur et al. in their review on therapeutics of antisnake venom explain the effectiveness of herbal plants, which act as coadjuvants and thus help to nullify the venom toxic action [68]. In recent literature, Kasturiratne et al. studied the global scenario of snakebite and deaths. They also elucidate that various traditional medicines were sometimes preferred with western drugs [70]. The protective effect of Mucuna in a study on mice or rat models proves that it has a good activity for curing snake bite, than few reported antivenom [71, 72].
\n
\n
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3.4 Anti-Parkinson’s activity of Mucuna species
\n
Parkinson’s disease (PD) was initially discovered by Dr. James Parkinson in 1817. It is a chronic neurological disorder triggered by a progressive loss of dopaminergic neurons present in the nigrostriatal part of the brain and found to be common in the US [73]. The major signs of the disease are complications in body movements, speaking, walking and many more complications arise as the disease progresses. Anti-Parkinson’s potential of Mucuna is well known from ancient times due to its l-dopa content [7, 74]. l-Dopa is a precursor of dopamine used in the treatment of neurodegenerative disorders. Various scientists studied the potential of Mucuna to produce l-dopa as a source of anti-Parkinson’s drug [8, 19, 75]. l-Dopa with other phytochemical compounds has a cumulative effect on the management of Parkinson’s disease. Patil et al. describe that there is a correlation among the l-dopa, protein and carbohydrate content [12]. Mucuna is a rich source of antioxidant compounds, which performs a very important role in the physiology of the body mainly functioning in the inhibition of damage occurred because of free radicals [76]. There are hundreds of compounds that function as antioxidants in the plant system mainly vitamins, polyphenols, enzymes, flavonoids and metals like zinc, selenium, etc. [77]. The efficiency of the use of l-dopa and another dopaminergic agent in the treatment of Parkinson’s disease is reviewed previously by Koller and Rueda [78]. The use of plants for the treatment is more beneficial than chemically manufactured medicines due to their infinitesimal occurrence of secondary complications by routine use and economical feasibility.
\n
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3.5 Use of Mucuna species in soil fertility
\n
Cover crops have a role in the nitrogen-fixing bacteria and improvement of soil fertility by restoration of soil nutrients. Enormous use of chemical fertilizer and water in soil makes soil infertile, to overcome this problem, farmers are implementing traditional methods to enhance soil fertility. Mucuna is one of the best examples of a cover crop that has a rich source of biological natural products, which will increase the enhance soil fertility and fix atmospheric nitrogen [35].
\n
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\n
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4. Conclusion
\n
\nMucuna is a medicinally and biochemically valuable plant used from ancient days, having a large market value due to the presence of a large number of bioactive compounds. The content of phytochemical compounds and other bioactive agents present in Mucuna fluctuates from species to species.\nl-Dopa is a chiefly present amino acid found abundantly in Mucuna plant, which is used for the treatment of Parkinson’s disease. It also contains a great amount of phenolics, flavonoids and antioxidants, which play a role in releasing oxidative stress. It also acts as a protein-rich diet. Due to all these properties, Mucuna has several applications in the pharmaceutical and food industries thereby uplifting the demand of Mucuna in day to day life.
\n
\n
Acknowledgments
\n
Suresh Suryawanshi sincerely thanks the Indian Council of Medical Research (ICMR) for providing SRF fellowship [Award No. 45/6/2019/MP/BMS]. Vishwas A. Bapat thanks the National Academy of Sciences, India, for the honorary scientist fellowship. Prof. Jyoti P. Jadhav sincerely thanks the Department of Biotechnology, Government of India, for “Interdisciplinary Programme of Life Sciences for Advanced Research and Education (IPLS-Reference No: BT/PR4572/INF/22/147/2012)”.
\n
Conflict of interest
The authors declare no conflict of interest.
\n',keywords:"Legumes, Mucuna, Parkinson\\'s disease, l-dopa, antioxidants",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/72106.pdf",chapterXML:"https://mts.intechopen.com/source/xml/72106.xml",downloadPdfUrl:"/chapter/pdf-download/72106",previewPdfUrl:"/chapter/pdf-preview/72106",totalDownloads:693,totalViews:0,totalCrossrefCites:1,totalDimensionsCites:3,totalAltmetricsMentions:0,impactScore:1,impactScorePercentile:57,impactScoreQuartile:3,hasAltmetrics:0,dateSubmitted:"February 9th 2020",dateReviewed:"March 15th 2020",datePrePublished:"May 9th 2020",datePublished:"October 21st 2020",dateFinished:"May 9th 2020",readingETA:"0",abstract:"The plant Mucuna is an annual climbing shrub with long vines that can reach over fifteen meters in length. About 100–150 Mucuna species are found in the tropic and subtropic regions of both hemispheres of the earth. The genus Mucuna belongs to the family Leguminosae. It is commonly known as Kewanch, velvet bean, cowhage and kappikachhu and is found widely in India as a hardy, herbaceous, vigorous, twining annual plant. The size and dimension of the Mucuna seeds, pods, platelets and leaves change from species to species. The hair present on pods is anthelmintic, which causes itching. People are seeking great attention towards Mucuna due to its several medicinal properties, including L-DOPA (L-3, 4-dihydroxyphenylalanine) along with supplementary antioxidants that are used for treating Parkinson’s disease and many neurodegenerative diseases. Thus it is being used in about 200 medicinal formulations. The current chapter outlines the work that determines the influence of different nutritional, anti-nutritional and medicinal values and bioactive agents from different parts of the Mucuna species present in India and its importance in medicine.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/72106",risUrl:"/chapter/ris/72106",book:{id:"10165",slug:"legume-crops-prospects-production-and-uses"},signatures:"Suresh S. Suryawanshi, Prajakta P. Kamble, Vishwas A. Bapat and Jyoti P. Jadhav",authors:[{id:"307840",title:"Dr.",name:"Prajakta P.",middleName:"P.",surname:"Kamble",fullName:"Prajakta P. Kamble",slug:"prajakta-p.-kamble",email:"prajaktamicro@gmail.com",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/307840/images/8808_n.jpg",institution:null},{id:"308178",title:"Dr.",name:"Suresh S.",middleName:"S",surname:"Suryawanshi",fullName:"Suresh S. Suryawanshi",slug:"suresh-s.-suryawanshi",email:"ssuram5@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Shivaji University",institutionURL:null,country:{name:"India"}}},{id:"317797",title:"Prof.",name:"Viawas A.",middleName:null,surname:"Bapat",fullName:"Viawas A. Bapat",slug:"viawas-a.-bapat",email:"suresh.suryawanshi55@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"317798",title:"Prof.",name:"Jyoti P.",middleName:null,surname:"Jadhav",fullName:"Jyoti P. Jadhav",slug:"jyoti-p.-jadhav",email:"biochemjpj@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Bioactive compounds from various parts of Mucuna species",level:"1"},{id:"sec_2_2",title:"2.1 Bioactive compounds from seeds of Mucuna\n",level:"2"},{id:"sec_3_2",title:"2.2 Bioactive compounds from leaves and roots of Mucuna\n",level:"2"},{id:"sec_4_2",title:"2.3 Bioactive compounds from callus of Mucuna\n",level:"2"},{id:"sec_5_2",title:"2.4 Bioactive compounds from cell suspension of Mucuna\n",level:"2"},{id:"sec_7",title:"3. Use of different bioactive compounds from Mucuna in various application",level:"1"},{id:"sec_7_2",title:"3.1 Antioxidant activity of Mucuna species",level:"2"},{id:"sec_8_2",title:"3.2 Antimicrobial activity of Mucuna species",level:"2"},{id:"sec_9_2",title:"3.3 Protective effect against snake venom",level:"2"},{id:"sec_10_2",title:"3.4 Anti-Parkinson’s activity of Mucuna species",level:"2"},{id:"sec_11_2",title:"3.5 Use of Mucuna species in soil fertility",level:"2"},{id:"sec_13",title:"4. Conclusion",level:"1"},{id:"sec_14",title:"Acknowledgments",level:"1"},{id:"sec_17",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'\nWilmot-Dear CM. A revision of Mucuna (Leguminosae-Phaseoleae) in China and Japan. Kew Bulletin. 1984;39:23-25. DOI: 10.2307/4107853\n'},{id:"B2",body:'\nWilmot-Dear CM. A revision of Mucuna (Leguminosae: Phaseoleae) in Thailand, Indochina and the Malay Peninsula. Kew Bulletin. 1992;47:203-245. DOI: 10.2307/4110664\n'},{id:"B3",body:'\nRen S, Wilmot-dear CM, Browne SP, Browne ZP. About 100 Species: Worldwide; 18 Species (Nine Endemic) in China, Including Two Incompletely Known Taxa and One Possibly Extinct Species (Mucuna championii). 2010. pp. 207-218\n'},{id:"B4",body:'\nAitawade MM, Yadav SR. Mucuna sanjappae, a new species from the north-Western Ghats, India. Kew Bulletin. 2012;67:539-543. DOI: 10.1007/s12225-012-9369-1\n'},{id:"B5",body:'\nLeelambika M, Sathyanarayana N. 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Significance of antioxidant potential of plants and its relevance to therapeutic applications. International Journal of Biological Sciences. 2015;11:982-991. DOI: 10.7150/ijbs.12096\n'},{id:"B77",body:'\nWaris G, Ahsan H. Reactive oxygen species: Role in the development of cancer and various chronic conditions. Journal of Carcinogenesis. 2006;5:1-8. DOI: 10.1186/1477-3163-5-14\n'},{id:"B78",body:'\nKoller WC, Rueda MG. Mechanism of action of dopaminergic agents in Parkinson’s disease. Neurology. 1998;50. DOI: 10.1212/wnl.50.6_suppl_6.s11\n'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Suresh S. Suryawanshi",address:null,affiliation:'
Department of Biochemistry, Shivaji University, India
'},{corresp:null,contributorFullName:"Prajakta P. Kamble",address:null,affiliation:'
Department of Microbiology, Shivaji University, India
'},{corresp:null,contributorFullName:"Vishwas A. Bapat",address:null,affiliation:'
Department of Biotechnology, Shivaji University, India
'},{corresp:"yes",contributorFullName:"Jyoti P. Jadhav",address:"biochemjpj@gmail.com",affiliation:'
Department of Biochemistry, Shivaji University, India
Department of Biotechnology, Shivaji University, India
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1. Introduction
Frostbite is defined as injury to body tissues caused by exposure to extreme cold, typically affecting the extremities and often involving only the skin, which initially becomes white and hard, but in severe cases resulting in gangrene of deeper tissues and loss of the affected parts [1].
The first physical evidence of frostbite injury dates back to 5000-year-old pre-Columbian mummy discovered in the Andes [2]. Baron Dominique Larrey, Napoleon’s surgeon-in-chief during the infamous 1812 to 1813 retreat from Moscow, gave the first description of pathophysiology and management of frostbite [3]. Heavy bombers crew during World War II sustained more injuries due to high altitude frostbite than from all other causes combined [4]. Nazi-German Waffen during WWII had more than 10 mountain division of troops well-trained and adapted to operate cold of Arctic and mountains. Many of those mountain troops experienced devastating cold injuries [5].
Thus, the frostbite is a significant cause of long term irreversible morbidity in military medicine. Despite this, frostbite management has remained constant and unchanged. One of the most important factor often ignored is hypoxia related injuries associated with frost bite. The soldiers are often deployed at high altitude, face harsh climatic conditions in terms of exposure to cold and hypobaric hypoxia. Collectively, both these factors usually alter the course of certain conditions like cold related injuries at this height. However a number of novel therapies have been introduced in the last two decades which have led to promising, tissue-saving, outcomes.
The aim of this chapter is basic understanding of frostbite at high altitude conditions and incorporating latest frostbite management strategies to existing ones, both at prehospital levels and hospital levels, in order to maximise the tissue salvage of the patients.
2. Epidemiology
Frostbite continues to afflict modern militaries [6, 7, 8]. Within the civilian, most common is mountaineers.
The predisposing factors to cold injury include high altitude (above 17,000 feet), alcohol consumption, psychiatric illness, smoking, immobility, homelessness, unplanned exposure to cold with inadequate protection, contact with cold objects, previous history of cold injury, medical conditions like atherosclerosis, medications (eg, b-blockers), and working with equipment that uses refrigerant liquids and gases [9, 10, 11, 12, 13, 14]. Also genetic factors like African American ethnicity, O group blood typing and angiotensin-converting enzyme DD allele may increase risk to cold injuries [7, 15, 16].
30–49 years are the Most susceptible age groups [17, 18]. Most common anatomic sites involved are hands and feets (90% of all recorded sites), others include ears, nose, cheeks and penis [17, 18, 19, 20, 21, 22].
3. Pathophysiology
Two mechanisms that are apparently responsible for cold injury include direct cellular injury and progressive dermal ischemia.
3.1 Direct cellular injury
Due to freezing of tissue there is extracellular ice crystal formation, leading to electrolyte disturbances, intracellular dehydration and shrinkage leading to cell injury and death [23]. As temperature further falls, there is intracellular ice crystal formation, which expands leading to mechanical destruction of cells [24].
The body responds initially to it by alternating cycles of vasoconstriction and vasodilatation, known as “the hunting reaction” [25]. When vasodilatation occurs, there is reestablishment of blood flow, which is called thawing. The repeated freeze/thaw cycle causes most damage, and further leads to progressive thrombotic phase [24, 26, 27].
3.2 Progressive dermal ischemia
Progressive dermal ischemia is more severe than the direct cellular damage [28, 29]. Figure 1 describes the events in progressive dermal ischemia [22].
Various studies have shown similarities in the progressive dermal ischemia due to frostbite and thermal burns [30, 31]. Blebs or blisters may develop secondary to vasodilatation, oedema, stasis and coagulation. Platelet and erythrocyte aggregates leads to thrombosis of the vessels in viable tissue. Local inflammatory response and associated injuries may cause increased compartment pressures [32]. Robson and Heggers found markedly elevated levels of prostaglandin F2a and thromboxane B2 (a stable metabolite of thromboxane A2) in frostbite blister fluid [30, 33, 34]. Raine et al. demonstrated that prostaglandin and thromboxane inhibitors resulted in significantly improved tissue survival in rabbit ear frostbite [35]. Prostaglandin F2a (PGF2a) and thromboxane A2 (TXA2) cause platelet aggregation and thrombosis which results in ischaemia [32]. Thus there is significant role of the metabolites of arachidonic acid pathway as mediators of progressive dermal ischemia in burn and frostbite.
Other studies indicate the cell mediated inflammatory response which leads to progressive ischemia and tissue necrosis is similar to the response seen following ischemic/reperfusion injury [36]. The ischemic/reperfusion injury has been described as the paradoxical exacerbation of cellular dysfunction and death, following restoration of blood flow to previous ischaemic tissues [37]. During reperfusion, an inflammatory reaction occurs with neutrophilic aggregation and adhesion to endothelial cells leading to the production of free radicals [38]. Manson, et al. also suggested the role of free radicals in ischemia/reperfusion related tissue necrosis leading to frostbite injury [39].
Thrombosis, endothelial damage, intravascular sludging, inflammatory mediators, free radicals, neutrophil adhesion, platelet aggregation, reperfusion injury, and oedema all play a role in contributing to progressive dermal ischemia and leads to cell death [22, 30, 35, 36, 39, 40].
Frostbite is more common at high altitude than at sea level. As the altitude increases the maximum oxygen uptake falls thereby reducing the body’s ability to produce heat, while dehydration, cold, the fall in plasma volume which occurs at high altitude and increased erythropoietin production all work to increase blood viscosity and reduce peripheral blood flow. This reduced peripheral perfusion due to hypoxia causes additive effect in pathophysiology of frostbite. A reduction in calorie intake also reduces insulating subcutaneous fat [39, 41]. Also, the blood microcirculation recovery after high altitude frostbite is significantly slower than the normal frostbite [42].
4. Clinical manifestations
Historically, the degrees classification has been favoured. It classifies frostbite into frostnip, first-degree, second-degree, third-degree, and fourth-degree frostbite depending on depth of injury [22]. This classifications fail to predict the extent of likely amputation levels and aid little in initial management.
Cauchy and colleagues [43] proposed a classification system for severity of frostbite cases, as depicted in Table 1 (Figure 2). The advantage of this classification is that it gives an early prognostic indicator of bone and tissue loss and the likely anatomic level of loss. This grading system relies on isotope bone scanning. In the field, Cauchy and colleagues [44] suggest the use of portable Doppler or the clinical stigmata of soft tissue cyanosis as surrogate markers for amputation risk.
Grade
Extent of initial lesion day 0
Bone scan, day 2
Blisters at day 2
Prognosis at day 2
1
No lesion
Unnecessary
No blisters
No amputation
2
Lesion distal phalanx only
Reduced radiotracer uptake
Clear blister fluid
Tissue excision
3
Lesion distal, inter-and proximal phalanx
No radiotracer uptake on digit
Hemorrhagic blister fluid
Bone amputation of digit
4
Lesion in carpel/tarsal
No tracer uptake in carpal/ tarsal
Hemorrhagic blisters carpal/ tarsal
Bone amputation of limb
Table 1.
Classification scheme for severity of frostbite injuries.
The initial assessment on arrival in hospital, day 0, is made after rapid rewarming.
Figure 2.
Grades of frostbite.
Initial symptoms include numbness and pale/bluish discolouration in the affected part. Following thawing, patient may complaint of throbbing pain and tingling sensation with/ without appearance of blisters (clear/hemorrhagic) in affected part. Long term sequelae includes cold insensitivity, sensory loss, hyperhidrosis [22], growth plate disturbances [25, 45], osteoarthritis [46], chronic pain [25], and hypertrophic calcification [47]. There are few case reports of frostbite with extensive limb involvement showing rare presentation as acute compartment syndrome and increasing rhabdomyolysis. There was no other clear aetiology of rhabdomyolysis in these cases and they required compartment release [48].
On physical examination favourable prognostic indicators include normal skin colour, sensation to pinprick, blisters with clear fluid and the ability of the skin to deform under direct pressure. Poor prognostic indicators include non blanching cyanosis, hemorrhagic blisters and hard, non deforming skin [22].
Chilblains is a self limiting, mild form of cold injury in which there is appearance of red, itchy lesions on the limbs on exposure to temperature above freezing point. Tissue loss is rare. It is managed conservatively by limb elevation and application of moisturising lotions [22].
5. Radiology
In order to provide early assessment of tissue viability and management several radiological techniques can be used like bone scanning, magnetic resonance angiography (MRA), and angiography.
Technecium 99 (99 Tc) triple-phase bone scanning has become the standard imaging study when used at day 2 post cold injury [43, 49, 50, 51]. It helps to assess tissue viability but fails to show clear-cut soft tissue demarcation. However, MRA is often easier to access and allows direct visualisation of thrombosed vessels and may show a clearer demarcation of viable and ischemic tissues. Therefore some authors advocate MRA as superior technique [52, 53]. Digital subtraction angiography can be performed on individuals who are being considered for thrombolysis. It visualises vessel patency but do not sufficiently clarifies the level of viability [49, 54].
6. Prevention
As “prevention is better than cure” it is the responsibility of commanders, team leaders, individuals, and companies/employers who place individuals in at-risk areas. The following preventive measures should be adopted: 1) maintain adequate hydration and nutritional status; 2) use multilayered clothing preferably wool or synthetics such as polypropylene as these materials insulate even when wet. Also avoid constricting items like tight cramp on straps. Proper fitting boots should be worn. Mittens are preferable to finger gloves; 3) avoid sweating and prolonged immobility; 4) Avoid fatigue and one should not climb in adverse weather conditions; 5) buddy care system should be followed and one should daily inspect foot to look for any signs of cold injury; 6) ensure beneficial behavioural responses to changing climatic conditions like avoiding alcohol and smoking. Alcohol causes cutaneous vasodilatation which gives temporary warmth but actually causes greater heat loss. Similarly, nicotine in cigarette causes vasoconstriction and thereby aggravates cellular hypoxia [55]; 7) do not touch metallic objects in extreme cold or in moderate cold if wet; 8) leaders/commanders must ensure that all are fit, trained, and capable of operating in proposed location/climate; this should take into account the co-morbidities and current medications; and 9) a thorough evacuation and medical plan must be in place before departure; this must include communications.
7. Management
Before evaluating the patient one should consider that once the boots are removed, the swelling may occur, so prevent redonning of boots. Also, freeze–thaw–freeze cycles must be avoided; therefore, only consider rewarming if this can be avoided. It may be better to walk out on a frozen foot.
7.1 Prehospital management
It is treatment by persons with limited medical background.
7.1.1 Basic care
One should thoroughly assess the patient as he may be having concurrent hypothermia. Remove all wet clothing and jewellery. Provide general warmth. Rehydrate the individual with adequate warm fluids. Avoid smoking and alcohol.
7.1.2 Rewarming
Immerse the affected part in water at 40 °C to 42 °C with a mild antibacterial agent like providone-iodine [25, 35, 54, 56]. If a thermometer is not available then first the unaffected limb should be placed in water for at least 30 seconds to ensure that the water is not too hot as the affected limb will have impaired temperature sensation. Twice-daily baths are recommended and redressing should be done every 12 to 24 hours [57]. Avoid mechanical trauma to the affected part. Do not rub or applying dry heat (heat pads) to frozen tissue. Thawing is complete only when the red/purple and pliable texture of affected part is achieved [25, 58]. Once thawing is complete, the limb should be allowed to air dry. Thereafter keep affected limb completely warm. Avoid re-exposure. Elevate the affected limb to reduce oedema [57].
7.1.3 Medications
Cold-injured part is a tetanus prone wound; therefore follow standard tetanus toxoid guidelines [23, 25, 59]. Give ibuprofen 12 mg/kg twice a day up to a maximum of 2400 mg/d, for analgesia and to reduce inflammation (unless contraindicated) [49]. It supersedes aspirin as aspirin inhibits prostaglandins, some of which are beneficial to healing [23, 24, 25]. Aloe vera is a topical inhibitor of thromboxane; [35] apply to the affected part and cover with a dry dressing. Blisters indicate thawing [57]. Do not aspirate or de-roof them in the field. Avoid circumferential dressings. Give tablet oxpentifylline 400 mg thrice a day; studies have shown that with Aloe vera, oxpentifylline leads to 30% improvement in overall tissue survival [60]. The role of prophylactic antibiotics is controversial [57], it is generally reserved if signs of infection and specific complications develop [22]. The doctors at forward location should seek expert help via telemedicine.
7.1.4 Portable recompression bag and oxygenation
Portable recompression bag simulate physiological “descent” and there is increase in SpO2 [44, 61]. It can be used as an adjunct, provided patient is fully conscious and it should not delay evacuation. Supplemental oxygen may be beneficial at high altitudes posts [44] with an aim to maintain SpO2 greater than 90% [57].
7.2 Hospital management
Once the patient is transferred to a hospital take detailed history including onset of injury (<24 hours or > 24 hours ago), mechanism of injury, climatic conditions at time of injury, any freeze–thaw–freeze events, and in-field treatment. Reassess the patient and affected parts thoroughly. Keep the individual in a warm room. Remove all jewellery if not removed previously. Rehydrate the patient with warm fluids and give high-protein, high-calorie diets [62]. Follow rewarming principles as described above.
Give tetanus toxoid, if not given previously. Continue oral ibuprofen and oxypentifylline as described above. Analgesics may be required on an individual basis (paracetamol, tramadol, opiates). The role of prophylactic antibiotics in frostbite is controversial [17]. However, systemic antibiotics must be commenced in proven infection as guided by skin swab culture sensitivity [63].
Blisters give an indication to the depth of injury. White/clear blisters indicate superficial injury and contains high levels of prostaglandin F2α and thromboxane A2 [30]; therefore aspiration may be beneficial. However, few authors have advocated that clear blisters should be left intact, and de-roofing may result in increased susceptibility to opportunistic infections [64]. Hemorrhagic blisters indicate structural damage to reticular dermis; many authors advocate them to be left intact due to risk of desiccation [18, 24]. The Wilderness Medical Society guidelines advise drainage of white/clear blisters and to leave hemorrhagic blisters alone [57].
Dressing of the affected areas should be done 12 or 24 hourly and the affected part should be splinted and elevated. Dressing should be non constrictive and loose with padding between the digits. Apply Aloe vera cream to the affected part. Bespoke safety footwear should be worn during the demarcation period.
Take photograph of the affected part on admission and subsequently every alternate day. If facilities are available one should consider imaging like bone scanning, magnetic resonance angiography (MRA), and angiography. It offers prognostic information and guide management.
7.3 Adjunctive therapies
The following adjunctive therapies have been described recently.
7.3.1 Low molecular weight dextran
It is a grade 2C recommendation for use when thrombolytics or iloprost are not going to be used. However, there are no clinical trials to prove its role and also it can cause anaphylaxis; [44] We do not recommend it.
7.3.2 Anticoagulation
Post thawing, thrombosis is seen to occur in superficial dermal plexus. Therefore anticoagulation with heparin may have a role in frostbite but there is no evidence in literature for it [22, 56, 65]. So it is not recommended as monotherapy.
7.3.3 Hyperbaric oxygen
Hyperbaric oxygen therapy (HBOT) increases oxygen delivery to the tissues provided there must be a patent vasculature [57]. However, it could help during rewarming phase and at high altitude (usually >4000 meters) when SpO2 is less than 90% [66]. It is suggested that immediately after rapid rewarming, do HBOT for 1 hour. Thereafter, it can be repeated every 3 hours during the first 12 hours while the patient is awaiting evacuation [44, 61].
7.3.4 Sympathetic nerve blocks
Many studies have shown that sympathetic nerve block in upper limb causes vasodilation, raised skin temperature and pain relief [67]. Its role in frost bite cases is mixed [68, 69, 70, 71]. However, it is possible that very early intervention with sympathetic blockade in the field may be more effective. Chandral et al. described a technique for giving peripheral nerve block [69]. The same technique was used by Pasquier et al. in field area for managing grade 2 frostbite in bilateral hand [72]. He performed bilateral wrist block using 0.5% ropivacaine. There was good recovery without amputation. Taylor et al. used continuous epidural anaesthesia for managing frostbite cases of lower limbs [73]. Therefore, for grade 2–4 frostbite cases following thawing, which are limited to hands, distal volar forearm nerve block may be considered. Similarly for lower limbs, continuous epidural catheter may be considered for analgesia and vasodilation.
7.3.5 Thrombolysis and vasodilation
Thrombolytic agents have been used for reversing microvascular thrombosis and restoring blood flow. Thrombolysis using streptokinase, urokinase or recombinant tissue plasminogen activator (rTPA) has resulted in reduced amputation rates [14, 49, 74, 75]. Limited data suggest that rTPA in frostbite is most effective when used within 6 to 24 hours of rewarming [14, 44, 49, 74, 76]. However, studies have shown that ilioprost (a synthetic analogue of prostacyclin PGI2) has better safety profile than rTPA and is most effective up to 48 hours after rewarming [77, 78]. In field location, grade 2 to 4 frostbite may result in tissue loss if not treated. Therefore, trained medicine specialist can initiate treatment with ilioprost or rTPA, considering their contraindications and complications, for grade 2 to 4 frostbite as per dosage and considerations given in Tables 2 and 3 respectively [44].
Administration and monitoring
Dilute 1 vial 0.5 mL iloprost in 24.5 mL NaCl 9% Syringe pump: 25 mL - speed: 1 mL/ h for 30 minutes, then 2 mL/h for 30 minutes, then 3 mL/h for 30 minutes, then 4 mL/h for weight < 75 kg or 5 mL/h for weight > 75 kg Continue until 25 mL is delivered; all patients receive 1 vial Monitor HR and BP every 30 minutes
Complications and their management
In case of side effects decrease to previous lower step If systolic BP <90 mmHg decrease to lower step
Contraindications
Hypotension, hypersensitivity, pulmonary edema, cardiac arrhythmia, active ulcer disease, major trauma; unknown effects on pregnancy
Precautions
Anticipate nausea and vomiting, pain and hypotension; keep patient supine
Table 2.
Protocol for intravenous prostacyclin.
HR, heart rate; BP, blood pressure.
Administration
Weight < 67 kg: 15 mg IV bolus, then 0.75 mg/kg over 30 minutes, then 0.35 mg/kg over next 60 minutes
Ideally given with a portable syringe pump
Weight > 67 kg: 15 mg IV bolus, then 50 mg over 30 minutes, then 35 mg over next 60 minutes. Total not to exceed 100 mg Heparin after bolus
Contraindications
Recent trauma, bleeding diathesis, stroke within 3 months, on anticoagulants, hypersensitivity; BP >180 mmHg systolic or 110 mmHg diastolic
Precautions
High altitude: HAPE or HACE, retinal haemorrhage, gastritis
rTPA, recombinant tissue plasminogen activator; IV, intravenous; BP, blood pressure; HAPE: high altitude pulmonary edema; HACE: high altitude cerebral edema.
7.3.6 Botulinum toxin
Botulinum toxin is produced by Clostridium botulinum. Botulinum toxin type A (BTX-A) blocks the release of the neurotransmitter acetylcholine at the motor end plate terminals, thereby inhibiting the smooth muscle vasoconstriction [79]. It also blocks the transmission of norepinephrine and prevents sympathetic vasoconstriction of vascular smooth muscle [80].
In addition it causes reduction in pain by blocking recruitment of specific α2- adrenoreceptors, which decreases the activity of chronically upregulated C-fibre nociceptors [81]. Also the effects last for 3–4 months. Norheim et al. used BTX-A injections at the neurovascular bundles in the palm of each hand at the level of the metacarpophalangeal joints in a patient with frostbite sequelae [82]. Their study shows that BTX-A has positive effects on skin perfusion, cold hypersensitivity and pain. They speculated that early treatment of frostbite sequelae with BTX-A may be advantageous.
7.4 Surgical treatment
The general dictum is “Frostbite in January, amputate in July” [25]. Avoid immediate or early amputation. Wait till demarcation is complete to maximise functional outcome [56]. It may take 3 months. However, in cases of wet gangrene or spreading sepsis, early amputation may be unavoidable [83, 84]. For such cases, using MRA/99Tc triple-phase bone scanning is useful in planning the site of amputation [63]. Some authors advocate that coverage with vascularised tissue and free tissue transfer, rather than autograft improves the viability of injured bone, tendon or nerve, if early surgical intervention is done [85, 86].
In case patient develops compartment syndrome, escharotomy or fasciotomy may be indicated in the early phase [25, 56].
8. Conclusion
For the military, frostbite sequelae constitute an occupational injury with a major career impact. These sequelae may compromise future operational capability of the soldier. This chapter highlights simple and effective treatment steps that all clinicians can perform through every echelon of care and thereby reduce the period in which the patient is unable to perform his or her normal duties as a soldier in a cold environment.
Conflict of interest
No potential conflict of interest was reported by the authors.
\n',keywords:"frostbite, rewarming, thrombolysis, prostacyclin, rTPA, gangrene, amputation, telemedicine, botulinum toxin",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/75697.pdf",chapterXML:"https://mts.intechopen.com/source/xml/75697.xml",downloadPdfUrl:"/chapter/pdf-download/75697",previewPdfUrl:"/chapter/pdf-preview/75697",totalDownloads:298,totalViews:0,totalCrossrefCites:0,dateSubmitted:"December 8th 2020",dateReviewed:"January 29th 2021",datePrePublished:"March 12th 2021",datePublished:"October 27th 2021",dateFinished:"March 12th 2021",readingETA:"0",abstract:"Cold injuries and its sequelae has for decades, been a relevant problem and an occupational hazard in the army, and continue to be so. These sequelae may hamper future operational capability of the soldier. Frostbite is also becoming more prevalent among the general population due to the increase in numbers of homeless people, along with an increasing participation in outdoor activities such as mountain hiking and skiing. Despite the advances in the field of medical sciences, frostbite management has remained constant and unchanged until recent years, when newer modalities of management have led to favourable, tissue-saving, outcomes. This chapter gives a background understanding of risk factors of frostbite and its pathophysiology and reviews the current evidence and latest frostbite management strategies. In addition, several adjunctive therapies and recent improvements in radiologic assessment of tissue viability provide new avenues of aggressive medical management and earlier surgical interventions.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/75697",risUrl:"/chapter/ris/75697",signatures:"Abhishek Kadian, Sachin Saini and Rajesh Khanna",book:{id:"9563",type:"book",title:"Current Topics on Military Medicine",subtitle:null,fullTitle:"Current Topics on Military Medicine",slug:"current-topics-on-military-medicine",publishedDate:"October 27th 2021",bookSignature:"Nikolai V. Gorbunov",coverURL:"https://cdn.intechopen.com/books/images_new/9563.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83968-995-6",printIsbn:"978-1-83968-994-9",pdfIsbn:"978-1-83968-996-3",isAvailableForWebshopOrdering:!0,editors:[{id:"180960",title:"Dr.",name:"Nikolai",middleName:null,surname:"Gorbunov",slug:"nikolai-gorbunov",fullName:"Nikolai Gorbunov"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"343661",title:"Assistant Prof.",name:"Abhishek",middleName:null,surname:"Kadian",fullName:"Abhishek Kadian",slug:"abhishek-kadian",email:"kadianabhishek@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"343662",title:"Dr.",name:"Sachin",middleName:null,surname:"Saini",fullName:"Sachin Saini",slug:"sachin-saini",email:"sachin10s2002@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"345943",title:"Dr.",name:"Rajesh",middleName:null,surname:"Khanna",fullName:"Rajesh Khanna",slug:"rajesh-khanna",email:"rajeshkhannajan2017@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Epidemiology",level:"1"},{id:"sec_3",title:"3. Pathophysiology",level:"1"},{id:"sec_3_2",title:"3.1 Direct cellular injury",level:"2"},{id:"sec_4_2",title:"3.2 Progressive dermal ischemia",level:"2"},{id:"sec_6",title:"4. Clinical manifestations",level:"1"},{id:"sec_7",title:"5. Radiology",level:"1"},{id:"sec_8",title:"6. Prevention",level:"1"},{id:"sec_9",title:"7. Management",level:"1"},{id:"sec_9_2",title:"7.1 Prehospital management",level:"2"},{id:"sec_9_3",title:"7.1.1 Basic care",level:"3"},{id:"sec_10_3",title:"7.1.2 Rewarming",level:"3"},{id:"sec_11_3",title:"7.1.3 Medications",level:"3"},{id:"sec_12_3",title:"7.1.4 Portable recompression bag and oxygenation",level:"3"},{id:"sec_14_2",title:"7.2 Hospital management",level:"2"},{id:"sec_15_2",title:"7.3 Adjunctive therapies",level:"2"},{id:"sec_15_3",title:"7.3.1 Low molecular weight dextran",level:"3"},{id:"sec_16_3",title:"7.3.2 Anticoagulation",level:"3"},{id:"sec_17_3",title:"7.3.3 Hyperbaric oxygen",level:"3"},{id:"sec_18_3",title:"7.3.4 Sympathetic nerve blocks",level:"3"},{id:"sec_19_3",title:"Table 2.",level:"3"},{id:"sec_20_3",title:"7.3.6 Botulinum toxin",level:"3"},{id:"sec_22_2",title:"7.4 Surgical treatment",level:"2"},{id:"sec_24",title:"8. Conclusion",level:"1"},{id:"sec_28",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'Dictionary, O.E., "art, n.1". 2016: Oxford University Press'},{id:"B2",body:'Post, P.W. and D.D. Donner, Frostbite in a pre-Columbian mummy. Am J Phys Anthropol, 1972. 37(2): p. 187-191'},{id:"B3",body:'baron Larrey, D.J., Memoirs of Military Surgery, and Campaigns of the French Armies, on the Rhine, in Corsica, Catalonia, Egypt, and Syria; at Boulogne, Ulm, and Austerlitz; in Saxony, Prussia, Poland, Spain, and Austria. Vol. 1. 1814: Joseph Cushing, 6, North Howard street'},{id:"B4",body:'Dembert, M.L., L.M. Dean, and E.M. Noddin, Cold weather morbidity among United States navy and marine corps personnel. Military medicine, 1981. 146(11): p. 771-775'},{id:"B5",body:'Dupuy, R.E. and T.N. Dupuy, The Harper Encyclopedia of Military History, 4ª edição. 1993, Nova York: HarperCollins Publishers'},{id:"B6",body:'Heil, K.M., E. Oakley, and A. 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New England Journal of Medicine, 2011. 364(2): p. 189-190'},{id:"B78",body:'Groechenig, E., Treatment of frostbite with iloprost. The Lancet, 1994. 344(8930): p. 1152-1153'},{id:"B79",body:'Fabregat, G., et al., Subcutaneous and perineural botulinum toxin type A for neuropathic pain: a descriptive review. The Clinical journal of pain, 2013. 29(11): p. 1006-1012'},{id:"B80",body:'Van Beek, A.L., et al., Management of vasospastic disorders with botulinum toxin A. Plastic and reconstructive surgery, 2007. 119(1): p. 217-226'},{id:"B81",body:'Morris, J.L., P. Jobling, and I.L. Gibbins, Differential inhibition by botulinum neurotoxin A of cotransmitters released from autonomic vasodilator neurons. American Journal of Physiology-Heart and Circulatory Physiology, 2001. 281(5): p. H2124-H2132'},{id:"B82",body:'Norheim, A.J., et al., A new treatment for frostbite sequelae; Botulinum toxin. International journal of circumpolar health, 2017. 76(1): p. 1273677'},{id:"B83",body:'Andrew, J., Life and limb: a true story of tragedy and survival. 2003: Portrait'},{id:"B84",body:'Mills, J.W., Frostbite. A discussion of the problem and a review of an Alaskan experience. Alaska medicine, 1973. 15(2): p. 27-47'},{id:"B85",body:'Greenwald, D., B. Cooper, and L. Gottlieb, An algorithm for early aggressive treatment of frostbite with limb salvage directed by triple-phase scanning. Plastic and reconstructive surgery, 1998. 102(4): p. 1069-1074'},{id:"B86",body:'Izmaĭlov, G., et al., Treatment of deep burns and frostbite of the hand and fingers. Vestnik khirurgii imeni II Grekova, 1988. 141(9): p. 80-82'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Abhishek Kadian",address:"kadianabhishek@gmail.com",affiliation:'
Army College of Medical Sciences, New Delhi, India
Army College of Medical Sciences, New Delhi, India
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Bioreactors in use range in mode of operation from batch, continuous, and fed batch bioreactors and are designed to optimize microbial processes in relationship to contaminated media and nature of pollutant. Designed bioreactors for bioremediation range from packed, stirred tanks, airlift, slurry phase, and partitioning phase reactors amongst others.",book:{id:"7727",slug:"biotechnology-and-bioengineering",title:"Biotechnology and Bioengineering",fullTitle:"Biotechnology and Bioengineering"},signatures:"Memory Tekere",authors:[{id:"231753",title:"Prof.",name:"Memory",middleName:null,surname:"Tekere",slug:"memory-tekere",fullName:"Memory Tekere"}]},{id:"66868",title:"Structural Design, Fabrication and Evaluation of Resorbable Fiber-Based Tissue Engineering Scaffolds",slug:"structural-design-fabrication-and-evaluation-of-resorbable-fiber-based-tissue-engineering-scaffolds",totalDownloads:1105,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"The use of tissue engineering to regenerate viable tissue relies on selecting the appropriate cell line, developing a resorbable scaffold and optimizing the culture conditions including the use of biomolecular cues and sometimes mechanical stimulation. This review of the literature focuses on the required scaffold properties, including the polymer material, the structural design, the total porosity, pore size distribution, mechanical performance, physical integrity in multiphase structures as well as surface morphology, rate of resorption and biocompatibility. The chapter will explain the unique advantages of using textile technologies for tissue engineering scaffold fabrication, and will delineate the differences in design, fabrication and performance of woven, warp and weft knitted, braided, nonwoven and electrospun scaffolds. In addition, it will explain how different types of tissues can be regenerated by each textile technology for a particular clinical application. The use of different synthetic and natural resorbable polymer fibers will be discussed, as well as the need for specialized finishing techniques such as heat setting, cross linking, coating and impregnation, depending on the tissue engineering application.",book:{id:"7727",slug:"biotechnology-and-bioengineering",title:"Biotechnology and Bioengineering",fullTitle:"Biotechnology and Bioengineering"},signatures:"Martin W. King, Jiyang Chen, Monica Deshpande, Ting He, Harshini Ramakrishna, Yu Xie, Fan Zhang and Fan Zhao",authors:[{id:"237132",title:"Prof.",name:"Martin",middleName:null,surname:"W. King",slug:"martin-w.-king",fullName:"Martin W. 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After a simple deacetylation procedure, chitin is converted into chitosan that consists in a polysaccharide structure of deacetylated-β-glucosamine. Chitosan has been largely employed in wastewater treatment the removal of colloids through coagulation-flocculation processes. Different chitosan based materials have been produced and tested in the removal of inorganic pollutants such as toxic metals and metalloids, nutrients, dyes, micropollutants and hydrocarbons. Sorbents such as magnetic-activated carbon chitosan have been successfully tested in the removal of antibiotics (ciprofloxacin, erythromycin and amoxicillin) from water. Raw chitosan and ZnO nanoparticles entrapped in chitosan have demonstrated an excellent potential for the removal of the insecticide permethrin from aqueous effluents. Chitin and chitosan in flake and powder form have also demonstrated a promising effectiveness in the removal of oil spilled in seawater. Superhydrophobic and superoleophilic sponges modified by thioles have been also prepared from chitosan and used for the removal of oil spills. Chitosan hydrogels have been tested as well as entrapment matrices for the immobilization of hydrocarbon-degrading biomass for oil spills. Strains such as R. corynebacteriorides (QBTo), Bacillus subtilis LAMI008 and B. pumilus have been successfully immobilized and employed in hydrocarbon degradation processes. 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