\r\n\t2) Human sexual disorders in males and females.
\r\n\t3) Psychological aspects of the human sexual response cycle and its disorders.
\r\n\t4) The therapeutic aspects.
\r\n\tThe human sexual response cycle and human sexual behavior are interrelated. How this inter-relationship and its association to normal sexual health need to be delineated. In a world torn between sex and sexually transmitted disease, clear-cut scientific information in the form of a monograph is required to educate.
\r\n\r\n\tHuman sexuality, gender identity, and sexuo-erotic orientation play great roles in human health and disease. Sex education is the need of the hour and a reflection will be timely.
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Implantation",doi:"10.5772/intechopen.101518",slug:"pacemakers-and-defibrillators-implantation",body:'Cardiac pacemakers (PPM) and implantable cardioverter defibrillators (ICD) are electrophysiological devices that affect different aspects of patients’ lives. Research and implantation of PPM and ICD began in the early 1960s. Nowadays, their role in the medical world is widely accepted because of advancements in new technologies and their widespread use, in addition to the improved life expectancy and quality of life in cardiac patients. Few companies produce and supply PPMs and ICDs.
They are a common treatment for irreversible bradycardia and tachyarrhythmias with specific indications. Cardiac pacemakers are made of a pulse generator that produces the electrical current required for the stimulation of the myocardium. One or two electrodes (leads) transmit the electrical activity from the pulse generator to the atrium and ventricle muscle.
As with other surgical procedures, patients require a precise evaluation and special care in preoperative, intraoperative, and postoperative periods. Implantation must be performed under anesthesia care. Anesthesia management plays a vital role as it involves general and local anesthesia.
Undoubtedly, despite the numerous benefits of using PPMs and ICDs, various local and cardiovascular complications may occur. Local complications include pain, swelling, wound hematoma, wound infection, and ipsilateral hemopneumothorax. Cardiovascular complications include lead displacement, lack of sensation and pacing, atrial and ventricular perforation, myocardial hematoma, diaphragmatic pacing, and cardiac tamponade.
Postoperative care should be short-term and long-term, which include wound care, patient education, taking medications, and periodic follow-up. The improvements in the patients’ quality of life are very impressive after implantation and could be affected by programming compatibility and psychological, social, and economic behaviors.
Patients are nominated for pacemaker (PPM) and implantable cardiac defibrillator (ICD) implantation according to the patient’s history, symptoms and signs, physical examinations and other documents, cardiac imaging (echocardiography) in case of bradycardia/tachycardia, and based on the 2021 European Society of Cardiology (ESC) guidelines on cardiac pacing and cardiac resynchronization therapy, which was developed by the Task Force on cardiac pacing and cardiac resynchronization therapy [1].
A majority of all pacemaker implantations are indicated to patients above 60 years old. After admitting the patient and obtaining informed consent, the necessary blood tests, chest X-ray, and electrocardiography are taken, and then the patient is prepared for the procedure. The patient is transferred to the electrophysiology laboratory, where it is essential to have properly functioning equipment. In addition, standard air conditioning is crucial in controlling air infections. In the era of the Covid-19 pandemic, we need to consider health protocols and guidelines for the personal protection of staff and patients. If there is no emergency condition, pacemaker and ICD implantation should be delayed; otherwise, we must follow all the instructions and protocols related to the prevention of the disease.
Single-chamber pacemaker, which has one lead that connects the pulse generator to the right ventricle or atrium.
Dual-chamber pacemaker, which has two leads that connect the pulse generator to the right atrium and ventricle, modifying the rhythm of the heart.
Biventricular pacemaker, which is also known as a cardiac resynchronization therapy (CRT) device and has three leads connecting the pulse generator to the right atrium and both ventricles, which is indicated in advanced heart failure.
Implantable cardioverter defibrillators (ICD), which include single-chamber and dual-chamber.
Pulse generators, which are implanted subcutaneously and their leads are divided into three categories: endocardial, epicardial, and subcutaneous. We generally apply endocardial leads with extensive experience in this field of medicine.
A new generation of PPM was introduced by Medtronic Company in 2016, offering leadless transcatheter pacing systems for bradyarrhythmia management. It is applied percutaneously via a minimally invasive approach, directly into the right ventricle, and does not require leads.
In the setting of device implantation by a cardiac surgeon, the required instruments for better management of the procedure are as illustrated in Figure 1. We have achieved desirable results using standard surgical techniques for gentle and homeostatic manipulation of tissue.
Surgical instruments required for surgical pacemaker and ICD implantation.
The electrophysiology laboratory (EP lab) should be equipped with the following: anesthesia machine, air mask bag unit (patient-ventilator), electrocardiogram (ECG or EKG), pulse oximetry, defibrillators, emergency trolley, suction machine, external pacing equipment, capnography, airway management equipment. Moreover, emergency medications, including dantrolene for malignant hyperthermia, intralipid for toxicity due to local anesthetics, and antidotes drugs (naloxone, neostigmine, sugammadex, flumazenil), resuscitation drugs (epinephrine, atropine), anesthetics (propofol, etomidate), sedatives (midazolam), analgesics (fentanyl), antiarrhythmic drugs, and inotropes should be available. In addition to inspecting and preparing the equipment, an experienced and trained staff (including an anesthetic team who are sufficiently skilled in resuscitation) should be present. All patients seeking pacemaker and ICD implantation require preoperative evaluations, including (ECG), chest radiograph, blood tests (complete blood count and differentiation, BUN, CR, PT, PTT, INR), and electrolyte levels (K, Na, Ca) (Figure 2).
Instrument setup for lead implantation based on Seldinger technique.
Medical history and medications: The patient’s past medical history (type of arrhythmia, history of myocardial infarction (MI), stroke, heart failure, valvular heart disease, previous cardiac revascularization, obstructive sleep apnea (OSA), COPD (chronic obstructive pulmonary disease), difficult intubation), ECG, current medications (anticoagulants, antithrombotic drugs, antihypertensive drugs, antiarrhythmic agents, diuretics), and any medication associated with the prolongation of VT (ventricular tachycardia) should be carefully evaluated.
Physical examination: The patient must be examined for devices such as IABP (intra-aortic balloon pump), VAD (ventricular assist device), other implantable heart devices; surgical scar; symptoms of compensated heart failure, vital signs, electrolytes, kidney function, and TTE (transthoracic echocardiogram) to rule out heart thrombosis and assess ventricular function and valvular heart disease.
The procedure should be explained to the patient to reduce her/his anxiety before getting informed consent.
The American Board of Anesthesiology recommends that patients should not eat solid food for at least 8 hours before a procedure and should not drink even clear liquids for at least 2 hours prior.
The anesthesia team’s performance is vital for the management of patients with multiple risk factors and older ages. The medical team must be prepared for potentially catastrophic events such as cardiac arrest, cardiac tamponade, and unstable arrhythmias. Therefore, make sure that surgical instruments and anesthesia support measures are ready for emergency sternotomy.
In these patients, the relationship between the EP physician and the anesthesiologist is crucial. The type of anesthesia is determined based on the patient’s medical history and condition and might involve monitored anesthesia care (MAC), sedation, regional anesthesia, or general anesthesia. The patient’s position is usually supine so that the right or left shoulder (according to the surgeon’s decision) is elevated by a pad. Also, the positions of the head and neck are very important and should be in a way that the patient feels comfortable. The patient’s head is rotated to the opposite side of the surgical site for easier access to the subclavian vein. The airway should be easily accessible because of intravenous sedation. Most patients undergo local anesthesia with intravenous sedation by applying oxygen through a non-rebreather mask. The hands should be neutrally placed on either side. Standard vital signs monitoring is performed with ECG, pulse oximetry, non-invasive blood pressure monitoring (NIBP), and capnography.
The patient should be constantly monitored for airway obstruction and respiratory failure regardless of the anesthetic technique. In case of airway obstruction, the chin-lift and jaw-thrust maneuvers are immediately performed. Excessive restlessness, anxiety, and pain intolerance due to electric shock are the reasons for choosing general anesthesia with intravenous sedation. The arterial line should be established for patients with severe conditions.
Postoperative care and monitoring are mandatory due to the probability of surgical and anesthesia complications caused by an underlying disease.
According to the European Society of Cardiology (ESC) guidelines on cardiac pacing and cardiac resynchronization therapy, antibiotic prophylaxis is recommended in PPM and ICD implantation procedures to prevent
To get better anatomical access to the central vessels of the heart, we use local anesthesia with the administration of 4.5 mg/kg of 2% lidocaine for the sake of the patient’s comfort. Then, an incision is made (2.5 inches for PPM and 3.5–4 inches for ICD) with a number 15 blade in the distal third of the right infraclavicular region of the anterior chest wall (Figure 3). The subcutaneous tissue is opened and dissected in a layer under the pectoralis major fascia with accurate homeostasis using electrocautery (Figure 4). The development of a subpectoral pocket may be advisable in patients with a low body-mass index and for esthetic reasons.
Right infraclavicular incision region and marker.
Right pectoralis major fascia.
Tran’s venous lead implantation is commonly performed through venous access via the right or left cephalic, subclavian or axillary vein. In case clinical signs of a venous occlusion of deep veins of the upper extremity are observed, preoperative assessment (colored Doppler sonogram, venography, or chest CT scan) may be useful to determine optimal venous access or find an alternative access way.
By applying the Seldinger technique, we first enter the right subclavian vein using a needle and syringe. Then, we insert a guide wire through the subclavian vein, superior vena cava, and the right atrium, determining the proper location using fluoroscopy. The lead introducer (7 French or 9 French) is sent through a guide wire and then the right ventricular (RV) lead (58 cm length) is passed through the introducer to the RV apex or interventricular septum, latter for patients who need more RV and LV contractile synchronization (Figure 5). The second guide wire is passed through the subclavian vein to the right atrium, and the 52 cm length lead is placed inside the right atrial appendage in the same manner and analyzed by a pacemaker programmer. An alternative technique is cephalic vein cut-down, which is occasionally performed by surgeons to reduce side effects. Subclavian vein access is associated with a 7.8-fold increased risk of pneumothorax [1]. In case subclavian venous access is not feasible, transfemoral lead implantation is alternatively performed, or leadless PPM or epicardial lead should be considered.
Proper position of activated leads in right atrial appendage and right ventricular apex with noticeable tip position.
Pre-activation lead analyses have revealed the proper lead location and features as follows:
Right ventricular (R) wave sensing: 5–20 Millivolts
Right atrial (P) wave sensing: 1–5 Millivolts
Lead impedance (resistance): 200–2000 Ohms
Pacing threshold: <1 Millivolts
After initial analysis and making sure about proper leads position, the ventricular and atrial leads are screwed (activated), fixed, and re-analyzed. The same steps are carried out for RV lead-coiled (58 or 65 cm length) and should be more cautious of which can cause more endocardial trauma to the heart structures because of more stiffness. The ST-segment elevation (STE) diagram is checked in pace maker programmer. After screwing, the suture sleeve of the lead should be tied with a 3-0 black silk suture to pectoralis major fascia. Thus, each lead is fixed in two areas, the endocardium (screwed) and on the pectoralis major muscle. In the next step, after changing the surgical gloves and irrigating the subcutaneous pocket with a normal saline solution ensuring strict observance of sterility, the outer end of the RV and RA leads is connected to the pulse generator and securely screwed. The pulse generator is then placed in the subcutaneous pocket, so that the outer end of the leads is rounded beneath the generator with no bending and kinking. The PPM and the ICD function should be programmed using a sterile head or wireless programmer. The wound is repaired in three layers following irrigation and homeostasis. The patient is then transferred to the recovery room for further vital signs monitoring. A sandbag weighing 1–3 kg can be placed on the wound site to prevent hematoma, and finally admitted to the OHICU. On the same day, chest X-ray and ECG tests are performed. Prior to discharge, we should make sure about wound healing and proper functioning of device (final analysis) and patient’s general conditions to be satisfactory and provide the patient with all required information about new lifestyle and device dependency, accordingly those patients with ICD should be trained and aware of the painfulness of related shock. Scheduling for further visits and analyses is recommended.
Final analyses consist of the following items to achieve optimum results:
Mood determination as recommended by the North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group (NASPE/BPEG)
Lower rate limit
Pacing amplitude
Pulse width
Sensitivity
Upper rate limit for atrial track
For ICD: determination of the VT and VF zone
Configuration of leads (bipolar and unipolar)
Implantation can be associated with as many complications as other cardiovascular surgeries in the preoperative phase. In addition, the presence of the device inside the vessel and the heart itself is associated with early and late complications. The majority of complications occur in the hospital or within a few months after the surgery. Therefore, the cardiac surgeon should be trained about the proper management of complications and treating life-threatening conditions, and obviously, the more experienced the surgeon, the fewer the complications. The complexity of the device generally increases the potential risks. Nowadays, the device pocket is considered a source of major complications. Therefore, preventing pocket hematoma and infection has become a standard care measure. Complications are now described as early and late.
Early complications include the following:
Late complications include the following:
Superficial infection: 1.2%
Pocket infection: 1.3% [4]
Diaphragmatic pacing requiring reintervention: 0.55%
Deep venous thrombosis
Upper extremity edema
Endocarditis
Programming failure (vertigo, headache, palpitation, and blurred vision)
Wound dehiscence
Lead fracture
Inappropriate shocks
Skin erosion
Pericarditis
Lead dislodgment (Figure 6)
Mortality (<30 days): 0.8–1.4%
Systemic infection: 0.5–1.2%
Tricuspid regurgitation: 16% [6]
Pacemaker syndrome: 5–80% [7]
Psychological problems: up to 35% of people develop anxiety disorder following ICD placement, although disabling problems necessitating admission are fairly uncommon [8]
Economic problems
Replacement of pulse generator (4%) and with one or more additional lead insertions: 15.3% [1]
Phlebitis or thrombophlebitis: 30–50% [9]
Right ventricular lead-coiled dislodgment as late complication.
The following points should be reminded and taught to patients for the post-discharge period.
Keep the wound clean and dry. If you notice a swollen wound, seek medical help.
You can take a shower 48 hours after the operation.
Do not move your pacemaker under the skin and manipulate it.
Do not move the arm on the same side of pacemaker implantation for up to 24 hours.
You should not lift the arm above the shoulder for up to 4 weeks.
The patient is instructed to seek medical support in case of fever and any discharge from the wound.
Consume the medications according to the physician’s instructions.
The patient should not lift more than 4–7 kg.
Avoid hitting, pressing, and sleeping on the operated site.
Before going to spaces with strong magnetic fields and electrical circuits, consult with the treating physician and be analyzed if necessary.
For periodic analyses, plan for 1 week, 1 month, 3 months, and 6 months later.
Always carry your pacemaker profile card with you.
This review chapter provided a detailed outline of all the required steps involved in the implantation of pacemakers and defibrillators. The sensitive nature of the procedure requires an in-depth and careful analysis of the patient’s medical history and present conditions to minimize the risk of future complications.
Extensive care and caution should be practiced in preoperative, intra-operative, and postoperative courses to ensure the risk of early complications, especially infection, are reduced. Patients need detailed instructions to learn how to live with their implanted devices. Patient-physician interaction would earn suitable long-life results.
None declared.
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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. 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:"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: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. 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Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:null,institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda",middleName:"R.",surname:"Gharieb",fullName:"Reda Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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Valarmathi",profilePictureURL:"https://mts.intechopen.com/storage/users/69697/images/system/69697.jpg",institutionString:"Religen Inc. | A Life Science Company, United States of America",institution:null},{id:"205081",title:"Dr.",name:"Marco",middleName:"Vinícius",surname:"Chaud",fullName:"Marco Chaud",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDGeQAO/Profile_Picture_1622624307737",institutionString:null,institution:{name:"Universidade de Sorocaba",institutionURL:null,country:{name:"Brazil"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"profile.detail",path:"/profiles/450737",hash:"",query:{},params:{id:"450737"},fullPath:"/profiles/450737",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()