Describes thermodynamics properties of PANI and its block PANI-PEO2000.
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"10907",leadTitle:null,fullTitle:"Herbs and Spices - New Processing Technologies",title:"Herbs and Spices",subtitle:"New Processing Technologies",reviewType:"peer-reviewed",abstract:"Herbs and Spices - New Processing Technologies is a collection of research and review chapters offering a comprehensive overview of recent developments in the field of herbs and spices, with a focus on plants containing bioactive components and the utilization of novel processing technologies in the development of functional products. The book consists of four sections containing fourteen chapters written by various researchers and edited by an expert active in the research of plants and bioactive compounds.",isbn:"978-1-83969-609-1",printIsbn:"978-1-83969-608-4",pdfIsbn:"978-1-83969-610-7",doi:"10.5772/intechopen.95216",price:119,priceEur:129,priceUsd:155,slug:"herbs-and-spices-new-processing-technologies",numberOfPages:276,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"f95ecdf9c56db9567aa29b880dba5836",bookSignature:"Rabia Shabir Ahmad",publishedDate:"December 1st 2021",coverURL:"https://cdn.intechopen.com/books/images_new/10907.jpg",numberOfDownloads:2975,numberOfWosCitations:0,numberOfCrossrefCitations:3,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:8,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:11,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 1st 2021",dateEndSecondStepPublish:"March 29th 2021",dateEndThirdStepPublish:"May 28th 2021",dateEndFourthStepPublish:"August 16th 2021",dateEndFifthStepPublish:"October 15th 2021",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"239057",title:"Dr.",name:"Rabia Shabir",middleName:null,surname:"Ahmad",slug:"rabia-shabir-ahmad",fullName:"Rabia Shabir Ahmad",profilePictureURL:"https://mts.intechopen.com/storage/users/239057/images/system/239057.jpg",biography:"Dr. Rabia Shabir Ahmad has a strong background in academics, teaching, and research. She successfully completed doctoral research funded by the Indigenous Fellowship Program, Higher Education Commission (HEC), Pakistan. During her academic career, Dr. Ahmad was awarded and successfully completed a Start-Up Research Grant Program (SRGP) and National Research Program for Universities (NRPU) project from the HEC as Principal Investigator in the area of functional foods. Along with her teaching and research supervising responsibilities, Dr. Ahmad is also a journal reviewer. She has published numerous research papers in international and national journals and edited several books.",institutionString:"Government College University, Faisalabad",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"5",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Government College University, Faisalabad",institutionURL:null,country:{name:"Pakistan"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"991",title:"Herbalism",slug:"herbalism"}],chapters:[{id:"79151",title:"Introductory Chapter: Herbs and Spices - An Overview",doi:"10.5772/intechopen.100725",slug:"introductory-chapter-herbs-and-spices-an-overview",totalDownloads:140,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Rabia Shabir Ahmad, Muhammad Imran, Muhammad Kamran Khan, Muhammad Haseeb Ahmad, Muhammad Sajid Arshad, Huda Ateeq and Muhammad Abdul Rahim",downloadPdfUrl:"/chapter/pdf-download/79151",previewPdfUrl:"/chapter/pdf-preview/79151",authors:[{id:"239057",title:"Dr.",name:"Rabia Shabir",surname:"Ahmad",slug:"rabia-shabir-ahmad",fullName:"Rabia Shabir Ahmad"},{id:"208645",title:"Dr.",name:"Muhammad",surname:"Kamran Khan",slug:"muhammad-kamran-khan",fullName:"Muhammad Kamran Khan"},{id:"208646",title:"Dr.",name:"Muhammad",surname:"Imran",slug:"muhammad-imran",fullName:"Muhammad Imran"},{id:"292145",title:"Dr.",name:"Muhammad",surname:"Haseeb Ahmad",slug:"muhammad-haseeb-ahmad",fullName:"Muhammad Haseeb Ahmad"},{id:"440128",title:"Dr.",name:"Muhammad Sajid",surname:"Arshad",slug:"muhammad-sajid-arshad",fullName:"Muhammad Sajid Arshad"},{id:"440129",title:"Ph.D.",name:"Huda",surname:"Ateeq",slug:"huda-ateeq",fullName:"Huda Ateeq"},{id:"440130",title:"Dr.",name:"Muhammad Abdul",surname:"Rahim",slug:"muhammad-abdul-rahim",fullName:"Muhammad Abdul Rahim"}],corrections:null},{id:"77429",title:"Medicinal Herbs: Important Source of Bioactive Compounds for Food Industry",doi:"10.5772/intechopen.98819",slug:"medicinal-herbs-important-source-of-bioactive-compounds-for-food-industry",totalDownloads:206,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Medicinal herbs accompany people throughout life – from birth to the grave. Almost every day they come to our table as a part of food in various forms, many are used for technical and bioenergetics purposes, and there is also a large group of plants used in medicine, pharmacy and food industry. In the last decade, the consumption of herbs and spices has increased. They grow spontaneously and free of chemical additives, and some studies have shown higher nutritional value, often more significant compared to other common food plants. Medicinal herbs become increasingly important due to its potential beneficial health effects related to its nutritional composition, such as the presence of vitamins, phenolic, anthocyanins, flavonoids, tannins, among others. These raw materials are considered to be promising, economically and ecologically advantageous for the food industry. In this chapter will be describe selected medicinal herbs from Lamiaceae family – bioactive compounds and possibility for using in food industry.",signatures:"Eva Ivanišová, Miroslava Kačániová, Tatsiana A. Savitskaya and Dmitry D. Grinshpan",downloadPdfUrl:"/chapter/pdf-download/77429",previewPdfUrl:"/chapter/pdf-preview/77429",authors:[{id:"352448",title:"Dr.",name:"Eva",surname:"Ivanišová",slug:"eva-ivanisova",fullName:"Eva Ivanišová"}],corrections:null},{id:"78517",title:"Structure: Activity and Emerging Applications of Spices and Herbs",doi:"10.5772/intechopen.99661",slug:"structure-activity-and-emerging-applications-of-spices-and-herbs",totalDownloads:163,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Herbs and spices are plant parts (herbs from leaves and spices from other parts) that are conventionally used in their fresh or dried state for flavouring, natural condiments, preservatives and for medicinal purposes. Worldwide, most spices are classified on the basis of taste, season of growth, economic importance, growth habit and plant part used. Black pepper, chilies, small cardamom, ginger and turmeric are some of the widely used spices while common herbs include thyme, basil and bay leaves. These herbs are basically classified according to usage, active constituents and period of life. Secondary metabolites such as Eugenol, thymol, limonene, cuminaldehyde, curcumin, piperine, quercetin, luteolin in these plant parts have been found to be responsible for anticancer, antimicrobial, antiviral, antidiabetic, antioxidant, anti-inflammatory and hypocholesterolemic effects. Their application in water fortification, milk and cheese processing, production of beauty products and pesticides among others could not be underestimated. Finally, adulteration, toxicity and allergic reactions are some of the identified limitations and challenges often encountered in the use of herbs and spices.",signatures:"Adeyemi Ojutalayo Adeeyo, Tshianeo Mellda Ndou, Mercy Adewumi Alabi, Hosana Dumisani Mkoyi, Erinfolami Motunrayo Enitan, Daniso Beswa, Rachel Makungo and John O. Odiyo",downloadPdfUrl:"/chapter/pdf-download/78517",previewPdfUrl:"/chapter/pdf-preview/78517",authors:[{id:"210242",title:"Ms.",name:"Rachel",surname:"Makungo",slug:"rachel-makungo",fullName:"Rachel Makungo"},{id:"261205",title:"Dr.",name:"Erinfolami Motunrayo",surname:"Enitan",slug:"erinfolami-motunrayo-enitan",fullName:"Erinfolami Motunrayo Enitan"},{id:"261217",title:"Mr.",name:"Adeyemi",surname:"Ojutalayo Adeeyo",slug:"adeyemi-ojutalayo-adeeyo",fullName:"Adeyemi Ojutalayo Adeeyo"},{id:"354613",title:"MSc.",name:"Mercy",surname:"Adewumi Alabi",slug:"mercy-adewumi-alabi",fullName:"Mercy Adewumi Alabi"},{id:"354615",title:"MSc.",name:"Tshianeo Mellda",surname:"Ndou",slug:"tshianeo-mellda-ndou",fullName:"Tshianeo Mellda Ndou"},{id:"354616",title:"Prof.",name:"John O.",surname:"Odiyo",slug:"john-o.-odiyo",fullName:"John O. Odiyo"},{id:"427802",title:"Mr.",name:"Hosana Dumisani",surname:"Mkoyi",slug:"hosana-dumisani-mkoyi",fullName:"Hosana Dumisani Mkoyi"},{id:"427803",title:"Dr.",name:"Daniso",surname:"Beswa",slug:"daniso-beswa",fullName:"Daniso Beswa"}],corrections:null},{id:"77299",title:"Health Benefits and Functional and Medicinal Properties of Some Common Indian Spices",doi:"10.5772/intechopen.98676",slug:"health-benefits-and-functional-and-medicinal-properties-of-some-common-indian-spices",totalDownloads:344,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:1,abstract:"India is the largest producer and consumer of some important common spices. Major Indian spices include pepper, cardamom, ginger, turmeric and chilies. Commercial cultivation in India is undertaken on 27 spices besides the herbal spices. Spices and herbs are mostly used as seasonings to impart flavors, pungency, aroma and color in the food. In addition, spices enhances shelf life of the food by preventing and delaying the spoilage and by preserving the sensory attributes of food products. Spices contain several important phytochemicals like aromatic compounds, essential oils, phenolics and pigments which imparts characteristic flavor and aroma and gives a herbal appeal to the food and beverages and enhances their consumer acceptability. In addition the active components of these herbs and spices are endowed with tremendous functional properties and medicinal values providing several health benefits and immunity. The era of Covid-19 has seen spiked consumption of spices and herbs based health drinks and concoctions for providing these health benefits and immunity. The present chapter deals with the characteristics of some important Indian spices, their usages, active components present in them along with exploring their health benefits, functional and immunomodulant properties.",signatures:"Vinod Kumar Paswan, Chandra Shekhar Singh, Garima Kukreja, Durga Shankar Bunkar and Basant Kumar Bhinchhar",downloadPdfUrl:"/chapter/pdf-download/77299",previewPdfUrl:"/chapter/pdf-preview/77299",authors:[{id:"213720",title:"Dr.",name:"Chandra Shekhar",surname:"Singh",slug:"chandra-shekhar-singh",fullName:"Chandra Shekhar Singh"},{id:"220872",title:"Dr.",name:"Vinod Kumar",surname:"Paswan",slug:"vinod-kumar-paswan",fullName:"Vinod Kumar Paswan"},{id:"420815",title:"Ms.",name:"Garima",surname:"Kukreja",slug:"garima-kukreja",fullName:"Garima Kukreja"},{id:"420817",title:"Mr.",name:"Durga Shankar",surname:"Bunkar",slug:"durga-shankar-bunkar",fullName:"Durga Shankar Bunkar"},{id:"420818",title:"Dr.",name:"Basant Kumar",surname:"Bhinchhar",slug:"basant-kumar-bhinchhar",fullName:"Basant Kumar Bhinchhar"}],corrections:null},{id:"77374",title:"Important Medicinal Plants in Ethiopia: A Review in Years 2015–2020",doi:"10.5772/intechopen.97937",slug:"important-medicinal-plants-in-ethiopia-a-review-in-years-2015-2020",totalDownloads:337,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Many studies on medicinal plants have been taking place in different parts of Ethiopia and the people use them for the preparation of traditional herbal medicine. The purpose of the current study is to review the assessment of the medicinal plants used in Ethiopia, to compile the components used, the method of preparation, the medical uses, and the compilation of the number of medicinal plants in 2015–2020. This review paper took place in the years 2015 to 2020 from the published papers. Various databases, such as Science Direct, PubMed, and Google Scholar, have been searched. The data were analyzed using frequency, percentages, charts, and numbers using the Microsoft Excel spreadsheet 2010. In Ethiopia, a total of 4,007 medicinal plants were identified from different areas by different authors in the years 2015–2020. But, from this total number of identified medicinal plants, there was a similarity between types of plant species. Therefore, this total result has present similarities in plant species and types found in different areas. In 2015, a total of 1,062 medicinal plants were identified from different areas by different authors. Similarly, 315, 613, 944, 341, 732 medicinal plants were identified by different authors in different study areas in the years 2016, 2017, 2018, 2019, and 2020 respectively. The years 2015 and 2018 were the years many plants of medicinal value were documented. The growth forms of medicinal plants were analyzed from 2015 to 2020 in the different study areas with different authors but with the same year and valued for each year and put the average one. To calculate the 2015 growth form of medicinal plants for example to calculate herbs, add all herbs identified by different authors in the same year, and take the average one. This method applied to all growth forms of medicinal plants each year. In all years (2015–2020) the dominant growth forms were herbs. The highest average of growth form was herb in the year 2020 which is 44.2%. In all years the least growth form was a climber. In all growth forms, the parts used for medicine were identified. Add each medicinal plant’s parts in the same year and then take the average for all years. In 2020 year, the traditional healers mostly used leaves (56.3%) for the preparation of remedy. In general, in all year leaves was dominant for the preparation of remedy. Oral and dermal ways of the route of administration were the most important in medicinal plants to treat directly different ailments. The route of administration was varying in percentage from year to year and also, a place to place according to the potential of traditional healers and type of diseases. But, different study areas and years showed that oral administration was the dominant one. In 2019, most of the prepared remedy was taken orally. Crushing was the most important and more cited in the preparation of remedy in the year 2015–2020. Also, powdering, boiling, chewing, concoction, grinding, direct and immediate, chopping, squeezing, decoction, boiling/unprocessed use, liquid form, Homogenizing in water, heating, cooking, smoking, and fumigation are common methods of preparation of remedy. In general, this review highlights the situation of Ethiopian traditional medicinal plants associated with their knowledge from years to years. In addition, this review paper plays an important role in the extraction of potential medicinal plants to discover new drugs through detailed researches in the future.",signatures:"Abebe Ayele Haile",downloadPdfUrl:"/chapter/pdf-download/77374",previewPdfUrl:"/chapter/pdf-preview/77374",authors:[{id:"356229",title:"M.Sc.",name:"Abebe",surname:"Ayele Haile",slug:"abebe-ayele-haile",fullName:"Abebe Ayele Haile"}],corrections:null},{id:"77905",title:"Curcuminoids: The Novel Molecules of Nature",doi:"10.5772/intechopen.99201",slug:"curcuminoids-the-novel-molecules-of-nature",totalDownloads:193,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Curcuminoids inactivate Nuclear Factor-Kappa B (NF-κB), a key pro-inflammatory transcription factor which is involved in inflammation and immune response in diseases like cancer. NF-κB activation is necessary to determine tumor microenvironment which controls migration and metastatis of cancer cells through chemokines and their receptors and involvement of some cell adhesion molecules. Therefore inhibition of NF-κB by curcuminoids could be a new approach in treatment of cancer by immune modulation. Curcuminoids are not bioavailable and therefore there were problems in efficacy. Now by using bioavailable curcuminoid formulations the problem has been resolved to a great extent. Out of 49 placebo controlled double blind clinical trials using curcuminoids, 17 have been found to be successful. Therefore curcuminoids could be developed as an adjunct therapy for diseases like cancer to save human life.",signatures:"Sitabja Mukherjee and Santosh K. Kar",downloadPdfUrl:"/chapter/pdf-download/77905",previewPdfUrl:"/chapter/pdf-preview/77905",authors:[{id:"356361",title:"Prof.",name:"Santosh Kumar",surname:"Kar",slug:"santosh-kumar-kar",fullName:"Santosh Kumar Kar"},{id:"426483",title:"Dr.",name:"Sitabja",surname:"Mukherjee",slug:"sitabja-mukherjee",fullName:"Sitabja Mukherjee"}],corrections:null},{id:"77972",title:"Herbs and Spices—New Processing Technologies. Syzygium aromaticum: Medicinal Properties and Phytochemical Screening",doi:"10.5772/intechopen.99199",slug:"herbs-and-spices-new-processing-technologies-em-syzygium-aromaticum-em-medicinal-properties-and-phyt",totalDownloads:154,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"All over the world, Plants have found to be a valuable source of herbs and spices for a long period of time to maintain the human health. Varieties of herbs and spices have been used to impart an aroma and taste to food for last few centuries. Several applications of plants species have been reported as antioxidative, anti-inflammatory, antidiabetic, antihypertensive and antimicrobial activities. Currently efforts are focused on their scientific merits, to provide science-based evidence for their traditional uses and to develop either functional foods or nutraceutical behavior. India is well recognized all over the world for their variety of herbs, spices and medicinal biodiversity. The WHO has listed more than 21000 plants, which are used for their medicinal purposes either in the form of essential oil or in the form of flavor. Among these, more than 2500 species and herbs are found in India, however; among them more than 150 species are used commercially on large scale. In India, the use of spices and herbs in the form of essential oil or in the form of flavor are traditionally used in routine treatment. For example, Curcumin which is found in turmeric are frequently used in medical facilities to wound healing, rheumatic disorders, and gastrointestinal symptoms etc.",signatures:"Vikrant Kumar, Deepak Mishra, Mukesh Chandra Joshi, Priyanka Mishra and Megha Tanwar",downloadPdfUrl:"/chapter/pdf-download/77972",previewPdfUrl:"/chapter/pdf-preview/77972",authors:[{id:"353149",title:"Dr.",name:"Vikrant",surname:"Kumar",slug:"vikrant-kumar",fullName:"Vikrant Kumar"},{id:"426459",title:"Dr.",name:"Deepak",surname:"Mishra",slug:"deepak-mishra",fullName:"Deepak Mishra"},{id:"426460",title:"Dr.",name:"Mukesh",surname:"Chandra Joshi",slug:"mukesh-chandra-joshi",fullName:"Mukesh Chandra Joshi"},{id:"426461",title:"Dr.",name:"Priyanka",surname:"Mishra",slug:"priyanka-mishra",fullName:"Priyanka Mishra"},{id:"426462",title:"Dr.",name:"Megha",surname:"Tanwar",slug:"megha-tanwar",fullName:"Megha Tanwar"}],corrections:null},{id:"78276",title:"Garlic as a Potential Nominee in Functional Food Industry",doi:"10.5772/intechopen.99819",slug:"garlic-as-a-potential-nominee-in-functional-food-industry",totalDownloads:136,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Functional and nutraceuticals products provide a bigger prospect to one’s health by permitting health costs and supporting economic growth in lower and middle developed countries. Because of this reason, mostly diversion of people is going towards functional food and these Phyto-based foods are turning out to be popular universal in the red to the number of statements from researchers for their therapeutic applications. Garlic is one of the ancient vegetables that is used worldwide in different aspects which includes seasoning, culinary purposes, flavoring, and medical purposes. The consumption of garlic word wide increases due to its convenience, tackiness, health benefits, and low side effects. Garlic has been utilized for thousands of years because of its rich active components, phytochemicals, and other Sulfur containing components. It has so much rich history to contribute to the food industry. It has been used as a food stabilizer to prevent the development of pathogens to the prevention of many diseases. The claimed vigor reimbursements of garlic are abundant, including, anticarcinogenic, antibiotic, anti-hypertensive, and cholesterol-lowering properties, the risk of cardiovascular disease lowering the effects of hypolipidemic, antithrombotic, anti-diabetic, antioxidant, antimicrobial, immunomodulatory, antimutagenic, and prebiotic activities. The present attempt of the chapter is to explore garlic history along with its active component’s involvement in the prevention of diseases and threats.",signatures:"Mavra Javed, Waqas Ahmed, Rehan Mian and Abdul Momin Rizwan Ahmad",downloadPdfUrl:"/chapter/pdf-download/78276",previewPdfUrl:"/chapter/pdf-preview/78276",authors:[{id:"356372",title:"Ph.D. Student",name:"Mavra",surname:"Javed",slug:"mavra-javed",fullName:"Mavra Javed"},{id:"357356",title:"Dr.",name:"Waqas",surname:"Ahmed",slug:"waqas-ahmed",fullName:"Waqas Ahmed"},{id:"357359",title:"Dr.",name:"Abdul",surname:"Momin Rizwan Ahmad",slug:"abdul-momin-rizwan-ahmad",fullName:"Abdul Momin Rizwan Ahmad"},{id:"426977",title:"Mr.",name:"Rehan",surname:"Mian",slug:"rehan-mian",fullName:"Rehan Mian"}],corrections:null},{id:"77388",title:"Phyto-Potential of Allium cepa and Allium sativum",doi:"10.5772/intechopen.98374",slug:"phyto-potential-of-em-allium-cepa-em-and-em-allium-sativum-em-",totalDownloads:185,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Garlic and onion are either cooked like a vegetable because of their green leaves or are also used as a condiment. Many scientific studies affirm the positives of both for their anti-inflammatory, antioxidant, and antimicrobial potential. Moreover, garlic and onion are regularly employed to treat cardiovascular illnesses, strokes, atherosclerosis, hypertension, hyperlipidemias, and thrombosis, and are also proved effective against Alzheimer’s, diabetes, and cancers. Here we have compiled a piece of information regarding the compounds present in garlic and onion along with their pharmacological properties. Although much more studies are required to refine the utilization and enhance garlic and medicine’s effectiveness. We hope this work will provide helpful information regarding their pharmacological aspects.",signatures:"Rubi Gupta and Prashant Kaushik",downloadPdfUrl:"/chapter/pdf-download/77388",previewPdfUrl:"/chapter/pdf-preview/77388",authors:[{id:"311935",title:"Dr.",name:"Prashant",surname:"Kaushik",slug:"prashant-kaushik",fullName:"Prashant Kaushik"},{id:"420021",title:"Dr.",name:"Rubi",surname:"Gupta",slug:"rubi-gupta",fullName:"Rubi Gupta"}],corrections:null},{id:"78065",title:"Meticulous Endorsement of Black Seed and Jambolana: A Scientific Review",doi:"10.5772/intechopen.99225",slug:"meticulous-endorsement-of-black-seed-and-jambolana-a-scientific-review",totalDownloads:138,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"The repository of traditional, historical and cultural heritage of natural prophylactic medicine to treat different disease, disorder and its aliment is limitless and time-immemorial. As per the hadith narrated by Ibn Abbas (RA), Prophet Muhammed specifically mentioned about Sulayman (AS) recorded the name and use of many herbal medicinal remedies after construction of his castle (Ibn Asakri’s Mukhtasar Tareekh Dimashq 3.393), in addition to it, Prophet Muhammed use to recommend 65 different herbal prophylactic medicines which are scientifically proved to be highly effective against almost all types of ailments, among this repository of 65, while prescribing the NS Prophet Muhammed narrated “use this black seeds regularly it is having the properties to cure all disease (ailment) except death (An authentic hadith narrated by Abu Hurayrah (RA) and recorded by Bukhari, Muslim Ahmad Ibn Majah). This in-depth review specially articulated to elaborate phytochemical, pharmacological and mechanistic approach to bring out the properties of not only NS but in addition, it focusing on the important properties of EJ. Preliminarily to say NS claim to have anti-inflammatory, analgesic, hepato-protective, neuro-protective, gastro-protective and other useful activity are due to two important constituents Thymoquinone (TQ) and NS oil (NSO). TQ has interaction with human serum albumin. Seeds containing volatile oils mainly Melanthin showed toxicity at larger doses. Whereas, EJ simultaneously proved its effectiveness underutilized fruit, crops are nutritious bearing wide range of pharmaceuticals properties. EJ fruit is highly perishable and is mainly used for the diabetes patients, it is well known as a traditional medicinal plant having essential bioactive compounds which are present in all parts of the plant. The major bioactive compounds present in the EJ roots are phytosterols, flavonoids, carotenoids, myricetin, oxalic acid, gallic acid, citronellol, cyanidin diglucoside, hotrienol, and polyphenols as well as micronutrients having many health benefits. It is also a good source of anthocyanin and effective against numerous health problems and act as chemo-preventive, radioprotective and demonstrating antineoplastic properties. The ripe fruits are pleasant, astringent taste and are eaten either raw or processed into different products mainly vinegar, jam, jellies and squash. The jambolana seed contains alkaloid, jambosine, and glycoside jambolin or antimellin. To be concluded, NS and EJ both bearing similar therapeutic and pharmacological endorsement with different remarkable biological active molecule, which will become future reference to find out the natural way to cure untreatable disease and its disorder such as HIV-Aids, Cancer and recent outbreak, etc. according to narration made by Prophet Muhammed .",signatures:"Nikhat Farhana",downloadPdfUrl:"/chapter/pdf-download/78065",previewPdfUrl:"/chapter/pdf-preview/78065",authors:[{id:"352421",title:"Dr.",name:"Nikhat",surname:"Farhana",slug:"nikhat-farhana",fullName:"Nikhat Farhana"}],corrections:null},{id:"76996",title:"Garlic in Traditional Indian Medicine (Ayurveda) for Health and Healing",doi:"10.5772/intechopen.97495",slug:"garlic-in-traditional-indian-medicine-ayurveda-for-health-and-healing",totalDownloads:244,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Traditional Indian Medicine (TIM)- Ayurveda is a Sanskrit Language word, which signifies “true knowledge of life”. It is recognized as one of the oldest Traditional health care systems of the World by World Health Organization. In fact, it was a main stream health care system till the introduction of convention medicine in India. Plant, animal and mineral origin natural substances are used in Ayurveda for health and healing. Of them, Garlic is one of the plant origin substances. Garlic is known as Lasuna, which signifies, destroyer of diseases. The fresh plants of Garlic are used as edible food substance and also the dried cloves are on ripening to alleviate the disorders rationally in TIM. Garlic is recommended as physical strength promoting, intellect promoting and as aphrodisiac to maintain healthy state of life. Its properties like- unctuous, hot, pungent, heavy has been described to alleviates skin diseases, intra abdominal tumor, chronic rhinitis, hemicranias, epilepsy, fainting etc. Its continuous use causes internal hemorrhage. The medicated milk, medicated oil preparation are used orally as well topically. A number of pharmaceutical forms are seen in more than 3000 years old original scriptures of Ayurveda and also in later works as it was in use by successive generation in India. A comprehensive review on Garlic is highlighted here, including original references with scientific evidences.",signatures:"Vinod Kumar Joshi and Apurva Joshi",downloadPdfUrl:"/chapter/pdf-download/76996",previewPdfUrl:"/chapter/pdf-preview/76996",authors:[{id:"290412",title:"Prof.",name:"Vinod Kumar",surname:"Joshi",slug:"vinod-kumar-joshi",fullName:"Vinod Kumar Joshi"},{id:"356261",title:"Dr.",name:"Apurva",surname:"Joshi",slug:"apurva-joshi",fullName:"Apurva Joshi"}],corrections:null},{id:"78215",title:"Pinaceae Species: Spruce, Pine and Fir as a New Culinary Herb and Spice",doi:"10.5772/intechopen.99280",slug:"pinaceae-species-spruce-pine-and-fir-as-a-new-culinary-herb-and-spice",totalDownloads:164,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The Pinaceae family has traditionally been used as medicine, resorted to as a famine food and for ornamental purposes as Christmas trees. In the last few years numerous restaurants have been using different species of Pinaceae family as a garnish or an aromatic spice, using them in different culinary applications like oils and infusions to flavor dressings and broths. Abies grandis (Grand fir), Pseudotsuga menziesii (Douglas fir), Pinus sylvestris (Scots pine) and Picea abies (Norway spruce) were researched on taxonomy, habitats and non-edible uses, culinary traditions, health and nutritional properties, aroma profile. The main compounds in Pinaceae family are monoterpenes, oxygenated monoterpenes, sesquiterpenes, oxygenate sesquiterpenes, diterpenes and hydrocarbons, especially α-β-pinene, limonene, α-terpinene, and even bornyl acetate, responsible for aroma compounds such as citrusy-, woody-, herbal-, or piney aromas. Modern gastronomy uses, sensory analysis and culinary applications were applied for demonstrating the possibilities on modern culinary application in this novel yet traditional spice.",signatures:"Nabila Rodríguez Valerón, Diego Prado Vásquez and Rasmus Munk",downloadPdfUrl:"/chapter/pdf-download/78215",previewPdfUrl:"/chapter/pdf-preview/78215",authors:[{id:"355150",title:"Associate Prof.",name:"Diego",surname:"Prado Vásquez",slug:"diego-prado-vasquez",fullName:"Diego Prado Vásquez"},{id:"424412",title:"Mr.",name:"Nabila",surname:"Rodríguez Valerón",slug:"nabila-rodriguez-valeron",fullName:"Nabila Rodríguez Valerón"},{id:"424414",title:"Mr.",name:"Rasmus",surname:"Munk",slug:"rasmus-munk",fullName:"Rasmus Munk"}],corrections:null},{id:"78252",title:"Genetic Resources of The Universal Flavor, Vanilla",doi:"10.5772/intechopen.99043",slug:"genetic-resources-of-the-universal-flavor-vanilla",totalDownloads:161,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Commercially cultivated vanilla (V. planifolia) is native to Mexico and its cultivation and breeding programmes face major bottlenecks. This study reports presence of important agronomic characters in two important and endangered species of Vanilla, V. aphylla and V. pilifera, indigenous to India. V. aphylla was tolerant to Fusarium wilt and had longer flower life than the cultivated vanilla. V. pilifera flowers were fragrant, showed signs of insect pollination and had large fruit size. The species were amenable to interspecific hybridization and successful reciprocal crosses were done. Sequence similarity studies indicated the clustering of leafy and leafless species separately.",signatures:"Minoo Divakaran and N.T. Fathima Rafieah",downloadPdfUrl:"/chapter/pdf-download/78252",previewPdfUrl:"/chapter/pdf-preview/78252",authors:[{id:"356055",title:"Dr.",name:"Minoo",surname:"Divakaran",slug:"minoo-divakaran",fullName:"Minoo Divakaran"},{id:"423667",title:"Ms.",name:"N.T.",surname:"Fathima Rafieah",slug:"n.t.-fathima-rafieah",fullName:"N.T. Fathima Rafieah"}],corrections:null},{id:"77625",title:"Herbs and Spices Fortified Functional Dairy Products",doi:"10.5772/intechopen.98775",slug:"herbs-and-spices-fortified-functional-dairy-products",totalDownloads:416,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Recently, an increased interest in exploiting the functional and medicinal health attributes of herbs and spices has been observed worldwide among the health conscious consumers to preserve and promote the health and nutrition and immunity particularly during the Covid-19 pandemic era. Fortification of dairy products with these herbs and spices so as to exploit the functional and medicinal attributes have also gained momentum. Herbs and spices are rich source of bioactive compounds such as anti-oxidants, vitamins, micro- and macro-minerals, phytochemicals like flavonoids, alkaloids, glycosides, tannins, essential oils, coumarin, organic acids, phenols and saponins. Milk and other dairy products have been popular compatible vehicles for delivering functional, nutritional and other health benefits of phytochemicals of herbs and spices among the consumers. This chapter explores the quality and functional attributes of herbs and spices fortified dairy products such as herbal spiked milk, curd and yoghurts, paneer, cheese and ice creams and other dairy products.",signatures:"Vinod Kumar Paswan, Hency Rose, Chandra Shekhar Singh, S. Yamini and Aman Rathaur",downloadPdfUrl:"/chapter/pdf-download/77625",previewPdfUrl:"/chapter/pdf-preview/77625",authors:[{id:"213720",title:"Dr.",name:"Chandra Shekhar",surname:"Singh",slug:"chandra-shekhar-singh",fullName:"Chandra Shekhar Singh"},{id:"220872",title:"Dr.",name:"Vinod Kumar",surname:"Paswan",slug:"vinod-kumar-paswan",fullName:"Vinod Kumar Paswan"},{id:"420811",title:"Ms.",name:"Hency",surname:"Rose",slug:"hency-rose",fullName:"Hency Rose"},{id:"420812",title:"Ms.",name:"Yamini",surname:"S",slug:"yamini-s",fullName:"Yamini S"},{id:"420814",title:"Mr.",name:"Aman",surname:"Rathaur",slug:"aman-rathaur",fullName:"Aman Rathaur"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"6302",title:"Herbal Medicine",subtitle:null,isOpenForSubmission:!1,hash:"b70a98c6748d0449a6288de73da7b8d9",slug:"herbal-medicine",bookSignature:"Philip F. 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Poultry, as well as animal producers, use sub-therapeutic levels of antimicrobials in feed to get maximum production. Furthermore, in serval countries, non-judicial use of antimicrobials while using for therapeutic purposes is also been observed. However, research has evidence that the use of antibiotics in food animals has many deleterious effects on the animals, the environment, and human beings. One of the prime examples of antimicrobials' side-effects is the development of antimicrobial resistance that results in a reduction of treatment options in human and animal medicine. Nowadays, scientists are looking for viable alternatives to antibiotics including prebiotics, probiotics, and synbiotics. Probiotics are live microorganisms that are helpful for digestion and health. They are also capable to reduce harmful bacteria in the gut when supplemented in the diet. Many available studies show that probiotic supplementation in poultry, fish, livestock, and pet animals led to improved production, health, immunity, and meat quality.
",isbn:"978-1-80356-588-0",printIsbn:"978-1-80356-587-3",pdfIsbn:"978-1-80356-589-7",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"3731c009f474c6ed4293f348ca7b27ac",bookSignature:"Dr. Asghar Ali Kamboh",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11578.jpg",keywords:"Beneficial Microorganisms, Probiotic Role in Health and Immunity, Supplementation of Probiotics in Poultry, Dietary Supplementation of Yeast in Farm Animals, Gut Health, Probiotic and Mucosal Immunity, Probiotics and Intestinal Architecture, Probiotics and Nutrient Absorption, Ban of Antibiotics in Food Animals, Regulatory Issues of Antibiotic Use in Farm Animals, Alternatives to Antibiotic in Animal Production, Consequences of Antimicrobials Use in Animals",numberOfDownloads:12,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 15th 2022",dateEndSecondStepPublish:"June 3rd 2022",dateEndThirdStepPublish:"August 2nd 2022",dateEndFourthStepPublish:"October 21st 2022",dateEndFifthStepPublish:"December 20th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"A well-known researcher in the area of Veterinary Sciences with a key interest in Veterinary Microbiology and immunology. Dr. Asghar Ali Kamboh completed his Ph.D. in Veterinary Science from Nanjing Agricultural University, China. He has published more than 100 research and review articles in national and international peer-reviewed journals. He is an editor/editorial board member of many scholarly journals in the area of animal health and production.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"225390",title:"Dr.",name:"Asghar Ali",middleName:null,surname:"Kamboh",slug:"asghar-ali-kamboh",fullName:"Asghar Ali Kamboh",profilePictureURL:"https://mts.intechopen.com/storage/users/225390/images/system/225390.jpeg",biography:"Dr. Asghar Ali Kamboh was born in Mehrabpur, Sindh, Pakistan. He completed his studies in Veterinary Medicine and Masters in Veterinary Microbiology in 2003 and 2007 respectively, with distinguished grades. In 2009, he was awarded an overseas scholarship by the Government of Pakistan and proceeded to China for doctoral studies. Currently, he is working as an Associate Professor in the Department of Veterinary Microbiology, Sindh Agriculture University, Tandojam. He has edited two books and published more than 100 research and review articles in national and international peer-reviewed journals. He has supervised/co-supervised more than 35 M.Phil students. He is also the author of many books and book chapters. 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PANI has been used for electrode of light emitting diode, Li ion rechargeable battery and corrosion protection [3, 4]. Nanocomposites (PANI-MMT) and (PANI-PEO-MMT) are interesting due to the special properties as abundance, low cost of MMT and attractive features such as a large surface area and ion- exchange properties [5, 6]. The clay is supplied by a local company known as ENOF Maghnia (Algeria) [7, 8]. Microwave heating has been found to be particularly advantageous for reactions under “dry” media [9, 10]. Microwave it’s rapidly method in modern chemistry because offer a certain number of advantage, that it can be completed in a few seconds or minutes and without a solvent [2, 11]. Absence of solvent reduces the risk of explosions when reaction takes place in a microwave oven [12, 13]. The absence of solvent reduces the risk of explosions when the reaction takes place in a closed vessel in an oven [14, 15]. Aprotic dipolar solvents with high boiling points are expensive and difficult to remove from the reaction mixtures [16, 17]. The aim of this paper is to study the polymerization of aniline and its homolog block copolymer PANI-PEO catalyzed by Maghnite- H+ under microwave irradiation [18]. This catalyst can be easily separated from the polymer product and regenerated by heating at a temperature above 100°C [19, 20]. The kinetics studies of different synthesis are discussed together with the mechanism of polymerization.
The temperature was maintained at 160°C in all experiments. Microwave irradiation was performed in a single mode focused CEM reactor (Model Discover, CEM Co., Matthew, NC) operating at 2.45 GHz with ability to control output power.
MMT clay was obtained from ENOF Maghnia (Algeria). The MMT-H+ (Mag-H+) was prepared as described by Belbachir et al. and water (pH < 7) was used to synthesize emeraldine salt clay (PANI/Mag-H+) by cationic polymerization [16]. Polyethylene oxide (relative molecular mass of 2.103) was obtained from Sigma Aldrich. Polyaniline (PANI) homopolymer was prepared in laboratory of polymers chemistry (Oran University, Algeria) by standard chemical intercaled method [21].
1H nuclear magnetic resonance (NMR) measurements were carried out on a 300 MHz Bruker NMR Spectrometer equipped with a probe BB05 mm, in CDCl3. Fourier transform infrared spectroscopy (FTIR) spectra were obtained between 900 and 4000 cm −1 on an ATI Matson FTIR No 9501165. Intrinsic viscosity, [η], was measured at 30°C in benzene.GPC measurements of the samples were carried out using a WISP 712, Waters Associates chromatograph. The purification of polymers were carried out by dissolving the product in chloroform (CHCl3) and filtering to eliminate the Maghnite-H+. Then, chloroform was removed by evaporation [22, 23].
Catalyst called (maghnite-H+) was prepared according to the process similar to that described by Belbachir et al. [24, 25]. The raw maghnite was placed in an erlenmeyer flask together with 100 ml of distilled water and a solution of sulfuric acid 0.25 M then stirred using a magnetic stirrer for 2 h at room temperature. After filtration up to pH 7, the activated maghnite-H+ is dried in the stove for 24 hours at 105°C for characterization [26].
Into a flask with 100 mL and stirred to allow proper mixing was put a mixture of Maghnite-H+ (5%) and solution of (H2SO4 0.25 M), adequate amount of aniline (0.05 mol) was added to a solution. The reaction mixture was then submitted to microwave irradiation at 160°C for 4 minutes. Finally, the mixture was cooled at room temperature, filtered and washed extensively with distilled water and methanol to remove catalyst and any unreacted aniline [27, 28].
Copolymer PANI-PEO was synthesized via a cationic polymerization. To a (0.05 mol) of monomer aniline was added a solution of PEO (0.05 g in 25 mL of distilled water) and (5 wt %) of maghnite-H+ as an initiator. The mixture was stirred for 15 min. Then it is treated in a microwave oven at the power of 950 W, the temperature and viscosity of the reactive mixture increase fast and gelation point is reached after 4 min at 160°C. The mixture was cooled at room temperature, filtered and washed extensively with distilled water and methanol to remove impurity [16, 29].
Synthesized polyaniline was confirmed by noticing the predominant peaks at the wave numbers of 1501 cm−1corresponding to C═C stretching of quinine ring, 1557 cm−1for C═C stretching of benzenoid ring, 1293 cm−1for C▬N stretching, 755 and 838 cm−1for C▬H vibration of Para coupling benzenoid and benzene rings. Finally, C▬H bending at 694–593 cm−1 corresponds to aromatic ring and 507 cm−1is stretching at out of the plane [30, 31].
As shown in (Figure 2), there are significant changes in both the intensities and the frequencies in the product (PANI-PEO2000). There are more pronounced between 690 and 1574 cm−1, significant interaction between the oxygen of the ether group of PEO and the nitrogen in the PANI [32]. As shown in (Figure 1), polyethylene oxide (PEO2000) show a band of methylene group (CH2) stretching between 2950 and 2840 cm−1 and a large broad band appears centered at 3442 cm−1which confirms that PEO2000 is highly hydrophilic [9].
FT-IR spectra of polyaniline (PANI) catalyzed by maghnite-H+ under microwave irradiation.
FT-IR spectra of block copolymer (PANI-PEO2000) catalyzed by maghnite-H+ under microwave irradiation.
Describes1H-NMR spectra of (PANI) catalyzed by maghnite-H+ under microwave irradiation.
Describes 1H-NMR spectrum of poly ethylene oxide (PEO2000).
Describes 1H-NMR spectra of the copolymer (PANI-PEO2000) catalyzed by maghnite-H+ under microwave irradiation.
UV spectral of the different form of (PANI-PEOs) catalyzed by maghnite-H+ under microwave irradiation.
Thermogram analysis measurements (DSC) of maghnite-H+ (heating rate 10°C/mn) catalyzed by maghnite-H+ under microwave irradiation.
Thermogram analysis (TGA) curves of a maghnite-H+ obtained in nitrogen atmosphere at heating rate of 10°C/min.
Thermogram analysis (TGA) curves of PANI prepared in the presence of Maghnite-H+ (0.25 M) under microwave irradiation.
Describes thermogram analysis (DSC) of PANI (heating rate 10°C/mn) catalyzed by maghnite-H+ under microwave irradiation.
Thermogram analysis (TGA) curves of PANI-PEO2000 prepared in the presence of maghnite-H+ (0.25 M) under micro wave irradiation.
Thermogram analysis (DSC) of PANI-PEO2000 (heating rate 10°C/mn) catalyzed by maghnite-H+ under microwave irradiation.
Describes gel permeation chromatograph of PANI with 2% maghnite-H+ at 160°C for 4 min.
Describes gel permeation chromatograph of PANI-PEO2000 with 2% maghnite-H+ at 160°C for 4 min.
Polyaniline was successfully synthesized as show in (Figure 3) and the different hydrogen peaks are present. The strongest sharp peaks centered at 7 and 7.8 ppm due to protons from phenylene and disubstituted phenylene units and the weak peak at 4.81 ppm due to (-NH) group but the peak at 6.22 ppm due to (–NH2) as end group [33, 34].
1H NMR spectroscopy at 300 MHz (Solvent CDCl3) and according to the work published by Yahiaoui et al., (Figure 4) for pure PEO showed different peaks: (a) the methylene groups (CH2−) at 2.6 ppm, and (b) the methylene (CH2O−) at 3.7 ppm [35, 36].
The block copolymer (PANI-PEO2000) was confirmed by 1HNMR spectrum as show in (Figure 5). The wide signal in the region of 6.8 to 8 ppm was assigned to benzenoid hydrogen of polyaniline. Signals at 3.25–3.75 ppm indicate peak of CH2O− and CH2CH2O− hydrogen of polyethylene oxide reported [37]. Peak at 1.5–2 ppm is due to CH2 hydrogen respectively [37, 38].
Conductive polymers synthesized PANI and PANI-PEO2000 has a conjugated system of double bonds in a backbone polymer. The UV-visible spectral peak in the 250–300 nm region is due to the aniline groups and
As shown in (Figures 7 and 8), the thermogram analysis of catalyst (maghnite-H+) shown two stages of weight loss. The weight loss in below 100°C is a result of free water and the weight loss around 600°C is associated with the dehydroxylation of silicate structure [37, 41].
For the thermogram analysis (TGA) of polyaniline (PANI), it can be found that the weight loss amounted 61, 17% at the temperature range of 187–600°C, which be true because polyaniline it is known a hygroscopic polymer as show in (Figure 9) [42, 43]. in the DSC thermogram of the PANI as show in (Figure 10), there were two endothermic peaks at 55.99 and 103.46°C.Therefore, these endothermic peaks were due to the evaporation of water, this is in agreement with the literature [44, 45]. The glass transition (Tg) appears at 74.06°C [46].
The curves of weight loss versus temperature showing the behavior of PANI-PEO2000 sample was presented in (Figure 11). The first significant weight loss occurs already at temperature between 50 and 100°C, that PANI-PEO2000 is hygroscopic and during the heating to 100°C the residual water evaporates [46]. Then the main mass loss, which corresponds to polymer degradation starts at about 200 and 500°C [47].
In polyaniline (PANI) monomer and block copolymer (PANI-PEO2000) as show in (Figure 12). Firstly, we notice the presence of two endothermic peak at (68, 39 and 190, 09°C) it is associated respectively to the evaporation of water absorbed by the copolymer and melting POE2000 block [48, 49]. The glass transition temperature of block copolymer (Tg = 16, 79°C) which is in agreement with the literature [50].
Table 1 describes thermodynamics properties of PANI and its block PANI-PEO2000. Tables 2 and 3 describes the molecular weight distribution averages for the polymer and it’s copolymer in the other hand (Figures 13 and 14) indicate a bimodal distribution. The macromolecular weight distribution of the obtained polymer and copolymer are narrow, this confirming the formation of the polymer PANI and the block copolymer PANI-PEO [51, 52].
Sample | T1 | T2 | T3 | Tg | ∆H1 | ∆H2 | ∆H3 | ∆Cp |
---|---|---|---|---|---|---|---|---|
PANI | 55.99 | 03.46 | X | 74.06 | 4.3161 | 20.5363 | X | 0.311 |
PANI-PEO2000 | 68.39 | 190.09 | X | 16.79 | 57.4130 | 17.8659 | X | 4.6837 |
Describes thermodynamics properties of PANI and its block PANI-PEO2000.
Sample name | RT | Area | % Area | Mn | Mw | Polydispersity |
---|---|---|---|---|---|---|
PANI | 17.973 23.638 | 1,318,425 20,616,195 | 6.01 93.99 | 644 33 | 746 114 | 1.15 3.41 |
Gel permeation chromatograph of PANI composite in THF catalyzed by maghnite-H+ under microwave irradiation.
Sample name | RT | Area | % Area | Mn | Mw | Polydispersity |
---|---|---|---|---|---|---|
PANI-PEO2000 | 17.917 23.032 | 130,748 9,960,549 | 1.30 98.70 | 2664 50 | 2701 264 | 1.013896 5.342141 |
Gel permeation chromatograph of block copolymer PANI-PEO2000 composite in THF catalyzed by maghnite-H+ under microwave irradiation.
The value of transverse strength and the electrical conductivity of the PANI and its block copolymer PANI-PEO2000 were calculated from Eqs. (1) and (2) as show in (Table 4) [53].
Sample | e (cm) | R(Ω) | ρ (Ω. cm) | σ (S/cm) |
---|---|---|---|---|
PANI | 0.1 | 1.880 | 25.792 | 0.038 |
PANI-PEO2000 | 0.1 | 0.976 | 0.163 | 6.134 |
Describes electrical properties of PANI and PANI-PEO catalyzed by maghnite-H+ under microwave irradiation.
The polyaniline powder was added to 50 ml of different solvent (DMF, Acetonitrile, toluene, dichloromethane, THF, and chloroform). The dry weight of the filter paper was used to calculate the solubility of the composites. The best solvents for PANI and its block are determined to be DMF and Toluene as show in (Table 5) and (Figure 15). Finally, we can calculate the band of energy by equation (3) [54].
Describes UV spectral of the copolymer (PANI-PEO2000) catalyzed by maghnite-H+ under microwave irradiation in different organic solvents.
Solvant | PANI | PANI-PEO2000 |
---|---|---|
DMF | 0.55 | 1.6 |
Toluene | 0.52 | 1.4 |
Chloroforme | 0.47 | 1.05 |
Dichloromethane | 0.39 | 0.95 |
Acetonitrile | 0.20 | 0.79 |
THF | 0.12 | 0.58 |
Describes solubility parameters of PANI and PANI-PEO2000 composites catalyzed by maghnite-H+ under microwave irradiation in different solvents (g/ml).
The solubility parameter (
Tables 6 and 7 describe intrinsic viscosity and properties physics of (PANI) and block (PANI-PEO2000) according to the Mark-Houwink equation:
Concentration | C | C1=2C/3 | C2=C/2 | C3= C/3 | C4=C/4 |
---|---|---|---|---|---|
Average | 3.60 | 3.61 | 3.61 | 3.60 | 3.59 |
Cinema (cst) | 0.61 | 0.61 | 0.61 | 0.60 | 0.6 |
Dynamic (cp) | 0.91 | 0.90 | 0.92 | 0.89 | 0.89 |
Relative | 1.00 | 1.01 | 1.01 | 1.01 | 1 |
Specific | 0.00 | 0.01 | 0.00 | 0.00 | 0 |
Reduced | 12.22 | 13.99 | 19.45 | 20.96 | 22.40 |
Inherent | 12.10 | 13.90 | 19.45 | 20.90 | 22.41 |
Solomon | 12.14 | 13.90 | 19.50 | 20.95 | 22.43 |
Visct. Intr (ml/g−1) | 25.80 | 25.78 | 25.77 |
Describes viscosimertic properties of pure PANI catalyzed by maghnite-H+ under microwave irradiation.
Concentration | C | C1=2C/3 | C2=C/2 | C3= C/3 | C4=C/4 |
---|---|---|---|---|---|
Average | 3.61 | 3.61 | 3.60 | 3.61 | 3.58 |
Cinema (cst) | 0.61 | 0.60 | 0.61 | 0.61 | 0.61 |
Dynamic (cp) | 0.91 | 0.91 | 0.91 | 0.88 | 0.90 |
Relative | 1.00 | 1.00 | 1.01 | 1.01 | 1.01 |
Specific | 0.00 | 0.01 | 0.01 | 0.01 | 0.00 |
Reduced | 7.49 | 12.10 | 14.37 | 13.55 | 18.05 |
Inherent | 7.40 | 12.05 | 14.31 | 13.50 | 17.99 |
Solomon | 7.44 | 12.07 | 14.33 | 13.51 | 18.01 |
Visct. Intr (ml/g−1) | 19.75 | 19.66 | 19.68 |
Describes viscosimertic properties of PANI-PEO2000 catalyzed by maghnite-H+ under microwave irradiation.
Figure 9 describe the effect of the amount of catalyst on the yield of this copolymerization (PANI-PEO). As can be seen in (Figure 16 and 19), the copolymerization rate increased with the amount of Mag-H + and reaches a maximum at 160°C with (5% wt) of catalyst, above this temperature and percentage of catalyst, the yield decreases.
Describes effect of the amount of mag-H+(catalyst) on the yield of copolymerization.
The increase in yield with temperature and molecular weight of catalyst is mainly due to the number of active sites in the catalyst responsible for initiating the reaction. Similar results are obtained by many research [55, 56].
We have used (2%,5% and 10%) by weight as the amount maghnite and varying time after keeping the other parameters (the amount of monomers and the temperature). It is observed that the average molecular weight increases with time and reaches a maximum at 4 minutes of reaction and decrease after this time as show in (Figure 17) [57].
Describes effect of the amount of mag-H + on the viscosimertic molecular weight of copolymerization.
We notice a significant change in the yield with increasing the amount ratio, in particular with increasing the amount of PEO used in this reaction processing. The (Figure 18.) below summarizes the influence of the molar ratio on Aniline/PEO upon the reaction yield. This phenomenon can explain by the high reactivity and solubility of the POE in water compared to the aniline in particular at high temperature [58].
Describes the effect of the molar ratio(ANI/PEO) upon the yield of copolymerization.
As shows in (Figures 20 and 21), the process of synthesis of PANI-Maghnite-H+ and its homolog PANI-PEO2000-Maghnite-H+ composites can be divided into the following three steps [59, 60, 61].
Describes effect of temperature on the yield of copolymerization.
Proposed mechanism of homopolymer (PANI) catalyzed by Maghnite-H + under microwave irradiation.
Proposed mechanism of block copolymer (PANI-PEO2000) catalyzed by Maghnite-H+ under microwave irradiation.
Based on Maghnite-H+ (Algerian ecologic catalyst MMT) and under microwave irradiation our polymer (PANI) and block copolymer (PANI-b-PEO) were successfully synthesized and investigate. This product was prepared in order to combine the mechanical and physical properties of PEO2000 with conducting properties of PANI. A possible mechanism of this cationic polymerization is discussed based on the results of the 1H NMR Spectroscopic analysis of these compounds. Thus all the two types of composites (PANI and PEO) provide opportunities and rewards creating new world wide interest in these new materials in electronics devises.
All work was supported by the DGRSDT of Algeria republic and was performed using the equipment of the center of research scientific and technics in analysis chemical and physical (CRAPC)-Tipaza-Algeria.
Burns are among the most challenging and physiologically complex injuries and can be associated with the development of early hemodynamic collapse and shock [1, 2]. Patients who have sustained significant burns are at risk of rapidly developing “burn shock” due to the simultaneous presence of local and systemic inflammatory response to injury that most closely resembles hypovolemic shock [3, 4]. While burns themselves have the potential to be the primary source of shock, the presence of large burns should not distract the vigilant provider from ruling out additional injuries during their assessment of a trauma patient [5, 6]. After addressing any immediate airway threat during the initial trauma evaluation, it is of utmost importance to promptly determine the presence of other potentially life-threatening non-burn injuries. Once other life-threatening injuries are ruled out, the resuscitating team’s focus can be directed toward managing the burn. Rapid initiation of therapy tailored to each burn patient during the initial 48 h from the time of burn injury is critical for preventing burn shock, secondary injuries, and other downstream sequelae [3]. In this chapter, we will discuss the fundamentals of burn shock, starting with pathophysiologic and mechanistic considerations and concluding with clinical management pearls.
\nBurn management begins with a complete history and physical examination, known as the “burn patient evaluation” (BPE), which is intended to quantify and classify the thermal injury [7, 8]. Burns are typically described and classified by etiologic cause, extent of body surface area involved, and depth [9, 10, 11]. There are three broad categories of etiologies associated with burn injuries—thermal, chemical, and electrical [12, 13, 14]. Thermal mechanisms can be further broken down into flame burns, scald burns, contact burns, steam burns, or flash burns [15, 16]. This chapter focuses primarily on thermal injuries, although many of the concepts discussed herein also apply to other burn types.
\nThe understanding of mechanistic considerations and associated tissue injury patterns is of critical importance when evaluating and treating burn victims [17, 18]. For example, thermal injury causes coagulative necrosis of the affected tissue, and the depth of injury is directly dependent on temperature and duration of exposure, which will vary widely across different types of thermal exposures and injured tissue characteristics [19, 20]. The extent of chemical-induced tissue injury will vary with substance type (acids, alkalis, or hydrocarbon-based organic solvents), concentration, and duration of exposure, but all require expedited clinical management and lavage (when appropriate) of affected areas [21, 22, 23, 24, 25]. Electrical injuries will vary in nature between high and low voltage exposure, and depending on exact circumstances, involved victims may be at an increased risk of presenting with cardiovascular and neurologic manifestations, as well as associated traumatic injuries from falling or violent muscle contractions [26, 27, 28, 29, 30].
\nThe skin plays a crucial role in maintaining physiologic homeostasis through thermal regulation, sensory reception, synthesis of vitamins and hormones, maintaining fluid/electrolyte balance, and providing barrier protection to underlying tissues [31, 32, 33, 34]. When exposed to excessive heat, human tissues develop clinical burn injury [35]. During thermal insult, the epidermis and dermis are able to limit the direct transfer of energy to underlying tissues [19]. Various pathophysiologic derangements occur including denaturation of macromolecular structures, cell membrane dysfunction or destruction, cytokine release, arrest of local blood flow, and eventually cell/tissue death [35]. Following the initial insult, the final depth of irreversible tissue injury may increase depending on how local tissues respond to the complex microvascular and inflammatory environment in their immediate surroundings [35, 36, 37, 38]. Morphologically, the tissue environment at the location of burn injury has three physiologically distinct zones. Based on the immediate proximity (e.g., distance or depth) from the primary burn site, these zones are the zone of coagulation, zone of stasis, and zone of hyperemia (Figure 1) [12, 38].
\nThis schematic displays how resuscitation interacts with the pathophysiologic changes associated with burn injury.
The zone of coagulation refers to the area of tissue that has been irreversibly damaged at the time of injury and has undergone coagulative necrosis [39, 40]. The zone of stasis, also known as the “watershed” region, represents the area of tissue injury that may be reversible under optimal resuscitative circumstances [40, 41]. This zone is characterized by vascular injury, capillary leakage, and high concentrations of thromboxane A2—a potent vasoconstrictor produced locally by platelets [1]. Catecholamines and serotonin also play an important role in modulating tissue responses within this zone [1]. The end effect is impaired tissue perfusion, and thus elevated risk of propagating the area of tissue necrosis during the initial 24–48 h following the index injury [1, 36, 42]. The zone of stasis is the area where early intervention with therapy directed at reducing vasoconstriction, optimizing perfusion, and controlling local inflammation may have the greatest effect at limiting the depth of injury. The zone of hyperemia is the most remote zone of cutaneous injury (relative to the primary burn site) where vasodilation is noted in viable tissue undergoing the healing process. This vasodilation is multifactorial and likely mediated through a combination of histamine- and kinin-related mechanisms [1, 43].
\nDepth/degree | \nEtiology | \nTissue layer | \nAppearance | \nPain | \nHealing time | \n
---|---|---|---|---|---|
Superficial I° | \nSunlight exposure, hot liquids with low viscosity and short exposure | \nEpidermis only | \nPink to red, moist, no blisters | \nModerate–severe | \n3–7 days | \n
Superficial partial IIa° | \nHot liquids, chemical burns with weak acid or alkali, flash | \nSuperficial (papillary) dermis | \nBlister, red, moist, intact epidermal appendages, blanching on pressure | \nSevere | \n1–3 weeks, long-term pigment changes may occur | \n
Deep partial IIb° | \nFlame, chemical, electrical, hot liquids with high viscosity | \nDeeper layer (reticular) dermis | \nDry, white, non-blanching, loss of all epidermal appendages | \nMinimal | \n3–6 weeks, with scars | \n
Deep III° | \nFlame, electrical, chemical, blast, self-immolation | \nFull skin thickness with extension into subcutaneous tissues | \nLeathery, dry, white or red with visibly thrombosed vessels | \nNo | \nDoes not heal by primary intention, requires skin graft | \n
IV° | \nMostly prolonged flame exposure | \nInvolves tendon, muscle, or bone | \nSkeletonizing of tissue, charring | \nNo | \nExtensive reconstructive, limb salvage versus amputation | \n
Description of clinical characteristics of burn wounds of various depths.
Accurate determination of burn wound depth is crucial for guiding clinical management (Table 1) [9, 44]. Some superficially limited burns may heal with local treatment alone, while deeper burns are more likely to require operative intervention. Although various tools are available to assist in this assessment [44, 45, 46, 47, 48, 49], burn depth is usually determined during BPE through visual inspection by an experienced practitioner who then goes on to classify his or her findings in accordance to pre-established “degrees of injury severity” outlined below:
Superficial—commonly referred to as “first degree”—burns are generally limited to the epidermis. The burned skin is characterized by the presence of blanching erythema that tends to appear dry (without blistering) and is very tender on exam due to the proximity of sensory nerve endings. Common examples include sunburns or mild scalding from hot water [50]. Management of these burns is directed at reducing further injury, pain control, and provision of comfort measures. Within the first hour, exposing the injury to cool water or applying a cold compress can help stop the burning process and relieve pain. Topical steroids, with their vasoconstrictive effects, are often considered “first-line” treatment for acute sunburn; however, their true efficacy remains controversial [51]. Topical applications such as menthol, camphor, pramoxine, lidocaine, and diclofenac gel, if available, may be useful for reducing pain, erythema, and edema. Soothing remedies such as aloe lotion (especially when refrigerated prior to application), baking soda, and oatmeal may provide additional relief. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) help provide analgesia and may assist in reducing sunburn erythema. Healing of superficial burns occurs typically over a period of 3–7 days and will not result in scar formation [50, 52]. Of note, these burns are usually not included when estimating the total body surface area (TBSA) during the BPE, mainly because burns limited to the epidermis tend not to cause significant fluid shifts or losses.
Moderate partial thickness burns—also referred to as “superficial second degree” injuries—by definition involve the superficial layers of the dermis [50]. Partial thickness burns are further divided into two subtypes—superficial (focus of the current paragraph) and deep (discussed in next paragraph). Superficial partial thickness burns have similar appearance to first degree burns but will additionally appear weepy and blistered [53]. Increased exposure of dermal nerve endings for pain, touch, temperature, and pressure contributes to these burns being very painful [54, 55]. Dermal blood vessels that carry oxygen and nutrients to the skin while removing metabolic waste products are also exposed giving the wound a blanching erythematous appearance. Exposure of sweat and sebaceous glands contributes to the wound’s weepy appearance and the increase in evaporative losses [56]. Hair follicles, sweat glands, and rete ridges are typically spared allowing for reepithelialization to occur over the following 1–2 weeks post injury; however, alteration in cellular milieu at the site of the injury may result in permanent skin discoloration [56, 57, 58]. Finally, the risk of scarring is increased at this injury severity level, as is the overall risk of infection.
Deep partial thickness burns—also known as “deep second degree burns”—extend deeper into the dermis, resulting in a wound that appears pale and mottled [59, 60]. Since not all nerve endings have been destroyed in this type of burn, there may be considerable amounts of associated pain. Coagulative necrosis of the dermis from deep partial thickness burns is considered to have extended beyond the rete ridges, thus leaving behind only hair follicles and sweat glands to contribute to reepithelialization [61]. Without the rete ridges, the healing process is significantly slower and may result in more severe scarring. Ablative fractional laser resurfacing, excision, and skin grafting can improve both the healing time and scar quality. Consequently, the boundaries of clinical management tend to become blurry when approaching deep partial thickness and full thickness burns (discussed in next paragraph).
Full thickness burns—also known as “third degree burns”—extend beyond the epidermal and dermal tissues and into the subcutaneous fat [62, 63]. Full thickness burns are associated with complete destruction of all nerve endings, dermal glands, and hair follicles. In addition, thermal damage to superficial veins causes thrombosis [64, 65]. As a result of the above changes, the burn area is insensate and may appear charred, brown, and leathery, or at times white and waxy. Only the wound edges have retained the necessary components for reepithelialization of the wound, which is why full thickness burns also require excision and grafting in order to heal [50, 66].
Fourth degree burns are defined as thermal injuries that involve tissues and structures deep to subcutaneous layer. This includes damage to muscle, tendon, or bone [67]. Patients who suffer from survivable fourth degree burns may require extensive limb-sparing efforts and reconstructive surgery to avoid amputation [67, 68].
Determining the size, or total body surface area, of a burn is the cornerstone of the BPE and provides fundamental information to guide subsequent clinical management. Properly conducted BPE also provides insight into the burn victim’s physiologic state and resuscitative fluid needs, as well as general prognostic information. It is important to remember that burn injuries have the potential to quickly evolve and progress if resuscitative conditions are not optimal [69, 70]. In other words, superficial and partial thickness burns can become deep partial thickness burns, and deep partial thickness burns have the potential to become full thickness burns. Optimizing the resuscitation effort can mitigate the tissue loss by enhancing perfusion and limiting secondary injury.
\nWhen performing the BPE, the “rule of nines” is a quick way to get an approximate estimate of burn size in the field in order to properly communicate the state of a patient over the radio to the accepting facility and initiate early goal directed therapy. When calculating TBSA of partial and full thickness burns on adults, the following body surface percentages are assigned to the corresponding anatomic regions (Figure 2):
Entire head is 9%
Neck is 1%
Anterior trunk is 18%
Posterior trunk is 18%
Each upper extremity is 9%
Each lower extremity is 18%
(A) Left, diagram showing body surface area allocations for adult burn patients; (B) right, schematic representation of body surface area allocations for pediatric burn patients.
When compared to adults, children have disproportionately larger heads [71], thus requiring an adjusted allotment of body surface area per anatomic region (Figure 2). Consequently, the adjusted percentages for TBSA evaluation in a child are:
Heads and neck combined are 18%
Anterior trunk is 18%
Posterior trunk is 18%
Each upper extremity is 9%
Each lower extremity is 14%
Another quick TBSA estimation technique is to use an area equal to the patient’s own palm (with extended fingers) as an equivalent of approximately 1% TBSA. This measuring standard is then applied to each burned area and is especially useful in cases of patchy injury distribution [72, 73].
\nDuring the secondary BPE, especially after full exposure is completed, a better estimation of TBSA can be obtained to more precisely direct further hemodynamic and fluid resuscitation. In the 1940s, Lund and Browder introduced a seminal paper on estimating burn size and provided a simple chart that breaks down TBSA of smaller areas of the body for different age groups [71, 74]. This method is considered to be the most accurate and reliable method of determining TBSA, with only a few caveats. More specifically, patient populations that may not be accurately represented by Lund and Browder’s chart include the morbidly obese, amputees, women with large breasts, and gravid women (Table 2) [71, 75].
\nArea | \n0–1 years | \n1–4 years | \n5–9 years | \n10–14 years | \n15 years | \nAdult | \n%2° | \n%3° | \n%TBSA | \n
---|---|---|---|---|---|---|---|---|---|
Head | \n19 | \n17 | \n13 | \n11 | \n9 | \n7 | \n\n | \n | \n |
Neck | \n2 | \n2 | \n2 | \n2 | \n2 | \n2 | \n\n | \n | \n |
Ant trunk | \n13 | \n13 | \n13 | \n13 | \n13 | \n13 | \n\n | \n | \n |
Post trunk | \n13 | \n13 | \n13 | \n13 | \n13 | \n13 | \n\n | \n | \n |
R buttock | \n2.5 | \n2.5 | \n2.5 | \n2.5 | \n2.5 | \n2.5 | \n\n | \n | \n |
L buttock | \n2.5 | \n2.5 | \n2.5 | \n2.5 | \n2.5 | \n2.5 | \n\n | \n | \n |
Genitalia | \n1 | \n1 | \n1 | \n1 | \n1 | \n1 | \n\n | \n | \n |
R arm | \n4 | \n4 | \n4 | \n4 | \n4 | \n4 | \n\n | \n | \n |
L arm | \n4 | \n4 | \n4 | \n4 | \n4 | \n4 | \n\n | \n | \n |
R forearm | \n3 | \n3 | \n3 | \n3 | \n3 | \n3 | \n\n | \n | \n |
L forearm | \n3 | \n3 | \n3 | \n3 | \n3 | \n3 | \n\n | \n | \n |
R hand | \n2.5 | \n2.5 | \n2.5 | \n2.5 | \n2.5 | \n2.5 | \n\n | \n | \n |
L hand | \n2.5 | \n2.5 | \n2.5 | \n2.5 | \n2.5 | \n2.5 | \n\n | \n | \n |
R thigh | \n5.5 | \n6 | \n6.5 | \n8 | \n8.5 | \n9 | \n\n | \n | \n |
L thigh | \n5.5 | \n6 | \n6.5 | \n8 | \n8.5 | \n9 | \n\n | \n | \n |
R leg | \n5 | \n5 | \n5.5 | \n6 | \n6.5 | \n7 | \n\n | \n | \n |
L leg | \n5 | \n5 | \n5.5 | \n6 | \n6.5 | \n7 | \n\n | \n | \n |
R foot | \n3.5 | \n3.5 | \n3.5 | \n3.5 | \n3.5 | \n3.5 | \n\n | \n | \n |
L foot | \n3.5 | \n3.5 | \n3.5 | \n3.5 | \n3.5 | \n3.5 | \n\n | \n | \n |
Total | \n\n | \n | \n |
Lund and Browder’s chart for calculating %TBSA of varying age groups, with sufficient granularity to provide adequate accounting of the size and depth of the patient’s burns, categorized by anatomic area.
When burns cover <10% of the TBSA, the associated inflammatory response and vascular leakage tend to remain localized within the immediate proximity of the injured tissue. However, as the TBSA approaches 15–20%, the overall quantity of cytokines released systemically into the circulatory system increases dramatically, contributing to systemic inflammatory response whereby uninjured anatomically distant body regions experience various deleterious downstream manifestations such as vasoactive changes, increased capillary permeability, and tissue edema [3, 76, 77]. In the setting of such more severe burns, abrupt fluid shifts from vasculature into the interstitial space quickly lead to clinically apparent hypovolemic shock. In the setting of severe burn injury, this type of shock is appropriately termed “burn shock” [78, 79]. The state of hypovolemic shock during the acute, or “ebb,” phase can be further exacerbated by the copresence of low cardiac output from decreased effective circulating blood volume, increased blood viscosity, and depressed cardiac contractility [77, 79, 80]. Most severely affected patients may experience multisystem organ failure (MOF) [81].
\nFrom a clinical management standpoint, the initiation of appropriate fluid resuscitation immediately upon the completion of BPE is imperative to providing (and maintaining) the necessary cardiovascular support. Every additional hour from time of injury that resuscitative fluid administration is delayed increases the risk of mortality [82]. Under resuscitation can lead to tissue hypoperfusion, acute renal injury, and death. Over-resuscitating, however, can cause increased tissue edema, compartment syndromes, acute respiratory distress syndrome (ARDS), infections (e.g., pneumonia), and MOF [83, 84, 85]. Therefore, proper resuscitation of burn patients requires individually tailored fluid administration and close monitoring in order to prevent secondary, mostly iatrogenic injuries.
\nInitiating appropriate intravenous fluid resuscitation requires establishing and maintaining dependable vascular access [3]. Short, large bore peripheral intravenous catheters placed through unburned skin are ideal because this approach avoids potentially thrombosed superficial veins underlying full thickness burn areas. That said, venous access through burned skin is preferred over no venous access, and in most situations may be more rapidly available then central venous access. Central venous access is reliable but comes with increased risk of complications compared to other available options such as saphenous venous cut-down or intraosseous route [86, 87]. Once adequate vascular access is established, fluid resuscitation should be initiated immediately. Optimally, a protocol-driven approach to fluid administration is preferred [88, 89].
\nThe rate of clinical failure (defined as patient deterioration or mortality) with prompt and adequate resuscitation is relatively low (e.g., <5% even for patients with burned TBSA >85%) [90]. As a general guideline, patients who benefit the most from formula-based, calculated fluid resuscitation include adults between 15 and 50 years of age with ≥20% TBSA involving second and third degree burns; children ≤15 years old and adults ≥50 years of age with ≥ 10% TBSA involving second and third degree burns. In practice, many institutions will consider initiating resuscitative fluids when adult burn victim presents with injuries involving ≥15% TBSA [91]. A significant body of research regarding modern fluid resuscitation protocols demonstrates that systemic capillary leakage during the initial 24-h period after injury permits movement of large molecules into the interstitial space [92, 93]. For this reason, colloids are generally considered to provide little added benefit to crystalloid administration in the first 24 h. The topic is somewhat controversial, however, as some researchers argue that capillary permeability may begin returning to normal as early as 6–8 h after injury [90, 94, 95]. Consequently, the latter group advocates that earlier colloid addition may reduce the total amount of fluid necessary to achieve hemodynamic resuscitation and intravascular volume restoration.
\nThe Parkland formula is among the most widely used and studied burn patient resuscitation paradigms [91, 96, 97, 98]. When originally published, this resuscitation approach advocated total crystalloid infusion of 4 mL/kg for each percent of body surface area burned [96, 97, 98]. The equation estimates the total amount of Ringer’s lactate to be given in the initial 24-h post-burn period. Half of the calculated total fluid amount is to be given in the first 8 h and the remaining over the following 16 h [91, 98]. At the same time, certain limitations inherent to formula-based resuscitative approaches do exist. For example, the Parkland formula has been noted to underestimate the total volume of Ringer’s lactate needed during the first 24 h in severe burns (>40% TBSA) [91, 99]. This tendency to need larger than estimated fluid volume is referred to as “fluid creep” [84, 100]. Although the exact factors responsible for this phenomenon are still being debated, one effective way of addressing it involves frequent urine output monitoring with hourly adjustments in fluid rates [84]. Goal urine output for adults is 0.5 mL/kg/h and for children ≤30 kg is 1 mL/kg/h. Some institutions have developed protocols that incorporate hourly fluid infusion rate adjustments of 10–30% depending on whether urine output is above or below goal [84]. As an example, we will consider using an hourly rate adjustment of 20% in an adult burn victim. In such scenario, if urine output decreased to <0.5 mL/kg/h, then the current fluid rate would be increased by 20%. If urine output was maintained at 0.5–1 mL/kg/h, then no rate adjustments are made. Finally, if urine output was measured to be >1 mL/kg/h, then the current fluid rate would be reduced by 20%.
\nChildren have larger surface/volume ratios compared to adults, which translates to disproportionately higher infusion rates. The Galveston formula is designed to account for this difference, whereby during the first 24 h, patients receive fluids based on 5000 mL/m2 × %TBSA +2000 mL/m2 daily maintenance [101]. Similar to Parkland formula, half of the calculated total is given in the first 8 h and the rest over the remaining 16 h [102]. Children have lower glycogen stores than adults and consequently should have 5% dextrose added to the primary resuscitative crystalloid solution [103, 104]. As the formula indicates, children require greater amount of resuscitation fluid per kilogram than adults. Unfortunately, children also have lower physiologic reserves, which may predispose them to side effects of more aggressive fluid resuscitation approaches [105]. For example, it has been shown that the cardiac output of pediatric burn victims may not return to pre-burn levels for 24–48 h post-injury, even with complete intravascular status restoration. Furthermore, excessive secretion of antidiuretic hormone may lead to oliguria that extends beyond 48–72 h post-burn [105]. Taking the above parameters into consideration, it is recommended that urine output surveillance and fluid rate adjustments be made on a more frequent basis than adults.
\nFollowing the initial 24 h of resuscitation, both Parkland and Galveston and some derived formulae provide for a transition to reflect the changing vascular environment as hemodynamic and vascular homeostasis returns. The so-called Baxter formula—a derivation of the Parkland method—introduces a fourth “8-h period” during which plasma is given at 0.3–0.5 mL/kg/%TBSA in order to complete resuscitation [106]. The Galveston formula for pediatric patients calls for Ringer’s lactate with dextrose at a rate of 3750 mL/m2 burned area + 1500 mL/m2 total area over a 24-h period [107]. It is important to remember that these formulae, like the many other proposed paradigms, should be considered within the overall context of a multifaceted approach to manage the burn patient. Once appropriate initial resuscitation has been completed, subsequent fluid administration should be tailored to maintain post-resuscitation stability while avoiding any secondary/iatrogenic injury.
\nAn important question arises regarding the course of action in cases where resuscitation formulae are followed appropriately yet the patient fails to meet the intended resuscitation endpoints. Such an occurrence may indicate that a secondary diagnosis (or a complication) is present, including inhalation injury, infection/sepsis, compartment syndrome, or an acute cardiovascular event (e.g., pulmonary embolism) [108]. There is no single perfect marker for determining when a patient is adequately resuscitated. Traditionally, monitoring urine output has been considered as the gold standard for ongoing assessment of resuscitative adequacy. This is because it is a convenient, practical, and inexpensive way to determine if tissues are being adequately perfused in near real-time [109]. The ability to maintain urine output of ≥ 0.5 mL/kg/h in adults and older children (>50 kg) may guide appropriate resuscitation in most patients, but relying on urine output alone can be both challenging and potentially misleading. For example, a recent systematic review showed that when compared to hourly urine output measurements, hemodynamic monitoring appeared to provide some degree of survival benefit, with no associated effect on renal failure [109]. At the same time, heterogeneity of data quality within that same review was problematic, and when only randomized controlled trials were examined in isolation, the mortality benefit of hemodynamic monitoring over hourly urine outputs was no longer present [109].
\nIn practice, a patient whose cumulative fluid resuscitation approaches 250 mL/kg during the initial 24 h post-injury period should place the treating clinician on high alert for complications related to excessive or over-resuscitation [100, 108]. Careful evaluation of the patient’s extremities for signs and symptoms of compartment syndrome should be performed. In particular, burned extremities in which escharotomies may not have been indicated initially may develop the need for escharotomy as increased tissue edema underlying the burned skin further exacerbates venous flow disruption and eventually leads to compromised arterial flow [3]. The emergence of compartment syndrome may be associated with the symptoms of numbness, tingling, or pain with passive movement of the involved extremity [110]. Assessment of capillary refill as well as Doppler signals of digital arteries, palmar arches, and plantar arches of affected limbs should be performed frequently as part of clinical surveillance [50, 111]. Finally, tissue pressure measurements can be checked, and if found to be >30–40 mmHg, this would also be an indication for urgent escharotomy [112, 113]. Burn care providers must remember that the determination to perform an escharotomy can (and often should) be made using clinical exam as the primary decision tool.
\nWhen performing escharotomy, areas of constrictive eschar are incised longitudinally along medial and lateral aspects of the affected body region/extremity [114, 115]. Even after escharotomy, severely injured limbs continue to be at risk for developing compartment syndrome requiring fasciotomy [116]. Although uncommon, sudden restoration of perfusion to muscle compartments after prolonged ischemia can potentiate the swelling within an already edematous muscle tissue and cause limb-threatening compartment pressure elevations [117, 118].
\nIntraabdominal organs and tissues are not excluded from the widespread edema resulting from the combination of physiologic changes due to initial injury and subsequent resuscitation. Development of abdominal compartment syndrome in a burn patient undergoing massive fluid resuscitation can be difficult to identify [119, 120]. Due to high sensitivity of the renal system to increased intraabdominal pressures, decreased urine output from diminished kidney perfusion is one of the earlier signs of abdominal compartment syndrome [121, 122, 123]. Of note, in a burn patient undergoing massive fluid resuscitation, observed decrease in urine output may be erroneously interpreted as insufficient resuscitation, thus prompting the clinician to inappropriately increase fluid administration [124, 125]. One important consideration is the performance of relevant clinical cross-checks, where additional clinical variables are examined concurrently, including elevated peak airway pressures and decreased tidal volumes in mechanically ventilated patients. Patients who develop abdominal compartment syndrome will become increasingly difficult to ventilate due to increased abdominal pressures being transmitted across the diaphragms into the thoracic cavity.
\nWhen indicated, abdominal compartment pressures are fairly easy to measure. Abdominal compartment pressures are most accurately obtained in patients who are ventilated, sedated, and paralyzed (however, this is rarely the case). Placed in the supine position, the patient should be completely flat and level with the ground. Through a Foley catheter, approximately 50–100 mL of normal saline is instilled into the empty bladder, and a pressure transducer is connected to the port at the proximal end of the catheter [126, 127]. Patients with abdominal pressures approaching 30 mmHg in the setting of end organ dysfunction should be considered for decompressive laparotomy [126].
\nIn the absence of chronic kidney disease and abdominal compartment syndrome, low urine output and depressed cardiac indices, especially in the setting of large volume fluid administration could indicate ongoing under-resuscitation and/or the presence of cardiac dysfunction. Key factors associated with the presence of clinical under-resuscitation include significant delays in initiating resuscitative fluids, underestimation of partial and full thickness burn %TBSA, or concurrent lung injury requiring mechanical ventilation [85, 88, 128]. Burn injuries have been shown to increase cardiac stress and cause myocardial dysfunction [1, 129]. Myocardial dysfunction, in turn, leads to decreased contractility and cardiac output [130]. Dedicated evaluation consisting of a clinical exam, an electrocardiogram (EKG), and bedside echocardiography may be indicated. Advanced hemodynamic monitoring may be of benefit in selected cases [99, 131, 132].
\nOverly aggressive intravenous fluid resuscitation has also been reported to lead to abnormal intraocular pressure elevations [84, 133]. Similar to other “compartment syndromes,” sustained intraocular pressures of ≥20–30 mmHg may lead to permanent injury and vision loss [133, 134, 135]. Any unexpected or unexplained symptoms of vision changes or ocular pain should prompt a thorough reevaluation for changes in the patient’s clinical exam, fluid balance, and any other aforementioned complications.
\n\n
The Parkland formula does not call for the transition to colloids prior to the first 24-h mark. If earlier administration of colloids is desired, one might consider transitioning to the Brooke Formula or West Penn formula [88, 93]. During the initial 24-h post-burn period, the Brooke Formula can be delivered as a combination of crystalloid and colloid fluids, including 1.5 mL/kg/%TBSA of Ringer’s lactate plus 0.5 mL/kg/%TBSA of a colloid and 2000 mL of 5% dextrose in water [81, 141, 142]. After the first 24-h period, the formula mandates reducing the crystalloid and colloid fluid rates by 50–75% and repeating the 2000 mL of 5% dextrose in water [81, 141, 142]. The West Penn formula—first published in the early 1990s—is the most recently proposed derivation of colloid-based burn resuscitation formulae. The West Penn formula calls for Ringer’s lactate at a set rate of 83 mL/h and fresh frozen plasma (FFP) at an initial rate of 75 mL/kg/36 h. The rate of FFP administration is then titrated on an hourly basis to a urine output of 0.5–1 mL/kg/h and both fluids are continued for until the 48-h mark after burn injury is reached [88, 143].
\nOver the past several decades, major advances have been made in our understanding of the complex physiologic changes that occur as a result of severe burn injury. While burn shock, as outlined in previous sections of this chapter, is historically compartmentalized as a form of “hypovolemic shock,” we now know that “fluids alone do not cure burn shock” [143]. Consequently, there are various strategies that may be employed to help counteract or “blunt” the cascading physiologic response to burn injury. For example, even simple measures such as increasing the ambient temperature (up to 33°C) have been shown to reduce the hypermetabolic response focused on maintaining elevated body core temperatures during the acute injury phase [144].
\nDelays in nutritional support can have devastating effects on patient outcomes [145]. The post-burn hypermetabolic state that begins immediately after injury can approach 200% of normal resting energy expenditure [146]. This can naturally lead to rapid depletion of energy stores, loss of muscle tissue, and further worsening of any pre-existing or acquired malnutrition. Malnutrition itself contributes to alterations in cell membrane transport, organ dysfunction, immune compromise, and delayed/abnormal wound healing [147]. Ideally, nutritional support is initiated within 6 h of injury. Due to the tremendous increase in metabolic demand, severely burned patients are simply unable to fully meet the caloric demands on their own accord. For this reason, it is recommended that a post-pyloric feeding access be placed on admission, with prompt (preferably protocol-driven) initiation of tube feeding formulae specifically tailored to meet individual patient requirements [148, 149]. For gastric tube feeds, the choice of continuous versus bolus administration may be a secondary consideration [150]. For post-pyloric feeding, continuous administration requires the presence of intact intestinal function.
\nUnfortunately, the gastrointestinal tract itself is affected adversely by severe burn injury, and varied degrees of ileus may develop in the acute post-burn timeframe [151]. In the setting of complete intolerance to enteral feeding, total parenteral nutrition may be considered on highly selective basis [152]. Total parenteral nutrition is generally not recommended due to associated increases in rates of complications and mortality compared to enteral feeding, and the latter should be started as soon as the gastrointestinal dysfunction resolves [152]. A commonly used formula for calculating caloric requirements is the Curreri formula (including its variants) which calls for 25 kcal/kg/day maintenance plus additional 40 kcal/%TBSA/day [153, 154, 155].
\nAdequate and prompt nutritional support is critical to the overall management of burn patients, and its importance parallels the severity (e.g., %TBSA) and complexity (e.g., inhalation component) of the injury [148, 156, 157]. In addition to ensuring adequate caloric provision, it may be important to consider supplementing the patient’s enteral intake with specific vitamins and minerals. For example, there has been increasing support in the literature for administration of high dose vitamin C (a.k.a., ascorbic acid) during the acute phase of burn injury [158, 159]. Cellular oxidative stress from reactive oxygen species generated immediately after burn injury appears to play a significant role in cardiovascular dysfunction of burn shock. Vitamin C is a powerful antioxidant, and it has been suggested that high dose ascorbic acid administration during the acute phase of burn shock may be protective to microvascular circulation, beneficial to cardiac output, help optimize fluid resuscitation, and may enhance wound healing [159, 160]. Other proposed components of the so-called “pharmacological” nutritional supplementation after burn injury include glutamine, arginine, n-3 (polyunsaturated) fatty acids, as well as various other vitamins and trace minerals [149, 161].
\nPatients who develop burn shock and remain hemodynamically labile despite large volume resuscitation may require additional cardiovascular support. Low cardiac output during the acute post-injury phase is a common component of early “burn shock” [162, 163] and may be more pronounced among geriatric patients [164]. In some cases, inotropic support with dobutamine may be required to maintain adequate systemic perfusion [165, 166]. Vasopressors should be avoided if possible as their vasoconstrictive properties can lead to decreased end-organ perfusion, including skin (and thus elevated risk of the propagation of primary injury or impaired healing of skin grafts) and bowel (e.g., contribution to potential bowel ischemia). This is especially applicable to patients with initial low cardiac output and early multiple organ dysfunction [167]. Patients who do require vasopressor support should undergo close hemodynamic monitoring (MAP, CVP, echocardiography, SvO2). As the patient transitions from the “ebb phase” to the “flow phase” (typically around the 48–72 h mark) of the post-burn state, hemodynamic behavior evolves toward the hyperdynamic profile [168]. As the hyperdynamic phase begins, cardiac output may exceed 1.5 times that of a normal baseline. Increases in cardiac output entail much greater cardiac work and overall energy expenditure. For these reasons, propranolol is highly efficacious during acute care in burn patients [169]. In fact, long-term propranolol administration initiated in the acute setting decreases cardiac work, decreases lipolysis, improves nitrogen balance, helps restore insulin sensitivity, and mitigates post-traumatic stress disorder [170, 171, 172, 173].
\nAs part of the hypermetabolic response to burn injury, significant increases in catecholamines, glucagon, and cortisol stimulate rapid glycolysis-gluconeogenesis cycle gyrations [174]. The result is the appearance of hyperglycemia and a concurrent state of insulin resistance. The magnitude of the overall effect appears to be dependent on the severity and size of the burn injury [175]. The administration of insulin to maintain a serum glucose goal of ≤120 mg/dL has proven to be effective in attenuating some of the hypermetabolic changes that take place immediately after injury [176]. Insulin administration has been shown to improve muscle protein synthesis, normalize mitochondrial function, reduce oxidative stress, limit lean muscle mass loss, accelerate healing time, and improve long-term rehabilitation [176, 177, 178, 179]. In addition to the normalization of serum glucose levels, the reduction in glycemic variability may be equally important [180, 181]. Other beneficial effects of goal-directed insulin therapy have been identified, including potential reductions in mortality, infections, sepsis, acute kidney injury, multiple organ failure, days on a ventilator, and hospital length of stay [177, 178, 182].
\nAlthough beyond the scope of the current chapter, various other endocrine system components are affected—both acutely and chronically—following burn injury [178, 183, 184, 185, 186, 187, 188]. This includes the thyroid hormone metabolism [183, 184], the hypothalamic–pituitary axis [185], the renin-angiotensin system [185, 187], the reproductive system [185], among others [186]. Additional important endocrine considerations include the effects of exogenous hormone therapies, such as oxandrolone, recombinant human growth hormone, and incretin analogs [188]. Readers are referred to the primary sources listed above for further information.
\nInhalation injury requiring mechanical ventilation is associated with increased mortality and greater volume of fluid resuscitation [189, 190, 191]. Carbonaceous debris in or around the mouth, facial burns, and singed facial or nasal hair are often cited as important clues during the BPE with respect to the presence of inhalation injury [192, 193]. However, the history of closed space smoke exposure is perhaps the most important clue as to whether or not a patient might have sustained an inhalation injury. Unlike burn injuries to the skin and subdermal tissues, which are primarily thermal in nature, inhalation injury is primarily a result of chemical exposure of tracheo-bronchial and pulmonary tissues to toxic products of combustion [191, 194, 195]. Primary thermal injury to the airway is often limited to the supraglottic region [195]. Diagnosis of lung injury is graded on a standardized scale from 0 to 4 based on bronchoscopic findings of airway edema, inflammation, mucosal necrosis, tissue sloughing, and presence of soot and carbonaceous material in the airway (see Table 3) [195].
\nInhalation injury grading scale | \n||
---|---|---|
Grade 0 | \nNo injury | \nNormal mucosa, absence of carbonaceous material | \n
Grade 1 | \nMild | \nMinor or patchy areas of erythema, carbonaceous deposits in bronchi | \n
Grade 2 | \nModerate | \nModerate degree of erythema, carbonaceous deposits, bronchorrhea, with or without bronchial compromise | \n
Grade 3 | \nSevere | \nSevere inflammation with friability, copious carbonaceous deposits, bronchorrhea, bronchial obstruction | \n
Grade 4 | \nMassive | \nMucosal sloughing, necrosis, endoluminal obliteration | \n
Description of inhalation injury severity grading based on bronchoscopic evaluation.
Endorf and Gamelli [190].
If there is any concern for inhalation injury based on the initial or subsequent BPE, patient should be placed on 100% oxygen via non-rebreather mask and undergo measurements of blood carboxyhemoglobin and cyanide levels [196, 197]. In patients with early evidence of upper airway edema or impending respiratory failure as suggested by oxygen saturations below 92% and the simultaneous presence of tachypnea with hypercapnia, intubation should be expeditious [128, 198, 199]. Ventilator management for these patients is similar to ARDS using low tidal volumes and pressure control ventilation with permissive hypercapnia (as high as PaCO2 of 60 mmHg) [200, 201]. Additionally, sloughing of the injured pulmonary lining requires aggressive pulmonary toilet, chest physiotherapy, frequent suctioning, bronchoscopic removal of casts, and nebulizer therapy [128, 202, 203]. Various nebulizer combinations and frequencies of albuterol, heparin, acetylcysteine, hypertonic saline, and racemic epinephrine should be considered on a case by case basis depending on injury severity and clinical progression [128]. Patients should be closely monitored for development of ventilator-assisted pneumonia considering their primary injury has induced a transient immunosuppressed state—a factor that is further exacerbated by the presence of inhalation injury [204, 205]. Finally, for patients with very severe inhalation injury who continue to worsen despite maximal traditional mechanical ventilatory support, the use of high-frequency oscillatory ventilation may be indicated [206, 207].
\nWhen excisional burn debridement is indicated, it is recommended that it be completed within the first 24–48 h after injury [208, 209]. Early debridement can help decrease the ongoing systemic response to inflammation stemming from the persistence of devitalized tissue [210, 211]. Removal of deep partial or full-thickness burn tissue with grafting and coverage with either permanent (preferred) or temporary graft can substantially decrease the daily rate of evaporative losses [212, 213]. Institution of aggressive operative management of burns, combined with optimization of non-surgical aspects of burn care, can result in a significant decline in mortality rates. More recent developments in this particular area include the introduction of selective enzymatic debridement agent designed specifically for burn wounds [214].
\nHistorically, the spheres of the dermatologist and the burn surgeon have failed to overlap as much as the associated anatomic and physiologic considerations might lead one to believe they should. Reasons for this lack of collegiality and collaboration have included training bias (i.e., an “elixir” versus “cold steel” approach), lack of awareness of the other’s expertise, and good old fashioned egos and turf wars. Thankfully, a new era of cooperation between these specialties has begun to emerge based on large part around the understanding that a multimodal, multidisciplinary approach may lead to more optimal clinical outcomes. The intersection of these two specialties may perhaps be best illustrated through several devastating dermatological conditions that involve the acute and extensive necrosis of cutaneous tissue, leading to catastrophic deterioration of the affected patient and a clinical picture that closely resembles a large thermal burn.
\nTEN is a severe, life-threatening disorder (with a mortality rate approaching 40%) characterized by generalized loss of epidermis and mucosa (Figure 3), typically involving more than 30% of the skin [215]. A tell-tale clinical finding that is almost always present in TEN is the phenomenon in which intact superficial epidermis can, via a pushing or shearing force, be dislodged and slid over underlying layers of skin; this indicates a plane of cleavage in the skin at the epidermal-dermal junction and is referred to as Nikolsky’s sign [216]. TEN is almost always medication-induced and involves a cytotoxic T-cell reaction with apoptosis of keratinocytes mediated by Fas ligand [217]. Consequently, the first step in treatment is similar to that of a burn injury—stop the underlying causative agent (i.e., discontinue all medications that are not essential). The next step is to confirm the diagnosis through a careful medication history and skin biopsy with frozen section. The finding of full-thickness epidermal involvement distinguishes TEN from other conditions such as staphylococcal scalded skin syndrome (see below), which may appear similar but are treated very differently. In addition to the more controversial therapeutic roles that systemic steroids, intravenous immunoglobulins, and plasmapheresis may play, the mainstay clinical TEN management is excellent “burn care,” ideally in a burn center with careful attention to pain management, electrolyte balance, topical disinfection, access to burn beds and nonadherent dressings, and prompt treatment of secondary infections. An ophthalmologic consultation is also required because of the risk of corneal erosions and scarring [218].
\nTypical appearance of toxic epidermal necrolysis (TEN).
The SSSS is typically characterized by fever and rapid onset of diffuse, painful erythema progressing to widespread formation of thin-walled, easily ruptured, fluid-filled vesicles and bullae (Figure 4). Newborns and small infants tend to be most susceptible, though adults may certainly be affected. Nikolsky’s sign is almost always present [216]. The clinical presentation of SSSS is the result of specific exotoxins that cleave desmoglein-1 (i.e., disrupt the connection between keratinocytes) and cause cellular detachment within the epidermis. While exotoxins are released by S. aureus, cultures to isolate these bacteria, however, are often negative. More helpful is a skin biopsy with frozen section that should demonstrate a very superficial epidermal split (in contrast to TEN where there is full-thickness epidermal necrosis). Differentiating SSSS from similar clinical presentations is critical because treatment typically involves the addition of medications (i.e., antibiotics) rather than the cessation of them. SSSS patients may require topical disinfection and careful placement on a burn bed covered with nonadherent sheeting. Attention to fluid replacement, pain management, electrolyte balance, and temperature and humidity control are paramount. Less urgent but just as important, the diagnosis of SSSS should prompt a search for staphylococcal “carriers” among close contacts of the affected patient. Healing is usually rapid with correct therapy and vigilant wound care [219].
\nTypical appearance of staphylococcal scalded skin syndrome (SSSS). Left—face; right—abdomen.
Necrotizing fasciitis refers to the severe and rapid destruction of skin, subcutaneous fat, and muscle caused by bacterial infection (e.g., group A streptococci, community-based methicillin-resistant
Directly relevant to the theme of the current chapter, all three of the above dermatological conditions (and many others) are subject to the same general complications and considerations, and their final prognosis is directly proportional to the extent of their skin injuries and the level of expert care they urgently receive.
\nIrreversible scarring has long been thought to be the unavoidable, aggregated response to gross tissue injury after a severe burn. From the historical “tooth and claw” injury perspective, such a clinical endpoint made perfect sense: the inflammatory cascade would effectively help plug hemorrhage, prevent infection, and patch up the wounded enough so that they could get back into action. In the context of modern medicine, however, scarring is no longer necessarily ideal. When one considers the phenomenon of the burn survivor’s paradox—in which severely burned patients are living longer through more extreme injuries but are consequently forced to deal with the physical, psychosocial, and financial implications associated with their survival—it is clear that a disfiguring or function-limiting scar no longer confers the same advantages it did in pre-historic times. Consequently, a relatively new field of dermato-surgical medicine is evolving to address this new perspective with a focus on scar prevention, mitigation, rehabilitation, and an overall goal to reintegrate the burn survivor to “normalcy.”
\nMany animals (e.g., starfish, salamanders, lizards, etc.) have long been known to be able to regenerate tissue; however, it was not until relatively recently, in 2012, that researchers demonstrated the phenomenon of skin shedding and tissue regeneration in an adult mammal population, using the African spiny mouse as a model [224]. Coupling this discovery with the fact that fetal wounds heal without a scar early in human gestation and that adult humans retain the capacity to heal micro-wounds (e.g., bee stings, venipuncture, or facial rejuvenation with a fractional carbon dioxide laser, etc.) without scarring, we can now start to imagine that the door to scarless burn wound healing may not be as permanently closed to us as we once believed.
\nPrevention of scarring might be as simple as ensuring that normal skin replaces the major wound defect [225, 226]. In essence, that is what full-thickness skin grafting seeks to accomplish, allowing the surgeon to bring in hair follicles, sweat glands, reticular dermis, subcutaneous fat, and other deep structures and relocating them to the wound bed. Unfortunately, it does so by creating another full-thickness skin wound at the donor site, a fact that limits this strategy to small wounds. Additionally, for a full-thickness graft to properly “take,” it must connect successfully to the wound bed’s underlying blood supply or the grafted tissue may die. Recently, an autologous micrografting device came to market offering to deliver the benefits of a full-thickness skin graft without the limitations. In this technique, the proprietary device (CelluTome™ Epidermal Harvesting System, KCI, an Acelity Company, San Antonio, TX) uses suction and heat to homogenously harvest hundreds of exceedingly small columns (700 μm diameter) of full-thickness skin without the need for anesthesia [227, 228]. The micrografts are then manually transferred directly to the recipient area. Donor sites reepithelialize within days and with little to no evidence of scarring. The recipient sites appear to demonstrate accelerated reepithelialization and seem to heal without the “fish-net” patterning associated with split-thickness skin grafts. While this novel technology is promising, long-term, prospective studies are needed to evaluate the true efficacy and clinical outcomes of this approach [227, 228, 229, 230].
\nThe “holy grail” of employing stem cell therapy to improve—or even perfect!—desired wound healing after burn injury has long attracted the attention of burn surgeons. Combined gene delivery with stem cell therapy remains particularly promising. This process involves inserting a gene into recipient cells with the goal of delivering a concoction of growth factor genes at critical time points in the wound healing process [231]. This could be accomplished through any number of techniques including viral transfection, high pressure injection, liposomal vectors, naked DNA application, and it even introduces a new potential role for laser-assisted drug delivery (see below) [232]. Optimized culture conditions, preconditioning cell treatments, and the development of ideal scaffolds or matrices to optimize cell mobilization, homing, adhesion, and differentiation remain elusive but may be just over the horizon.
\nIn burn patients where the injuries are so extensive that donor site availability is limited or not practical, the notion of culturing human keratinocytes remains a still hopeful approach. From a general perspective, this technique is accomplished by, first, taking a small sample of the patient’s own healthy skin [233]. Next, the cells within the epidermis are separated, and the keratinocytes are grown, a process that involves providing the cells with specific nutrients. The resulting cultured skin is then applied to cover the burn wound, thus reducing the amount of healthy skin that must be removed for traditional burn wound grafting. Several companies are developing competing technologies to accomplish this goal, with one company receiving FDA approval, in 2018, for its proprietary “spray-on skin” system [234].
\nMultiple laser and energy-based devices are now employed within the burn scar management algorithm in an effort to better “rehabilitate” the injured skin. This armamentarium includes, primarily, the vascular-specific pulsed dye laser (PDL), which helps to reduce erythema and hypertrophic scar formation, and the technique of ablative or non-ablative fractional laser resurfacing, which helps to normalize scar texture, thickness, and stiffness of the scars.
\nThe pulsed dye laser (PDL) was the first laser to be specifically developed to treat port wine birthmarks with the principle of “selective photothermolysis” in mind [235]. First-generation PDL devices utilized a yellow light emitting at wavelength 577 nm to target oxyhemoglobin, a chromophore with absorption peaks located around 418, 542, and 577 nm. Through diffusion of heat, this laser caused selective thermal damage of the abnormally dilated blood vessels with minimal to no collateral damage of surrounding cutaneous structures. Eventually, 585 and 595 nm wavelength PDL devices were developed to allow slightly deeper penetration through the skin (to a depth of around 1.2 mm) while still maintaining precise absorption. The development of surface cooling devices has, subsequently, afforded the use of higher energy fluences with larger spot sizes and improved treatment in darker skin surfaces. When applied to hypertrophic burn scars, PDL causes selective photothermolysis that induces coagulation necrosis of capillaries within the scar itself [236]. Because hypertrophic burn scars are characterized by pathologic neovascularization, PDL devices help to mitigate inflammation and collagen production and reduce the overall hypervascular response. From a patient perspective, PDL is also useful for helping to improve overall burn scar texture, pruritus, pain, and pliability [237].
\nLaser resurfacing has long been used for cosmetic indications such as treatment of fine rhytids of the eyelids and mouth, treatment of photoaging, and management of dyspigmentation. Original “fully ablative” devices, such as the carbon dioxide laser, target intracellular water as the main chromophore. Because of the abundance of water in human tissue, this process leads to non-selective and near-immediate vaporization of treated skin and a denaturation of surrounding extracellular proteins. In contrast to ablative devices, nonablative approaches induce coagulation as their primary mechanism of action without directly destroying tissue or exposing dermis to the external environment. The concept of “fractional photothermolysis” was fairly recently introduced and describes treatment of the target tissue with the generation of a precise array of evenly spaced areas of injury known as microscopic treatment zones (MTZ) [238]. Clinically, this technique results in untreated areas between the MTZs, containing significant amounts of intact epidermis and dermis available as a reservoir for a more rapid micro-healing response. With ablative fractional resurfacing (AFR) technologies, such as the fractional carbon dioxide (CO2) and Erbium-YAG lasers, the operating surgeon may change device parameters to adjust for desired depth of treatment (to a maximum of about 3.5–4.0 mm with current devices) and accurately control the total ablated surface area within a treated area. The general rule for AFR is to decrease density (i.e., total ablated surface area) while increasing fluence (i.e., energy). How repeated pixelated thermal injuries to a burn scar could result in subjective and objective improvements is not entirely understood; however, the technique has consistently demonstrated the ability to facilitate rapid reepithelialization and a vigorous scar remodeling process while maintaining excellent safety margins [239, 240, 241, 242, 243]. Perhaps most notably, long-term, persistent gains in pliability, resulting in improved function and quality of life, most likely occur from a gradual process of diffuse dermal remodeling and a relative rehabilitation of dysfunctional scar tissue [244].
\nThe varied nature of individual burn scars, the heterogeneity of burn patients, small sample sizes, a lack of treatment controls, and the cost of the devices themselves have been major limitations to research surrounding the use of lasers in the treatment of burn scars. Thankfully, several large, prospective studies are currently underway to investigate the utility of these devices, including in the pediatric population.
\nThe notion that certain medications or agents could be delivered topically through burn scar tissue has three potential advantages over oral administration of the same agent: directed therapy to the targeted tissue, limited systemic toxicity and side effects, and avoidance of first-pass metabolism. To this end, various chemical, biochemical, and physical strategies have attempted to enhance topical drug delivery into burn scar tissue. It is only relatively recently that AFR devices have been utilized for this purpose [245]. In a process referred to as “laser-assisted drug delivery,” AFR devices create vertical columns of ablated tissue in the MTZs that then serve as conduits or channels for delivery of specific topical medications or agents. Pairing the delivery of topical agents temporally with AFR therapy is believed to allow for increased penetration and absorption of the applied agents, an approach that is particularly helpful in the treatment of burn scar tissue given its variable and fibrotic nature. Corticosteroids, 5-fluorouracil (5-FU), imiquimod, methotrexate, and other immunomodulators have all been used for this purpose with varying degrees of success. Overall, laser-assisted drug delivery is a promising intervention for burn scar treatment. Investigation of the optimal channel depth and channel density continues and will likely depend on each individual drug or agent’s chemical structure and the desired clinical target. Likewise, many drugs and agents have not been designed to be delivered to their target tissues in this manner, so larger prospective studies to determine safety and efficacy of this procedure will be critical.
\nThe primary goal of clinical management of burns is to prevent the development of “burn shock.” Early classification of burns by depth and size is critical to goal-directed treatment strategies, with subsequent approaches guided by the post-injury physiological and metabolic demands. Appropriate anticipation and proactive, multimodality support of the patient, through fluid resuscitation, nutritional supplementation, and pharmacologic therapy is required for optimizing patient outcomes. Additionally, clinicians should closely monitor the patient for the development of secondary adverse events, such as infections and under- or over-resuscitation. Management of burns is complex and requires specialized facilities, teams of experienced burn surgeons, dedicated burn nurses, social workers, nutritionists, physical therapists, occupational therapists, pharmacists, respiratory interventionists, pain specialists, dermatologists, and psychologists [246, 247]. The tremendous amount of progress in treatment of thermal injuries over the past several decades was possible because of the continuous evolution of trauma systems and burn centers, along with the development of state-of-the-art resuscitative and procedural approaches.
\nThe critical timeline for thermal injury management occurs in the first 48 h from time of initial burn. Early burn classification should determine need for referral to a designated burn center (Table 4). The American Burn Association (ABA) list criteria for burn injuries that warrant referral to a designated burn center including: partial thickness burns of greater than 10% TBSA, burns involving the face, hands, feet, genitalia, or major joints, any third degree burns, electrical burns, chemical burns, inhalation injuries, burn injury to patients with significant pre-existing medical conditions, burns with additional traumatic injury, burns in children, or any burn injury to patients who may require special social, emotional, or rehabilitative assistance.
\nBurn center referral criteria | \n|
---|---|
1 | \nPartial thickness burns >10% TBSA | \n
2 | \nBurns involving the face, hands, feet, genitalia, perineum, or major joints | \n
3 | \nThird degree burns in any age group | \n
4 | \nElectrical burns, lightning injury | \n
5 | \nChemical burns | \n
6 | \nInhalation injury | \n
7 | \nBurn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality | \n
8 | \nAny patient with burns and traumatic injury wherein the burn poses the greatest risk of morbidity/mortality. When a traumatic injury poses the greatest risk, adequate stabilization of the patient at a trauma center may be necessary prior to transport | \n
9 | \nBurned children in hospitals lacking the qualified personnel/equipment necessary to care for children | \n
10 | \nBurn injury to patients who require special social, emotional, or rehabilitative intervention | \n
Summary of burn center referral criteria; Legend: TBSA = Total body surface area.
Excerpted from Guidelines for the Operation of Burn Centers (pp. 79–86), Resources for Optimal Care of the Injured Patient 2006, Committee on Trauma, American College of Surgeons.
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Jideani",authors:[{id:"201151",title:"Ph.D. Student",name:"Yvonne",middleName:null,surname:"Maphosa",slug:"yvonne-maphosa",fullName:"Yvonne Maphosa"}]},{id:"29979",doi:"10.5772/25344",title:"The Therapeutic Benefits of Essential Oils",slug:"the-therapeutic-benefits-of-essential-oils",totalDownloads:24091,totalCrossrefCites:43,totalDimensionsCites:103,abstract:null,book:{id:"1419",slug:"nutrition-well-being-and-health",title:"Nutrition, Well-Being and Health",fullTitle:"Nutrition, Well-Being and Health"},signatures:"Abdelouaheb Djilani and Amadou Dicko",authors:[{id:"63044",title:"Prof.",name:"Jilani",middleName:null,surname:"AbdelWahab",slug:"jilani-abdelwahab",fullName:"Jilani AbdelWahab"},{id:"116762",title:"Prof.",name:"Amadou",middleName:null,surname:"Dicko",slug:"amadou-dicko",fullName:"Amadou Dicko"}]},{id:"29974",doi:"10.5772/29471",title:"Antioxidant and Pro-Oxidant Effects of Polyphenolic Compounds and Structure-Activity Relationship Evidence",slug:"antioxidant-and-prooxidant-effect-of-polyphenol-compounds-and-structure-activity-relationship-eviden",totalDownloads:8699,totalCrossrefCites:12,totalDimensionsCites:81,abstract:null,book:{id:"1419",slug:"nutrition-well-being-and-health",title:"Nutrition, Well-Being and Health",fullTitle:"Nutrition, Well-Being and Health"},signatures:"Estela Guardado Yordi, Enrique Molina Pérez, Maria João Matos and Eugenio Uriarte Villares",authors:[{id:"78010",title:"MSc.",name:"Estela",middleName:null,surname:"Guardado Yordi",slug:"estela-guardado-yordi",fullName:"Estela Guardado Yordi"},{id:"79173",title:"Dr.",name:"Enrique",middleName:null,surname:"Molina Perez",slug:"enrique-molina-perez",fullName:"Enrique Molina Perez"},{id:"97576",title:"Dr.",name:"Eugenio",middleName:null,surname:"Uriarte Villares",slug:"eugenio-uriarte-villares",fullName:"Eugenio Uriarte Villares"},{id:"120476",title:"Dr.",name:"Maria",middleName:null,surname:"Joao Matos",slug:"maria-joao-matos",fullName:"Maria Joao Matos"}]}],mostDownloadedChaptersLast30Days:[{id:"76640",title:"Control of Clinical Laboratory Errors by FMEA Model",slug:"control-of-clinical-laboratory-errors-by-fmea-model",totalDownloads:1208,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Patient safety is an aim for clinical applications and is a fundamental principle of healthcare and quality management. The main global health organizations have incorporated patient safety in their review of work practices. The data provided by the medical laboratories have a direct impact on patient safety and a fault in any of processes such as strategic, operational and support, could affect it. To provide appreciate and reliable data to the physicians, it is important to emphasize the need to design risk management plan in the laboratory. Failure Mode and Effect Analysis (FMEA) is an efficient technique for error detection and reduction. Technical Committee of the International Organization for Standardization (ISO) licensed a technical specification for medical laboratories suggesting FMEA as a method for prospective risk analysis of high-risk processes. FMEA model helps to identify quality failures, their effects and risks with their reduction/elimination, which depends on severity, probability and detection. Applying FMEA in clinical approaches can lead to a significant reduction of the risk priority number (RPN).",book:{id:"9808",slug:"contemporary-topics-in-patient-safety-volume-1",title:"Contemporary Topics in Patient Safety",fullTitle:"Contemporary Topics in Patient Safety - Volume 1"},signatures:"Hoda Sabati, Amin Mohsenzadeh and Nooshin Khelghati",authors:[{id:"340486",title:"M.Sc.",name:"Hoda",middleName:null,surname:"Sabati",slug:"hoda-sabati",fullName:"Hoda Sabati"},{id:"348872",title:"M.Sc.",name:"Amin",middleName:null,surname:"Mohsenzadeh",slug:"amin-mohsenzadeh",fullName:"Amin Mohsenzadeh"},{id:"348874",title:"MSc.",name:"Nooshin",middleName:null,surname:"Khelghati",slug:"nooshin-khelghati",fullName:"Nooshin Khelghati"}]},{id:"69876",title:"Leadership Styles in Nursing",slug:"leadership-styles-in-nursing",totalDownloads:3122,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Recent developments in the field of management-organization and organizational behavior and new concepts have also led to the emergence of new leadership styles in leadership. Leadership in health services is important for following innovations and adapting to current situations. Nurses working together with other health personnel in hospitals providing health services constitute an important group in leadership. Nursing, which is a key force for patient safety and safe care, is a human-centered profession, and therefore leadership is a key skill for nurses at all levels. The leadership styles of nurse managers are believed to be an important determinant of job satisfaction and persistence of nurses. The need for nurses with leadership skills and the need for nurses to develop their leadership skills are increasing day by day. There are several leadership styles defined in nursing literature. These leadership styles are examined under the titles of relational leadership style, transformational leadership, resonant leadership, emotional intelligence leadership, and participatory leadership. The task-focused leadership style is explored under the headings of transactional and autocratic leadership, laissez-faire leadership, and instrumental leadership.",book:{id:"9047",slug:"nursing-new-perspectives",title:"Nursing",fullTitle:"Nursing - New Perspectives"},signatures:"Serpil Çelik Durmuş and Kamile Kırca",authors:null},{id:"58916",title:"Factors Affecting the Attitudes of Women toward Family Planning",slug:"factors-affecting-the-attitudes-of-women-toward-family-planning",totalDownloads:8541,totalCrossrefCites:9,totalDimensionsCites:18,abstract:"Everyone has the right to decide on the number and timing of children without discrimination, violence and oppression, to have the necessary information and facilities for it, to access sexual and reproductive health services at the highest standard. Deficient or incorrect family planning methods, wrong attitudes and behaviors toward the methods and consequent unplanned pregnancies, increased maternal and infant mortality rates are the main health problems in most countries. Individuals’ learning modern family planning methods and having positive attitude for these methods may increase the usage of these methods and contributes the formation of healthy communities. It is considered important to examine the current attitudes and determinants in order to spread the choice of effective method.",book:{id:"6142",slug:"family-planning",title:"Family Planning",fullTitle:"Family Planning"},signatures:"Nazli Sensoy, Yasemin Korkut, Selcuk Akturan, Mehmet Yilmaz,\nCanan Tuz and Bilge Tuncel",authors:[{id:"216377",title:"Prof.",name:"Nazli",middleName:null,surname:"Sensoy",slug:"nazli-sensoy",fullName:"Nazli Sensoy"},{id:"216589",title:"Dr.",name:"Yasemin",middleName:null,surname:"Korkut",slug:"yasemin-korkut",fullName:"Yasemin Korkut"},{id:"216595",title:"Dr.",name:"Selcuk",middleName:null,surname:"Akturan",slug:"selcuk-akturan",fullName:"Selcuk Akturan"},{id:"216596",title:"Dr.",name:"Canan",middleName:null,surname:"Tuz",slug:"canan-tuz",fullName:"Canan Tuz"},{id:"216598",title:"Dr.",name:"Bilge",middleName:null,surname:"Tuncel",slug:"bilge-tuncel",fullName:"Bilge Tuncel"},{id:"216599",title:"Dr.",name:"Mehmet",middleName:null,surname:"Yilmaz",slug:"mehmet-yilmaz",fullName:"Mehmet Yilmaz"}]},{id:"69631",title:"Cultural Practices and Health Consequences: Health or Habits, the Choice Is Ours",slug:"cultural-practices-and-health-consequences-health-or-habits-the-choice-is-ours",totalDownloads:889,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Human beings are social animals with an innate desire to conform to socially accepted norms and values. Over periods of time, some of these norms become standards that all members of the community are expected to adhere to. Deviance from these standards is seen as absurd, wrong, or frankly abnormal. However, many of these cultural mores have no scientific basis and, some of them actually promote behaviors with negative health consequences. This chapter examines the cultural practices of some communities in Africa and their health consequences and, explores ways to address the challenges.",book:{id:"9138",slug:"public-health-in-developing-countries-challenges-and-opportunities",title:"Public Health in Developing Countries",fullTitle:"Public Health in Developing Countries - Challenges and Opportunities"},signatures:"Radiance Ogundipe",authors:[{id:"302308",title:"Dr.",name:"Radiance",middleName:null,surname:"Ogundipe",slug:"radiance-ogundipe",fullName:"Radiance Ogundipe"}]},{id:"55808",title:"The Role of Legumes in Human Nutrition",slug:"the-role-of-legumes-in-human-nutrition",totalDownloads:5425,totalCrossrefCites:63,totalDimensionsCites:109,abstract:"Legumes are valued worldwide as a sustainable and inexpensive meat alternative and are considered the second most important food source after cereals. Legumes are nutritionally valuable, providing proteins (20–45%) with essential amino acids, complex carbohydrates (±60%) and dietary fibre (5–37%). Legumes also have no cholesterol and are generally low in fat, with ±5% energy from fat, with the exception of peanuts (±45%), chickpeas (±15%) and soybeans (±47%) and provide essential minerals and vitamins. In addition to their nutritional superiority, legumes have also been ascribed economical, cultural, physiological and medicinal roles owing to their possession of beneficial bioactive compounds. Research has shown that most of the bioactive compounds in legumes possess antioxidant properties, which play a role in the prevention of some cancers, heart diseases, osteoporosis and other degenerative diseases. Because of their composition, legumes are attractive to health conscious consumers, celiac and diabetic patients as well as consumers concerned with weight management. The incorporation of legumes in diets, especially in developing countries, could play a major role in eradicating protein-energy malnutrition especially in developing Afro-Asian countries. Legumes could be a base for the development of many functional foods to promote human health.",book:{id:"5963",slug:"functional-food-improve-health-through-adequate-food",title:"Functional Food",fullTitle:"Functional Food - Improve Health through Adequate Food"},signatures:"Yvonne Maphosa and Victoria A. Jideani",authors:[{id:"201151",title:"Ph.D. Student",name:"Yvonne",middleName:null,surname:"Maphosa",slug:"yvonne-maphosa",fullName:"Yvonne Maphosa"}]}],onlineFirstChaptersFilter:{topicId:"200",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82616",title:"The Quantum Theory of Reproduction. How Unique is an Individual?",slug:"the-quantum-theory-of-reproduction-how-unique-is-an-individual",totalDownloads:12,totalDimensionsCites:0,doi:"10.5772/intechopen.105769",abstract:"Our understanding of nature’s way is founded on quantum mechanics. In its existence of over 80 years, quantum theory has been describing the physical world. The attraction of studying quantum mechanics is the perception of the conceptual structure of nature. This is aided by the mathematical structure that exposes the internal logic of the subject by inventing a notation that embeds the philosophy of the question. To describe how unique each individual is. A calculation method was applied. The uniqueness of an individual is one in two nonillion, octillion, septillion, sextillion, quintillion, quadrillion, trillion, billion, million and thousand. Individuals are indefinitely unique.",book:{id:"11284",title:"Studies in Family Planning",coverURL:"https://cdn.intechopen.com/books/images_new/11284.jpg"},signatures:"Zouhair O. Amarin"},{id:"81930",title:"Smoking and Its Consequences on Male and Female Reproductive Health",slug:"smoking-and-its-consequences-on-male-and-female-reproductive-health",totalDownloads:14,totalDimensionsCites:0,doi:"10.5772/intechopen.104941",abstract:"Smoking contributes to the death of around one in 10 adults worldwide. Specifically, cigarettes are known to contain around 4000 toxins and chemicals that are hazardous in nature. The negative effects of smoking on human health and interest in smoking-related diseases have a long history. Among these concerns are the harmful effects of smoking on reproductive health. Thirteen percent of female infertility is due to smoking. Female smoking can lead to gamete mutagenesis, early loss of reproductive function, and thus advance the time to menopause. It has been also associated with ectopic pregnancy and spontaneous abortion. Even when it comes to assisted reproductive technologies cycles, smokers require more cycles, almost double the number of cycles needed to conceive as non-smokers. Male smoking is shown to be correlated with poorer semen parameters and sperm DNA fragmentation. Not only active smokers but also passive smokers, when excessively exposed to smoking, can have reproductive problems comparable to those seen in smokers. In this book chapter, we will approach the effect of tobacco, especially tobacco smoking, on male and female reproductive health. This aims to take a preventive approach to infertility by discouraging smoking and helping to eliminate exposure to tobacco smoke in both women and men.",book:{id:"11284",title:"Studies in Family Planning",coverURL:"https://cdn.intechopen.com/books/images_new/11284.jpg"},signatures:"Amor Houda, Jankowski Peter Michael, Micu Romeo and Hammadeh Mohamad Eid"},{id:"81468",title:"The Knowledge and Use of Intra-Uterine Device by Women Attending Ante-Natal Clinic at Enugu State Teaching Hospital, Parklane",slug:"the-knowledge-and-use-of-intra-uterine-device-by-women-attending-ante-natal-clinic-at-enugu-state-te",totalDownloads:24,totalDimensionsCites:0,doi:"10.5772/intechopen.104097",abstract:"Intrauterine contraception has been recognized globally as one of the modern long-term reversible contraceptive methods suitable for women of all reproductive ages. It represents the most cost-effective method for preventing unwanted pregnancies, scientifically proven for its safety, efficacy and cost-effectiveness and is known to last longer in preventing pregnancy than other methods. This study assessed the knowledge of mothers attending ESUT teaching hospital, Parklane on intrauterine contraceptive device, the use as well as the common side effects experienced by the users. A descriptive survey research design was used to sample 175 mothers. A structured researcher developed questionnaire was used for data collection. The findings revealed that more than half of the respondents have good knowledge of intrauterine device but only 23 (14%) respondents make use of it. The commonly experienced side effects identified were irregular bleeding (75%) and vaginal discharge (62.5%). Although, the respondents had good knowledge of intrauterine device, their uptake of the method was poor. Therefore, there is a need to improve contraceptive counseling to ensure that women understand the relative effectiveness of IUDS. The study also recommended the need for better education for both clients and providers to improve the accessibility and acceptability of intrauterine device.",book:{id:"11284",title:"Studies in Family Planning",coverURL:"https://cdn.intechopen.com/books/images_new/11284.jpg"},signatures:"Chukwuasokam Caleb Aniechi and Uloma Cynthia Ezuma"},{id:"81003",title:"Perspective Chapter: Modern Birth Control Methods",slug:"perspective-chapter-modern-birth-control-methods",totalDownloads:38,totalDimensionsCites:0,doi:"10.5772/intechopen.103858",abstract:"This chapter focuses on various modern birth control methods, including combined oral contraceptives, progestogen-only pills, progestogen-only injectables, progestogen-only implants, intrauterine devices, barrier contraceptives, and emergency contraceptive pills. Each contraceptive method is covered in detail, including mechanism of action, effectiveness, health benefits, advantages, disadvantages, risks, and side-effects.",book:{id:"11284",title:"Studies in Family Planning",coverURL:"https://cdn.intechopen.com/books/images_new/11284.jpg"},signatures:"Rahma Al Kindi, Asma Al Salmani, Rahma Al Hadhrami, Sanaa Al Sumri and Hana Al Sumri"},{id:"80084",title:"Contraceptive Implants",slug:"contraceptive-implants",totalDownloads:174,totalDimensionsCites:0,doi:"10.5772/intechopen.101999",abstract:"Contraceptive implants or implantable contraceptive are five subdermal implants, rods the size of pencil lead that are embedded just under the skin on the inside of the upper arm. The rods contain etonogestrel, the metabolite of desogestrel, an equivalent progestin. Implants are often used during breastfeeding without an impact on milk production. It was identified that age does not affect the use of contraceptive implants but educational status is significant to its usage; there is an association between the age at first birth and the use of contraceptive implants; the number of liveborn children has a significant impact or influence on the use of implants; etc. This chapter focuses on types of contraceptive implants and its mechanism of action; global statistics on contraceptive implants; side effects; health benefits and positive characteristics of contraceptive implants; those who can and cannot use contraceptive implants; reasons women are not interested in contraceptive implants and factors influencing its usage.",book:{id:"11284",title:"Studies in Family Planning",coverURL:"https://cdn.intechopen.com/books/images_new/11284.jpg"},signatures:"Paul Hassan Ilegbusi"}],onlineFirstChaptersTotal:5},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:122,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"6",title:"Infectious Diseases",doi:"10.5772/intechopen.71852",issn:"2631-6188",scope:"This series will provide a comprehensive overview of recent research trends in various Infectious Diseases (as per the most recent Baltimore classification). Topics will include general overviews of infections, immunopathology, diagnosis, treatment, epidemiology, etiology, and current clinical recommendations for managing infectious diseases. 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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},editorTwo:null,editorThree:null},subseries:{paginationCount:3,paginationItems:[{id:"7",title:"Bioinformatics and Medical Informatics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",isOpenForSubmission:!0,annualVolume:11403,editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",slug:"slawomir-wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",biography:"Professor Sławomir Wilczyński, Head of the Chair of Department of Basic Biomedical Sciences, Faculty of Pharmaceutical Sciences, Medical University of Silesia in Katowice, Poland. His research interests are focused on modern imaging methods used in medicine and pharmacy, including in particular hyperspectral imaging, dynamic thermovision analysis, high-resolution ultrasound, as well as other techniques such as EPR, NMR and hemispheric directional reflectance. Author of over 100 scientific works, patents and industrial designs. Expert of the Polish National Center for Research and Development, Member of the Investment Committee in the Bridge Alfa NCBiR program, expert of the Polish Ministry of Funds and Regional Policy, Polish Medical Research Agency. Editor-in-chief of the journal in the field of aesthetic medicine and dermatology - Aesthetica.",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null},{id:"8",title:"Bioinspired Technology and Biomechanics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",isOpenForSubmission:!0,annualVolume:11404,editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",slug:"adriano-andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",biography:"Dr. Adriano de Oliveira Andrade graduated in Electrical Engineering at the Federal University of Goiás (Brazil) in 1997. He received his MSc and PhD in Biomedical Engineering respectively from the Federal University of Uberlândia (UFU, Brazil) in 2000 and from the University of Reading (UK) in 2005. He completed a one-year Post-Doctoral Fellowship awarded by the DFAIT (Foreign Affairs and International Trade Canada) at the Institute of Biomedical Engineering of the University of New Brunswick (Canada) in 2010. Currently, he is Professor in the Faculty of Electrical Engineering (UFU). He has authored and co-authored more than 200 peer-reviewed publications in Biomedical Engineering. He has been a researcher of The National Council for Scientific and Technological Development (CNPq-Brazil) since 2009. He has served as an ad-hoc consultant for CNPq, CAPES (Coordination for the Improvement of Higher Education Personnel), FINEP (Brazilian Innovation Agency), and other funding bodies on several occasions. He was the Secretary of the Brazilian Society of Biomedical Engineering (SBEB) from 2015 to 2016, President of SBEB (2017-2018) and Vice-President of SBEB (2019-2020). He was the head of the undergraduate program in Biomedical Engineering of the Federal University of Uberlândia (2015 - June/2019) and the head of the Centre for Innovation and Technology Assessment in Health (NIATS/UFU) since 2010. He is the head of the Postgraduate Program in Biomedical Engineering (UFU, July/2019 - to date). He was the secretary of the Parkinson's Disease Association of Uberlândia (2018-2019). Dr. Andrade's primary area of research is focused towards getting information from the neuromuscular system to understand its strategies of organization, adaptation and controlling in the context of motor neuron diseases. 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Singh",profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"8018",title:"Extracellular Matrix",subtitle:"Developments and Therapeutics",coverURL:"https://cdn.intechopen.com/books/images_new/8018.jpg",slug:"extracellular-matrix-developments-and-therapeutics",publishedDate:"October 27th 2021",editedByType:"Edited by",bookSignature:"Rama Sashank Madhurapantula, Joseph Orgel P.R.O. and Zvi Loewy",hash:"c85e82851e80b40282ff9be99ddf2046",volumeInSeries:23,fullTitle:"Extracellular Matrix - Developments and Therapeutics",editors:[{id:"212416",title:"Dr.",name:"Rama Sashank",middleName:null,surname:"Madhurapantula",slug:"rama-sashank-madhurapantula",fullName:"Rama Sashank Madhurapantula",profilePictureURL:"https://mts.intechopen.com/storage/users/212416/images/system/212416.jpg",institutionString:"Illinois Institute of Technology",institution:{name:"Illinois Institute of Technology",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Proteomics",value:18,count:4},{group:"subseries",caption:"Metabolism",value:17,count:6},{group:"subseries",caption:"Cell and Molecular Biology",value:14,count:9},{group:"subseries",caption:"Chemical Biology",value:15,count:14}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:9},{group:"publicationYear",caption:"2021",value:2021,count:7},{group:"publicationYear",caption:"2020",value:2020,count:12},{group:"publicationYear",caption:"2019",value:2019,count:3},{group:"publicationYear",caption:"2018",value:2018,count:2}],authors:{paginationCount:302,paginationItems:[{id:"280338",title:"Dr.",name:"Yutaka",middleName:null,surname:"Tsutsumi",slug:"yutaka-tsutsumi",fullName:"Yutaka Tsutsumi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/280338/images/7961_n.jpg",biography:null,institutionString:null,institution:{name:"Fujita Health University",country:{name:"Japan"}}},{id:"116250",title:"Dr.",name:"Nima",middleName:null,surname:"Rezaei",slug:"nima-rezaei",fullName:"Nima Rezaei",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/116250/images/system/116250.jpg",biography:"Professor Nima Rezaei obtained an MD from Tehran University of Medical Sciences, Iran. 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:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. 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