Summary of leadership approaches [32].
\\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
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However, the uterine environment is easily disturbed by an inflammatory process following aerobic and anaerobic bacterial invasion, which can occur during natural breeding, artificial insemination (AI), reproductive examination, parturition, postnatal infection (pneumovaginal infections), and mostly during a delayed postnatal cleaning of the uterus as a result of poor conformation [1].
These bacterial uterine infections cause conception and embryo survival failures despite many repeated breeding during the season. In the horse industry, endometritis due to uterine infectious of bacterial origin brings about 25–60% economic losses, leading to infertility. In pregnant mares, these infectious diseases can appear as failure to conceive, early fetal losses, mid-gestational abortion, placentitis, birth of a septic neonate, postpartum metritis, or delays in rebreeding and can be related with other systemic pathologies of viral, bacterial, and fungal origin [2]. Besides in nonpregnant mares, these infections are most often caused by opportunistic or commensal and venereal microorganisms, with a large variety of species have been isolated.
The healthy mare has three functional genital seals forming a barrier between the external environment and the uterine lumen [3, 4].
Lips of vulva: examination of vulvar and perineal conformation should be included in all prebreeding examinations or evaluations for infertility. The vulva should be a vertical position aligned with the anal opening. The labia should be tight, with most of length below the tuber ischii. The vulvar lips may become parted as a consequence of malformation caused by previous traumatic injuries. In older multiparous mares, there is a tendency for extreme relaxation of the vulvar lips, particularly during estrus, as well as tilting of the dorsal aspect of the vulva becomes horizontal as it is pulled cranially over the tuber ischii. These anatomic changes predispose the mare to pneumavagina (windsucking) and pneumouterus, ultimately causing urine to pool in the cranial vagina producing ascending infection and contaminate the uterus when the cervix is open. Pneumovagina may lead to an urovagina (urine pooling within the vagina) when the vestibule and urethral opening are displaced cranially. In this situation, contamination with fecal material adds to the increased risk of infection.
Vulvovaginal constriction: immediately in front of the external urethral opening is the vulvovaginal constriction or vestibular seal. In genitally healthy mares, this forms the second line of defense against aspirated air and fecal material. In a normal mare, the vestibulovaginal area remains sealed even when the vulvar labia are parted. Compromised vestibulovaginal sphincter function is suspected when air is sucked into the vagina of compromised secondary to rectovaginal tears and other foaling injuries.
Cervix: forms the important third (and last) protective physical barrier to protect the uterus from the external environment. The cervix must also relax during estrus to allow intrauterine ejaculation or insemination of semen and drainage of uterine fluid, late pregnancy, and the immediate postpartum period. An inflammation of the cervix is usually associated with endometritis and/or vaginitis.
If the closure of the vulva is compromised, it results in the development of a pneumovagina with consequent aspiration of bacteria and other contaminated products [5]. The initial development of vaginitis can result in cervicitis and acute endometritis and therefore can lead subfertility. Usually, in mares, contamination of the caudal reproductive tract with bacteria during pregnancy can result in embryonic death. In late pregnancy, it can result in the development of placentitis and abortion [4, 6].
The more severe conformational abnormalities result in failure of the vulval closing, increasing fecal contamination since the vulva forms a platform in which feces can collect. In these cases, the vulval lips are angled at 25° for even 50° to the vertical. According to Bradecamp [6], defective vulval conformation can be:
Congenital, rare to find.
Acquired, which is due to vulval enlarging resulting for the repeated foaling, injury to perineal tissue and poor body condition (old, thin mares). Older and pluriparous mares are frequently affected with pneumovagina. However, in cases of young mares that are in work and have little body fat and/or poor vulval conformation, it can develop these pathology.
Pneumovagina might occur during estrus when the perineal tissues are more relaxed. Some mares make a noise while walking; however, the diagnosis of other mares may be difficult by the absence of noises. The pathognomonic sign is the presence of hyperemia and a frothy exudate in the anterior vagina, on examination with a speculum. Poor cervical dilation may reduce uterine clearance, while cervical damage or incompetence may predispose to infection. Finally, susceptible mares may accumulate more fluid within their uterus than normal mares because of a greater production of glandular secretions secondary to inflammation. The consequence of decreased physical clearance is that bacteria, inflammatory by-products and fluid remain in the uterine lumen, inducing more inflammation, mucosal cell damage, and fibrosis. The persistent inflammation may result in premature luteolysis. Ultimately, chronic inflammation results in degenerative changes within the endometrium and reduced fertility [5–7].
Real-time ultrasound examination of the uterus may reveal the presence of air or urine as hyperechoic or hypoechoic foci seen at the opposed luminal surfaces, respectively. Cytological and histological examination of the endometrium may demonstrate significant numbers of neutrophils indicative of an endometritis [6]. The clinical presentation of acute or chronic reproductive tract infections in the mare is salpingitis, cervicitis, and vaginitis [2, 5].
Vulvitis (inflammation of the vulva), vaginitis (inflammation of the vagina), and cervicitis (inflammation of the cervix) can develop due to different reasons such as difficult labor, chronic contamination of the reproductive tract due to poor conformation, sexually transmitted diseases, or mating. Bruises and hematomas (a pool of blood under the surface of the skin) of the vagina may be found in mares following delivery of a foal. Severe inflammation of the vulva and vagina, including local tissue death, may also occur [8]. Infectious vaginitis and cervicitis may occur as part of the uterine infection process or as a result of local irritation or laceration. Vaginal injuries secondary to breeding or parturition may lead to abscess formation and adhesions [9].
The sinus and fossa clitoral (the folded lining near the clitoris) should always be considered as a location of bacterial growth. The clitoral swabs are taken from the clitoral fossa and the clitoral sinuses to rule out acquired
Among causes that produce infectious vulvitis and vaginitis include contamination by
Equine coital exanthema is a benign venereal disease caused by equine herpesvirus type-3 (EHV-3). EVH-3 is a member of the subfamily Alphaherpesvirinae [13]. Although the primary route of transmission is venereal, outbreaks have been documented in which transmission occurred through contaminated supplies and instruments or by the use of a single glove for rectal examination of many mares [14]. Clinical signs in mares might develop 4–8 days after sexual contact and are clearly expressed by the presence of numerous circular red nodules up to 2 mm in diameter on three different parts of the genital tract: vulvar and vaginal mucosa, the clitoral sinus, and perineal skin. These lesions primarily develop into vesicles, then into pustules and eventually rupture, leaving shallow, painful, ulcerated areas that may amalgamate into larger lesions. Edema can develop in the perineum and may extend between the thighs. Sometimes, ulcers will be found on the teats, nasal mucosa, and lips. Secondary infection of the ulcers by
Dourine also produces vulvitis, vaginitis, and cervicitis in the mare. Dourine is sexually transmitted disease caused by the protozoan parasite,
CEM is a transmissible, venereal disease of horses produced by the bacterium
Other microorganisms that have been isolated from fossa and sinus clitoral are
Despite significant research and study, endometritis continues to be a major clinical problem in broodmare practice and a major source of subfertility. Appropriate diagnosis and treatment are imperative when attempting to get these mares in foal. Many cycling mares fail to conceive due to infections in their reproductive tracts and for this reason they are called “dirty mares.” Dirty mares or mares with endometritis refer to the acute or chronic inflammatory process involving the endometrium. Reduction of fertility associated with endometritis—both acute and chronic—has been recognized for many years. This subfertility is due to an inappropriate environment within the uterus for the development of the embryo. In some cases, the endometritis may cause early regression of the corpus luteum (CL). One of the main obstacles in producing the maximum number of live, healthy foals from mares bred during the previous season is the mare, which is susceptible to persistent, acute endometritis following breeding [24–26]. A combination of a bacteriological and a cytological examination improved the diagnostic performance in subfertile mares [27].
Positive cytology to
The key to successful management of these mares is to identify them before or shortly after breeding and manage them appropriately. Treatment generally consists of a combination of uterine lavage and ecbolic administration to enhance uterine clearance and administration of intrauterine antibiotics [29–32].
Overall, endometritis is classified as follows [33]:
Venereal infectious endometritis.
Nonvenereal infectious endometritis.
Persistent post-mating endometritis.
Endometriosis (chronic degenerative endometritis).
Chronic infectious endometritis.
The uterine lumen of the normal fertile mare is bacteriology sterile despite the fact that the reproductive tract is contaminated with bacteria from the act of breeding, foaling, and veterinary procedures. As it has been previously expressed mares with imperfect vulval conformation can input air with bacteria into the genital tract, which can develop into endometritis. The uterus responds to these bacteria with a rapid influx of neutrophils killing the bacteria rapidly (within 24 hours). Then, these inflammatory products are mechanically removed, and the endometritis resolves itself. Usually, the failure to resolve this inflammation results in what is commonly known as “susceptible” mare. This “susceptible” mares have a delay in uterine clearance, and the inflammatory products accumulate as uterine fluid. Such mares have a reduced pregnancy rate due to an inappropriate environment for the early development of the embryo [34]. However, the reproductive tract of mare possesses various mechanisms to protect itself against infection: physical barriers as vulva, vestibulovaginal sphincter, and cervix, local immune mechanisms and the physical ability to eliminate products of inflammation, as described below. The uterine infections become established when one or several of these natural defense mechanisms fail or become overwhelmed. These infections become established when normal defense fails to clear potentially pathogenic organisms that are introduced into the uterus. The most common sources of uterine contamination include coitus, parturition, AI, septic genital examination, and manipulation. Age, parity, number of barren years, and uterine biopsy grade influence likelihood of persistence of infection [2].
The uterine cavity is protected from ascending infection by several anatomic structures. The first line of defense in the prevention of contamination of the vagina and eventually the uterus is provided by the seal of the normal vulvar labia. The second physical barrier is the vestibulovaginal sphincter. And the third important anatomic barrier is the cervix. However, in some mares, compromised cervical function is observed, and its entity may remain open during anestrus and even diestrus. The most common cause of cervical incompetence is a lesion consequent to dystocia [3]. A plan for treatment and prevention of uterine infection should include a plan to reestablish normal barrier function. Surgical procedures such as episioplasty, vestibulovaginoplasty, and rectovaginal tear repair should be considered if indicated and reestablish the uterine contractility in the elimination of bacteria, fluid, and inflammatory products from the uterus after breeding [35].
An adaptive immune response in the mare’s uterus has been demonstrated. The endometrium of the mare is inhabited by T lymphocytes. Genitally normal mares had greater numbers of CD4+ (TH cells) and CD8+ cells (TC cells) in the stratum compactum than in the stratum spongiosum. The density of these cells was either increased during estrus or found to be independent of cycle stage. Also it was not influenced by age and larger numbers of CD4+ and CD8+ cells that are present in the uterine body than in the uterine horns. Following insemination or mares with endometritis, the number of CD4+ and CD8+ cells is increased. Thus, the number of CD4+ cells doubled in lymphoid aggregates, and the number of CD8+ cells in the luminal and glandular epithelium increases. Therefore, an adaptive response is initiated following antigenic stimulation of the endometrium [24, 36].
As the most common etiological agent in bacterial endometritis,
On the other hand, cytokines play an important role in the reproductive processes [39]. The complexity of their regulation is due to pleiotropism of cytokines, where each cytokine has multiple target cells of different organs and where responses may differ according to cell type. The response to endometritis is mediated by inflammatory mediators such as leukotriene B4 (LTB4) and prostaglandins (PG) E2. Mares susceptible to endometritis have a higher expression of pro-inflammatory cytokines (interleukin-1 β-I; L-1β), IL-6, and tumor necrosis factor-α (TNF-α) during estrus and IL-1β and TNF-α during diestrus [24, 34]. An overregulated endometrial gene expression of pro- and anti-inflammatory cytokines (IL-1β, IL-6, IL-8) and a systemic acute phase response (APR) have been described in mares with experimentally induced
In response to endometritis, endometrial mRNA transcripts of pro-inflammatory cytokines are excellently regulated in resistant mares. These resistant mares have an initial high-expression levels followed by normalization within a short period of time. By contrast, susceptible mares have an extended expression of pro-inflammatory cytokines, leading to the hypothesis that an unbalanced endometrial gene expression of inflammatory cytokines might play an important role in the pathogenesis of persistent endometritis [36, 38]. In addition, endometritis gives rise to a systemic APR and an up-regulated endometrial gene expression of serum pro- and anti-inflammatory cytokines and serum amyloid type A (SAA) [28, 36].
The contact of endometrium with infectious agents results in altered synthesis and secretion of inflammatory mediators (cytokines and arachidonic acid metabolites) and disturbs endometrial functional balance of PGE2, PGI, PGF2α, and leucotrienes [41]. The events leading to endometritis are initiated by a local reaction to the primary antigen, with production of inflammatory mediators, especially PGE2, and neutrophil influx. Increased vascular permeability resulting from proinflammatory mediators exacerbates the neutrophil influx and leakage of serum proteins into the uterus [2, 42]. PGF2α is considered as the most accurate markers of inflammation during endometritis for use in practice [42]. Furthermore, in sustained endometritis in mares, PG may not only cause early luteolysis or early pregnancy loss but may also be related to endometrial fibrosis pathogenesis by stimulating collagen deposition [43].
The predominant immunoglobulins (Igs) in the uterine secretions are IgG, IgM, and IgA produced within the endometrium. Uterine Ig concentration does not differ between mares susceptible and resistant to endometritis, suggesting that this is not a major factor in susceptibility to infection. Susceptible mares tend to have slightly higher concentrations of intrauterine Ig than do resistant mares, but susceptible mares are less efficient at opsonizing streptococci during acute infection [44, 45]. The inoculation with
In addition to the traditional functions, neutrophils are able to release DNA in response to infectious stimuli, forming neutrophil extracellular traps and killing pathogens [46]. Neutrophil chemotaxis is induced by bacteria, endotoxin, spermatozoa, semen extenders, and sterile water and saline solutions. A massive entry of neutrophils into the uterine lumen occurs in both susceptible and resistant mares after local exposure to foreign proteins. In some mares, this stimulation causes a persistent-induced endometritis. Therefore, neutrophils play an important role in this phenomenon, and their effects are exacerbated if bacteria are present.
Susceptible mares have higher nitric oxide (NO), which is a bactericidal agent produced by macrophages and neutrophils following incorporation of microorganisms than can cause myometrial relaxation in their uterine secretions and greater inducible NO expression compared with resistant mares. The NO facilitates smooth muscle relaxation, but its role in persistent endometritis is a possible role of NO, either directly or in a NO-associated pathway, in delayed uterine clearance [47]. The activated neutrophils also are an important source of reactive oxygen species (ROS), which can play a role in the pathogenesis of endometritis in mares [42, 48].
Resistant mares are able to eliminate most fluid in response to the effects of oxytocin and PG on the myometrium. Susceptible mares fail to eliminate fluid often because of intrinsic endometrial or myometrial pathology that reduces uterine contractions less efficient in uterine clearance. The phagocytic activity of neutrophils is higher on entry into the uterine cavity [44]. Phagocytic activity may be highest during estrus since in ovariectomized mares treated with estrogens neutrophil phagocytic activity was greater. Phagocytic activity of circulating neutrophils is no different between susceptible and resistant mares; however, phagocytic activity and life span of uterine neutrophils are significantly reduced in susceptible mares. Susceptible mares also have additional uterine clearance problems and accumulate more fluid, which may contribute to a reduction in the viability of neutrophils [24, 44].
Young mares experimentally inoculated with
Opsonizing activity in the uterus has a peak of 8 hours after inoculation with
The prevention of persistent infection is due to physical clearance of pathogens and inflammatory debris from the uterus and is most effective during estrus [50]. However, mares susceptible to infectious endometritis are unable to eliminate bacteria from the uterus in the immediate post-ovulatory period [51]. Younger mares are able to eliminate both
Some anatomic changes, such as pendulous uteri or broad ligaments, defective myometrial activity and degenerative changes to the vascular and lymphatic drainage of the uterus, are also involved in delayed uterine clearance and the pathogenesis of the endometritis. Ulceration, degeneration, or lack of cilia of the endometrium may be involved in failure of mucociliary clearance [52, 53].
In susceptible mares, myometrial contractions are less frequent and of shorter duration and intensity, perhaps because of increased fibrosis or another biochemical factors affecting uterine contractibility. Alghamdi et al. [47] informed that uterine contractions are reduced in the presence of NO, which is found in high concentration in susceptible mares.
Strzemienski et al. [54] reported that cell-free uterine flushes from mares in mid-diestrus possess antibacterial activity. However, Johnson et al. [55] have failed to demonstrate inherent antibacterial activity of uterine fluid from noncycling mares or from E2- or P4-supplemented ovariectomized mares. The discrepancy in the results from these studies may be based on any qualitative and quantitative differences between the uterine secretions from cycling and noncycling mares. Recently, it has been identified in the equine endometrium an antimicrobial and immunomodulator member of the transferring gene family that is expressed by epithelial cells and neutrophils. Lactoferrin’s antibacterial property lies in its ability to sequester-free iron, thereby inhibiting bacterial growth. Although lactoferrin expression was overregulated during early estrus, protein staining was uninfluenced by cycle and was most intense in the glandular epithelium. According with Kolm et al. [56], expression of lactoferrin was increased in mares with delayed physical clearance during early estrus, which might represent a response to inflammation. From the point of view of host–pathogen interactions, unless a diminished response in lactoferrin expression and production were observed, it is unlikely to explain how this could be a factor in susceptibility to endometritis.
It has been suggested that mucociliary clearance may play an important role in the clearance of infections and that disruption of mucociliary currents in the susceptible mare leads to persistence of infection [33]. Mucus production and secretion and optical density are increased during estrus in mares with delayed clearance. The biological implication of these alterations in the mucus is unknown. The effects of fluid accumulation and uterine pathogens on mucociliary clearance are basis for future research [57]. Bacterial pathogens of the uterus affect the elasticity and stickiness of the uterine mucus. It was identified that
Infection produced by opportunistic microbes is a major cause of infertility in the mare and inflicts major losses on the equine breeding industry due to early embryonic loss, placentitis, birth of septic foals, and postpartum metritis. Early pregnancy loss is estimated to affect 25–40% of the broodmares and uterine infections reported in 25–60% of barren mares [2].
The organisms most frequently isolated from mares with acute endometritis are
At a rate of up to 50% of the endometritis cases,
Other commensal bacteria isolated from reproductive tract of mare include
The pathogenicity of bacteria depends on their ability to adhere to the endometrium, preventing their removal by normal uterine clearance mechanisms. Adhesive proprieties of
In contrast to a true sexually transmitted diseases, persistent infectious endometritis is often the result of contamination of the uterus by the mare’s fecal flora combined with compromised uterine defenses [24, 67]. Different bacteria such as
Most mares presented with fungal endometritis have a history of previous bacterial endometritis. These mares usually undergo intense therapy that includes frequent uterine lavages and intrauterine infusion of antibiotics. The frequent uterine manipulation, associated with anatomical problems leading to pneumovagina, results in chronic contamination of the uterus. In addition, antibiotics drained from the uterus alter the normal bacterial flora in the vagina, predisposing to an excessive growth of opportunistic fungal organisms, making the vagina and external genitalia the primary reservoir for pathogens. Affected mares tend to be old and pluriparous with poor perineal conformation or maiden mares with cervical incompetence. Mares may have been treated repeatedly with intrauterine antibiotics, have normal or abnormal estrous cycles, may be presented with a history of anovulatory follicles, or have endocrine dysfunction such as equine pituitary disorders or insulin resistance. Prolonged progesterone therapy may predispose mares to fungal endometritis because cervical drainage is decreased and uterine muscular activity and neutrophil function are altered [4]. Other factors contributing to fungal infections include the presence of a moist environment, exposure to a large number of fungi and the presence of necrotic focus as occurring with trauma, abortion, and retained placenta [4, 70].
Diagnosis is based on the presence of fungal elements and inflammatory cells in endometrial smears. Yeast appears as small, round, single cell, brown to black spores on cytological smears obtained from infected mares, whereas molds have long filamentous hyphae [4, 71]. It has suggested that the hyphae are more invasive than yeast and, consequently, more difficult to treat and eliminate.
Another important observation about the difficulty in treating fungal infections is the ability of certain species to produce biofilms, both
Prolonged antibiotic therapy may be a predisposing factor for yeast overgrowth [69]. The use of antibiotic-containing semen extenders for AI may be partially responsible for the apparent increase in the number of mares with fungal endometritis. Transmission of fungal organisms from stallions has not been demonstrated, although fungi have been cultured from the urethra (
In terms of impairment of fertility, the significance of these organisms in the mare and the stallion is not yet well established [1].
Pyometra may be produced by accumulation of a pus accumulation in the uterus in addition to the persistence of the CL beyond its normal lifespan [75].
Pyometra can be caused by different causes. Including interference cleaning liquid is described from the uterus, obstruction of flow caused by the cervix closed by hormonal influence or cervical pathology such as fibrosis and adhesions, or secondary to trauma, such as experienced during dystocia. Progesterone from a persistent CL can close the cervix. Similarly, exogenous progesterone administered continuously cleaning the uterine avoided. Endometrial cups have been observed as a cause of pyometra where no fetuses or fetal membranes were found within the uterine lumen [76].
Intrauterine accumulation of purulent material was observed in mares with open cervix [77]. These mares may have an innate resistance to a reduced endometrial infection, which can progress to a pyometra [4]. The most common organism associated with pyometra in the mare is
Mares with pyometra have vulvar discharge when the cervix is relaxed or open. The pus is often creamy, it may be variable, with higher volumes associated with, watery, thin gray appearance. Smaller volumes are associated with pus cheesy exudate thickened. Rarely are clinical signs of systemic disease [79].
The bacterial diseases with potential capacity of be transmissible through fresh-cooled or cryopreservated semen are
Exist other diseases that may be transmitted very infrequently by this route or that potentially could be disseminated through contamination of semen. These diseases are as follows:
Internal genital infections of the testes, epididymis, and accessory sex glands, the major of which are bacterial in nature, such as
Acute to chronic systemic diseases characterized by circulation of the respective causal agents in the bloodstream, as equine infectious anemia (EIA), equine piroplasmosis;
Infections of the urinary system with the potential for contamination of the urogenital tract, such as leptospirosis, equine rhinitis A virus infection;
A miscellany of infective agents, including viruses, bacteria, mycoplasmas, chlamydiae, fungi, and yeast that may shed in semen [18].
Infections caused by
Although
CEM is a transmissible, exotic, venereal disease caused by
Thoroughbred horses appear to be more severely affected by the disease than other breeds. Because animals may be asymptomatic, the disease is difficult to detect and control. Due to its high contagiousness, CEM is a serious disease and can have detrimental consequences on equine reproductive efficiency. When CEM becomes established in the United States, the horse industry suffered great economic losses [1].
Initial exposure to the disease usually results in infertility. An infected mare may fail to conceive or abort. The disease frequently is associated with an endometritis [18, 83]. Abortion due to
The exposure of the mare to
The infertility is temporary (only a few weeks), with adverse effect on a mare’s fertility. Persistence of
In contrast to the mare, exposure of the stallion to
Equine viral arteritis (EVA) is a contagious viral infection affecting both mares and stallions. Prevalence of EVA ranges from 1–3% in Quarter Horses to 7% in Arabians and Thoroughbreds and to 80% in Standardbreds. Mares clinically affected with EVA may show fever, limb edema, anorexia, depression, inflammation around the eyes, nasal discharge, skin rash, and abortion. The significance of EVA infection in stallions is that certain strains can develop carrier status in 30–60% of infected stallions. Carrier stallions can transmit the virus by natural breeding or AI with fresh, cooled, or frozen semen. Mares bred with EVA-infected semen may lead to outbreaks of abortion and deaths in foals [90]. Due to these reasons, EVA is responsible for major restrictions in the international movement of horses and semen. Serologic or blood testing is used for screening both mares and stallions. Detectable antibody titers develop 2–4 weeks following exposure and are maximal at 2–4 months and remain stable for several years. If a stallion is serologically positive, the presence or absence of virus in his semen should be determined to confirm if he is a chronic carrier or shedder of the virus. The carrier state has only been documented in adult stallions. It should be emphasized that not all seropositive stallions are shedders and carriers of the virus [91].
In the stallion infection of the testes, epididymis and accessory glands may be a localized or part of a systemic disease. Though rare in occurrence, orchitis caused by a range of bacteria including
Due to their potential to be transmitted by the venereal route acute and chronic systemic infectious diseases, they have come under consideration. These diseases included Eastern equine encephalomyelitis and Western equine encephalomyelitis, West Nile encephalitis, vesicular stomatitis, African horse sickness, EIA, and equine piroplasmosis. They can also pose a risk of venereal transmission if at the time of breeding or semen collection there is trauma of the stallion’s genitalia, bleeding, and contamination of the ejaculate with blood containing the respective etiological agent [18].
To date, there is no evidence of occurrence of venereal transmission of any of the aforementioned diseases, with the exception of piroplasmosis, in which mare showed
Usually, an underlying condition, such as pneumovagina, predisposes the horse to chronic infectious endometritis. The definitive diagnosis is by biopsy should show endometrial infiltration with lymphocytes and plasma cells. Chronic infectious endometritis is more common in older mares and primiparous mares with poor perineal conformation. The predisposing factors for chronic infections in mares include self-repeated contaminations, cervix fibrosis, cervical tears or adhesions, and/or “mare older maiden” syndrome and mares in which holes uterus well below the edge of the pelvis. The organisms most frequently isolated in cases of chronic infectious endometritis include the same of acute (
A close examination of the reproductive system by rectal ultrasound can provide evidence of chronic inflammation or infection. The accumulation of fluid within the uterine lumen, endometrial edema, the presence of hyperechoic spots within the uterine lumen, and an even greater thickness of the uterine wall can all be signs of chronic infection. Culturing of endometrial biopsies or uterine fluids is more sensitive for the identification of
Chronic degenerative endometritis or endometriosis is degenerative change that occurs in older mares or following repeated inflammation of the uterus. Degenerative fibrosis can be the result of normal aging processes or may be the end-product of a life of continuous reinfection: anyway, healing uterine mucosa causes infertility in older mares [34]. Problems related to weaken reproductive structures can cause urinary retention, a condition in which the mares do not empty completely urine, especially during estrus. Thus, the retained liquid can cause inflammation and prevent conception. The use of antibiotics is not always good. One of the disadvantages of using antibiotics is the fact that kills good and bad bacteria, leaving the animal with no natural protection against future bacterial or fungal invasions. The definitive diagnosis can only be achieved by biopsy, which shows degenerative histological changes in the uterus [93].
Inflammation of the endometrium is caused by a response to exogenous materials introduced directly into the uterus at breeding, as components of the semen, extender in the case of AI, bacteria, and other debris [24, 96]. Two hormones, PGF2α and oxytocin, regulate myometrial contractions after the influx of neutrophils into the uterine lumen and their phagocytic activity after opsonization of the target [67]. This uterine defense mechanism reaches a pick at around 6–12 hours post-mating or AI [97]. In normal mares, most of the inflammatory products are cleared by physical uterine mechanisms within 48 hours after breeding, and the infection is cleared before the embryo leaves the fallopian tube and enters to the uterus on about days 5–6 post-ovulation [98], the uterine inflammation has to be under control by 96 hours post-ovulation to maximize survival of the embryo [67]. A susceptible mare with persistent post-mating endometritis is unable to clear such fluid by 96 hours, and the resulting prolonged inflammation generates an embryo-toxic environment. In addition, premature lysis of the CL is caused by PGF2α and subsequent progesterone deficiency, all contribute to embryo mortality and infertility [99]. This is more common in older and multiparous mares. They present with a history of short cycling and often and vaginal discharge approximately 2 weeks post-breeding [100].
After abdominal surgery or peritonitis, infectious inflammation of the ovaries (oophoritis) with abscessation and peritoneal adhesions may occur. Oophoritis could be a consequence of repeated transvaginal ultrasound-guided follicular aspiration [101, 102]. Affected mares present abdominal pain, anorexia, fever of unknown origin, and weight loss. Transrectal ultrasonography can help in the diagnosis of these infections. For the extend evaluation of the lesions and confirmation of the diagnosis, laparoscopy may be achieved. Ovariectomy is usually required for treatment of this condition [103]. Although it is rare in the mare, salpingitis may result from ascending infection of
Postpartum uterine infections are of particular importance because of their severity and effect on the general health of the mare. The incidence of postpartum metritis—i.e., infection of the uterus within 7–10 days postpartum, sometimes involving the endometrium, myometrium, and perimetrium—in foaling mares is low but increases when birthing trauma and/or retained placenta occurs [2, 3]. Septic postpartum metritis is often a result of nonhygienic manipulation during foaling, obstetric manipulations, and retained placenta. Mares with postpartum may present severe systemic complications as endotoxemia and laminitis. The etiology of septic/toxic metritis is associated with uterine atony or inertia. Trauma to the uterus, autolysis of placental remnants, and excessive lochia accumulation likely contribute to rapid growth of gram negative as
The novel Coronavirus (referred to as Covid-19) in the rest of this chapter caused major disruptions worldwide during 2020. Industries across the globe have been forced to rethink their operational models to ensure resiliency when faced with disruptions like the Covid-19 pandemic. Organizations have had to get accustomed to conducting business and being profitable despite strict lockdown restrictions imposed by governments, to prevent the rapid spread of Covid-19. In the case of higher education, which services approximately 80% of the student population across 150 countries had to cease in-person learning [1, 2] and transfer to online learning [3, 4] by the end of March 2020. The rapid transfer to online learning resulted in various unexpected costs for institutions, academics, administrative staff, and students [3, 5]. Higher education institutions in South Africa were also impacted by lockdowns, with academics being required to work remotely. Leadership has had to apply a consistent approach in managing academics whilst achieving institutional goals and objectives, by making efficient use of online mechanisms. To date, there has been no evidence indicating which leadership approaches work best for remote teams, especially in the Private Higher Education (PHE) sector [6]. This chapter focuses on the positive impact of leadership consistency on academics and their mandate to serve all students.
The South African higher education landscape consists of approximately 131 private and 26 public higher education institutions, 50 technical and vocational education and training (TVET) colleges, 9 community education and training (CET) colleges, and 287 registered private colleges [7]. This sector is strictly regulated by the Council on Higher Education (CHE), which is an independent statutory quality council overseen by the Department of Higher Education, Science and Technology (DHET) [8, 9]. A record number of 208,978 students (16% of the student population) enrolled at Private Higher Education Institutions (PHEIs) in South Africa in 2019. This figure increases year on year, as there is an extremely high demand for higher education qualifications [9, 10]. This demand is created by the assumption that a higher education qualification increases job prospects and improves the quality of life [11, 12]. It is, however, important to note that the success of PHEIs in South Africa depends on their ability to deliver graduates with industry-relevant competencies that will enable them to actively contribute to the economy and become global citizens [13].
The Covid-19 pandemic exposed the weaknesses of HEI, including their inability to swiftly move to online learning. This inability is mainly the result of higher education institutions (HEIs) not using online learning management systems (LMSs), like Blackboard, Sakai, and Moodle [4, 13, 14, 15, 16, 17, 18, 19]. Some of the most notable challenges that leaders have had to manage to include:
Academic’s resistance to a methodological change in teaching and learning practices through an LMS.
Time constraints on the development of adequate, skills-focused assessments online and in open-book format to assess students’ knowledge competencies [20].
The ability of academics to incorporate new technological tools and software to enable student learning in the online environment [20]. The lack of technological skills and inability to quickly master online software and technology, which placed further stress and anxiety on academics and students (on top of the shorter academic semester) [19].
Student engagement, which has proven even more challenging online given the disruption that comes with the use of the technology when teaching through online platforms [21].
The Covid-19 pandemic has been impacting academics and students, with leadership having to find ways to save the academic year without compromising education quality or academics and student wellbeing. The sudden shift to online teaching and learning impacted academics’ ability to effectively deliver on deadlines [22]. Leadership teams have had to ensure that students continue their studies whilst academics continue to deliver on the PHEI’s mandate. This requires consistency in current leadership approaches with a slight adjustment to the application of the leadership style.
A unique feature of HEIs in South Africa is each institution’s perception of quality and how it should be applied (in conjunction with institutional strengths) to achieve its goals [15]. This creates diversity amongst the various HEIs; each institution views itself as unique and the best in delivering graduates to the market. There is a constant drive to ensure that high-quality graduates gain immediate employment and that business intelligence software is used to identify potential gaps in the learning process. However, the social, economic, and policy/governance conditions [23] in South Africa make it extremely challenging for leadership, especially at PHEIs, to keep academics engaged despite the constant changes in the regulatory and external environment. The biggest challenge since the restructuring of HEIs in the early 2000s has been the transformation into a digital learning community, which was fast-tracked by the Covid-19-pandemic. This fast-tracked shift to online teaching and learning has raised several questions about the equality, accessibility, training, and accountability of academics from a student perspective [4, 24]. HEI leadership had to carefully consider how the sudden shift to online learning would affect PHEI students and academics. As such, leadership has had to remain principle-driven in the decision-making process and ensure that students are at the center of each decision [17]. In addition, leaders in this sector are required to be flexible, adaptable, and reflective in their leadership approaches, especially during times of disruption or change [25, 26, 27].
An individual’s ability to influence others in reaching a common goal or objective, using a motivation to establish coherence amongst the team [16, 17, 28], is considered leadership. It is the leader’s responsibility to continuously monitor the external environment and influence the team’s approach in achieving a goal. A leader gives direction when no one else can see the way forward. The Covid-19 pandemic forced HEI leadership teams to reaffirm and showcase their abilities to get teams on board and implement changes as a collective to ensure students successfully complete the academic year [4, 26, 29, 30]. Leadership teams had to ensure that academics, operations, administration, information technology systems, and facilities departments (amongst others) worked together to deliver exceptional service and support to students during the shift to online learning.
With the constant change in HEIs, leaders must constantly adapt to the changes in the external and internal business environments, whilst prioritizing the aim and purposes of the institution [24, 26]. The vision of the PHEI in question is to provide students with a quality higher education experience, focusing on equitable delivery of material and assessments through the institution’s LMS. In addition, the PHEI in question aims to leave no student behind and ensure that students become global citizens who, at some point in time, will pay it forward. The vision of the institution has always been its main driver, and this did not change during the hard lockdown (27 March to 21 April 2020). Rather, the institution reaffirmed its vision amongst academics and found solutions to better support students and make its vision a reality. The extent to which leadership teams promoted efficacy amongst their teams was critical to the success of the new working conditions and the delivery of quality higher educational material and assessments to students [31].
Table 1 provides an overview of the various leadership approaches that exist. Given this chapter’s nature and purpose, middle-level managers in a PHEI was the target population. At middle-level management, it is important that leaders focus on achieving the goals and objectives of the PHEI as determined by the senior executive team. The other two leadership categories (contemporary leadership and emerging approaches to leadership) align with lower levels of management and executive management, respectively. It could, however, be argued that leadership is not just one of these styles, but the ability to analyze situations and apply whichever leadership style is necessary to ensure that a specific goal is reached.
Leadership category | Leadership style/approach | Summary |
---|---|---|
Contemporary leadership |
| |
| ||
| ||
| ||
New leadership paradigm |
| |
| ||
| ||
Emerging approaches to leadership |
| |
| ||
| ||
|
Summary of leadership approaches [32].
Leaders in the PHE sector must constantly wear two hats: an academic hat and a business hat. It is close to impossible to have these two idealists join in a conversation and agree on matters without significant debate. If the debate aligns with other HEIs, the academia and arguments around it often get a seat at the table. When a disruption like Covid-19 occurs, it becomes difficult to find a solution that will be beneficial to the business (financially and sustainably), and ensure that students continue to receive a quality education during the disruption. This requires that academic leadership teams in PHEIs have a variety of leadership skills while following a consistent leadership approach and successfully marrying business and academia. It takes time and effort to get a workable solution that ensures student-centricity and business sustainability. Consistency in leadership is what ensured the PHEI in question’s success and enabled it to guide academics and students through the hard lockdown as well as the enduring pandemic.
Table 1 shows the variety of leadership styles available. This research emphasizes the characteristics of transactional leadership, transformational leadership, and crisis leadership. All three of these leadership approaches align with the PHEI in question, as it is has remained goal-oriented (transactional) and people-oriented (transformational) throughout the pandemic (crisis). These three approaches will be unpacked in the following. The findings will showcase how a blend of these three theories ensured academic consistency and efficacy in delivering quality higher education to students.
Educational leaders applying a transactional approach clearly define individual roles and responsibilities in alignment with organizational processes and procedures, whereafter an agreement is reached on the timeframe within which goals must be achieved [33, 34, 35, 36]. A reward or incentive is in most instances attached to an individual’s key performance areas (KPAs) and takes the form of performance bonuses, additional leave, salary increase, or (in cases of unsatisfactory performance) disciplinary action [36, 37]. The relationship that exists in this leadership approach is often a leader vs. follower approach, which could be detrimental to individuals wanting to challenge the status quo and bring new ideas to the table. Leaders applying this form of leadership are more focused on achieving organizational goals and objectives than on developing individuals in gaining more skills and improving organizational processes and procedures.
Transformational leaders focus on developing and inspiring individuals through a collaborative approach by being proactive about change whilst staying focused on the institutional goals and objectives [33, 35, 37]. These leaders carefully analyze academic’s expectations and then influence them and gain their trust. Additional support and guidance are provided to help academics align their personal goals with that of the institution, ensuring that individual and organizational goals and objectives are met [38, 39, 40, 41]. Solidarity keeps transformational leaders moving forward, as long as the goals and objectives to be achieved are framed with the collective approach in mind. The problem with transformational leaders is that they can be both charismatic and narcissistic in their approach to transforming others in reaching organizational goals and objectives. Furthermore, these leaders are often ignorant of present challenges and only focus on the future and how the future will look and feel different from the present [35]. This often puts more pressure on academics to achieve the future self, just to arrive there and find that the goalpost has shifted again. Ultimately, the transformational leader is one that inspires, motivates, stimulates, and gives individual attention to academic, making them feel a sense of value and worth [39, 40, 42].
The fast reaction required by HEI leaders in South Africa to shift to online teaching and learning leans itself to the preferred leadership style to apply. Given the fast-changing pace of higher education, being flexible, adaptable, and able to predict future changes from the volatile external environment is a key competency for any leader, whether it is related to a crisis or not [43]. There are three key factors that leaders face when leading a team through a crisis, namely: the ability to “improve awareness of the factors that constitute a crisis”; “the ability to clearly explain the experiences associated with the crisis being dealt with”; and “the ability to navigate a crisis” [43]. It is critical that leaders who find themselves in a crisis situation have the ability to clearly direct the attention of academics to where their focus should be and how to resolve the crisis; make sense of the situation and communicate a clear message to the teams so that everyone is on the same page; promote the collaborative work culture until the crisis has been resolved; and engage in adaptive leadership styles to ensure that the ultimate goal of the organization is achieved throughout the crises [4, 24, 44].
It is evident that a mixture of the three leadership approaches enabled the PHEI in question to successfully support students and academics through the hard lockdown and enduring pandemic in 2020. One leadership approach would not have had the same impact as a combination of the three leadership styles, together with consistency. The sudden change of leadership style in a crisis like the Covid-19 pandemic could increase stress for academics and students, confirming the importance of consistency in leadership. What has to be determined is whether or not leaders can follow their leadership approaches remotely using technology in a higher education setting.
The research question focused on determining the impact of Covid-19 on leadership approaches of managers in a PHEI to effectively manage academic performance while they work remotely. The study applied a phenomenology approach in which an inductive qualitative approach enabled the researcher to source rich data on the changes in leadership approaches due to the Covid-19 pandemic [45, 46, 47, 48] directly from the managers and academics.
Semi-structured interview schedules were developed, and the managers and academics were asked similar questions. The application of the inductive approach enabled the researcher to ask “what” managers and academics perceived the leadership approach of the manager to be before and during the Covid-19 pandemic. The “how” question came into effect by asking managers their perception of whether their leadership style had changed and how it changed (if at all) [49]. Academics were asked to describe how they perceived their manager’s leadership style after the first hard lockdown (27 March to 21 April 2020) when they had to work remotely. The four managers from the four faculties that agreed to participate in this research were all interviewed face-to-face at the PHEI in the question’s offices. The academics requested online interviews given that they had to talk about their line managers and were not comfortable doing so in the open-plan offices at the institution where they work. The institution had five faculties at the time of the research being conducted, but only four of the five faculties signed the participant consent form acknowledging their interest in participating in the research. The remaining faculty never responded to any of the email communication that was sent to invite individuals to participate in the research.
The academic parameters included a minimum of 3 years of working experience, the designation of senior academic in their faculty, and at least 3 years of reporting to the relevant line manager. Of the five senior academics who conformed to the parameters at the time, only four academics (one from each faculty, apart from the faculty not participating) indicated their interest in participating in the research. The respondents all agreed to the interviews being recorded and it lasted 45–60 minutes. The interviews took place in November 2020, 8 months after the hard lock down and just before the second wave started in South Africa. This enabled the respondents to reflect on the time that had passed and consider the changes and the effects it had had on them as managers and academics.
The interviews were transcribed, then thematically analyzed by the researcher. The researcher read through the transcribed interviews and identified specific themes identified by each of the managers and the academics. The researcher familiarized themselves with the content of the transcripts, whereafter a coding process followed from which themes were generated. The various themes were reviewed, defined, and written up [50]. The inductive approach enabled the researcher to identify key themes for consideration by managers when it comes to deciding on leadership approaches to apply during a crisis. The credibility and dependability of the data rest on the triangulation of the data from the managers and the senior academic members reporting to the respective managers. This confirmed that the responses from managers are a true reflection of what transpired during the hard lockdown in the respective faculties. The researcher obtained ethical clearance (R. 15,487) from the PHEI to conduct this research.
The findings revealed two core themes, namely consistency during a crisis and the culmination of various leadership characteristics are important. Consistency is critical and it was evident in all the interviews with the relevant managers that minor amendments were made to their leadership style application, but that new styles were not adopted. The academics confirmed this by stating that their managers were “
The crisis leadership style element manifested in the form of weekly faculty meetings changing to daily meetings (educational managers and academics noted this). One of the academics responded by saying: “
A statement from one of the academics captured what another academic said, namely that they have “
Contrary to the view of the authors [51] the educational leaders embraced the online tools and software to support their leadership style through regular informal check-ins with academics, switching on videos to show their faces, and make time in meetings for academic to share their best practices in dealing with hard lockdown regulations [24, 25, 26]. It is clear that educational leaders analyzed the situation and adapted using the relevant tools and software to engage with academics and ensure student material is delivered [52].
This chapter outlined the challenges that Covid-19 brought to the PHEI sector in South Africa. Table 1 summarizes the key characteristics of the various leadership approaches. Each leadership approach is unique and has a specific aim. It is important to note that subordinates will not necessarily analyze the leader’s performance in different situations or circumstances, but rather look at the extent to which the leader practices consistent, fair, and equitable decision-making within the given circumstances. Future research should be done on the leadership applied within public higher education institutions to determine if there is consistency between public and private institutions of higher education.
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His research focuses on biochemistry, biophysics, genetics, molecular biology, and molecular medicine with specialization in the fields of drug design, protein structure-function, protein folding, prions, microRNA, pseudogenes, molecular cancer, epigenetics, metabolites, proteomics, genomics, protein expression, and characterization by spectroscopic and calorimetric methods.",institutionString:"University of Health Sciences",institution:null},{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",biography:"Hiroyuki Kagechika received his bachelor’s degree and Ph.D. in Pharmaceutical Sciences from the University of Tokyo, Japan, where he served as an associate professor until 2004. He is currently a professor at the Institute of Biomaterials and Bioengineering (IBB), Tokyo Medical and Dental University (TMDU). From 2010 to 2012, he was the dean of the Graduate School of Biomedical Science. Since 2012, he has served as the vice dean of the Graduate School of Medical and Dental Sciences. He has been the director of the IBB since 2020. Dr. Kagechika’s major research interests are the medicinal chemistry of retinoids, vitamins D/K, and nuclear receptors. He has developed various compounds including a drug for acute promyelocytic leukemia.",institutionString:"Tokyo Medical and Dental University",institution:{name:"Tokyo Medical and Dental University",country:{name:"Japan"}}},{id:"94311",title:"Prof.",name:"Martins",middleName:"Ochubiojo",surname:"Ochubiojo Emeje",slug:"martins-ochubiojo-emeje",fullName:"Martins Ochubiojo Emeje",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94311/images/system/94311.jpeg",biography:"Martins Emeje obtained a BPharm with distinction from Ahmadu Bello University, Nigeria, and an MPharm and Ph.D. from the University of Nigeria (UNN), where he received the best Ph.D. award and was enlisted as UNN’s “Face of Research.” He established the first nanomedicine center in Nigeria and was the pioneer head of the intellectual property and technology transfer as well as the technology innovation and support center. Prof. Emeje’s several international fellowships include the prestigious Raman fellowship. He has published more than 150 articles and patents. He is also the head of R&D at NIPRD and holds a visiting professor position at Nnamdi Azikiwe University, Nigeria. He has a postgraduate certificate in Project Management from Walden University, Minnesota, as well as a professional teaching certificate and a World Bank certification in Public Procurement. Prof. Emeje was a national chairman of academic pharmacists in Nigeria and the 2021 winner of the May & Baker Nigeria Plc–sponsored prize for professional service in research and innovation.",institutionString:"National Institute for Pharmaceutical Research and Development",institution:{name:"National Institute for Pharmaceutical Research and Development",country:{name:"Nigeria"}}},{id:"268659",title:"Ms.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/268659/images/8143_n.jpg",biography:"Dr. Zhan received his undergraduate and graduate training in the fields of preventive medicine and epidemiology and statistics at the West China University of Medical Sciences in China during 1989 to 1999. He received his post-doctoral training in oncology and cancer proteomics for two years at the Cancer Research Institute of Human Medical University in China. In 2001, he went to the University of Tennessee Health Science Center (UTHSC) in USA, where he was a post-doctoral researcher and focused on mass spectrometry and cancer proteomics. Then, he was appointed as an Assistant Professor of Neurology, UTHSC in 2005. He moved to the Cleveland Clinic in USA as a Project Scientist/Staff in 2006 where he focused on the studies of eye disease proteomics and biomarkers. He returned to UTHSC as an Assistant Professor of Neurology in the end of 2007, engaging in proteomics and biomarker studies of lung diseases and brain tumors, and initiating the studies of predictive, preventive, and personalized medicine (PPPM) in cancer. In 2010, he was promoted to Associate Professor of Neurology, UTHSC. Currently, he is a Professor at Xiangya Hospital of Central South University in China, Fellow of Royal Society of Medicine (FRSM), the European EPMA National Representative in China, Regular Member of American Association for the Advancement of Science (AAAS), European Cooperation of Science and Technology (e-COST) grant evaluator, Associate Editors of BMC Genomics, BMC Medical Genomics, EPMA Journal, and Frontiers in Endocrinology, Executive Editor-in-Chief of Med One. He has\npublished 116 peer-reviewed research articles, 16 book chapters, 2 books, and 2 US patents. His current main research interest focuses on the studies of cancer proteomics and biomarkers, and the use of modern omics techniques and systems biology for PPPM in cancer, and on the development and use of 2DE-LC/MS for the large-scale study of human proteoforms.",institutionString:null,institution:{name:"Xiangya Hospital Central South University",country:{name:"China"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a Principal Investigator and Scientist at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via machine-learning-based analyses of exosomal signatures. Dr. Paul has published in more than fifty peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award, a senior member of the Institute of Electrical and Electronics Engineers (IEEE), and an editorial board member for several international journals.",institutionString:"University of California Los Angeles",institution:{name:"University of California Los Angeles",country:{name:"United States of America"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals. He is currently working on the protective activity of phenolic compounds in disorders associated with oxidative stress and inflammation.",institutionString:null,institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Dr.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329248",title:"Dr.",name:"Md. Faheem",middleName:null,surname:"Haider",slug:"md.-faheem-haider",fullName:"Md. Faheem Haider",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329248/images/system/329248.jpg",biography:"Dr. Md. Faheem Haider completed his BPharm in 2012 at Integral University, Lucknow, India. In 2014, he completed his MPharm with specialization in Pharmaceutics at Babasaheb Bhimrao Ambedkar University, Lucknow, India. He received his Ph.D. degree from Jamia Hamdard University, New Delhi, India, in 2018. He was selected for the GPAT six times and his best All India Rank was 34. Currently, he is an assistant professor at Integral University. Previously he was an assistant professor at IIMT University, Meerut, India. He has experience teaching DPharm, Pharm.D, BPharm, and MPharm students. He has more than five publications in reputed journals to his credit. Dr. Faheem’s research area is the development and characterization of nanoformulation for the delivery of drugs to various organs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/system/329795.png",biography:"Dr. Mohd Aftab Siddiqui is an assistant professor in the Faculty of Pharmacy, Integral University, Lucknow, India, where he obtained a Ph.D. in Pharmacology in 2020. He also obtained a BPharm and MPharm from the same university in 2013 and 2015, respectively. His area of research is the pharmacological screening of herbal drugs/natural products in liver cancer and cardiac diseases. He is a member of many professional bodies and has guided many MPharm and PharmD research projects. Dr. Siddiqui has many national and international publications and one German patent to his credit.",institutionString:"Integral University",institution:null},{id:"255360",title:"Dr.",name:"Usama",middleName:null,surname:"Ahmad",slug:"usama-ahmad",fullName:"Usama Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255360/images/system/255360.png",biography:"Dr. Usama Ahmad holds a specialization in Pharmaceutics from Amity University, Lucknow, India. He received his Ph.D. from Integral University, Lucknow, India, with his work titled ‘Development and evaluation of silymarin nanoformulation for hepatic carcinoma’. Currently, he is an Assistant Professor of Pharmaceutics, at the Faculty of Pharmacy, Integral University. He has been teaching PharmD, BPharm, and MPharm students and conducting research in the novel drug delivery domain. From 2013 to 2014 he worked on a research project funded by SERB-DST, Government of India. He has a rich publication record with more than twenty-four original journal articles, two edited books, four book chapters, and several scientific articles to his credit. He is a member of the American Association for Cancer Research, the International Association for the Study of Lung Cancer, and the British Society for Nanomedicine. Dr. Ahmad’s research focus is on the development of nanoformulations to facilitate the delivery of drugs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"333824",title:"Dr.",name:"Ahmad Farouk",middleName:null,surname:"Musa",slug:"ahmad-farouk-musa",fullName:"Ahmad Farouk Musa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333824/images/22684_n.jpg",biography:"Dato’ Dr Ahmad Farouk Musa\nMD, MMED (Surgery) (Mal), Fellowship in Cardiothoracic Surgery (Monash Health, Aust), Graduate Certificate in Higher Education (Aust), Academy of Medicine (Mal)\n\n\n\nDato’ Dr Ahmad Farouk Musa obtained his Doctor of Medicine from USM in 1992. He then obtained his Master of Medicine in Surgery from the same university in the year 2000 before subspecialising in Cardiothoracic Surgery at Institut Jantung Negara (IJN), Kuala Lumpur from 2002 until 2005. He then completed his Fellowship in Cardiothoracic Surgery at Monash Health, Melbourne, Australia in 2008. He has served in the Malaysian army as a Medical Officer with the rank of Captain upon completing his Internship before joining USM as a trainee lecturer. He is now serving as an academic and researcher at Monash University Malaysia. He is a life-member of the Malaysian Association of Thoracic & Cardiovascular Surgery (MATCVS) and a committee member of the MATCVS Database. He is also a life-member of the College of Surgeons, Academy of Medicine of Malaysia; a life-member of Malaysian Medical Association (MMA), and a life-member of Islamic Medical Association of Malaysia (IMAM). Recently he was appointed as an Interim Chairperson of Examination & Assessment Subcommittee of the UiTM-IJN Cardiothoracic Surgery Postgraduate Program. As an academic, he has published numerous research papers and book chapters. 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Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. 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