Tocolytics.
\r\n\tThe fifth topic is “complications and drug side effects in the treatment of pigmentation disorders”. These include drug allergies, hyper- and hypopigmentation, persistent skin depigmentation, scars, skin burns, and the potential for skin cancer and skin lymphoma. The last topic is called “coping and support along with skin pigmentation diseases”. Increase the quality of life, psychotherapy, team therapy, and asking for understanding and support from family members.
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It represents a major cause of neonatal morbidity and mortality in both developed and developing countries with European and North American figures ranges between 5–10% of all deliveries. In the UK it represents 7.3% of live births
Extreme preterm birth is defined as preterm birth prior to 28 weeks gestation. It accounts for 5–10% of preterm deliveries. The major concern of extreme preterm birth is the significant risk of neonatal mortality as the survival rates are very low at these gestations (0.4% at 22 weeks, 7% at 24 weeks) while the main concern of preterm births above 28 weeks is the neonatal morbidity as the survival rates are 77% at 28 weeks and 97% at 36 weeks.
The aetiology of preterm labour is multifactorial with a common pathway resluting in increased relasee of prostaglandins and cytokines within the cervix, myometrium and fetal membranes. The release of prostaglandins is triggered by infective or inflammatory process [1], uterine overdistension as in cases with polyhydraminons and mutiple preganacy or choriodecudidual haemorrhage as in cases with abruption.
In modern obstetrics, 30–40% of preterm deliveries are iatrogenic. The most common cause of which is severe pre-eclampsia associated with intrauterine growth restriction (IUGR) and antenatal fetal distress. Other common iatrogenic preterm deliveries include, Grade 3 and 4 placenta praevia or placenta abruption with major bleeding, sever IUGR with absent or reversed end-diastolic flow. It is also notable that the increased number of large loop excision of transformation zone (LLETZ) procedures for abnormal cervical cells leads to cervical scarring and iatrogenic cervical incompetence and hence preterm delivery.
Identifying high risk patients is crucial in managing and preventing preterm labour. Prediction of preterm labour is possble through; risk assessment, uterine activity monitoring, cervical length assessment and fetal fibronectin assessment.
Patients with previous preterm labour are at higher risk of having pretem term birth. The risk is 17% after one previous preterm delivery and increases to 28% after two preterm deliveries. Patients with previous preterm premature rupture of membranes (PROM) [2], previous second trimester loss and thoese who are known to have cervical incomptence and congenital uterine anaomalies are at higher risk for preterm birth. Fruther more uterine overdistention as with Polyhydraminos and mutiple pregnancy is associated with preterm delivery. Patient with placental abruption are also known to be at higher risk of preterm labour.
It notable that uterine activity increases prior to onset of pretrm labour by 24 hours. However, the use of home uterine contraction monitors or self palpations has not proven to be useful as they had poor postive predictive vlaues and their use did not improve the perinatal outcomes.
Clinical assessment of cervical status in terms of dilatation, softening and effacement can predict preterm labour, However it has low sensitivity and repeated vaginal examination in it self may incease the cervical prostaglandins relase and subsquently increase the incidnce of preterm labour.
Utrasound assessment of cervical length is a reliable method and highest predictive value up to 70% is notable with cervical length under 25 mm in womens with risk factors for preterm labour. Serial cervical length assessment is recommended in hight isk group between 16–24 weeks. Cervical length is best measured by transvaginal scan with empty bladder as full bladder may lead to false increase in the cervical length measurments. The risk of preterm labour increases from 1% at cervical length of 25 mm to 4% at 15 mm cervical length. The marked increased risk is notable at 5 mm cervical length with preterm birth risk of 78% [4, 5].
Cervical length assessment is not routine in womens with no risk factors for preterm birth as the positive predictive value is low in this group. Also, preventive interventions as cervical cerclage is not recommended in low risk group as they have shown no improvement in the outcome in this group [4].
The presence of funnelling of the internal os is another helpful finding in predicting the preterm birth, However, it is less accurate compared to cervical length assessment due to inter and intra observer variations [6].
Fetal fibronectin is normally present in high concentration prior to 21 weeks of gestation in cervical and vaginal secretions prior to membranes fusion. Inflammatory process, uterine overdistension and choriodecidual haemorrhage increase fetal fibronectin secretion after 21 weeks gestation.
Fetal fibronectin testing by swabbing the posterior fornix or ectocervix between 22 and 34 weeks gestation in recommended as postive results in high risk group especially in presence of symptoms warrant admistration of steriods and hospital admission. Fetal fibronectin testing is not recommeded in womens with no risk factors as it has not shown to be effective in improving the outcome despite more than half of preterm birth occurs in this group [7].
Testing for fetal fibronectin is contraindicated before 22 weeks gestation, in presence of preterm premature rupture of membranes, active vaginal bleeding and intercourse in the previous 24 hours.
Other biochemical markers such as Insulin like growth factor binding protein-1, interleukin-6, interleukin-8 and tumour necrosis factor-alpha (TNF-α) were assessed in research setting for use in predicting preterm labour. However, none of those markers is currently used in routine practice [8].
Preterm birth is associated with significant neonatal morbidities such as respiratory distress syndrome, necrotizing enterocolitis, retinopathy of prematurity, neonatal sepsis, intraventricular haemorrhage and periventricular leucomalacia. Longterm impact of prematurity are mainly cognitive and motor impairement which are more prevelant in extreme preterm births. Prolongation of pregnancy with tocolytic agents and adminstration of antenatal steriods signficantly reduces the neonatal morbidities in preterm births [1, 9].
EPICure data [9] may be useful tool in counselling the parents about fetal prognosis. Neonatal mortality is higher with preterm birth at lower gestational ages with survival rate of 7% at 24 weeks compared to 77% at 28 weeks and 97% at 32 weeks. The survival rates improves 2.2% daily between 24 and 28 weeks gestions. Preterm delivery at 36 weeks is associated with 99% survival rate [1, 9, 10].
Mutiple preventive measures were tested for prevention of preterm labour such as treatment of asymptomatic bacteruria and bacterial vaginosis, prophylactic antibiotics in womens with postive fetal fibronectin and reduced cervical length, cervical cerclage, prophlactic tocolysis and hormonal supplements. Some were proved to be effective in reducing preterm deliveries while others shown no significant diffierence in the outcome regarding the incidance of preterm birth and its associated morbidities.
Bacterial vaginosis occurs in 10–22% of pregnant womens with unknown aetiology. Treating the bacterial vagnoisis and hence reducing its associated inflammatory process was proved to reduce the incidance of preterm birth in womens with risk factors for preterm labour especially those with postive fetal fibronectin testing. Asymptomatic bacteruria occurs in 2–9% pregnant womens and its associated inflammtory process can participate in increasing prostagladins levels in cervicovaginal secretions and hence the preterm birth. Treating asymptomatic bacteruria in high risk group reduces the incidence of preterm birth but not in low risk group.
Antibiotic treatment for prophylactic antibiotics in womens with postive fetal fibronectin and in womens reduced cervical length in absence of infective or inflammatory process is not recommeded due to limited evidence and lack of proven efficacy.
Cervical cerclage proved to reduce the incidence of preterm birth in women with 2nd trimester losses and those with cervical length of 25 mm or less on transvaginal ultrasound between 16–24 weks gestation [4, 11]. Cervical cerclage can be done by transvaginal route (McDonald or Shirodkar techniques) or transadominal route when there is insufficient cervical tissue to hold the suture or when the vaginal approach has failed previously [1, 4]. Counselling prior such procedure is essential to involve the pros and cons. Complications of the procedure can include; bleeding, infection (endometritis), increased frequency of contractions, cervical trauma, preterm premature rupture of membranes, suture displacement, sepsis, cervical scarring. Cervical cerclage is contraindicated in presence of fetal anomaly, intrauterine infection, active bleeding and preterm premature rupture of membranes [1, 6].
Prophylactic tocolysis for high risk women has not proved to reduce the preterm birth rate and is not recommended.
Progesterone supplement via vaginal or intramuscular route on weekly basis till 36 weeks can be considered to promote reduction of uterine activity. Its use is limited to clinical trials in European guidlines [12, 13] while the recent NICE guideline in UK and in North America, progesterone supplementation is recommended for clinical use for reuction of preterm births [1, 14].
Use of cervical pessaries, bed rest and restrticting physical activity and intercourse have no proved evidence of preventing preterm labour [15, 16].
The mangement of preterm labour fall into five areas; the use of tocolysis, adminstration of antibiotics, admistration of antenatal steriods, magnisum sulphate for neuroprotection and finally the considerations for the mode of delivery.
It is important to realise that the aim of tocolysis in modern obstertics is limited to gain few days to allow admistration of antenatal steriods which proved to reduce perinatal morbidities in preterm birth and allow in utero transfer (Table 1).
Tocolytics | Mechanism | Dose | Side effects | Contraindications |
---|---|---|---|---|
Ritodrine - b2-agonists Currently not in use | b2-receptor stimulation reduces free intra-cellular Ca+2 via cyclic AMP and hence muscle relaxation | 50–100 μ g/min IV then, increase by 50 μ g/min every 10 min. (up to 350 μ g/min) | Maternal; Hyperglycemia hypokalemia Tremors and nervousness Dyspnea and chest pain Palpitations and arrhythmia Hypotension Pulmonary edema Fetal/neonatal; Tachycardia Hypoglycemia Hypocalcemia Hyperbilirubinemia hypotension IVH | Dysrhythmias or other significant cardiac disease Diabetes mellitus Uncontrolled thyroid disease |
Calcium channel blockers (CCB) - Nifedipine Currently first line | Inhibit influx of calcium into cell and hence prevent myometrial contraction | 20–30 mg, then 10–20 mg every 4–8 hours (max 90 mg/day) | Maternal; Transient hypotension, headache and dizziness, Nausea Flushing Fetal/neonatal; None | Cardiac disease Hypotension Use with magnesium (collapse) Use with caution in renal disease |
Atosiban - Oxytocin receptor antagonists Currently second line | Competitively inhibit oxytocin receptors | 6.75 mg IV bolus, then 300 μg/min every 3 hours. (max 45 hours) | Maternal; Minimal; Nausea and vomiting Hot flushes Hypotension and dizzness Fetal; None | None |
Cyclo-oxygenase (COX) inhibitors Non-selective; indomethacin Selective (COX-2 inhibitor); sulindac nimesulide | Inhibition of COX leads to reduced PGs synthesis and hence myometrial relaxation | Indomethacin: 50–100 mg loading dose, then 25–50 mg every 6 hours for max 48 hours Sulindac: 200 mg every 12 hours for max 48 hours. | Maternal; Minimal if used for 48 hours; Less with COX2 inhibitors; Peptic ulcerations Thrombocytopenia Postpartum haemorrhage Allergic reaction. Fetal; Main concern; premature closure of ductus arteriosus Risk of neonatal necrotizing enterocolitis, IVH and renal dysfunction | Renal or hepatic disease Active peptic ulcer Uncontrolled hypertension NSAID-sensitive asthma and thrombocytopenia |
Magnesium sulfate (MgSO4) Currently not in use | Intracellular calcium antagonist | Initial: 4–6 g/30 min, then: 2–4 g/h | Maternal; Headache and flushing Lethargy Muscle weakness and diplopia Dry mouth Pulmonary edema Fetal/neonatal; Lethargy Hypotonia Hypocalcemia Respiratory depression | Myasthenia gravis |
Tocolytics.
Ritodrine and other b-agonists as terbutaline, salbutamol were used as tocolytic agent but currently not recommeded as first line due to its maternal and neonatal side effects. They act on b2 receptors in myometrial smooth muscles via a cAMP dependent mechanism leading to reduction in the intracellular calcium causing muscular relaxation. Cochrane review on B2-agonists concluded that they decrease the number of preterm births within 48 hours but not within 7 days [1, 17, 18].
Maternal side effects include; palpitations and arrhythmias, chest pain, hypotension, flushing, nausea, headache, pulmonary oedema, hypokalaemia and hyperglycaemia. Neonatal side effects include; tachycardia, hypotension, hypoglycaemia, hypocalcemia and ileus. It is not proved that B2-agnosists are associated with neonatal periventericular haemorrhage [18].
It is a nonsteroidal anti-inflamatory agent which inhibit cyclo-oxygenase enzyme and subsequently reduces myomeytrial prostaglandins concentration which inturn down regulates myometrial cells gap junctions, down regulates oxytocin receptors and reduces intracellular calcium levels. It has better tocolytic effect and better safety profile than b-agonists but its routine use is limited due to the associated fetal side effects [18].
Maternal side effects include; risks of peptic ulcerations, thrombocytopenia and postpartum haemorrhage and allergic reaction. Fetal side effects include; premature closure of ductus arteriosus. There is risk of neonatal necrotizing enterocolitis, intraventericular haemorrhage and renal dysfunction [18].
It is a nonsteriodal anti-inflammatory agent which act specifically on cycloxgenase-2 enzyme which is upregulated in preterm labour. The mechanism of action is simillar to indomethacin but with better maternal side effect profile. Its routine use is limited due to fetal concerns over premature closure of the ductus and renal idysfunction [18].
Atosiban is an oxytocin analogue competitively blocks oxytocin and vasopressin receptors leading to reduced intracelluar calcium and lesser prostagladins production. It is recommended and licenced in preterm labour [1, 18, 19]. Its side effects include; maternal nausea, vomiting, hot flushes, hypotension and dizzness. It has simillar effectivness to B2-agonists and nifidipine but with a safer profile however, it is more expensive and given intravenously [1, 18].
It is a calcium channel blocker that is proved to be effective in reducing preterm birth with lesser side effects compared to B2-agonists. It is admnistered orally and it is considered first line treatment option [1, 18]. The side effects of its use include; headache, dizzness, ankle odema, and constipation.
Cochrane review did not support its use for tocolysis as studies repeorted did not show that magnesium sulphate delayed or prevented preterm birth [18].
The use of antibiotics is recommeded with preterm premature rupture of membranes (PPROM) based on ORACLE trial and chochrane review which proved that they reduce the time to delivery and the incidence of chorioamnionitis. They also decrease the ioccurance of neonatal sepsis and the need for neonatal surfactant and oxygen therapy. On the other hand; the ORACLE trial did not recommed its use in preterm labour without premature rupture of membranes as there was no difference in the neonatal outcomes [1, 20, 21].
It is also concluded that erythromycin is a better choice compared to coamoxiclav in women with preterm labour associated with premature rupture of membranes due to increased risk of necrotizing enetrocoilitis with the use of co-amoxiclav [20, 21].
The Royal College of Obstetricians and Gynaecologists (RCOG) recommeded the use of antenatal corticosteriods in women with threating preterm labour as it is proven that their use has significant reduction in neonatal respiratory distress syndrome, intraventricular haemorrhage and neonatal death without increase in neonatal sepsis in women who has preterm labour and PPROM.
The use of antenatal steriods is recommeded with threatening preterm labour between 24 weeks and 34 weeks gestations may be considered up to 35 + 6 weeks with the optimal benefit within a window of one to seven days [1, 22].
The agent of choice is betamethasone as it has lesser risk of periventericular leucomalacia compared to the use of dexamethasone [22].
It is recommeded that betamethasone is adminstered intramuscularly in patients with preterm labour as the oral adminstration is associated with higher risk of neonatal sepsis and intraventricular haemorrhage. It is recommended to be used as two doses of 12 mg, 24 hours apart.
The use of mutiple courses of antenatal steriods is not recommeded as per RCOG guidance as it is associated with increassed risks of maternal osteoprosis, infection and imparied glucose tolerance. Multiple courses of steriods is associated with fetal risks including; intrauterine growth restriction, low birth weight, necrotizing enterocolitis, adrenal insufficiency and abnormal neurological development. Compared to a single course, mutiple courses have no benefit of improving neonatal respiratory distress syndrome, chronic lung disease and intraventericular haemorrhage [1, 22].
Children born to women given magnesium sulphate for seizure prevention in severe pre-eclampsia were noted to have lower rates of cerebral palsy. This is possibly because magnisum decreases extracellular glutamate with hypoxia and hence reduces excitotoxicity. It also limits calcium influx through voltage-gated channels and in turn reduces the activation of apoptosis. Further more it reduces oxidative stress and reduces the production of pro-inflammatory cytokines.
It is use for neuroprotection is recommeded for use in women with established preterm labour or planned to hace elective preterm birth within 24 hours at gestations between 24 and 30 weeks. It is can be considered between 30 and 34 weeks [1, 23].
Vaginal delivery is considered to be appropriate choice in gestations under 24 weeks as the neonatal survival rate is very low. The challanging decision is the balance of vaginal delivery versus caesarean section in preterm delivery between 24 weeks and 37 weeks gestation [1, 24].
The decision for caesarean section is recommended to be for the obstetric reasons such as malpresentations and intrapartum fetal distress. Cochrane review for elective caesarean section in women with threating preterm labour between 24 and 37 weeks gestation has not shown statistically significant difference in the neonatal outcomes with regard the incidence of respiratory distress syndrome and neonatal seizures.
There is no evidence to support routine prophylactic outlet forceps or episiotomy when considering vaginal delivery between 24 and 37 weeks gestations. It is advisable to leave the fetal membranes intact till late in labour to reduce the risk of cord prolapse. The fetal scalp electrode and fetal blood sampling use is contraindicated prior to 34 weeks gestation and hence any suspicious fetal monitoring trace should be considered as indication for caesarean section. Their use is considered between 34 and 36 weeks gestation. It is also important to note that ventouse delivery is contraindicated prior to 34 weeks gestation. Consideration should be taken for caesarean section in preterm delivery with breech presentation [1, 24].
Delayed cord clamping for at least 30 seconds but no longer than three minutes is advisable in preterm deliveries to allow auto transfusion of the baby. Senior obstetrician should be consulted in planning the delivery and the decision-making throughout the labour [1, 24].
Parents should have discussion with joint obstetric and neonatal team prior embarking onto labour is helpful to ensure their understanding of challenges for the preterm baby such as ability to maintain stable core body temperature, ability to breath spontaneously and feeding difficulties. The expected postnatal care for the preterm baby should be planned as detailed as possible with the parents and ensure the availability of the facilities.
Preterm delivery is defined as delivery before 37 weeks completed gestation. It represents a major cause of neonatal morbidity and mortality in both developed and developing countries with European and North American figures ranges between 5–10% of all deliveries. In the UK it represents 7.3% of live births
Extreme preterm birth is defined as preterm birth prior to 28 weeks gestation. It accounts for 5–10% of preterm deliveries. The major concern of extreme preterm birth is the significant risk of neonatal mortality as the survival rates are very low at these gestations (0.4% at 22 weeks, 7% at 24 weeks) while the main concern of preterm births above 28 weeks is the neonatal morbidity as the survival rates are 77% at 28 weeks and 97% at 36 weeks.
The aetiology of preterm labour is multifactorial with a common pathway resluting in increased relasee of prostaglandins and cytokines within the cervix, myometrium and fetal membranes. The release of prostaglandins is triggered by infective or inflammatory process [1], uterine overdistension as in cases with polyhydraminons and mutiple preganacy or choriodecudidual haemorrhage as in cases with abruption.
In modern obstetrics, 30–40% of preterm deliveries are iatrogenic. The most common cause of which is severe pre-eclampsia associated with intrauterine growth restriction (IUGR) and antenatal fetal distress. Other common iatrogenic preterm deliveries include, Grade 3 and 4 placenta praevia or placenta abruption with major bleeding, sever IUGR with absent or reversed end-diastolic flow. It is also notable that the increased number of large loop excision of transformation zone (LLETZ) procedures for abnormal cervical cells leads to cervical scarring and iatrogenic cervical incompetence and hence preterm delivery.
Identifying high risk patients is crucial in managing and preventing preterm labour. Prediction of preterm labour is possble through; risk assessment, uterine activity monitoring, cervical length assessment and fetal fibronectin assessment.
Patients with previous preterm labour are at higher risk of having pretem term birth. The risk is 17% after one previous preterm delivery and increases to 28% after two preterm deliveries. Patients with previous preterm premature rupture of membranes (PROM) [2], previous second trimester loss and thoese who are known to have cervical incomptence and congenital uterine anaomalies are at higher risk for preterm birth. Fruther more uterine overdistention as with Polyhydraminos and mutiple pregnancy is associated with preterm delivery. Patient with placental abruption are also known to be at higher risk of preterm labour.
It notable that uterine activity increases prior to onset of pretrm labour by 24 hours. However, the use of home uterine contraction monitors or self palpations has not proven to be useful as they had poor postive predictive vlaues and their use did not improve the perinatal outcomes.
Clinical assessment of cervical status in terms of dilatation, softening and effacement can predict preterm labour, However it has low sensitivity and repeated vaginal examination in it self may incease the cervical prostaglandins relase and subsquently increase the incidnce of preterm labour.
Utrasound assessment of cervical length is a reliable method and highest predictive value up to 70% is notable with cervical length under 25 mm in womens with risk factors for preterm labour. Serial cervical length assessment is recommended in hight isk group between 16–24 weeks. Cervical length is best measured by transvaginal scan with empty bladder as full bladder may lead to false increase in the cervical length measurments. The risk of preterm labour increases from 1% at cervical length of 25 mm to 4% at 15 mm cervical length. The marked increased risk is notable at 5 mm cervical length with preterm birth risk of 78% [4, 5].
Cervical length assessment is not routine in womens with no risk factors for preterm birth as the positive predictive value is low in this group. Also, preventive interventions as cervical cerclage is not recommended in low risk group as they have shown no improvement in the outcome in this group [4].
The presence of funnelling of the internal os is another helpful finding in predicting the preterm birth, However, it is less accurate compared to cervical length assessment due to inter and intra observer variations [6].
Fetal fibronectin is normally present in high concentration prior to 21 weeks of gestation in cervical and vaginal secretions prior to membranes fusion. Inflammatory process, uterine overdistension and choriodecidual haemorrhage increase fetal fibronectin secretion after 21 weeks gestation.
Fetal fibronectin testing by swabbing the posterior fornix or ectocervix between 22 and 34 weeks gestation in recommended as postive results in high risk group especially in presence of symptoms warrant admistration of steriods and hospital admission. Fetal fibronectin testing is not recommeded in womens with no risk factors as it has not shown to be effective in improving the outcome despite more than half of preterm birth occurs in this group [7].
Testing for fetal fibronectin is contraindicated before 22 weeks gestation, in presence of preterm premature rupture of membranes, active vaginal bleeding and intercourse in the previous 24 hours.
Other biochemical markers such as Insulin like growth factor binding protein-1, interleukin-6, interleukin-8 and tumour necrosis factor-alpha (TNF-α) were assessed in research setting for use in predicting preterm labour. However, none of those markers is currently used in routine practice [8].
Preterm birth is associated with significant neonatal morbidities such as respiratory distress syndrome, necrotizing enterocolitis, retinopathy of prematurity, neonatal sepsis, intraventricular haemorrhage and periventricular leucomalacia. Longterm impact of prematurity are mainly cognitive and motor impairement which are more prevelant in extreme preterm births. Prolongation of pregnancy with tocolytic agents and adminstration of antenatal steriods signficantly reduces the neonatal morbidities in preterm births [1, 9].
EPICure data [9] may be useful tool in counselling the parents about fetal prognosis. Neonatal mortality is higher with preterm birth at lower gestational ages with survival rate of 7% at 24 weeks compared to 77% at 28 weeks and 97% at 32 weeks. The survival rates improves 2.2% daily between 24 and 28 weeks gestions. Preterm delivery at 36 weeks is associated with 99% survival rate [1, 9, 10].
Mutiple preventive measures were tested for prevention of preterm labour such as treatment of asymptomatic bacteruria and bacterial vaginosis, prophylactic antibiotics in womens with postive fetal fibronectin and reduced cervical length, cervical cerclage, prophlactic tocolysis and hormonal supplements. Some were proved to be effective in reducing preterm deliveries while others shown no significant diffierence in the outcome regarding the incidance of preterm birth and its associated morbidities.
Bacterial vaginosis occurs in 10–22% of pregnant womens with unknown aetiology. Treating the bacterial vagnoisis and hence reducing its associated inflammatory process was proved to reduce the incidance of preterm birth in womens with risk factors for preterm labour especially those with postive fetal fibronectin testing. Asymptomatic bacteruria occurs in 2–9% pregnant womens and its associated inflammtory process can participate in increasing prostagladins levels in cervicovaginal secretions and hence the preterm birth. Treating asymptomatic bacteruria in high risk group reduces the incidence of preterm birth but not in low risk group.
Antibiotic treatment for prophylactic antibiotics in womens with postive fetal fibronectin and in womens reduced cervical length in absence of infective or inflammatory process is not recommeded due to limited evidence and lack of proven efficacy.
Cervical cerclage proved to reduce the incidence of preterm birth in women with 2nd trimester losses and those with cervical length of 25 mm or less on transvaginal ultrasound between 16–24 weks gestation [4, 11]. Cervical cerclage can be done by transvaginal route (McDonald or Shirodkar techniques) or transadominal route when there is insufficient cervical tissue to hold the suture or when the vaginal approach has failed previously [1, 4]. Counselling prior such procedure is essential to involve the pros and cons. Complications of the procedure can include; bleeding, infection (endometritis), increased frequency of contractions, cervical trauma, preterm premature rupture of membranes, suture displacement, sepsis, cervical scarring. Cervical cerclage is contraindicated in presence of fetal anomaly, intrauterine infection, active bleeding and preterm premature rupture of membranes [1, 6].
Prophylactic tocolysis for high risk women has not proved to reduce the preterm birth rate and is not recommended.
Progesterone supplement via vaginal or intramuscular route on weekly basis till 36 weeks can be considered to promote reduction of uterine activity. Its use is limited to clinical trials in European guidlines [12, 13] while the recent NICE guideline in UK and in North America, progesterone supplementation is recommended for clinical use for reuction of preterm births [1, 14].
Use of cervical pessaries, bed rest and restrticting physical activity and intercourse have no proved evidence of preventing preterm labour [15, 16].
The mangement of preterm labour fall into five areas; the use of tocolysis, adminstration of antibiotics, admistration of antenatal steriods, magnisum sulphate for neuroprotection and finally the considerations for the mode of delivery.
It is important to realise that the aim of tocolysis in modern obstertics is limited to gain few days to allow admistration of antenatal steriods which proved to reduce perinatal morbidities in preterm birth and allow in utero transfer (Table 1).
Tocolytics | Mechanism | Dose | Side effects | Contraindications |
---|---|---|---|---|
Ritodrine - b2-agonists Currently not in use | b2-receptor stimulation reduces free intra-cellular Ca+2 via cyclic AMP and hence muscle relaxation | 50–100 μ g/min IV then, increase by 50 μ g/min every 10 min. (up to 350 μ g/min) | Maternal; Hyperglycemia hypokalemia Tremors and nervousness Dyspnea and chest pain Palpitations and arrhythmia Hypotension Pulmonary edema Fetal/neonatal; Tachycardia Hypoglycemia Hypocalcemia Hyperbilirubinemia hypotension IVH | Dysrhythmias or other significant cardiac disease Diabetes mellitus Uncontrolled thyroid disease |
Calcium channel blockers (CCB) - Nifedipine Currently first line | Inhibit influx of calcium into cell and hence prevent myometrial contraction | 20–30 mg, then 10–20 mg every 4–8 hours (max 90 mg/day) | Maternal; Transient hypotension, headache and dizziness, Nausea Flushing Fetal/neonatal; None | Cardiac disease Hypotension Use with magnesium (collapse) Use with caution in renal disease |
Atosiban - Oxytocin receptor antagonists Currently second line | Competitively inhibit oxytocin receptors | 6.75 mg IV bolus, then 300 μg/min every 3 hours. (max 45 hours) | Maternal; Minimal; Nausea and vomiting Hot flushes Hypotension and dizzness Fetal; None | None |
Cyclo-oxygenase (COX) inhibitors Non-selective; indomethacin Selective (COX-2 inhibitor); sulindac nimesulide | Inhibition of COX leads to reduced PGs synthesis and hence myometrial relaxation | Indomethacin: 50–100 mg loading dose, then 25–50 mg every 6 hours for max 48 hours Sulindac: 200 mg every 12 hours for max 48 hours. | Maternal; Minimal if used for 48 hours; Less with COX2 inhibitors; Peptic ulcerations Thrombocytopenia Postpartum haemorrhage Allergic reaction. Fetal; Main concern; premature closure of ductus arteriosus Risk of neonatal necrotizing enterocolitis, IVH and renal dysfunction | Renal or hepatic disease Active peptic ulcer Uncontrolled hypertension NSAID-sensitive asthma and thrombocytopenia |
Magnesium sulfate (MgSO4) Currently not in use | Intracellular calcium antagonist | Initial: 4–6 g/30 min, then: 2–4 g/h | Maternal; Headache and flushing Lethargy Muscle weakness and diplopia Dry mouth Pulmonary edema Fetal/neonatal; Lethargy Hypotonia Hypocalcemia Respiratory depression | Myasthenia gravis |
Tocolytics.
Ritodrine and other b-agonists as terbutaline, salbutamol were used as tocolytic agent but currently not recommeded as first line due to its maternal and neonatal side effects. They act on b2 receptors in myometrial smooth muscles via a cAMP dependent mechanism leading to reduction in the intracellular calcium causing muscular relaxation. Cochrane review on B2-agonists concluded that they decrease the number of preterm births within 48 hours but not within 7 days [1, 17, 18].
Maternal side effects include; palpitations and arrhythmias, chest pain, hypotension, flushing, nausea, headache, pulmonary oedema, hypokalaemia and hyperglycaemia. Neonatal side effects include; tachycardia, hypotension, hypoglycaemia, hypocalcemia and ileus. It is not proved that B2-agnosists are associated with neonatal periventericular haemorrhage [18].
It is a nonsteroidal anti-inflamatory agent which inhibit cyclo-oxygenase enzyme and subsequently reduces myomeytrial prostaglandins concentration which inturn down regulates myometrial cells gap junctions, down regulates oxytocin receptors and reduces intracellular calcium levels. It has better tocolytic effect and better safety profile than b-agonists but its routine use is limited due to the associated fetal side effects [18].
Maternal side effects include; risks of peptic ulcerations, thrombocytopenia and postpartum haemorrhage and allergic reaction. Fetal side effects include; premature closure of ductus arteriosus. There is risk of neonatal necrotizing enterocolitis, intraventericular haemorrhage and renal dysfunction [18].
It is a nonsteriodal anti-inflammatory agent which act specifically on cycloxgenase-2 enzyme which is upregulated in preterm labour. The mechanism of action is simillar to indomethacin but with better maternal side effect profile. Its routine use is limited due to fetal concerns over premature closure of the ductus and renal idysfunction [18].
Atosiban is an oxytocin analogue competitively blocks oxytocin and vasopressin receptors leading to reduced intracelluar calcium and lesser prostagladins production. It is recommended and licenced in preterm labour [1, 18, 19]. Its side effects include; maternal nausea, vomiting, hot flushes, hypotension and dizzness. It has simillar effectivness to B2-agonists and nifidipine but with a safer profile however, it is more expensive and given intravenously [1, 18].
It is a calcium channel blocker that is proved to be effective in reducing preterm birth with lesser side effects compared to B2-agonists. It is admnistered orally and it is considered first line treatment option [1, 18]. The side effects of its use include; headache, dizzness, ankle odema, and constipation.
Cochrane review did not support its use for tocolysis as studies repeorted did not show that magnesium sulphate delayed or prevented preterm birth [18].
The use of antibiotics is recommeded with preterm premature rupture of membranes (PPROM) based on ORACLE trial and chochrane review which proved that they reduce the time to delivery and the incidence of chorioamnionitis. They also decrease the ioccurance of neonatal sepsis and the need for neonatal surfactant and oxygen therapy. On the other hand; the ORACLE trial did not recommed its use in preterm labour without premature rupture of membranes as there was no difference in the neonatal outcomes [1, 20, 21].
It is also concluded that erythromycin is a better choice compared to coamoxiclav in women with preterm labour associated with premature rupture of membranes due to increased risk of necrotizing enetrocoilitis with the use of co-amoxiclav [20, 21].
The Royal College of Obstetricians and Gynaecologists (RCOG) recommeded the use of antenatal corticosteriods in women with threating preterm labour as it is proven that their use has significant reduction in neonatal respiratory distress syndrome, intraventricular haemorrhage and neonatal death without increase in neonatal sepsis in women who has preterm labour and PPROM.
The use of antenatal steriods is recommeded with threatening preterm labour between 24 weeks and 34 weeks gestations may be considered up to 35 + 6 weeks with the optimal benefit within a window of one to seven days [1, 22].
The agent of choice is betamethasone as it has lesser risk of periventericular leucomalacia compared to the use of dexamethasone [22].
It is recommeded that betamethasone is adminstered intramuscularly in patients with preterm labour as the oral adminstration is associated with higher risk of neonatal sepsis and intraventricular haemorrhage. It is recommended to be used as two doses of 12 mg, 24 hours apart.
The use of mutiple courses of antenatal steriods is not recommeded as per RCOG guidance as it is associated with increassed risks of maternal osteoprosis, infection and imparied glucose tolerance. Multiple courses of steriods is associated with fetal risks including; intrauterine growth restriction, low birth weight, necrotizing enterocolitis, adrenal insufficiency and abnormal neurological development. Compared to a single course, mutiple courses have no benefit of improving neonatal respiratory distress syndrome, chronic lung disease and intraventericular haemorrhage [1, 22].
Children born to women given magnesium sulphate for seizure prevention in severe pre-eclampsia were noted to have lower rates of cerebral palsy. This is possibly because magnisum decreases extracellular glutamate with hypoxia and hence reduces excitotoxicity. It also limits calcium influx through voltage-gated channels and in turn reduces the activation of apoptosis. Further more it reduces oxidative stress and reduces the production of pro-inflammatory cytokines.
It is use for neuroprotection is recommeded for use in women with established preterm labour or planned to hace elective preterm birth within 24 hours at gestations between 24 and 30 weeks. It is can be considered between 30 and 34 weeks [1, 23].
Vaginal delivery is considered to be appropriate choice in gestations under 24 weeks as the neonatal survival rate is very low. The challanging decision is the balance of vaginal delivery versus caesarean section in preterm delivery between 24 weeks and 37 weeks gestation [1, 24].
The decision for caesarean section is recommended to be for the obstetric reasons such as malpresentations and intrapartum fetal distress. Cochrane review for elective caesarean section in women with threating preterm labour between 24 and 37 weeks gestation has not shown statistically significant difference in the neonatal outcomes with regard the incidence of respiratory distress syndrome and neonatal seizures.
There is no evidence to support routine prophylactic outlet forceps or episiotomy when considering vaginal delivery between 24 and 37 weeks gestations. It is advisable to leave the fetal membranes intact till late in labour to reduce the risk of cord prolapse. The fetal scalp electrode and fetal blood sampling use is contraindicated prior to 34 weeks gestation and hence any suspicious fetal monitoring trace should be considered as indication for caesarean section. Their use is considered between 34 and 36 weeks gestation. It is also important to note that ventouse delivery is contraindicated prior to 34 weeks gestation. Consideration should be taken for caesarean section in preterm delivery with breech presentation [1, 24].
Delayed cord clamping for at least 30 seconds but no longer than three minutes is advisable in preterm deliveries to allow auto transfusion of the baby. Senior obstetrician should be consulted in planning the delivery and the decision-making throughout the labour [1, 24].
Parents should have discussion with joint obstetric and neonatal team prior embarking onto labour is helpful to ensure their understanding of challenges for the preterm baby such as ability to maintain stable core body temperature, ability to breath spontaneously and feeding difficulties. The expected postnatal care for the preterm baby should be planned as detailed as possible with the parents and ensure the availability of the facilities.
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This chapter is an updated overview of the signaling pathways going from external signals such as osmolarity and ionic concentration and their membrane reception to their transduction through the membrane and their final reception at the flagellar axoneme level. Additional factors such as energy management will be addressed as they constitute a limiting factor of the motility period of fish spermatozoa. Modern technologies used nowadays for quantitative description of fish sperm flagella in movement will be briefly described as they are more and more needed for prediction of the quality of sperm used for artificial propagation of many fish species used in aquaculture. The chapter will present some applications of these technologies and the information to which they allow access in some aquaculture species.",book:{id:"7912",slug:"biological-research-in-aquatic-science",title:"Biological Research in Aquatic Science",fullTitle:"Biological Research in Aquatic Science"},signatures:"Jacky Cosson",authors:[{id:"188281",title:"Dr.",name:"Jacky",middleName:null,surname:"Cosson",slug:"jacky-cosson",fullName:"Jacky Cosson"}]},{id:"20911",doi:"10.5772/19948",title:"The Significance of Suspended Sediment Transport Determination on the Amazonian Hydrological Scenario",slug:"the-significance-of-suspended-sediment-transport-determination-on-the-amazonian-hydrological-scenari",totalDownloads:4181,totalCrossrefCites:13,totalDimensionsCites:24,abstract:null,book:{id:"304",slug:"sediment-transport-in-aquatic-environments",title:"Sediment Transport in Aquatic Environments",fullTitle:"Sediment Transport in Aquatic Environments"},signatures:"Naziano Filizola, Jean-Loup Guyot, Hella Wittmann, Jean-Michel Martinez and Eurides de Oliveira",authors:[{id:"36890",title:"Dr.",name:"Naziano",middleName:null,surname:"Filizola",slug:"naziano-filizola",fullName:"Naziano Filizola"},{id:"60004",title:"Dr.",name:"Jean-Michel",middleName:null,surname:"Martinez",slug:"jean-michel-martinez",fullName:"Jean-Michel Martinez"},{id:"60005",title:"Dr.",name:"Jean-Loup",middleName:null,surname:"Guyot",slug:"jean-loup-guyot",fullName:"Jean-Loup Guyot"},{id:"102592",title:"Dr.",name:"Hella",middleName:null,surname:"Wittmann",slug:"hella-wittmann",fullName:"Hella Wittmann"},{id:"102593",title:"Mr.",name:"Eurides",middleName:null,surname:"De Oliveira",slug:"eurides-de-oliveira",fullName:"Eurides De Oliveira"}]},{id:"60698",doi:"10.5772/intechopen.74923",title:"Overview on Mediterranean Shark’s Fisheries: Impact on the Biodiversity",slug:"overview-on-mediterranean-shark-s-fisheries-impact-on-the-biodiversity",totalDownloads:1123,totalCrossrefCites:14,totalDimensionsCites:19,abstract:"Bibliographic analysis shows that the Mediterranean Sea is a hot spot for cartilaginous species biodiversity, including sharks, rays, and chimaeras; 49 sharks and 36 rays were recorded in this region. However, they are by far the most endangered group of marine fish in the Mediterranean Sea. The IUCN Red List shows clearly the vulnerability of elasmobranchs and the lack of data; 39 species (53% of 73 assessed species) are critically endangered, endangered, or vulnerable. The biological characteristics of elasmobranchs (low fecundity, late maturity, and slow growth) make them more vulnerable to fishing pressure than most teleost fish. Overfishing, the wide use of nonselective fishing practices, and habitat degradation are leading to dramatic declines of these species in the Mediterranean Sea. In general, elasmobranchs are not targeted but are caught incidentally. In many fisheries, they are, however, often landed and marketed. A decline in cartilaginous fish species landings has been observed while fishing effort has generally increased. Better understanding of the composition of incidental and targeted catches of sharks by commercial fisheries are fundamentally important for the conservation of these populations. Moreover, problems encountered by elasmobranchs in the area are highlighted, and conservation measures are suggested.",book:{id:"6266",slug:"marine-ecology-biotic-and-abiotic-interactions",title:"Marine Ecology",fullTitle:"Marine Ecology - Biotic and Abiotic Interactions"},signatures:"Mohamed Nejmeddine Bradai, Bechir Saidi and Samira Enajjar",authors:null}],mostDownloadedChaptersLast30Days:[{id:"60368",title:"Biological and Medicinal Importance of Sponge",slug:"biological-and-medicinal-importance-of-sponge",totalDownloads:2585,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"Sponges are multicellular, heterotrophic parazoan organisms, characterized by the possession of unique feeding system among the animals. They are the most primitive types of animals in existence, featuring a cell-based organization where different cells have different tasks, but do not form tissues. Sponges (Porifera) are a predominantly marine phylum living from the intertidal to the abyssal (deepest ocean) zone. There are approximately 8500 described species of sponges worldwide with a prominent role in many reef coral communities. Several ecological studies reported have shown that secondary metabolites isolated from sponges often serve defensive purposes to protect them from threats such as predator attacks, biofouling, microbial infections, and overgrowth by other sessile organisms. In the recent years, interest in marine sponges has risen considerably due to presence of high number of interesting biologically active natural products. More than 5300 different natural products are known from sponges and their associated microorganisms, and every year hundreds of new substances are discovered. In addition to the unusual nucleosides, other classes of substances such as bioactive terpenes, sterols, fatty acids, alkaloids, cyclic peptides, peroxides, and amino acid derivatives (which are frequently halogenated) have been described from sponges or from their associated microorganisms. Many of these natural products from sponges have shown a wide range of pharmacological activities such as anticancer, antifungal, antiviral, anthelmintic, antiprotozoal, anti-inflammatory, immunosuppressive, neurosuppressive, and antifouling activities. This chapter covers extensive work published regarding new compounds isolated from marine sponges and biological activities associated with them.",book:{id:"6344",slug:"biological-resources-of-water",title:"Biological Resources of Water",fullTitle:"Biological Resources of Water"},signatures:"Musarat Amina and Nawal M. 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This chapter is divided into different sections such as the Nigerian fisheries sector, marine fisheries resources in Nigeria, status of marine fisheries production in Nigeria, marine fisheries regulations, and constraints to optimal marine fisheries production in Nigeria. We concluded that the contribution of aquaculture to marine fisheries production has been low, compared to the marine capture fisheries production. Also, we noted that despite the availability of regulations, noncompliance by fisher folks has not helped to optimize marine fisheries production. We therefore recommended that the culture of marine fishes should be intensified. Marine waters should also be protected against destruction and pollution as a result of human activities. Available marine fisheries regulations should be enforced and violators of the regulations should be punished as stipulated in the regulations.",book:{id:"6266",slug:"marine-ecology-biotic-and-abiotic-interactions",title:"Marine Ecology",fullTitle:"Marine Ecology - Biotic and Abiotic Interactions"},signatures:"Olalekan Jacob Olaoye and Wahab Gbenga Ojebiyi",authors:null},{id:"57327",title:"Closed Aquaculture System: Zero Water Discharge for Shrimp and Prawn Farming in Indonesia",slug:"closed-aquaculture-system-zero-water-discharge-for-shrimp-and-prawn-farming-in-indonesia",totalDownloads:2527,totalCrossrefCites:2,totalDimensionsCites:4,abstract:"This chapter focuses on the development and application of zero water discharge (ZWD) system, which has become an alternative solution to conventional methods of aquaculture production. With this system, it is expected to answer many issues in aquaculture cultivation, such as environmental damage, disease outbreak, and land-use change, and to create a sustainable aquaculture cultivation system. ZWD system is an improved batch system with an emphasis on microbial manipulation in rearing tank. The principle of microbial selection is based on the role of each microbial component in nutrient cycle in the rearing tank. This chapter contains in detail how methods and stages are performed in order to conduct this system, including design of construction system, cultivation of microbial components, initial conditioning of this system, and microbial manipulation. The performance of the system was tested in crustacean culture such as white shrimp and giant freshwater prawns, and it showed that the system can increase the average survival rate of 10–20%. In addition, the technical and economic feasibility of this system was evaluated to illustrate the production efficiency upon the application of this system in the industry.",book:{id:"6344",slug:"biological-resources-of-water",title:"Biological Resources of Water",fullTitle:"Biological Resources of Water"},signatures:"Gede Suantika, Magdalena Lenny Situmorang, Pingkan Aditiawati,\nDea Indriani Astuti, Fahma Fiqhiyyah Nur Azizah and Harish\nMuhammad",authors:[{id:"216920",title:"Dr.",name:"Gede",middleName:null,surname:"Suantika",slug:"gede-suantika",fullName:"Gede Suantika"},{id:"220079",title:"Dr.",name:"Magdalena Lenny",middleName:null,surname:"Situmorang",slug:"magdalena-lenny-situmorang",fullName:"Magdalena Lenny Situmorang"},{id:"220081",title:"Dr.",name:"Pingkan",middleName:null,surname:"Aditiawati",slug:"pingkan-aditiawati",fullName:"Pingkan Aditiawati"},{id:"220082",title:"Dr.",name:"Dea Indriani",middleName:null,surname:"Astuti",slug:"dea-indriani-astuti",fullName:"Dea Indriani Astuti"},{id:"220083",title:"MSc.",name:"Fahma Fiqhiyyah Nur",middleName:null,surname:"Azizah",slug:"fahma-fiqhiyyah-nur-azizah",fullName:"Fahma Fiqhiyyah Nur Azizah"}]},{id:"59973",title:"Genetic Applications in the Conservation of Neotropical Freshwater Fish",slug:"genetic-applications-in-the-conservation-of-neotropical-freshwater-fish",totalDownloads:1716,totalCrossrefCites:3,totalDimensionsCites:9,abstract:"Neotropical fish correspond to approximately 30% of all fish species worldwide. The diversity of fish species found in Neotropical basins reflects variations in life-history strategies and exhibition of particular morphological, physiological and ecological attributes. These attributes are mainly related to different forms of feeding, life maintenance and reproduction. Today, fish populations are being threatened by anthropogenic actions that are having a visible impact on the natural state of continental aquatic ecosystems. The main causes are overfishing, non-native species introduction, reservoir-dam systems, mining, pollution and deforestation. The biology and population dynamics of the species are still unclear due to lack of research. Genetic tools can be useful resources for the conservation of Neotropical fish species in several ways. Molecular genetic markers are considered powerful tools to identify cryptic and hybrid fish and also allow the evaluation of the genetic variability and structure of populations of Neotropical ichthyofauna. Several analyses of molecular markers have been performed on Neotropical fish, including allozyme analysis, restriction fragment length polymorphisms in regions of DNA (RFLP), randomly amplified polymorphic DNA (AFLP), randomly amplified polymorphic DNA (RAPD), microsatellites, single nucleotide polymorphisms (SNPs) and mitochondrial DNA (mtDNA) markers. In order to analyse a high number of markers, next generation sequencing has allowed researchers to generate a large amount of genomic information that can be applied to the conservation of Neotropical fish.",book:{id:"6344",slug:"biological-resources-of-water",title:"Biological Resources of Water",fullTitle:"Biological Resources of Water"},signatures:"Vito Antonio Mastrochirico Filho, Milena V. Freitas, Raquel B.\nAriede, Lieschen V.G. Lira, Natália J. Mendes and Diogo T.\nHashimoto",authors:[{id:"215385",title:"Dr.",name:"Diogo",middleName:null,surname:"Hashimoto",slug:"diogo-hashimoto",fullName:"Diogo Hashimoto"},{id:"226741",title:"MSc.",name:"Vito",middleName:null,surname:"Matrochirico-Filho",slug:"vito-matrochirico-filho",fullName:"Vito Matrochirico-Filho"},{id:"226743",title:"MSc.",name:"Milena",middleName:null,surname:"Freitas",slug:"milena-freitas",fullName:"Milena Freitas"},{id:"226744",title:"MSc.",name:"Raquel",middleName:null,surname:"Ariede",slug:"raquel-ariede",fullName:"Raquel Ariede"},{id:"226745",title:"MSc.",name:"Natália",middleName:null,surname:"Mendes",slug:"natalia-mendes",fullName:"Natália Mendes"},{id:"226746",title:"MSc.",name:"Lieschen",middleName:null,surname:"Lira",slug:"lieschen-lira",fullName:"Lieschen Lira"}]},{id:"62582",title:"Mangrove Species Distribution and Composition, Adaptive Strategies and Ecosystem Services in the Niger River Delta, Nigeria",slug:"mangrove-species-distribution-and-composition-adaptive-strategies-and-ecosystem-services-in-the-nige",totalDownloads:2198,totalCrossrefCites:5,totalDimensionsCites:15,abstract:"Mangroves of the Niger River Delta grade into several plant communities from land to sea. This mangrove is a biodiversity hot spot, and one of the richest in ecosystem services in the world, but due to lack of data it is often not mentioned in many global mangrove studies. Inland areas are sandy and mostly inhabited by button wood mangroves (Conocarpus erectus) and grass species while seaward areas are mostly inhabited by red (Rhizophora racemosa), black (Laguncularia racemosa) and white (Avicennia germinans) mangroves species. Anthropogenic activities such as oil and gas exploration, deforestation, dredging, urbanization and invasive nypa palms had changed the soil type from swampy to sandy mud soil. Muddy soil supports nypa palms while sandy soil supports different grass species, core mangrove soil supports red mangroves (R. racemosa), which are the most dominant of all species, with importance value (Iv) of 52.02. The red mangroves are adapted to the swampy soils. They possess long root system (i.e. 10 m) that originates from the tree stem to the ground, to provide extra support. The red mangrove trees are economically most viable as the main source of fire wood for cooking, medicinal herbs and dyes for clothes.",book:{id:"6411",slug:"mangrove-ecosystem-ecology-and-function",title:"Mangrove Ecosystem Ecology and Function",fullTitle:"Mangrove Ecosystem Ecology and Function"},signatures:"Aroloye O. Numbere",authors:[{id:"215285",title:"Dr.",name:"Aroloye O.",middleName:null,surname:"Numbere",slug:"aroloye-o.-numbere",fullName:"Aroloye O. Numbere"}]}],onlineFirstChaptersFilter:{topicId:"105",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},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:140,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,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:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,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:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"August 2nd, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:33,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:42,paginationItems:[{id:"82914",title:"Glance on the Critical Role of IL-23 Receptor Gene Variations in Inflammation-Induced Carcinogenesis",doi:"10.5772/intechopen.105049",signatures:"Mohammed El-Gedamy",slug:"glance-on-the-critical-role-of-il-23-receptor-gene-variations-in-inflammation-induced-carcinogenesis",totalDownloads:11,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chemokines Updates",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",subseries:{id:"18",title:"Proteomics"}}},{id:"82875",title:"Lipidomics as a Tool in the Diagnosis and Clinical Therapy",doi:"10.5772/intechopen.105857",signatures:"María Elizbeth Alvarez Sánchez, Erick Nolasco Ontiveros, Rodrigo Arreola, Adriana Montserrat Espinosa González, Ana María García Bores, Roberto Eduardo López Urrutia, Ignacio Peñalosa Castro, María del Socorro Sánchez Correa and Edgar Antonio Estrella Parra",slug:"lipidomics-as-a-tool-in-the-diagnosis-and-clinical-therapy",totalDownloads:7,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82440",title:"Lipid Metabolism and Associated Molecular Signaling Events in Autoimmune Disease",doi:"10.5772/intechopen.105746",signatures:"Mohan Vanditha, Sonu Das and Mathew John",slug:"lipid-metabolism-and-associated-molecular-signaling-events-in-autoimmune-disease",totalDownloads:17,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82483",title:"Oxidative Stress in Cardiovascular Diseases",doi:"10.5772/intechopen.105891",signatures:"Laura Mourino-Alvarez, Tamara Sastre-Oliva, Nerea Corbacho-Alonso and Maria G. 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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},{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. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"117248",title:"Dr.",name:"Andrew",middleName:null,surname:"Macnab",slug:"andrew-macnab",fullName:"Andrew Macnab",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"322007",title:"Dr.",name:"Maria Elizbeth",middleName:null,surname:"Alvarez-Sánchez",slug:"maria-elizbeth-alvarez-sanchez",fullName:"Maria Elizbeth Alvarez-Sánchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",country:{name:"Mexico"}}},{id:"337443",title:"Dr.",name:"Juan",middleName:null,surname:"A. Gonzalez-Sanchez",slug:"juan-a.-gonzalez-sanchez",fullName:"Juan A. Gonzalez-Sanchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico System",country:{name:"United States of America"}}},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}}]}},subseries:{item:{id:"8",type:"subseries",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",hasOnlineFirst:!1,hasPublishedBooks:!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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Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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