Clinical criteria for diagnosing VAP by age [2].
\r\n\tFood insecurity results in fear of hunger and starvation that ultimately affects one’s ability to work for sustainability and economic growth of the country. In addition to this, food insecurity results in various chronic diseases due to reduce immunity that ultimately, a burned on the county economy. Therefore, this book will intend to discuss in detail about the food insecurity challenges and their effect on the quality of life. This book will also aim to provide an overview about the new trends and future prospective that help to resolve the food security issues.
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This is a significant complication that worsens the prognosis of the underlying disease, increases mortality, prolongs hospitalization, worsens the quality of life of patients and increases the cost of treatment, so NI pays special attention. In the United States, the Center for Disease Control and Prevention (CDC) is the leading authority in this area. CDC procedures and guidelines are the most widely used standard worldwide. In the USA, a nationwide NI surveillance system has been organized since the 1970s. The United Kingdom also has a long tradition in the control of NI, which is organized in the system of laboratory service of the British public health service (Public Health Laboratory Service). The main guarantor, which organizes congresses dedicated to NI, is the Hospital Infection Society (HIS), which publishes a globally important and recognized journal - the Journal of Hospital Infection [1]. The aim of the journal is to publish high-quality research and information related to the prevention and control of NI [2]. NIs need to be diagnosed and treated in time, but the most important thing is their prevention in various hospital wards, especially in intensive care units. Infections acquired in connection with hospitalization can lead to significant morbidity and mortality, but preventive anti-infective measures can significantly affect these results. Equally important is prevention in hospital staff in order to reduce the risk of infections spreading to other patients and staff. In this way, it is possible to prevent the absence of staff from work, which can have a positive effect on the skills of the staff of the intensive care unit. Nosocomial infections are also associated with financial expenses, which include hospital expenses, reduced productivity of sick staff as well as their income due to absence from work.
The intervention of anti-epidemic measures in the case of infections caused by pseudomonad strains has not yet reached such sophistication as in the case of MRSA for time, personnel and economic reasons. In the absence of an epidemic, intervention in sporadic cases consists of informing nursing staff of the occurrence of a multidrug-resistant agent, including providing all patient demographics and relieving careful adherence to the barrier treatment, cleansing, desinfection and isolation regimen [3].
If we add eye, ear, nose, and throat infections to pneumonia, then respiratory tract infections are the most common site of nosocomial infections for almost all age groups in pediatric JIS [4]. Much attention has been paid to ventilator-associated pneumonia (VAP) as the most common and potentially preventable nosocomial infection. Other nosocomial respiratory infections include sinusitis, otitis media and tracheitis. Contamination of the patient’s respiratory tract may come from a device with which the patient has been in direct contact, namely an endotracheal tube, nasogastric tube, aspiration catheters, bronchoscopes, but also from a device with which he has not been in direct contact, such as a mechanical ventilator, ventilator hose, nebulizers and devices that supply oxygen. The human vector that most likely transmits infection to a patient is hospital staff. The most common risk factors are poor hand hygiene, insufficient isolation of patients and contaminated objects such as stethoscopes. Family members and other patients may also transmit the infection to patients hospitalized in a pediatric ICU. All of these factors must be considered and controlled to minimize the occurrence of nosocomial respiratory tract infections [2].
Nosocomial pneumonia is the second most common nosocomial infection in pediatric ICUs after catheter infections of the bloodstream. Nosocomial infection can occur in any patient, but is most common in infants, young children, and patients over 65 years of age. Patients in pediatric ICUs who are most at risk for pneumonia are patients who have been intubated and mechanically ventilated. The risk increases due to the circumvention and alteration of the host’s defenses, as the vocal cords remain open and the risk of aspiration of gastrointestinal contents increases. The risk of nosocomial pneumonia is 6-20 times higher in ventilated patients compared to non-ventilated patients. Ventilator-associated pneumonia (VAP) is defined as the development of new pneumonia for at least 48 hours after the start of mechanical ventilation. Independent risk factors for the development of VAP in children are immunodeficiency, immunosuppression and neuromuscular blockade. Other risk factors are genetic syndromes with neuromuscular weakness, burns, steroid administration and total parenteral nutrition [2]. Children have a higher risk of VAP with antibiotics, with a longer stay in the ICU, with catheters in place with a risk of haematogenous spread, treatment with H2-receptor blockers, reintubation and transport outside the ICU during intubation. The presence of a nasogastric tube increases the risk as it provides a direct pathway from the upper gastrointestinal tract to the oropharynx. In-line nebulizers and manipulation of the ventilator circuit can affect the risk of nosocomial pneumonia. VAP in children accounts for 10-26% of nosocomial infections. The incidence of pediatric nosocomial pneumonia within the hospital is highest at the neonatal JIS, followed by the pediatric JIS, and the pediatric ward. Nosocomial pneumonia has the highest mortality of all pediatric nosocomial infections and ranges from 20–70%. Although the duration of endotracheal intubation increases the risk of nosocomial pneumonia, the highest risk is during the first 2 weeks of intubation. Almost all intubated children have a colonized endotracheal tube with nosocomial microorganisms within 5 days [2]. The most frequently identified bacteria in pediatric JIS are gram-negative bacilli, especially
The diagnosis of VAP in children can be made on a clinical basis without the use of bronchoscopy. A set of clinical diagnostic criteria and alternative criteria that vary with age are given in the table (Table 1). The presence of pneumatoceles on chest X-rays in children under 12 months of age meets the radiographic criteria for pneumonia, which are listed in the table. The diagnosis of VAP can be made based on clinical and radiographic criteria. Identification of the causative microorganism is essential for targeted antibiotic therapy. Identification of the microorganism is difficult because endotracheal tube culture is inaccurate due to colonization of the endotracheal tube and upper airways by gram-negative bacilli and staphylococci, which occurs within a few days after intubation. In adult and older children, bronchoalveolar lavage and protected swab specimens have been used successfully. In young children, it is not possible to obtain a protective sample for the size of the required bronchoscope, and the bronchoalveolar lavage performed has a high incidence of contamination. Methods for determining the causative microorganism are positive blood culture that cannot be explained by other sources, positive pleural fluid cultures, and a positive bronchoalveolar lavage sample despite its limitations, >5% of bronchoalveolar lavage cells containing intracellular bacteria and positive pulmonary parenchyma culture. When nosocomial pneumonia is suspected, empirical treatment should be initiated to cover the most likely microorganisms, taking into account hospital resistance. Once the agent is identified, the antibiotic coverage needs to be adjusted [2].
All patients | 1-12 year of age | <12 months of age | |
---|---|---|---|
At least 2 serial CXR with new or progressive and persistent infiltrate or consolidate or cavitation that developes later than 48 hrs post initiation of mechanical ventilation | |||
At least one of shaded criteria AND At least two of the non-shaded criteria | At least 3 of the criteria below | Worsening gas exchange AND at least 3 of the criteria below | |
>38°C without other recognized cause | >38,4°C or <37°C without other recognized cause | Temperature instability without other recognized cause | |
<4000/mm3 OR ˃12,000/mm3 | <4000/mm3 OR ˃>15,000/mm3 | ˂4000/mm3 OR ˃15,000/mm3 and band forms ˃10% | |
If >70 years of age without other recognized cause | Not applicable | Not applicable | |
New onset purulent sputum OR change in character of sputum OR increased respiratory symptoms | |||
New onset or worsening of cough, dyspnea, or tachypnea | Apnea, tachypnea, increased work of breathing, or grunting | ||
Rales or bronchial breath sounds | Wheezing, rales, or ronchi | ||
Not applicable as separate criteria | + | ||
Present | Present | Required criteria | |
Not applicable | <100 beats/min OR > 170 beats/min |
Clinical criteria for diagnosing VAP by age [2].
In 2004, The Institute for Healthcare Improvement developed a set of evidence-based recommendations for practitioners to reduce mortality. The evidence was based on research in adults.
The package of recommendations for VAP in adults includes the following interventions [8]:
raising the patient’s head above the bed between 30 and 45°,
a break in sedation and daily reassessment of extubation,
prophylaxis of stress ulcers,
prophylaxis of deep vein thrombosis.
The application of these measures can reduce the incidence of VAP to 45%, although the last 2 points do not directly lead to nosocomial pneumonia, but are designed to treat complications in monitored, sedentary adult patients with ICU. In children, many centers use only low-risk interventions such as raising the head above the bed, considering extubation, and using stress ulcer prophylaxis. Intervention such as omission of sedation is unpredictable and risky in young children due to the high risk of unwanted extubation [9].
Measures often used in pediatric centers focus on specific risk factors [2]:
measures to prevent iatrogenic spread of infection compliance with good hand hygiene use of general preventive measures use of appropriate isolation techniques according to infectious microorganisms
measures to prevent aspiration of gastric contents elevated head above bed between 30 and 45 degrees monitor/drainage of gastric contents
measures to improve oral hygiene mouthwashes/cleaning with chlorhexidine 0.12% use of toothbrush and oral swab in daily oral hygiene
measures to reduce risk factors of the endotracheal tube use of in-line suction device, where is suitable and available preferential suction of the hypopharynx over endotracheal suction and relocation of the ET tube
measures to prevent contamination of respiratory equipment single-purpose oropharyngeal suction device prevention of condensate accumulation in the respiratory circuit prevention of contamination of respiratory device
measures to reduce the length of mechanical ventilation daily consideration of extubation attempts interruption of neuromuscular blockade.
Hygiene of hands with alcoholic solutions or soap and water, together with adherence to general precautions and appropriate isolation, are the most effective methods. The raised position of the head prevents aspiration of the stomach contents. The risk of aspiration can be further minimized by decompression of the stomach with a gastric tube and continuous monitoring of the residue. Mouth hygiene is important. The American Dental Association recommends starting continuous oral hygiene in infants before the appearance of dentition. The recommendation for the use of oral swabs and brushing teeth in critically ill patients is based on the fact that the dental plaque consists predominantly of gram-negative bacteria and forms within 48 hours of admission to the ICU [2].
In children, secretion of secretions from the hypopharynx is recommended to prevent VAP. It is recommended that this aspiration be performed prior to aspiration from the endotracheal tube, to prevent aspiration of secretions from the hypopharynx, and prior to manipulation of the endotracheal tube. In some centers, they also aspirate secretions before positioning the patient on the bed. The use of a closed in-line extraction system may not have a direct effect on reducing the incidence of VAP, but may be effective in preventing contamination of the extraction device. Condensed steam in the respiratory circuit can potentially contaminate and theoretically cause infection, so condensate must be removed from the circuit. Staff should be conscientious and avoid contaminating the respirator and its accessories [9].
In the prevention of nosocomial pneumonia, it is important to minimize the length of the patient’s mechanical ventilation. The presence of an endotracheal tube poses a risk of VAP and not the positive pressure ventilation associated with it. Daily consideration is recommended as to whether the patient can be extubated. Discontinuation of sedation is impractical for most children in pediatric ICUs, as it can potentially lead to unwanted extubation, especially in children who are small enough to cooperate or understand the need for intensive care interventions. Studies in adults and children show that the use of non-invasive ventilation in ICU contributes to reducing the incidence of VAP [2].
One of the most important challenges for physicians is the adequate treatment of infections due to Gram-negative pathogens because of the increasing antimicrobial resistance in the healthcare setting [10].
Among infections caused by Gram-negative rods,
An anti-pseudomonal cephalosporin, or a carbapenem, or an anti-pseudomonal β-lactam/BLI represents potential options for definitive therapy. Aminoglycosides should not be used as monotherapy because success rates for aminoglycosides are low [8]. This may be due to the poor penetration of aminoglycosides into the lung, which require high peak serum concentrations to obtain adequate lung concentrations, thus increasing the risk of nephrotoxicity or ototoxicity [12, 13]. However, because in Europe fluoroquinolone resistance rate in P. aeuruginosa exceeds 30% [14], it is appropriate to use combination therapy including aminoglycosides for empirical therapy of serious VAP. A based approach is recommended of the prescription of an anti-pseudomonal β-lactam (piperacillin/tazobactam, ceftolozane/tazobactam, ceftazidime, cefepime, or a carbapenem) plus a second anti-pseudomonal agent (aminoglycoside or a fluoroquinolones). As for aerosol therapy, there is not routinely recommended the use of inhaled antibiotics for the treatment of
Factors that affect the complex process of origin and spread of nosocomial infections are divided into internal and external:
internal factors are closely related to the biological balance of the patient: age (over 60 years, up to 3 years), alcoholism, drug addiction, hormonal disorders (diabetes), malignant tumors, immunodeficiency, obesity, malnutrition, circulatory disorders, polytraumas, burns, pressure ulcers, ulcus cruris, other serious diseases (liver disease, AV shunt, cardiomyopathy),
external factors are related to therapeutic, prophylactic and diagnostic interventions and are used exclusively in treatment of patients in hospital facilities: length of hospital stay, surgery, transplantation, tracheostomy, endotracheal cannula, gastric tube, urinary catheterization, iv catheterization, infusion, transfusion, foreign bodies, drainage, instrumental procedure, repeated anesthesia, endoscopy, hemodialysis, radiation therapy, cytostatic therapy, immunosuppressive therapy, broad spectrum ATB therapy, hormonal therapy [3].
Hospital placement: plays an important role, with the highest incidence being typical of ICU. The incidence of nosocomial infection also depends on the type of ICU, while the different incidence will be on surgical, traumatological, burn, neurological, neurosurgical or cardiological ICU. Pediatric ICU is unique in that it provides care in all of these areas for all children except newborns [2].
The patient’s age may affect the risk of nosocomial infection. In the pediatric population, young children are most at risk, especially newborns. The highest incidence of nosocomial infections among pediatric patients is in children less than 1 year of age. The relative immaturity of the newborn’s immune system, associated with routine ICU procedures that bypass the physical barriers of infection such as skin and mucous membranes, is responsible for the increased risk. Parenteral nutrition with high concentrations of glucose and lipids is another risk factor for infection. The fact that premature infants are most affected by these risk factors explains why neonatal ICUs have a higher incidence of nosocomial infections than pediatric ICUs [2, 4, 16]. Pediatric ICU is also unique in that each childhood has a different incidence depending on the type of nosocomial infection. In children under 5 years of age, the 3 most common nosocomial infections are in the following order: bloodstream infections, so-called bloodstream infections, pneumonia and urinary tract infections. In children aged 5 to 12 years, the 3 most common are nosocomial infections: pneumonia, bloodstream infections and urinary tract infections. In adolescents, the order of the most common nosocomial infections is: bloodstream infections, urinary tract infections, and then pneumonia [2, 4, 16]. Immunosuppressed patients after chemotherapy, human immunodeficiency virus infection, or steroid use are equally at risk for developing nosocomial infection.
Nosocomial infections do not have an apparent sex predilection.
Particular risk factors for the development of nosocomial infection are length of hospital stay and initial antibiotic therapy [17].
Staff shortages are a particular risk factor for the increased incidence of nosocomial infections, due to increased staff workload and poor hand hygiene [18].
Erythrocyte transfusion is a risk factor for the development of nosocomial infections in critically ill patients on ICU. In a prospective study, the incidence of nosocomial infection was 14.3% in patients with blood transfusions and 5.8% in patients without blood transfusions. In the group of patients with blood transfusions, there was a higher incidence of nosocomial infections, which was significant in seriously ill patients with a probability of survival of less than 25%. Patients with more than a 25% chance of survival had higher mortality, longer stays on the ICU, and longer hospitalizations compared with patients who did not receive a blood transfusion [19].
It is not possible to eliminate all nosocomial infections, but one third of cases could be prevented if organized infection control programs were put in place.
Preventive measures can be divided into 2 categories, namely standard measures and transmission-based measures. Standard measures can always be used and are designed to prevent personnel from coming into contact with potentially infectious body fluids. The most important standard measure is hand hygiene. Washing hands with soap and water is considered the gold standard. The use of anhydrous antiseptic agents is accepted, but not in cases where visible dirt is present, proteinaceous body fluids such as blood, or spores contamination is suspected. In these cases, it is necessary to use soap and water. Hand hygiene must be observed before and after the patient’s examination, but also when gloves are worn. In case of contact with body fluids or secretions, it is advisable to use barriers such as gloves, masks, eye protectors and coats [2, 3].
Transmission-based measures aim to protect against the transmission of infectious micro-organisms from patients with a proven or suspected infection, as well as from patients colonized by specific micro-organisms. These additional measures are more than standard measures and are based on the path of transmission: contact, droplets, or airborne transmission.
Contact transfer measures apply to a wide range of micro-organisms that spread by direct contact with the patient or by indirect contact through contaminated objects such as toys, a stethoscope and unwashed hands. Preventive measures include, in addition to standard measures, isolation rooms for the patient or group, coats and gloves.
Droplet transfer measures are directed against microorganisms that spread a short distance from the patient by coughing and sneezing. These measures include isolation rooms for one patient or for a group of patients with the same microorganism. Healthcare professionals should wear masks with eye protection in addition to standard measures.
Measures to prevent airborne transmission include additional precautions against microorganisms which spread through the air stream. Patients should be isolated in rooms with ionized air. For other airborne microorganisms, a respirator is required when entering the patient’s room. Isolation of a patient may be based on clinical symptoms or circumstances present on admission to the hospital and should always be initiated before isolating the microorganism [2, 3].
Nosocomial infections are a major cause of morbidity and mortality in the intensive care unit, which can usually be prevented. Although not all nosocomial infections can be eliminated due to the specific nature of JIS patients, the incidence can be significantly reduced by control measures. Simple measures such as strict hand hygiene, isolation, sterility, elevated head position, judicious use, and prompt removal of central catheters, urinary catheters, and endotracheal tubes can dramatically affect the frequency of nosocomial infections. Although not all nosocomial infections can be prevented, intensive care targets should be zero. Consistent application and monitoring of the effectiveness of infection control measures must go a long way towards achieving the goal. The medical community must take steps to reduce and prevent nosocomial infections. Future efforts should be made to distinguish community-acquired infection from nosocomial infection, to reduce the development of resistant organisms through prudent use of antibiotics, to design JIS to isolate patients and ensure hand hygiene, and to develop barrier design [2, 3].
Adherence to infection control procedures, including hand hygiene, is one of the most useful and well-established methods for preventing nosocomial infections.
Isolation measures are crucial in preventing the transmission of infections among hospitalized patients.
Following cultures at the time of patient admission may reduce the spread of nosocomial resistant organisms.
Prevention of catheter blood infections begins at the time of insertion with sterility. Catheter care and the use of catheters that are impregnated with antiseptics or antibiotics may further reduce the risk of infection.
Routine removal of central venous catheters does not reduce the risk of catheter blood infections.
VAP prevention is facilitated by the use of a protocol that includes raising the head above bed level and considering extubation daily.
Vitamin D is a fat-soluble secosteroid. It is a prohormone that can be ingested or derived from body sterols by the photolytic activity of ultraviolet rays on human skin. Vitamin-D is not only an essential element in bone health, but it is also a pro-hormone that plays a well-recognized role in other organs of body. Vitamin D deficiency is a worldwide health issue that affects more than one billion children and adults globally [1]. Vitamin-D deficiency in neonates has been linked to higher risk of respiratory distress syndrome, lower respiratory infections, food sensitivities, asthma, type I diabetes, autism and schizophrenia [2, 3, 4, 5, 6, 7, 8, 9]. Serum 25-hydroxycholecalciferol (25[OH]D) is the main circulating metabolite of vitamin D with a reported half-life of approximately three weeks [10]. It is the best estimator of human body vitamin D stores. During pregnancy it crosses the placenta through passive or facilitated transport according to a concentration gradient [11, 12]. Vitamin-D status in the fetus and newborn infant is largely determined by maternal vitamin-D status [11]. The main risk factor for vitamin-D deficiency in neonates is maternal vitamin-D deficiency [13]. Rickets was a global problem in the early 20th century. It virtually disappeared in developed countries after its causal pathway was identified and fortification of milk with vitamin-D was implemented at population level [14]. Recent reports have suggested that rickets is re-emerging [15, 16] and vitamin-D deficiency is widespread in developed and developing countries [15, 17, 18, 19, 20, 21]. Globally, vitamin-D deficiency at birth is prevalent and in general reflects deficient maternal vitamin-D status [10, 22, 23, 24].
Vitamin D is unique among vitamins because it can be made in the skin from sunlight exposure. Vitamin D has two forms: Ergocalciferol (D2) and Cholecalciferol (D3). D2 is produced from ultraviolet irradiation of the yeast sterol ergosterol and is naturally found in sun-exposed mushrooms. D3 is synthesized in the skin from the cholesterol precursor 7-dehydrocholesterol which is naturally present in the skin or obtained from lanolin [25]. Vitamin D (in the form of D2, or D3, or both) that is ingested is assimilated into chylomicrons, which are absorbed into the lymphatic system and enter the venous blood. Vitamin D that comes from the skin or diet is biologically inert and needs its first hydroxylation in the liver by the vitamin D-25-hydroxylase to 25[OH]D [25, 26]. 25[OH]D undergoes a second hydroxylation in the kidneys by the 25[OH]D-1α-hydroxylase to form the biologically active form of vitamin D 1,25[OH]2D (3, 8). 1,25[OH]2D interacts with its vitamin D nuclear receptor, which is present in the small intestine, kidneys, and other tissues [25, 26].
1,25[OH]2D plays a main physiological role in bone hemostasis. It stimulates intestinal calcium absorption [27]. Without vitamin D, only 10 to 15% of dietary calcium and about 60% of phosphorus are absorbed. Vitamin D sufficiency enhances calcium and phosphorus absorption by 30–40% and 80%, respectively [25, 28]. 1,25[OH]2D interacts with its vitamin D receptor in the osteoblast to stimulate the expression of receptor activator of nuclear factor κB ligand; this, in turn, interacts with receptor activator of nuclear factor κB to induce immature monocytes to become mature osteoclasts, which dissolve the matrix and mobilize calcium and other minerals from the skeleton. In the kidney, 1,25[OH]2D stimulates calcium reabsorption from the glomerular filtrate [25, 29].
The strong correlation between maternal and infant 25[OH]D levels offers further evidence that newborn 25[OH]D levels are dependent on maternal plasma 25[OH]D levels [12, 30, 31]. There is no clear consensus on the cut off levels of serum 25[OH]D levels to define vitamin deficiency. The US Endocrine Society has categorized vitamin D deficiency as 25[OH]D < 20 ng/mL, vitamin D insufficiency as levels 21–30 ng/mL, sufficiency as levels greater than 30 ng/mL, and toxicity as vitamin D levels more than 150 ng/mL [32]. The American Academy of Pediatrics (AAP) and Institute of Medicine define vitamin D deficiency as serum 25[OH]D < 15 ng/mL, mild to moderate deficiency as 5–15 ng/mL, severe deficiency as levels less than 5 ng/mL, and insufficiency as 16–20 ng/mL. They define sufficiency as levels between 21 and 100 ng/mL, excess as 101–149 ng/mL, and intoxication as levels more than 150 ng/mL [33]. The Kidney Disease Outcome Quality Initiative supports the AAP in defining vitamin D deficiency as levels <15 ng/mL. However, it defines insufficiency as levels between 16 and 30 ng/mL and sufficiency as levels of more than 30 ng/mL. An expert committee of the US Food and Nutrition Board (FNB) at the National Academies of Sciences, Engineering, and Medicine (NASEM) concluded that people are at risk of vitamin D deficiency at serum 25[OH]D concentrations less than 12 ng/mL. The same cutoffs were used for both pregnant women and neonates, because experts contend that there is no reason to think the definition of vitamin-D sufficiency varies by age [16].
An US survey from National Health and Nutrition Examination Survey (NHANES) 2011–2014 on serum 25[OH]D levels found that 5.7% women had vitamin D deficiency (<12 ng/ml) and 17.8% women had vitamin D insufficiency (12–20 ng/mL). Rates of deficiency and insufficiency were 7.6% and 23.8% respectively in adults aged 20–39 years. Rates of deficiency varied by race and ethnicity: 17.5% of non-Hispanic Blacks, 7.6% of non-Hispanic Asians, 5.9% of Hispanics, and 2.1% of non-Hispanic White people were at risk of vitamin D deficiency respectively. Vitamin D status in the United States remained stable in the decade between 2003 and 2004 and 2011–2014 [34].
Boston’s cross-sectional study from 2005 to 2007 reported vitamin-D deficiency (25[OH]D < 20 ng/mL) in 35.8% of the mothers and 58% of the neonates, severe deficiency (25[OH]D < 15 ng/mL) in 23.1% of the mothers and 38.0% of the neonates. Risk factors for neonatal vitamin-D deficiency included maternal deficiency (adjusted odds ratio [aOR]: 5.28 [95% CI: 2.90–9.62]), winter birth (aOR: 3.86 [95% CI: 1.74–8.55]), African-American (AA) race (aOR: 3.36 [95% CI: 1.37–8.25]), and maternal body mass index of 35 (aOR: 2.78 [95% CI: 1.18–6.55]) [31].
A Canadian study found a prevalence of 25% vitamin D insufficiency (defined as serum 25-[OH]D < 40 nmol/L) in women aged 18–35 years during the winter season [17]. Vitamin D deficiency is also common in Europe and the Middle East. Vitamin D deficiency defined as serum 25[OH]D < 50 nmol/L or 20 ng/mL, occurs in 6–33% of the population in Northern Europe, in 30–60% in Western, Southern and Eastern Europe and 30–90% in the Middle East countries. Severe deficiency (serum 25(OH)D < 30 nmol/L or 12 ng/mL) is found in >10% of Europeans [35]. Vitamin D deficiency is usually is more prevalent in immigrants from non-Western countries, compared with native European people [36]. This is even worse in pregnant non-Western immigrants, who displayed mean serum 25(OH)D levels around 25 nmol/L [37].
The major proportion of vitamin D is produced endogenously with skin exposure of the skin to sunlight. In tropical areas like India, Africa and middle east, where there is abundant overhead sun for most or all of the year, deficiency of vitamin D is unexpected. However, despite stable and sufficient sun exposure in countries across equator, high prevalence of vitamin D deficiency in pregnancy ranging 26–95% in such areas was reported [38]. In Africa, Asia and the Middle East, women have been always regarded as “high risk” for vitamin D deficiency [39, 40]. In 2009, the International Osteoporosis Foundation reported that vitamin D deficiency was seen in 84% of pregnant women and 96% of infants in Asia [41]. In India, 50–90% of the population suffers from vitamin D deficiency due to inadequate exposure to sunlight and a lower dietary intake [42, 43, 44]. A recent study from northern India reported the prevalence of vitamin D deficiency in 85.5% of mothers and 74% of infants [45]. Vitamin D deficiency, defined as <50 nmol/L of 25[OH]D and severe vitamin D deficiency defined as <30 nmol/L of 25[OH]D was reported in 34% and 18% of the population respectively in African countries [46]. Vitamin D deficiency is even worse in mainland China with deficiency seen in 72% and severe deficiency seen in 37% of pregnant women [47].
Despite the wide intake of prenatal vitamins, Vitamin D deficiency in pregnancy is still common worldwide. The adverse outcomes of pregnancy secondary to vitamin D deficiency include miscarriages, preeclampsia, intrauterine growth restriction (IUGR), increased risk for gestational diabetes, preterm birth and low birth weight infants [48, 49, 50]. Vitamin D deficiency in pregnant women may affect fetal growth, tooth enamel formation and bone ossification [13]. Decreased vitamin D levels in general is associated with increased mortality and vitamin D supplementation reduces mortality [51]. The reasons behind increased mortality include diabetes mellitus, cardiovascular disease and cancer [52]. Vitamin D deficiency has been associated with several autoimmune diseases, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), Hashimoto Thyroiditis (HT), and multiple sclerosis (MS). Autoimmune diseases are more commonly seen in females than males. Pregnant women with these autoimmune disorders are at increased risk for poor pregnancy outcomes [48, 53].
Animal studies showed that vitamin D deficiency causes placental inflammation which leads to placental insufficiency and potentially fetal IUGR [53]. In both pregnancy and lactation it is important to have adequate vitamin D levels to avoid disturbances in bone and mineral metabolism [54]. The fetal and neonatal status of vitamin D is entirely dependent on the mother’s vitamin D levels. This confirms the correlation of mother and cord blood 25[OH]D concentrations. While 25[OH]D crosses the placenta, 1,25[OH]2D is produced by the fetal kidneys [54]. Research regarding the exact physiological role of vitamin D in pregnancy and lactation is ongoing. There is convincing data that vitamin D is important for the immunomodulation of the maternal-fetal interface [54, 55, 56, 57, 58]. Vitamin D is also crucial for the prevention of pre-eclampsia by stabilizing the endothelium through non-genomic mechanisms [54]. Other functions of vitamin D may include stimulation of sex hormone secretion, implantation/placentation and respiratory epithelium maturation. Vitamin D may also induce epigenetic changes in expressing vitamin D receptors and enzymes involved in vit D metabolism throughout the male and female reproductive tracts [54, 55, 56, 57, 58].
Vitamin D deficiency is prevalent worldwide in pregnant women and infants. In pregnancy, maternal vitamin D physiology is altered to facilitate the transfer of calcium to the fetus. In pregnancy there is a significant increase in 1,25[OH]2 D concentrations with a two-fold increase in the first trimester followed by a 2–3-fold increase during the second and third trimesters of pregnancy. Then there is a rapid decrease after delivery. PTH-related peptide may also regulate serum 1,25[OH]2D concentrations in pregnancy. 1,25[OH]2D synthesis is dependent up the levels of 25[OH]D. There is a positive correlation between serum 1,25[OH]2D and 25[OH]D concentrations and it is stronger in pregnant women compared to non-pregnant women [54].
Eating foods fortified with vitamin D as well as adequate exposure to sunlight are needed for upholding a normal vitamin D status. The most common reasons for vitamin D deficiency are low sun exposure, decreased vitamin D intake, obesity, and low socio-economic conditions. Various factors influence vitamin D synthesis from sunlight, such as latitude, pigmentation, and area of skin exposed. Many prevalent social and cultural practices in Asia and middle east that prevent the adequate exposure of young women and adolescent girls to sunlight contribute to vitamin D deficiency [59]. Increasing urbanization resulting in greater pollution and decreased time spent outdoors coupled with greater skin pigmentation contribute to vitamin D deficiency [60]. When women in these circumstances become pregnant with already low serum 25 [OH]D levels, this contributes to vitamin D deficiency or insufficiency in their offspring. These children at increased risk for developing rickets [49]. Furthermore, vitamin D supplementation is not part of antenatal care programs in developing countries like India [59].
Diets low in vitamin D are more common in people who have milk allergy or lactose intolerance and those who consume an ovo-vegetarian or vegan diet. Women who are homebound, have occupations that limit sun exposure, or who wear long dresses, robes, or head coverings for religious reasons are at risk for vitamin D deficiency due to limited exposure to sunlight [61]. The use of sunscreen also limits vitamin D synthesis from sunlight. Obese women have lower vitamin D levels than nonobese individuals. The skin’s capacity to produce vitamin D is not affected by obesity. In fact, thick subcutaneous fat sequesters more of vitamin D [62, 63]. Serum levels transiently increase following weight loss possibly due to the release of vitamin D in the circulation. This was noted in obese patients after roux-en-y gastric bypass surgery as well as patients with non-surgical weight loss. However, 1 year after a Roux-en-y gastric bypass surgery, vitamin D levels returned to baseline values [64]. Finally, since vitamin D is fat soluble, its absorption is poor in individuals with fat malabsorption disorders like celiac disease, cystic fibrosis, ulcerative colitis and Crohn’s disease [65].
Due to the bone deposition that mostly occurs in the latter half of the pregnancy, vitamin D requirements for the fetus are higher at this time frame [66]. In early pregnancy the plasma levels of 1,25(OH)2D increase and peak in the third trimester. It is estimated that the fetus accumulates 2–3 mg/day of calcium in the skeleton in the first trimester. This calcium accumulation doubles in the third trimester [67]. When infants are born prematurely, the time required for this transfer of Vitamin D and calcium is truncated [68].
Saraf and et al. conducted a global summary and systematic review of maternal and newborn vitamin D status by looking at studies published between 1959 and 2014. They found that 75% of newborns had vitamin D deficiency (defined as 25[OH]D level < 50 nmol/L) and that severe vitamin D deficiency (defined as 25[OH]D level < 25 nmol/L) occurred in 29% of newborns. In this summary, the average newborn 25[OH]D levels in nmol/L by region is as follows: 35–77 (Americans), 20–50 (European), 5–50 (Mediterranean), 20–22 (South-East Asia), 32–67 (Western Pacific) and 27–35 (African). They also found wide variability in 25[OH]D levels within in each defined region [24]. Both this study and another systemic review by Hilger and colleagues found that the average 25[OH]D levels in the general populations in North America were higher compared to Europe and the Middle East [69]. Furthermore, two other reviews found that vitamin D deficiency and severe vitamin D deficiency were more common in South-East Asia and the Eastern Mediterranean regions for newborns [41, 70]. Racial disparity in serum 25[OH]D levels has been well documented in several studies. AA preterm infants and their mothers have lower serum 25[OH]D levels compared to white infants [71, 72, 73]. Seto and colleagues measured cord blood 25 [OH]D levels in 276 AA term infants and 162 term white infants and found that AA infants had a 3.6 greater adjusted odds of vitamin D deficiency [74].
Currently, there continues to be emerging information on the distribution of 25[OH]D levels in preterm neonates. A few studies have documented 25[OH]D levels from neonates at birth with sample sizes ranging from 8 to 278 neonates [2, 75, 76, 77, 78, 79, 80] with mean 25[OH]D levels ranging from ~6.5 ng/mL among preterm neonates in the United Arab Emirates [78] to 26.8 ng/mL preterm neonates in Canada [10]. A recent study on 596 preterm infants from Ohio, USA reported median 25[OH]D level of 18.5 ng/mL for infants born at 34–36 weeks and 18.6 ng/mL for infants born <32 weeks [81].
The levels of 25[OH]D between the mother and the fetus are positively correlated [68, 81, 82]. Kassai et al. found that mothers who gave birth to preterm neonates had significantly lower mean 25[OH]D blood levels compared to those mothers who gave birth at term. Also, preterm neonates had significantly lower 25[OH]D levels compared to term neonates [83]. A study by Burris et al. measured umbilical cord plasma levels of 25[OH]D in 471 infants born at <37 weeks. They found that babies born at <32 weeks are at increased risk for vitamin D deficiency (25[OH]D levels <20 ng/dL) compared to infants born between 32 and 37 weeks [79]. Monagni et al. studied 120 mother infant dyads at three children’s hospitals in Ohio where neonates were delivered at <32 weeks. They not only found that low serum concentrations of 25[OH]D (defined as <50 nmol/L) was common in preterm neonates at admission (64%), but they also found that maternal 25[OH]D levels were lower in infants born at <28 weeks compared to those that were born between 28 and 32 weeks’ gestation. Serum 25[OH]D concentrations in preterm infants directly correlated with maternal vitamin D status at the time of delivery. Low 25[OH]D levels were noted at either 36 weeks post-menstrual age (PMA) or at discharge in 40% of infants <28 weeks and 30% of infants between 28 and 32 weeks PMA. Even though infants received vitamin D supplementation from various sources and intake progressively increased during their hospitalization, only 60% received 400 IU vitamin D daily by 36 weeks PMA or discharge [68].
In contrast to the above studies, a Canadian study and an US study did not show any significant difference in vitamin-D status between term and preterm neonates [10, 81]. A study of 3731 term infants in Jordan revealed that 94% had vitamin D deficiency defined as 25[OH]D level < 50 nmol/L. Shahraki et al. found that 25[OH]D levels in preterm neonates were not significantly lower than term neonates. Over 50% of both the term and preterm infants in this study had vitamin D insufficiency and about 25% had vitamin D deficiency [82]. In a cohort born in Cleveland area in US (latitude 410N), Kanike et al. reported a remarkably high proportion of vitamin-D deficiency and insufficiency among neonates at birth, 31% and 49% respectively. Notably, they noted low stores of vitamin D despite 75% of women reporting regular multivitamin intake during pregnancy. Vitamin D deficiency was found to be more common in AA neonates (63%) than Caucasian (27%) neonates [81]. Bodnar et.al studied 400 mother–infant pairs in Pittsburgh. They showed that nearly 50% of AA neonates and 10% of white neonates, had serum 25[OH]D levels at birth less than 15 ng/mL despite adequate compliance with a 400 IU daily vitamin-D intake by 90% of their mothers [22]. A prolonged winter season with limited sun exposure in Cleveland might be a contributing factor to the vitamin-D deficiency found in this population. There has been no significant improvement in the vitamin-D status among neonates born to AA women in the last 3 decades in Cleveland area [12].
Vitamin-D deficiency is the most common cause of rickets and also increases the risk of respiratory distress syndrome, lower respiratory infections, food sensitivities, asthma, type I diabetes, autism and schizophrenia [2, 3, 6, 8, 15]. Vitamin D deficiency in pregnancy impairs fetal lung development partially through suppressing type II pneumocyte differentiation increasing the risk of respiratory distress syndrome in the newborn period [84]. Furthermore, studies have shown that early onset sepsis and late onset sepsis occurs more frequently in term infants with vitamin D deficiency [85, 86, 87]. To highlight, one study by Singh and Chaudari found that vitamin D deficiency was more common in neonates with early onset sepsis and was associated with increased severity of sepsis and mortality [87].
Vitamin D deficiency prevents effective absorption of dietary calcium and phosphorus. Vitamin D stores in newborn are completely dependent on vitamin D supply from the mother [12]. Not surprisingly, poor maternal vitamin D status during pregnancy is a major risk factor for infant rickets [13, 88, 89]. Severe chronic vitamin D deficiency leads to overt skeletal abnormalities in children like rickets [90, 91]. However, neonates who are vitamin-D insufficient have no apparent skeletal or calcium metabolism abnormalities [16]. In developing countries rickets has been ranked among the five most prevalent diseases in children [92]. Poorer outcomes during pregnancy, at birth and during infancy are associated with lower serum 25[OH]D levels [24, 93]. Reduced bone mass at 9 years of age was seen in children born with low serum 25[OH]D concentrations [94].
There is conflicting data about role of vitamin D and neurodevelopmental outcomes. A meta-analysis by Tous and colleauges found that infants born to mothers with vitamin D insufficiency had lower scores in both mental and language development [95]. In contrast, Wang et al. found that vitamin D deficiency was not associated with neurodevelopment in infancy [84]. A prospective cohort study by McCarthy et al. found no association between antenatal 25[OH]D levels and neurodevelopmental outcomes at 5 years. Tous et al. found that maternal vitamin D deficiency is associated with lower birth weights, smaller head circumference, increased risk for small for gestational age (SGA) status, and preterm birth. Maternal vitamin D insufficiency was associated with increased risk for infants with SGA status and preterm birth [95]. Seto and colleagues found that black infants with vitamin D deficiency had 2.4 greater adjusted odds for SGA status at birth. The association between SGA and vitamin D deficiency was not demonstrated in white infants [74]. Furthermore, a systematic review by Pligt et al. found the maternal vitamin D deficiency was associated with low birth weight, SGA status at birth, stunting of growth immediately after delivery, and preterm birth [96].
As per the US federal government’s 2020–2025 guidelines, fortified foods and dietary supplements are beneficial when it is impossible to meet needs for one or more nutrients during certain life stages such as pregnancy. Milk, many ready-to-eat cereals, and some brands of yogurt, orange juice and margarines are fortified with vitamin D. Trout, tuna, salmon, and mackerel are fatty fish with a high content of vitamin D. One tablespoon of cod liver oil has 1360 IU of vitamin D. Cheese, beef liver and egg yolks naturally contain small amounts of vitamin D. The United States and Canada mandates the fortification of infant formula with 1–2.5 mcg/100 kcal (40–100 IU) vitamin D and 1–2 mcg/100 kcal (40–80 IU) respectively.
Global consensus recommendations on prevention and management of nutritional rickets states that pregnant women should receive 600 IU/d of vitamin-D, preferably as a combined preparation with other recommended micronutrients such as iron and folic acid [97]. The Endocrine Society clinical practice guidelines also recommend at least 600 IU/d of vitamin D in pregnant and lactating women. They also recognize that 1500–2000 IU/day of vitamin D may be needed to maintain 25[OH]D levels>30 ng/mL [32]. However, the average prenatal supplements contain only 400 IU of vitamin D [97]. There is also mounting evidence of the importance of vitamin D supplementation to achieve serum 25[OH]D level of ≥40 ng/ml [55].
Rostami et al. evaluated the effectiveness of a prenatal screening study for optimizing vitamin-D status during pregnancy. The outcome of this program was the prevention of complications of pregnancy. They observed a > 25-fold increase in the number of pregnant women who were able to accomplish a 25[OH]D that was >20 ng/mL when they were screened for their vitamin-D status and provided supplementation compared with pregnant women who were not screened and consequently were not counseled to take vitamin-D supplements. They observed an outstanding decrease in adverse outcomes in pregnant women who were screened and received vitamin-D supplementation. They reported 60%, 50%, and 40% decreases in preeclampsia, gestational diabetes, and preterm delivery, respectively [98].
A recent Cochrane review on Vitamin D supplementation in pregnancy included 30 clinical studies on 3700 pregnant women and reported that taking vitamin D supplements in pregnancy probably reduces the risk of pre-eclampsia, gestational diabetes, post-partum hemorrhage and low-birthweight infant, but there was no difference in the risk of preterm birth before 37 weeks. They also reported that taking vitamin D and calcium together in pregnancy may increase the risk of preterm birth. These results warrant further research [99]. Prenatal supplementation with 4400 IU daily decreased the incidence of asthma and recurrent wheezing in these children at age 3 years by 6.1% [100].
In the 2020 WHO guidelines, routine oral supplementation of vitamin D is not recommended for pregnant women to improve maternal and perinatal outcomes. Pregnant women should be encouraged to receive adequate nutrition, which is best achieved through consumption of a healthy, balanced diet. Pregnant women should be advised that sunlight is the most important source of vitamin D. The amount of time needed in the sun is not known and depends on many variables, such as the amount of skin exposed, the time of day, latitude and season, skin pigmentation and sunscreen use. For pregnant women with suspected vitamin D deficiency, vitamin D supplements may be given at the current recommended nutrient intake of 200 IU per day. This may include women in populations where direct sun exposure is limited.
Vitamin D status is more significant during pregnancy, affecting not only the mother but also her growing fetus, and later, her growing child. There are variations in vitamin D status based on gestation at birth, global region of birth, race, and maternal vitamin D status during pregnancy. The current literature suggests that neonates are at high risk of vitamin-D deficiency, even when mothers are compliant with prenatal vitamins. Current prenatal vitamins may not contain enough vitamin-D to prevent deficiency. There has been substantial debate surrounding the daily requirement of vitamin D and what constitutes sufficiency during pregnancy. Higher-dose supplementation may be needed to improve maternal and neonatal vitamin-D status. Future multicenter studies are needed to determine the minimum dose of vitamin-D requirements during pregnancy to achieve vitamin-D sufficiency. It is time to rethink our approach to ensure vitamin-D sufficiency in pregnant women and their newborn infants.
The authors have indicated no financial relationships relevant to this article to disclose. The authors have indicated they have no potential/perceived conflicts of interest to disclose.
N.K and J.C conceptualized and drafted the initial manuscript and reviewed and revised the manuscript. N.KG reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
IntechOpen - where academia and industry create content with global impact
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\\n\\nCo-founded by Alex Lazinica and Vedran Kordic: “We are passionate about the advancement of science. As Ph.D. researchers in Vienna, we found it difficult to access the scholarly research we needed. We created IntechOpen with the specific aim of putting the academic needs of the global research community before the business interests of publishers. Our Team is now a global one and includes highly-renowned scientists and publishers, as well as experts in disseminating your research.”
\\n\\nBut, one thing we have in common is -- we are all scientists at heart!
\\n\\nSara Uhac, COO
\\n\\nSara Uhac was appointed Managing Director of IntechOpen at the beginning of 2014. She directs and controls the company’s operations. Sara joined IntechOpen in 2010 as Head of Journal Publishing, a new strategically underdeveloped department at that time. After obtaining a Master's degree in Media Management, she completed her Ph.D. at the University of Lugano, Switzerland. She holds a BA in Financial Market Management from the Bocconi University in Milan, Italy, where she started her career in the American publishing house Condé Nast and further collaborated with the UK-based publishing company Time Out. Sara was awarded a professional degree in Publishing from Yale University (2012). She is a member of the professional branch association of "Publishers, Designers and Graphic Artists" at the Croatian Chamber of Commerce.
\\n\\nAdrian Assad De Marco
\\n\\nAdrian Assad De Marco joined the company as a Director in 2017. With his extensive experience in management, acquired while working for regional and global leaders, he took over direction and control of all the company's publishing processes. Adrian holds a degree in Economy and Management from the University of Zagreb, School of Economics, Croatia. A former sportsman, he continually strives to develop his skills through professional courses and specializations such as NLP (Neuro-linguistic programming).
\\n\\nDr Alex Lazinica
\\n\\nAlex Lazinica is co-founder and Board member of IntechOpen. After obtaining a Master's degree in Mechanical Engineering, he continued his Ph.D. in Robotics at the Vienna University of Technology. There, he worked as a robotics researcher with the university's Intelligent Manufacturing Systems Group, as well as a guest researcher at various European universities, including the Swiss Federal Institute of Technology Lausanne (EPFL). During this time he published more than 20 scientific papers, gave presentations, served as a reviewer for major robotic journals and conferences and, most importantly, co-founded and built the International Journal of Advanced Robotic Systems, the world's first Open Access journal in the field of robotics. Starting this journal was a pivotal point in his career since it proved to be the pathway to the foundation of IntechOpen with its focus on addressing academic researchers’ needs. Alex personifies many of IntechOpen´s key values, including the commitment to developing mutual trust, openness, and a spirit of entrepreneurialism. Today, his focus is on defining the growth and development strategy for the company.
\\n"}]'},components:[{type:"htmlEditorComponent",content:"Our business values are based on those any scientist applies to their research. We have created a culture of respect and collaboration within a relaxed, friendly and progressive atmosphere, while maintaining academic rigour.
\n\nCo-founded by Alex Lazinica and Vedran Kordic: “We are passionate about the advancement of science. As Ph.D. researchers in Vienna, we found it difficult to access the scholarly research we needed. We created IntechOpen with the specific aim of putting the academic needs of the global research community before the business interests of publishers. Our Team is now a global one and includes highly-renowned scientists and publishers, as well as experts in disseminating your research.”
\n\nBut, one thing we have in common is -- we are all scientists at heart!
\n\nSara Uhac, COO
\n\nSara Uhac was appointed Managing Director of IntechOpen at the beginning of 2014. She directs and controls the company’s operations. Sara joined IntechOpen in 2010 as Head of Journal Publishing, a new strategically underdeveloped department at that time. After obtaining a Master's degree in Media Management, she completed her Ph.D. at the University of Lugano, Switzerland. She holds a BA in Financial Market Management from the Bocconi University in Milan, Italy, where she started her career in the American publishing house Condé Nast and further collaborated with the UK-based publishing company Time Out. Sara was awarded a professional degree in Publishing from Yale University (2012). She is a member of the professional branch association of "Publishers, Designers and Graphic Artists" at the Croatian Chamber of Commerce.
\n\nAdrian Assad De Marco
\n\nAdrian Assad De Marco joined the company as a Director in 2017. With his extensive experience in management, acquired while working for regional and global leaders, he took over direction and control of all the company's publishing processes. Adrian holds a degree in Economy and Management from the University of Zagreb, School of Economics, Croatia. A former sportsman, he continually strives to develop his skills through professional courses and specializations such as NLP (Neuro-linguistic programming).
\n\nDr Alex Lazinica
\n\nAlex Lazinica is co-founder and Board member of IntechOpen. After obtaining a Master's degree in Mechanical Engineering, he continued his Ph.D. in Robotics at the Vienna University of Technology. There, he worked as a robotics researcher with the university's Intelligent Manufacturing Systems Group, as well as a guest researcher at various European universities, including the Swiss Federal Institute of Technology Lausanne (EPFL). During this time he published more than 20 scientific papers, gave presentations, served as a reviewer for major robotic journals and conferences and, most importantly, co-founded and built the International Journal of Advanced Robotic Systems, the world's first Open Access journal in the field of robotics. Starting this journal was a pivotal point in his career since it proved to be the pathway to the foundation of IntechOpen with its focus on addressing academic researchers’ needs. Alex personifies many of IntechOpen´s key values, including the commitment to developing mutual trust, openness, and a spirit of entrepreneurialism. Today, his focus is on defining the growth and development strategy for the company.
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On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. 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After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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Accessions of the cultivated species (Capsicum annuum, C. baccatum, C. chinense, C. frutescens, and C. pubescens) have not all been analyzed for their capsaicinoids content. Identifying Capsicum species and accessions (genotypes) within species with high levels of antioxidants and bioactive compounds (capsaicin, dihydrocapsaicin, vitamin C, vitamin E, phenols, and β-carotene) that contribute to human disease therapy is the focus of this investigation. The main objectives of this chapter are to compile an overview of most recent achievements of the pharmacological properties of hot pepper compounds and provide a rationale for their use as analgesics and to present an evidence that supports the use of capsaicinoids in the treatment of neuropathic pain and other top leading death of worldwide human diseases.",book:{id:"6810",slug:"capsaicin-and-its-human-therapeutic-development",title:"Capsaicin and its Human Therapeutic Development",fullTitle:"Capsaicin and its Human Therapeutic Development"},signatures:"George F. Antonious",authors:[{id:"174916",title:"Dr.",name:"George",middleName:"Fouad",surname:"Antonious",slug:"george-antonious",fullName:"George Antonious"}]},{id:"62311",title:"CAP and Metabolic Diseases: A Mini Review on Preclinical Mechanisms and Clinical Efficacy",slug:"cap-and-metabolic-diseases-a-mini-review-on-preclinical-mechanisms-and-clinical-efficacy",totalDownloads:1313,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"Capsaicin (CAP) is the chief active ingredient of natural chili peppers. It has culinary and medicinal benefits. CAP activates its receptor, transient receptor potential vanilloid subfamily 1 (TRPV1), which is expressed in the sensory and motor neurons, adipocytes, liver, vascular smooth muscle cells, neuromuscular junction, skeletal muscle, heart and brain. The specificity of CAP to activate TRPV1 is the fundamental mechanism for its medicinal benefits to treat pain, obesity, hypertension, and other diseases. Preclinical data from rodent model of high fat diet-induced obesity collectively suggest that CAP exerts its effects by activating TRPV1 signaling pathway, which stimulates thermogenic mechanisms in the white and brown adipose tissues to induce browning of white adipose tissues and brown adipose tissue thermogenesis. This leads to enhancement of metabolic activity and thermogenesis to counter obesity. Although CAP and its pungent and non-pungent analogs are used in human clinical studies, their effects on satiety and energy expenditure have been the highlights of such studies. The precise mechanism of action of CAP has not been evaluated in humans. This article summarizes these data and suggests that long-term safety and tolerance studies are important for advancing CAP to treat human obesity.",book:{id:"6810",slug:"capsaicin-and-its-human-therapeutic-development",title:"Capsaicin and its Human Therapeutic Development",fullTitle:"Capsaicin and its Human Therapeutic Development"},signatures:"Baskaran Thyagarajan, Vivek Krishnan and Padmamalini Baskaran",authors:null},{id:"61453",title:"A Matter of Taste: Capsaicinoid Diversity in Chile Peppers and the Importance to Human Food Preference",slug:"a-matter-of-taste-capsaicinoid-diversity-in-chile-peppers-and-the-importance-to-human-food-preferenc",totalDownloads:1254,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Chile peppers are valued worldwide for their distinct capsaicinoid compounds that have been used traditionally in medicine and culinary practices. With 32 known species, five of them domesticated, they provide unique chemical profiles, when consumed by humans. Capsaicinoids, the spicy compounds, are alkaloids used to deter herbivory in the wild, offering protection to the chile pepper fruit seeds. Among the 22 known capsaicinoid structures, capsaicin and dihydrocapsaicin are normally the most abundant. In humans, capsaicin binds to nociceptor TRPV1 that generates a heat sensation. Capsaicin also mitigates inflammation responses in the digestive tract and has the potential to aid in nutrient absorption. Distinct heat profiles were recently described for the five domesticated Capsicum species showing a difference in heat sensations specific to species and pod type. Due to the many capsaicinoid structures, we explore the implications and opportunities of having a diverse array of heat profiles in genetically diverse Capsicum species.",book:{id:"6810",slug:"capsaicin-and-its-human-therapeutic-development",title:"Capsaicin and its Human Therapeutic Development",fullTitle:"Capsaicin and its Human Therapeutic Development"},signatures:"Ivette Guzmán and Paul W. 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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"}}}},{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"}}}}]},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:"May 18th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:27,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:6,paginationItems:[{id:"22",title:"Applied Intelligence",coverUrl:"https://cdn.intechopen.com/series_topics/covers/22.jpg",isOpenForSubmission:!0,annualVolume:11418,editor:{id:"27170",title:"Prof.",name:"Carlos",middleName:"M.",surname:"Travieso-Gonzalez",slug:"carlos-travieso-gonzalez",fullName:"Carlos Travieso-Gonzalez",profilePictureURL:"https://mts.intechopen.com/storage/users/27170/images/system/27170.jpeg",biography:"Carlos M. Travieso-González received his MSc degree in Telecommunication Engineering at Polytechnic University of Catalonia (UPC), Spain in 1997, and his Ph.D. degree in 2002 at the University of Las Palmas de Gran Canaria (ULPGC-Spain). He is a full professor of signal processing and pattern recognition and is head of the Signals and Communications Department at ULPGC, teaching from 2001 on subjects on signal processing and learning theory. His research lines are biometrics, biomedical signals and images, data mining, classification system, signal and image processing, machine learning, and environmental intelligence. He has researched in 52 international and Spanish research projects, some of them as head researcher. He is co-author of 4 books, co-editor of 27 proceedings books, guest editor for 8 JCR-ISI international journals, and up to 24 book chapters. He has over 450 papers published in international journals and conferences (81 of them indexed on JCR – ISI - Web of Science). He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. He is the founder of The IEEE IWOBI conference series and the president of its Steering Committee, as well as the founder of both the InnoEducaTIC and APPIS conference series. He is an evaluator of project proposals for the European Union (H2020), Medical Research Council (MRC, UK), Spanish Government (ANECA, Spain), Research National Agency (ANR, France), DAAD (Germany), Argentinian Government, and the Colombian Institutions. He has been a reviewer in different indexed international journals (<70) and conferences (<250) since 2001. He has been a member of the IASTED Technical Committee on Image Processing from 2007 and a member of the IASTED Technical Committee on Artificial Intelligence and Expert Systems from 2011. \n\nHe has held the general chair position for the following: ACM-APPIS (2020, 2021), IEEE-IWOBI (2019, 2020 and 2020), A PPIS (2018, 2019), IEEE-IWOBI (2014, 2015, 2017, 2018), InnoEducaTIC (2014, 2017), IEEE-INES (2013), NoLISP (2011), JRBP (2012), and IEEE-ICCST (2005)\n\nHe is an associate editor of the Computational Intelligence and Neuroscience Journal (Hindawi – Q2 JCR-ISI). He was vice dean from 2004 to 2010 in the Higher Technical School of Telecommunication Engineers at ULPGC and the vice dean of Graduate and Postgraduate Studies from March 2013 to November 2017. He won the “Catedra Telefonica” Awards in Modality of Knowledge Transfer, 2017, 2018, and 2019 editions, and awards in Modality of COVID Research in 2020.\n\nPublic References:\nResearcher ID http://www.researcherid.com/rid/N-5967-2014\nORCID https://orcid.org/0000-0002-4621-2768 \nScopus Author ID https://www.scopus.com/authid/detail.uri?authorId=6602376272\nScholar Google https://scholar.google.es/citations?user=G1ks9nIAAAAJ&hl=en \nResearchGate https://www.researchgate.net/profile/Carlos_Travieso",institutionString:null,institution:{name:"University of Las Palmas de Gran Canaria",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"23",title:"Computational Neuroscience",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",isOpenForSubmission:!0,annualVolume:11419,editor:{id:"14004",title:"Dr.",name:"Magnus",middleName:null,surname:"Johnsson",slug:"magnus-johnsson",fullName:"Magnus Johnsson",profilePictureURL:"https://mts.intechopen.com/storage/users/14004/images/system/14004.png",biography:"Dr Magnus Johnsson is a cross-disciplinary scientist, lecturer, scientific editor and AI/machine learning consultant from Sweden. \n\nHe is currently at Malmö University in Sweden, but also held positions at Lund University in Sweden and at Moscow Engineering Physics Institute. \nHe holds editorial positions at several international scientific journals and has served as a scientific editor for books and special journal issues. \nHis research interests are wide and include, but are not limited to, autonomous systems, computer modeling, artificial neural networks, artificial intelligence, cognitive neuroscience, cognitive robotics, cognitive architectures, cognitive aids and the philosophy of mind. \n\nDr. Johnsson has experience from working in the industry and he has a keen interest in the application of neural networks and artificial intelligence to fields like industry, finance, and medicine. \n\nWeb page: www.magnusjohnsson.se",institutionString:null,institution:{name:"Malmö University",institutionURL:null,country:{name:"Sweden"}}},editorTwo:null,editorThree:null},{id:"24",title:"Computer Vision",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",isOpenForSubmission:!0,annualVolume:11420,editor:{id:"294154",title:"Prof.",name:"George",middleName:null,surname:"Papakostas",slug:"george-papakostas",fullName:"George Papakostas",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hYaGbQAK/Profile_Picture_1624519712088",biography:"George A. Papakostas has received a diploma in Electrical and Computer Engineering in 1999 and the M.Sc. and Ph.D. degrees in Electrical and Computer Engineering in 2002 and 2007, respectively, from the Democritus University of Thrace (DUTH), Greece. Dr. Papakostas serves as a Tenured Full Professor at the Department of Computer Science, International Hellenic University, Greece. Dr. Papakostas has 10 years of experience in large-scale systems design as a senior software engineer and technical manager, and 20 years of research experience in the field of Artificial Intelligence. Currently, he is the Head of the “Visual Computing” division of HUman-MAchines INteraction Laboratory (HUMAIN-Lab) and the Director of the MPhil program “Advanced Technologies in Informatics and Computers” hosted by the Department of Computer Science, International Hellenic University. He has (co)authored more than 150 publications in indexed journals, international conferences and book chapters, 1 book (in Greek), 3 edited books, and 5 journal special issues. His publications have more than 2100 citations with h-index 27 (GoogleScholar). His research interests include computer/machine vision, machine learning, pattern recognition, computational intelligence. \nDr. Papakostas served as a reviewer in numerous journals, as a program\ncommittee member in international conferences and he is a member of the IAENG, MIR Labs, EUCogIII, INSTICC and the Technical Chamber of Greece (TEE).",institutionString:null,institution:{name:"International Hellenic University",institutionURL:null,country:{name:"Greece"}}},editorTwo:null,editorThree:null},{id:"25",title:"Evolutionary Computation",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",isOpenForSubmission:!0,annualVolume:11421,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. Dr Ventura also holds the positions of Affiliated Professor at Virginia Commonwealth University (Richmond, USA) and Distinguished Adjunct Professor at King Abdulaziz University (Jeddah, Saudi Arabia). Additionally, he is deputy director of the Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI) and heads the Knowledge Discovery and Intelligent Systems Research Laboratory. He has published more than ten books and over 300 articles in journals and scientific conferences. Currently, his work has received over 18,000 citations according to Google Scholar, including more than 2200 citations in 2020. In the last five years, he has published more than 60 papers in international journals indexed in the JCR (around 70% of them belonging to first quartile journals) and he has edited some Springer books “Supervised Descriptive Pattern Mining” (2018), “Multiple Instance Learning - Foundations and Algorithms” (2016), and “Pattern Mining with Evolutionary Algorithms” (2016). He has also been involved in more than 20 research projects supported by the Spanish and Andalusian governments and the European Union. He currently belongs to the editorial board of PeerJ Computer Science, Information Fusion and Engineering Applications of Artificial Intelligence journals, being also associate editor of Applied Computational Intelligence and Soft Computing and IEEE Transactions on Cybernetics. Finally, he is editor-in-chief of Progress in Artificial Intelligence. He is a Senior Member of the IEEE Computer, the IEEE Computational Intelligence, and the IEEE Systems, Man, and Cybernetics Societies, and the Association of Computing Machinery (ACM). Finally, his main research interests include data science, computational intelligence, and their applications.",institutionString:null,institution:{name:"University of Córdoba",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"26",title:"Machine Learning and Data Mining",coverUrl:"https://cdn.intechopen.com/series_topics/covers/26.jpg",isOpenForSubmission:!0,annualVolume:11422,editor:{id:"24555",title:"Dr.",name:"Marco Antonio",middleName:null,surname:"Aceves Fernandez",slug:"marco-antonio-aceves-fernandez",fullName:"Marco Antonio Aceves Fernandez",profilePictureURL:"https://mts.intechopen.com/storage/users/24555/images/system/24555.jpg",biography:"Dr. Marco Antonio Aceves Fernandez obtained his B.Sc. (Eng.) in Telematics from the Universidad de Colima, Mexico. He obtained both his M.Sc. and Ph.D. from the University of Liverpool, England, in the field of Intelligent Systems. He is a full professor at the Universidad Autonoma de Queretaro, Mexico, and a member of the National System of Researchers (SNI) since 2009. Dr. Aceves Fernandez has published more than 80 research papers as well as a number of book chapters and congress papers. He has contributed in more than 20 funded research projects, both academic and industrial, in the area of artificial intelligence, ranging from environmental, biomedical, automotive, aviation, consumer, and robotics to other applications. He is also a honorary president at the National Association of Embedded Systems (AMESE), a senior member of the IEEE, and a board member of many institutions. His research interests include intelligent and embedded systems.",institutionString:"Universidad Autonoma de Queretaro",institution:{name:"Autonomous University of Queretaro",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null},{id:"27",title:"Multi-Agent Systems",coverUrl:"https://cdn.intechopen.com/series_topics/covers/27.jpg",isOpenForSubmission:!0,annualVolume:11423,editor:{id:"148497",title:"Dr.",name:"Mehmet",middleName:"Emin",surname:"Aydin",slug:"mehmet-aydin",fullName:"Mehmet Aydin",profilePictureURL:"https://mts.intechopen.com/storage/users/148497/images/system/148497.jpg",biography:"Dr. Mehmet Emin Aydin is a Senior Lecturer with the Department of Computer Science and Creative Technology, the University of the West of England, Bristol, UK. His research interests include swarm intelligence, parallel and distributed metaheuristics, machine learning, intelligent agents and multi-agent systems, resource planning, scheduling and optimization, combinatorial optimization. Dr. Aydin is currently a Fellow of Higher Education Academy, UK, a member of EPSRC College, a senior member of IEEE and a senior member of ACM. In addition to being a member of advisory committees of many international conferences, he is an Editorial Board Member of various peer-reviewed international journals. He has served as guest editor for a number of special issues of peer-reviewed international journals.",institutionString:null,institution:{name:"University of the West of England",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:0,paginationItems:[]},overviewPagePublishedBooks:{paginationCount:1,paginationItems:[{type:"book",id:"10843",title:"Persistent Organic Pollutants (POPs)",subtitle:"Monitoring, Impact and Treatment",coverURL:"https://cdn.intechopen.com/books/images_new/10843.jpg",slug:"persistent-organic-pollutants-pops-monitoring-impact-and-treatment",publishedDate:"April 13th 2022",editedByType:"Edited by",bookSignature:"Mohamed Nageeb Rashed",hash:"f5b1589f0a990b6114fef2dadc735dd9",volumeInSeries:1,fullTitle:"Persistent Organic Pollutants (POPs) - Monitoring, Impact and Treatment",editors:[{id:"63465",title:"Prof.",name:"Mohamed Nageeb",middleName:null,surname:"Rashed",slug:"mohamed-nageeb-rashed",fullName:"Mohamed Nageeb Rashed",profilePictureURL:"https://mts.intechopen.com/storage/users/63465/images/system/63465.gif",biography:"Prof. Mohamed Nageeb Rashed is Professor of Analytical and Environmental Chemistry and former vice-dean for environmental affairs, Faculty of Science, Aswan University, Egypt. He received his Ph.D. in Environmental Analytical Chemistry from Assiut University, Egypt, in 1989. His research interest is in analytical and environmental chemistry with special emphasis on: (1) monitoring and assessing biological trace elements and toxic metals in human blood, urine, water, crops, vegetables, and medicinal plants; (2) relationships between environmental heavy metals and human diseases; (3) uses of biological indicators for monitoring water pollution; (4) environmental chemistry of lakes, rivers, and well water; (5) water and wastewater treatment by adsorption and photocatalysis techniques; (6) soil and water pollution monitoring, control, and treatment; and (7) advanced oxidation treatment. Prof. Rashed has supervised several MSc and Ph.D. theses in the field of analytical and environmental chemistry. He served as an examiner for several Ph.D. theses in analytical chemistry in India, Kazakhstan, and Botswana. He has published about ninety scientific papers in peer-reviewed international journals and several papers in national and international conferences. He participated as an invited speaker at thirty international conferences. Prof. Rashed is the editor-in-chief and an editorial board member for several international journals in the fields of chemistry and environment. He is a member of several national and international societies. He received the Egyptian State Award for Environmental Research in 2001 and the Aswan University Merit Award for Basic Science in 2020. 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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. 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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"}}},subseries:[{id:"14",title:"Cell and Molecular Biology",keywords:"Omics (Transcriptomics; Proteomics; Metabolomics), Molecular Biology, Cell Biology, Signal Transduction and Regulation, Cell Growth and Differentiation, Apoptosis, Necroptosis, Ferroptosis, Autophagy, Cell Cycle, Macromolecules and Complexes, Gene Expression",scope:"The Cell and Molecular Biology topic within the IntechOpen Biochemistry Series aims to rapidly publish contributions on all aspects of cell and molecular biology, including aspects related to biochemical and genetic research (not only in humans but all living beings). We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics include, but are not limited to: Advanced techniques of cellular and molecular biology (Molecular methodologies, imaging techniques, and bioinformatics); Biological activities at the molecular level; Biological processes of cell functions, cell division, senescence, maintenance, and cell death; Biomolecules interactions; Cancer; Cell biology; Chemical biology; Computational biology; Cytochemistry; Developmental biology; Disease mechanisms and therapeutics; DNA, and RNA metabolism; Gene functions, genetics, and genomics; Genetics; Immunology; Medical microbiology; Molecular biology; Molecular genetics; Molecular processes of cell and organelle dynamics; Neuroscience; Protein biosynthesis, degradation, and functions; Regulation of molecular interactions in a cell; Signalling networks and system biology; Structural biology; Virology and microbiology.",annualVolume:11410,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"79367",title:"Dr.",name:"Ana Isabel",middleName:null,surname:"Flores",fullName:"Ana Isabel Flores",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRpIOQA0/Profile_Picture_1632418099564",institutionString:null,institution:{name:"Hospital Universitario 12 De Octubre",institutionURL:null,country:{name:"Spain"}}},{id:"328234",title:"Ph.D.",name:"Christian",middleName:null,surname:"Palavecino",fullName:"Christian Palavecino",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000030DhEhQAK/Profile_Picture_1628835318625",institutionString:null,institution:{name:"Central University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"186585",title:"Dr.",name:"Francisco Javier",middleName:null,surname:"Martin-Romero",fullName:"Francisco Javier Martin-Romero",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSB3HQAW/Profile_Picture_1631258137641",institutionString:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}}]},{id:"15",title:"Chemical Biology",keywords:"Phenolic Compounds, Essential Oils, Modification of Biomolecules, Glycobiology, Combinatorial Chemistry, Therapeutic peptides, Enzyme Inhibitors",scope:"Chemical biology spans the fields of chemistry and biology involving the application of biological and chemical molecules and techniques. In recent years, the application of chemistry to biological molecules has gained significant interest in medicinal and pharmacological studies. This topic will be devoted to understanding the interplay between biomolecules and chemical compounds, their structure and function, and their potential applications in related fields. Being a part of the biochemistry discipline, the ideas and concepts that have emerged from Chemical Biology have affected other related areas. 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Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. 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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. 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