International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 8(8), April, 2016

Pages: 37-43

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MAGNITUDE OF PULMONARY DISEASES - INCIDENTALLY DIAGNOSED ON AUTOPSY - AT LARGEST HOSPITAL AND MEDICAL COLLEGE OF RAJASTHAN

Author: Kalpana Mangal, Praveen Dhakar, Ajay Yadav, Karuna Gupta, Sapna Gandhi

Category: Healthcare

Abstract:Objective: A wide histopathological spectrum of preventable diseases can affect lungs. Many times radiological and clinical findings in pulmonary diseases are non specific hence pathology investigations can play important role in prompt diagnosis. In our 4 years cross-sectional study period (January2012- December2015), we have examined lungs of 1715 medico-legal autopsy cases. Objectives: 1. To know the histopathological spectrum of Lung diseases. 2. To know the frequency of pulmonary lesions in respect to age and sex. Materials and Methods: Representative sections from pulmonary lesions were taken and studied with the help of H and E and special stains wherever necessary. Results: The various pulmonary lesions were edema and congestion in 1325 (77.2%) cases, non tubercular pneumonia 137 (7.99%) cases, bronchopneumonia 15 (0.87%) cases, interstitial pneumonia 6 (0.35%) cases. Cases of tubercular pneumonia were 70 (4.08%) and pulmonary malignancies were 7 (0.41%) cases out of total pulmonary lesions. Pneumonias were occupying a large number, next to edema and congestion. Conclusion: The present study reveals the load and spectrum of lung disease in the largest Hospital and Medical College of Rajasthan, where infectious lesions (non-tubercular and tubercular pneumonias) are still the most common preventable causes of morbidity and mortality; hence autopsy study can be of great value in improving the vision and diagnostic setups for better clinical assessment, timely diagnosis and therapy.

Keywords: Edema and Congestion, Pneumonia, Autopsy, ARDS, Emphysema

Full Text:

INTRODUCTION The lungs are ingeniously constructed to carry out their cardinal function: the exchange of gases between inspired air and blood.1 During their functional course, lungs can become vulnerable for a wide range of inflammatory, neoplastic and other lesions, and almost always involved secondarily by terminal events of cardiovascular causes.2 Millions of people all over the world suffer by various chronic respiratory diseases, which can be prevented, if diagnosed timely.3 Most of the time clinical and radiological findings in pulmonary diseases are non specific hence prompt pathology investigations and diagnosis are essential to improve patient’s survival and to reduce further morbidity and mortality.4 Autopsy is an important and most useful way to find out the condition of internal organs, for this a systematic examination of organs was undertaken according to standardised research protocol, to evaluate diseases or injury that may be present and to determine cause and manner of death.5In present study, status of lungs was examined grossly and microscopically. On gross examination we observed various findings like consolidation, nodule, scarring, fibrosis, collapse, or hyper inflated lungs as well as congestion. Pulmonary diseases are the significant cause of death worldwide affecting mostly 20-59 years age group. We performed this retrospective study to describe spectrum of various histopathologically proven pulmonary lesions and their incidences in respect to age and sex over a 4 year period that is January 2012 to December 2015.

MATERIAL AND METHODS Study was conducted in the department of pathology, SMS medical college Jaipur on 1715 specimens of lung from deceased of 0 - >70 years of age. We examined all lungs grossly as well as microscopically. The medical and clinical histories were traced. Gross examination of lungs included colour, volume (collapsed or inflated), and consistency, presence of any consolidation, nodule, bullae, scarring, fibrosis, infarction and congestion. All specimens were adequately fixed in 10% formalin, weighed, and dimensions measured. Sections from representative areas were taken and paraffin blocks were made following standard protocol. Four micron sections were cut and stained with haematoxylin and eosin according to standard procedures.6 Special stains were used wherever required. All the cases were analysed by descriptive statistics.

RESULTS In this study, we have observed that 1305 (76.09%) cases were from male deceased while 410 (23.91%) were of female, out of total 1715 cases. The male to female ratio was 3.18:1. Distribution of various pulmonary lesions out of 1715 autopsy cases was done (Table-1). After histopathological examinations, various pathological lesions were noted in 1549 (90.32%) cases while 166 (09.68%) cases were within normal limits. Out of these 1549 cases edema and congestion were the most common findings seen in 1325 (77.26%) cases, 1009 (76.15%) were males and 316 (23.85%) were females with male to female ratio (3.19:1). Most common age group affected was 20-59 years i.e.1106 cases (83.47%) and predominant age group in congestion and edema was 20-39 years with 621 cases (46.87%). Non tubercular pneumonia was the second most common finding noted in 137 cases (7.99%), 106 (77.37%) were males, females were 31 (22.63%) and male to female ratio 3.42:1. Most common age group affected was 20-59 years i.e. 108 (78.83%) cases. Tubercular pneumonia was the next common finding i.e. 70 cases (4.08%), 59 (84.29%) were males while 11 (15.11%) were female with male to female ratio 5.36:1. Most common age group affected was 20-59 years i.e. 59 (84.29%) cases. Next in order were malignant pulmonary lesions (including primary and secondary) 7 (0.41%) cases. All the cases found were males, most common age group affected was 40-59 years i.e. 4 (57.14%) cases, lung abscess and acute respiratory distress syndrome were 3 (0.17%) each with male to female ratio 1:2 in both the cases, as well as most common age group affected was 20-39 years in both the cases, as shown in table -2. Other findings were aspirational lung diseases 2 (0.12%), emphysema 2 (0.12%). Causes of death were taken out (Table-3). These were, due to unknown reason 812 (47.34%), sudden death 399 (23.27%), alcoholism 209 (12.17%), long illness 139 (8.11%), heart attack 122 (7.11%), poisoning 18 (1.08%), hanging 11 (0.63%) and drowning 5 (0.29%).

DISCUSSION The role and value of autopsy remains a vital component for the study and evaluation of the disease process, inspite of advances in diagnostic technology. There are large no. of cases of preventable respiratory diseases, still leads to morbidity and mortality.7, 8 and 9 In the present study age and sex wise distribution of pulmonary cases shows that the incidences were higher in 20-59 years age group. It is comparable to study done by V. Selvam et al where they found maximum incidences of pulmonary diseases in 3rd to 4th decades of life, men were more prone to death by diseases as compare to women 410 (23.91%)10 , while in study conducted by Chauhan et al, most common age group was 50->60 years.7 The reason may be that as men usually were bread earners and women usually indulged in household works. This makes the men more vulnerable for exposure of risk factors on their respective occupations as well as more addiction for smoking and alcoholism makes them prone for various diseases. Other studies were also showing comparable results with higher disease incidences in males as compare to females .11 In present study, we observed congestion and edema in 1325 (76.26%) cases while Chauhan et al found 182 (54.32%) and V. Selvam observed 32 (29.6%) cases. Non tubercular pneumonias were 137 (7.99%) in present study, while Chauhan et al and V. Selvam found.

Magnitude of Pulmonary diseases 14.62% and 10.2% respectively. Tubercular pneumonias in our study were 70 (4.08%) while these were 6.26% and 2.80% respectively in Chauhan et al and V. Selvam et al studies. Cases of emphysema were quite high in study conducted by V. Selvam et al i.e. 50% and Chauhan et al 7.06% while in present study they were only 0.12%. we found 0.17% each in lung abscess and ARDS cases, 0.12% cases of aspirational lung diseases. These cases were not found in studies conducted by Chauhan et al and V. Selvam et al. Malignant pulmonary lesions were found 0.41% in our study while it was 2.08% in study by Chauhan et al. No specific pathology was observed in 166 (9.68%) cases. [Table-4 ] The reason of difference amongst studies may be due to difference in sample size and pattern of studies.12 ,13 and  14

CONCLUSION The present study provides a comprehensive data about spectrum and frequency of Lung lesions, and up to our knowledge no such study has been done in our region. Autopsy studies can be of great value in improving the vision and diagnostic setup for better clinical assessment and timely diagnosis, to reduce further morbidity and mortality.

ACKNOWLEDGMENT
Authors wish to express and convey their sincere thanks and gratitude to all those who helped for completion of this research article. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to author’s /editors/ publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

Authors acknowledge that we did not get any grants for this study; required funds were generated by  ourselves. The Authors declare and acknowledges that we have no conflict of interest.

References:

1. Kumar Abbas, Aster, Robbins, Cotran. Pathologic basis of disease. South Asia Ed. Vol 2, Elsevier:8e

2. Manjit S Bal, P S Sethi, Anil K Suri, Vijay K Bodal, G Kaur. Histopathological pattern in lung autopsies, Journal of Punjab Academy of Forensic Medicine and Toxicology 2008; 8(2):29- 31.

3. John E Hall. Guyton and Hall Textbook of Medical Physiology, 13th Edition, Elsevier: Saunders, 2015.

4. Kasper, Fauci, Hauser, Longo, Jameson, Loscalzo. Harrison’s principles of internal medicine, 19th ed. Vol 2, Mc Graw Hill; Indian edition:2015.

5. KS Narayan Reddy, OP Murty. The essentials of Forensic Medicine and Toxicology, 33rd edition. JayPee Brothers:2014.

6. D. John Bancroft Manual of Histological techniques and their diagnostic application – Harry Charles 1994.

7. Chauhan, Madhuri Agrawal, Nirali Thakkar: Histopathological lesions in lung autopsy Journal of research in medical and dental science/vol.3/ issue 2/april-june.

8. Manjit et al: Journal of Punjab Academy of Forensic Medicine and Toxicology 2008.

9. Schwartz DA et al Herman CJ. Editorial response: the importance of autopsy in emerging and re emerging infectious diseases. Clin infect Dis 1996;23:248-54.

10. V. Selvam , R. Thamil Selvi, P.M. Subramaniam,Vijayanath: Journal of Pharmaceutical and Biomedical Sciences 2015.

11. Gupta BD et al: Journal of Forensic Medicine and Toxicology 2003.

12. Mangal K. et al : Incidence of Liver diseases – A retrospective Study of 1348 Autopsy cases at tertiary care centre Jaipur – Original Article, International Journal of Current Research – Vol.7,issue ,12,pp.23725-23729, Dec.2015.

13. Smita et al: study of liver pathology in autopsy cases-original article. International Journal of Current Research vol.6 issue 03 pp.5795-5797, March 2014.

14. Sotoudehamanesh R et al. silent liver diseases in autopsies from forensic medicine of Tehran. Archives of Iranian medicine 2006 oct.9(4):324-28.

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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

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This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

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Best Article Award

A study by Dorothy Ebere Adimora et al. entitled \"Remediation for Effects of Domestic Violence on Psychological well-being, Depression and Suicide among Women During COVID-19 Pandemic: A Cross-cultural Study of Nigeria and Spain\" is awarded Best Article of Vol 14 issue 23
A study by Muhas C. et al. entitled \"Study on Knowledge & Awareness About Pharmacovigilance Among Pharmacists in South India\" is awarded Best article for Vol 14 issue 22
A study by Saurabh Suvidha entitled \"A Case of Mucoid Degeneration of Uterine Fibroid with Hydrosalphinx and Ovarian Cyst\" is awarded Best article of Vol 14 issue 21
A study by Alice Alice entitled \"Strengthening of Human Milk Banking across South Asian Countries: A Next Step Forward\" is awarded Best article of Vol 14 issue 20
A study by Sathyanarayanan AR et al. entitled \"The on-task Attention of Individuals with Autism Spectrum Disorder-An Eye Tracker Study Using Auticare\" is awarded Best article of Vol 14 issue 19
A study by Gupta P. et al. entitled \"A Short Review on \"A Novel Approach in Fast Dissolving Film & their Evaluation Studies\" is awarded Best Article of Vol 14 issue 18.
A study by Shafaque M. et al. entitled \"A Case-Control Study Performed in Karachi on Inflammatory Markers by Ciprofloxacin and CoAmoxicillin in Patients with Chronic Suppurative Otitis Media\" is awarded Best Article of Vol 14 issue 17
A study by Ali Nawaz et al. entitled \"A Comparative Study of Tubeless versus Standard Percutaneous Nephrolithotomy (PCNL) \? A Randomized Controlled Study\" is awarded Best Article for Vol 14 issue 16.
A study by Singh R. et al. entitled \"A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)\" is awarded Best Article for Vol 14 issue 15
A Study by Humaira Tahir et al. entitled "Comparison of First Analgesic Demand after Major Surgeries of Obstetrics and Gynecology between Pre-Emptive Versus Intra-Operative Groups by Using Intravenous Paracetamol: A Cross-Sectional Study" is awarded Best Article for Vol 14 issue 14
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A Study by Vinita S & Ayushi S entitled "Role of Colour Doppler and Transvaginal Sonography for diagnosis of endometrial pathology in women presenting with Abnormal Uterine Bleeding" is awarded Best Article for Vol 14 issue 08
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A Study by Maryam MJ et al. entitled "Evaluation Serum Chemerin and Visfatin Levels with Rheumatoid Arthritis: Possible Diagnostic Biomarkers" is awarded Best Article for Vol 14 issue 02
A Study by Shanthan KR et al. entitled "Comparison of Ultrasound Guided Versus Nerve Stimulator Guided Technique of Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries" is awarded Best Article for Vol 14 issue 01
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A Study by Manoj KP et al. entitled "A Randomized Comparative Clinical Trial to Know the Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block Against Multimodal Analgesia for Postoperative Analgesia Following Caesarean Section" is awarded Best Article Award of Vol 13 issue 23
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A Study by Isha Gaurav et al. entitled "Association of ABO Blood Group with Oral Cancer and Precancer – A Case-control Study" is awarded Best Article for Vol 13 issue 20
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A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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