International Journal of Current Research and Review
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IJCRR - 13(2), January, 2021

Pages: 71-75

Date of Publication: 16-Jan-2021


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Prognosis and Early Diagnosis of Preeclampsia Based on Clinic?-Genetic and Endothelial Predictors

Author: Makhmudova Sevara Erkinovna, Agababyan Larisa Rubenovna

Category: Healthcare

Abstract:Introduction: Preeclampsia (PE) is a disease that continues to be the main cause of maternal and fetal mortality and complications in 5-8% of pregnancies characterized by hypertension and proteinuria and is one of the leading causes of maternal and perinatal mortality. Our group recently demonstrated that PIGF genetic polymorphisms affect the susceptibility to preeclampsia (PE). Objective: To improve the prognosis and early diagnosis of preeclampsia based on clinical-genetic and endothelial predictors for rational management of patients with preeclampsia, reducing maternal and perinatal mortality. Methods: We examined 160 pregnant women aged 18 to 40 years with a physiological course of pregnancy observed in the 2,3 \?maternity complexes of Samarkand (11-40 weeks). The concentration of PIGF and sFlt-1 in the blood serum of pregnant women was determined. Total genomic DNA was isolated, single-nucleoid polymorphisms were detected by real-time polymerase chain. Results: In patients with preeclampsia, the concentration of PIGF, sFlt-1, and their ratio values significantly differed from those in patients with the physiological course of pregnancy, and the dependence of the detected changes on the severity of preeclampsia was also observed. Conclusion: Concentrations of PIGF, sFlt-1 and their ratio values are highly informative indicators of preeclampsia. Their ratio should be carried out in the first and second trimesters of pregnancy as part of screening programs. The determination of preeclampsia markers at the end of the second and third trimester of pregnancy can serve as a basis for the final diagnosis of preeclampsia and the development of tactics for prolonging pregnancy

Keywords: Preeclampsia, Placental growth factor, Pregnancy, Proteinuria, Prognosis, Clinic?-genetic predictors, Polymorphism

Full Text:

Introduction

Preeclampsia is one of the most serious complications in obstetrics, which determines high rates of maternal morbidity and mortality.1 This pathology continues to be a dangerous complication of pregnancy and for the fetus, leading to delayed intrauterine development, premature birth, low birth weight, and perinatal mortality.2 There are many hypotheses for the occurrence of this pregnancy complication, among which the most relevant is the theory that considers preeclampsia as a multifactorial disease, where many genetic and environmental factors are involved in its development.3 The ability to identify risk factors before pregnancy will allow timely assess the likelihood of developing preeclampsia and prescribe preventive treatment.4 To date, it has been established that more than 100 polymorphic variants of genes are associated with preeclampsia, in particular, genes of metabolism, the main complex of histocompatibility, lipid metabolism, cytokines and growth factors, hemostasis, regulation of endothelial function, vascular system, etc.5,6 However, differences in methodology for determining the severity of preeclampsia, the ethnicity of the surveyed, and the combination of analyzed allelic variants in different samples determine the ambiguity of the results obtained by different authors.7 This dictates the necessity for in-depth research to identify the risk group, develop prognostic criteria, and conduct therapeutic and preventive measures to reduce perinatal losses and improve the maternal and child health.8

It was found out that the development of PE is based on a violation of placentation due to the defect in the remodelling of myometrial vessels, which leads to incomplete invasion of trophoblast in the early stages of pregnancy.9 In the future, the damaged ischemic placenta begins to secrete an excessive amount of a powerful antiangiogenic factor - a soluble receptor for vasculo endothelial growth factor (VEGF), identified as soluble fms-like tyrosine kinase 1 (sFlt-1).10 This factor inhibits both VEGF and placental growth factor (PIGF), which ensure normal placental development and function.11 Circulating in the mother's bloodstream, sFlt-1 can contribute to the development of systemic endothelial dysfunction, which is the basis of all clinical manifestations of PE.4,5 There is reason to believe that the severity of clinical manifestations of PE is due to the period of pregnancy when it first started: the earlier PE debuts, the more severe.12

Materials and methods

We examined 160 pregnant women aged 18 to 40 years with a physiological course of pregnancy observed in the 2,3 –maternity complexes of Samarkand (11-40 weeks). The main and control groups were comparable in age, social characteristics, and obstetric and gynaecological history. All women delivered healthy babies at a term of 38-40 weeks, with a rating on the Apgar scale of 8-9 scores, with normal weight and growth indicators. The postpartum period was uncomplicated for all of them. The exclusion criteria were multiple pregnancies, hypertension, and a history of preeclampsia. When assessing the reproductive function, it was found that the majority of women in both groups were primiparas (p≥0.05). Pelvic inflammatory processes were equally common (p=0.05). The group of patients with preeclampsia consisted of 82 pregnant women at 20-40 weeks, including 52 women with moderate preeclampsia and 30 with severe preeclampsia. The diagnosis of preeclampsia was established based on generally accepted criteria-hypertension (blood pressure ≥140/90 mmHg) and proteinuria (protein content above 0.3 g in daily urine). The severity of preeclampsia was assessed based on objective indicators and the patient's clinical condition. The group of patients with mild preeclampsia included pregnant women with a blood pressure of 140-160/90 mm Hg, with proteinuria of more than 0.3 g, but not less than 2 g/day. The group of patients with severe preeclampsia included pregnant women with a blood pressure of 160/110 mmHg or more, with proteinuria of more than 2 g/day.

The concentration of PIGF and sFlt-1 in the blood serum of pregnant women was determined using Elecsys PIGF and Elecsys sFlt-1 electrochemiluminescent diagnostic test systems of the Hoffmann La Roche concern (Switzerland) on a Cobas e411 automatic analyzer of the same company. The spectrum of the studied polymorphisms is presented in Table 3. Total genomic DNA was isolated from 100 µl of whole venous blood by the sorbent method using the set "Proba-GS Genetics", NP-480-100 (AGTR1_1166 rs5186), NP-476-100 (AGTR2 G1675A rs1403543); for endothelial nitric oxide synthetase, 3 sets were used: NP-554-100 (eNOS_786 rs 2070744), NP-555-100 (eNOS_774 rs 1549758), NP-419-100 (eNOS_298 1799983); single-nucleoid polymorphisms were detected by real-time polymerase chain reaction using the above sets (DNA technology, Russia).

To obtain the serum, the samples were centrifuged for 15 min at 2000 rates and room temperature. The concentration of markers was determined on the same day, no later than 1.5 hours after blood collection. The concentration of PIGF and sFlt-1 in the blood serum of pregnant women was determined using Elecsys PIGF diagnostic test systems (Ref. no. 05144671190, Roche Diagnostics GmbH, Mannheim, Germany) and Elecsys sFlt-1 (Ref.no. 05109523190, Roche Diagnostics GmbH, Mannheim, Germany) on an automatic Cobas e411 electrochemiluminescence analyzer (Hitachi, Japan). The results were processed using the computer program Statistica®.

Results

The data obtained indicate that during the physiological course of pregnancy, the concentration of PIGF increases during 11-33 weeks of pregnancy and decreases sharply by the time of delivery. The concentration of sFlt-1 in healthy pregnant women begins to increase significantly from the 34th week of pregnancy and reaches its maximum values at 37-40 weeks of pregnancy, which is probably due to the necessity to reconstruct blood vessels to prevent massive bleeding during childbirth. The sFlt-1/PIGF ratio has maximum values in the period of 11-14 and 37-40 weeks of pregnancy, while the minimum values are observed in 24-33 weeks of gestation (Table 1).

The obtained results allow us to form reference intervals of PIGF and sFlt-1 concentrations and their ratio values in the dynamics of physiological pregnancy from the 11th to the 40th week. Table 1 shows the medians and reference intervals as the 5th and 95th percentiles. It should be noted that these intervals were developed using the Elecsys PIGF and Elecsys sFlt-1 diagnostic test systems (Hoffmann-La Roche, Switzerland) and the Core diagnostic platform (Hitachi, Japan).

In patients with preeclampsia, the concentration of PIGF, sFlt-1, and their ratio values significantly differed from those in patients with the physiological course of pregnancy, and the dependence of the detected changes on the severity of preeclampsia was also observed (Table 2).

It was interesting to study indicators in the group of pregnant women with arterial hypertension (n=14) at 37-40 weeks of pregnancy (Table 2). Analysis of Table 2 shows that the concentration of both factors in patients with PE is about 2 times lower than in healthy pregnant women, while the ratio value is within the obtained reference interval.

It was observed that in women with preeclampsia, the frequency of low-functional variants in the genes associated with the development of arterial hypertension (type 1 and 2 receptor genes for angiotensin II and nitric oxide synthase) was statistically significantly higher than in women with a physiological course of pregnancy (Table 3 and Table 4).

It is known that the hormone angiotensin II causes vasoconstriction and is the main regulator of aldosterone synthesis. The result of this action is an increase in the volume of circulating blood and an increase in systemic blood pressure. Angiotensin II interacts with two types 1 and 2 angiotensin cell receptors encoded by AGTR1 and AGTR2 genes, respectively. Replacement of adenine (A) with cytosine (C) at position 1166 in the regulatory region of the AGTR1 gene leads to an increase in its expression. The amplification mechanism is caused by the following actions. During the synthesis of the receptor protein with non-coding regions of mRNA, translated from the AGTR1 1166A allele according to the complementarity principle, interact with microRNA miR155, and the translation process is inhibited, which leads to a decrease in protein synthesis. MicroRNAs cannot bind to the AGTR1 1166C polymorphic allele, which increases the synthesis of protein products and changes the functional activity of the receptors.10 The cardiovascular effects of angiotensin II-mediated by AT2 receptors are opposite to those caused by AT1 receptors, which means that the interaction of angiotensin II with type 2 receptors causes a decrease in blood pressure. An increase in the number of angiotensin II type 2 receptors on the cell surface is determined by AGTR2 1675G allele, since it is associated with activation of gene transcription. The nucleotide replacement of G1675A in the regulatory region of the gene negatively changes the nature of the regulation of gene expression. As a result, carriers of this low-functional polymorphism have a decrease in the number of type 2 receptors and a partial loss of their function (participation in NO production, vascular dilatation), which contributes to an increased risk of hypertension. This study revealed the higher frequency of homozygous carriage of this low-functional polymorphism in women with preeclampsia compared to women with a physiological course of pregnancy. Paying attention to the fact that the AGTR2 gene is localized in the X chromosome, the phenotypic manifestation of the heterozygous carrier of the 1675A allele can be smoothed due to the phenomenon of allelic exclusion during the process of inactivation in one of the sex chromosomes. In homozygotes, the phenotypic effect is not graded by this phenomenon, which probably determines the high frequency of the AGTR2 1675A/A genotype in the group of women with a complicated pregnancy.

Endothelial dysfunction is of great importance in the pathogenesis of preeclampsia, it is manifested by an increase in the "sensitivity" of the vascular wall to the pressor effects of mediators with a simultaneous decrease in the production of vasodilators, such as nitric oxide (NO) 9. Nitric oxide is the main endothelial relaxation factor involved in maintaining vascular wall tone and thrombogenesis. Constitutional endothelial NO synthase type 3 (NOS3, synonym ?NOS) is involved in the synthesis of NO in the endothelium and, consequently, in the regulation of vascular tone, blood flow, and blood pressure.8 Currently, 3 allelic variants of endothelial NO synthetase (NOS3) gene is most actively studied: 4a/4b in intron 5, structural replacement 894G>T in exon 7, and polymorphism of the promoter region of gene – 786T>C. These polymorphisms are low-functional, which means that if they are present in the genotype, the expression of the NOS3 gene decreases. Reduced production of endothelial NO synthetase causes a decrease in the concentration of nitric oxide in the bloodstream, resulting in reduced vasodilation, which may be an important mechanism for the development of arterial hypertension. There is data in the literature about the association of low-functional variants of the endothelial NO-synthetase gene with various obstetric pathologies based on changes in vascular tone (PE, placental insufficiency, fetal growth restriction syndrome) 3,6. According to the results of this study, women with preeclampsia have an increased frequency of allele-786C in the NOS3 gene (Table 4).

Discussion

Analysis of the obtained data indicates significant differences in the dynamics of PIGF and sFlt-1 concentrations and their ratio during physiological pregnancy and pregnancy complicated by preeclampsia. The most pronounced changes are in the values of the sFlt-1/PIGF ratio, besides, the degree of deviation of the listed parameters correlates with the severity of preeclampsia. This indicator is the most informative in the early diagnosis of preeclampsia. The results obtained are fully consistent with the published data that the development of preeclampsia is closely associated with an imbalance in the synthesis of angiogenic and antiangiogenic factors.5,7,9 It is known that the process of placenta formation begins with the implantation of cells of fetal origin (cytotrophoblast) into decidual tissue (modified endometrial layer of the pregnant uterus). The cytotrophoblast is not only embedded into the endometrium layer (interstitial invasion) and spiral arteries (endovascular invasion) but also reaches the inner third of the endometrium. As a result, at the end of the first trimester, several dozen wide, gaping arteries are formed in the uteroplacental region and the uteroplacental blood flow begins to function actively. Before its formation, the function of a powerful stimulus of the first wave of cytotrophoblastic invasion (CTI) is carried out by local tissue hypoxia, which is characteristic of the embryo microenvironment up to 8-10 weeks of development. Hypoxic stimulus increases the expression of specific cell adhesion molecules, stimulates the synthesis of cytokines and vascular growth factors.1

The presence of polymorphisms of genes that regulate vascular tone (renin-angiotensin system and endothelial nitric oxide synthetase) that predispose to hypertension complications significantly increases the risk of preeclampsia developing. The associations identified in this study can be used as genetic markers of predisposition to the formation of preeclampsia, which will allow the timely formation of a risk group and correction of therapeutic and preventive measures (Figure 1).

Figure 1. The ratio of sFlt/PIGF in normal pregnancies, moderate (MPE), and severe preeclampsia (SPE).

The next stage of cytotrophoblast invasion (CTI) deep into the myometrium (the second wave of invasion) occurs at the 16th-18th week of pregnancy. ?ytotrophoblast transforms the larger arteries of the lower third of the myometrium, turning them into wide cavities. As a result, the volume of maternal blood entering the placenta increases.1,5,6 The separation of two waves of CTI is conditional since it is an ongoing process, which in its significance is a key mechanism for the development of normal pregnancy or the occurrence of preeclampsia. The statement that preeclampsia begins at the 20th week of pregnancy corresponds only to the time of occurrence of well-known symptoms, while the initial mechanisms are laid and implemented much earlier in the form of defects in the luteal phase of the cycle, violations of implantation and placentation, as well as background diseases of the mother.4,7 These and other factors are the cause of CTI insufficiency.3 Endothelial dysfunction plays a central role in the pathogenesis of preeclampsia. Increased synthesis of vasoactive mediators leads to a predominance of vasoconstriction and, as a result, insufficient blood circulation in the placental vessels.8,9 Before the appearance of clinical symptoms, the uteroplacental blood flow usually decreases and the resistance of the uterine vessels increases, placental ischemia develops.7 Apparently, in patients predisposed to the development of preeclampsia, a decrease in the concentration of PIGF and an increase in the concentration of sFlt-1 indicate abnormal placental development. The reasons for a patient’s predisposition to the development of preeclampsia are still not fully established, but it is noted that one of the possible causes is a genetic factor. It has been shown that the development of preeclampsia in the mother increases the risk of this pathology in her daughter.10,12 It is also believed that the aetiology and pathogenesis of preeclampsia are due to the presence of immunopathological mechanisms and several environmental factors. Prevention and treatment of preeclampsia is quite a complex task. In this regard, early diagnosis of preeclampsia before its clinical manifestations is one of the tasks in obstetrics, the solution of which will allow assessing the risk and feasibility of preserving the pregnancy.4,9 The availability of reference intervals of PIGF, sFlt-1 concentrations and their ratio is currently the most informative for the diagnosis of preeclampsia, which allows evaluation of peculiarities of these molecules secretion since the end of the first trimester of pregnancy. Previously, it was shown that already in the first trimester of pregnancy it is possible to diagnose an imbalance in the synthesis of PIGF and sFlt-1, as a result of which the ratio of these indicators increases.10 An increase in sFlt-1 concentration seems to disrupt the intracellular mechanism of PIGF synthesis regulation, which consequently leads to the development of systemic endothelial insufficiency and the progression of clinical signs of preeclampsia (hypertension and proteinuria), as well as to a delay in fetal development.3,9,11

Conclusion

Based on the performed study, it was found that concentrations of PIGF, sFlt-1, and their ratio values are highly informative indicators of preeclampsia, and the reference intervals of PIGF, sFlt-1 concentrations, and their ratio values can be used as "standards". Besides, the determination of the concentration of these markers and the calculation of their ratio should be carried out in the first and second trimesters of pregnancy as part of screening programs for the diagnosis of intrauterine fetal pathology. The determination of preeclampsia markers at the end of the second and third trimester of pregnancy can serve as a basis for the final diagnosis of preeclampsia and the development of tactics for prolonging pregnancy.

Conflict of Interest: None Declared

Acknowledgement: None acknowledged

Funding Information: None Agency Acknowledged

References:

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  2. Carty DM, Delles C, Dominiczak AF. Preeclampsia and future maternal health. J Hypertens 2010;28:1349–1355.

  3.  Foidart YM, Schaaps YP, Chantraine F. Dysregulation of anti-angiogenic agents (sFlt-1, PIGF and sendoglin) in preeclampsia- a step forward but not the definitive answer. J Reprod Immunol 2009;82:106-111.

  4. Hammerova L, Chabada J, Drobny J, Batorova A. Lonfi tudinal evaluation of markers of hemostasis in pregnancy. Bratisl Lek Listy 2014;115(3):140-144.

  5.  McElrath T, Lim K-H, Pare E, Rich-Edwards J. Longitudinal evaluation of predictive value for preeclampsia of circulating angiogenic factors through pregnancy. Am J Obst Ginecol. 2010;11:407e1-e7.

  6.  Verlohren S, Herraiz Y, Lapaire O. The sFlt-1/PIGF radio in different types of hypertensive pregnancy disorders and its prognostic potential in peeclamptic patients. Am J Obstet Gynecol 2012;1:58e1-e8.

  7. Lam C, Lim KH, Karumanchi SA. Circulating angiogenic factors in the pathogenesis and prediction of preeclampsia. Hypertens Res 2005;46:1077-1085.

  8. Maynard S, Min J, Merchan J, Lim K. Excess placental soluble fms-like tyrosine kinase-1 (sFlt-1) may contribute to endometrial dysfunction, hypertension and proteinuria in preeclampsia. J Clin Invest 2003;111:649-658.

  9. Roberts JM, Bell MJ. If we know so much about preeclampsia, why haven´t we cured the disease? J Reprod Immunol 2013; 99:1–9.

  10.  Shibata E, Rajakumar A, Roberts RW. Soluble fms-like tyrosine kinase 1 is increased in preeclampsia but not in normotensive pregnancies with small-for-gestational-age neonates: relationship to circulating placental growth factor. J Clin Endocrinol Metab 2005;90:4895-4903.

  11.  Wang A, Rana S, Karumanchi SA. Preeclampsia: the role of angiogenic factors in its pathogenesis. Physiology 2009;24:147-158.  

  12. Yelliffe-Pawlowsky L, Shaw G, Currier R. Association of early preterm birth with abnormal levels of routinely collected first and second-trimester biomarkers. Am J Obstet Gynecol 2013;208:128-140.

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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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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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