International Journal of Current Research and Review
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IJCRR - 7(17), September, 2015

Pages: 27-33

Date of Publication: 11-Sep-2015


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PREVALENCE OF CARDIAC COMORBIDITIES AND ITS RELATION TO SEVERITY STAGING OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Author: Vineeth Alexander, R. Pajanivel, K. Surendra Menon, Arun Prasath

Category: Healthcare

Abstract:Background: Complexity of COPD and mortality from the disease is increased by co morbidities and exacerbations Objective: This study was conducted with aim to find the prevalence of cardiac co morbidity in COPD and its relation to severity staging of COPD. Methods: The present cross sectional study was done in Pulmonary Medicine outpatient department of Mahatma Gandhi Medical College and Research Institute, Pondicherry from March 2013 to June 2014. The study diagnosed and newly diagnosed of COPD patients were subjected to Pulmonary Function Test (PFT), assessment of blood pressure, electrocardiography and echocardiography. The statistical analysis was done to assess the cardiovascular status of the study subjects and its relation to severity staging of COPD. Results: In the total of 44 cases selected for study 42 (95.5%) were males and 2(4.5%) were females. On the basis of GOLD guidelines there were 5(11.4%), 13(29.5%), 16(36.4%) and 10(22.7%) mild, moderate, severe, and very severe COPD respectively. Right axis deviation, p-pulmonale, T-wave inversions, dominant R-wave, persistent S-wave in electrocardiography were present in 45.5%,52.6%,40.0%,33.3%,36.4% of severe and 54.5%, 36.8%, 60.0%, 58.3%, 63.6% in very severe cases of COPD. In echocardiography, right atrium and ventricle dilatation, left ventricular dysfunction, tricuspid regurgitation, and regional wall motion abnormalities were present in 55.6%, 46.15%, 50.0%, 37.5% of severe and 38.9%, 53.85%, 33.3%, 62.5% of very severe cases of COPD. Pulmonary artery systolic pressure and systemic hypertension increased with severity of COPD.
Conclusion:
Prevalence of cardiac co morbidities increases with the increase in severity of COPD. The severe and very severe stages of COPD are associated with significant cardiovascular diseases.

Keywords: COPD, Electrocardiography, Echocardiography, Pulmonary artery systolic pressure

Full Text:

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow limitation that is not fully reversible1 . It is a leading cause of death worldwide2 . COPD bring forth high healthcare costs3 , imposes a significant burden in footing of disability and impaired quality of life4 . It is an important public health dispute that is both preventable and treatable. Among the diseases causing chronic morbidity and mortality throughout the world many elderly people suffer from COPD and die prematurely from it or its complications. In coming decades because of continued exposure to risk factors, COPD is projected to increase globally5 . COPD has been considered symptomatically as chronic bronchitis, anatomically as emphysema, physiologically as airflow obstruction in the past6 . Both genetic and environmental factors play a role in development of COPD. In addition to tobacco smoke, heavy exposure to occupational dusts, chemicals and indoor/outdoor air pollution may cause

COPD. The hereditary deficiency of 1-antitrypsin is genetic risk factor for development of COPD7-9. The socioeconomic status is inversely related to the development of COPD10. Complexity and mortality of COPD is increased by its co morbidities and exacerbations11-14. COPD is a more complex systemic disease that has significant extra pulmonary effects along with pulmonary involvement15-17. In relation to COPD and its manifestations and co morbidities there are two different views. The first view is that there is systemic spillover of the inflammatory and reparatory events occurring in the lungs of COPD patients and second view is that the pulmonary manifestations occurring in COPD is just a form of expression of systemic inflammatory state with multiple organ compromise14,18. In two-thirds of the COPD patients there is one or two co morbidities19. The most common co morbidities described in association with COPD are arterial hypertension, coronary artery disease, heart failure, respiratory infections, lung cancer, diabetes mellitus and osteoporosis. There is significant impact of co morbidities on health status, healthcare costs and prognosis of COPD. The mortality is more from co morbid disease than COPD itself20-22. The most frequent and most important disease coexisting with COPD is cardiovascular diseases23, 24. Cardiovascular diseases particularly ischemic heart disease has been observed as the cause of death in COPD patients recently25, 26. It may be associated with smoking as it is a cause of both. But forced expiratory volume in first second (FEV1) is a well known risk factor for the development of ischemic heart disease that is independent of smoking habit27. There is limited studies and research into the co-morbidities of COPD. Most of the studies have analyzed the relation of COPD with several isolated diseases. This study was conducted to find the prevalence of cardiac co-morbidity in relation to severity staging of COPD.

METHODOLOGY

This study was an institutional cross sectional study done in Pulmonary Medicine outpatient department of Mahatma Gandhi Medical College and Research Institute, Pondicherry from March 2013 to June 2014. The study was approved by the institutional ethical committee. The study subjects were all the patients who were previously diagnosed and newly diagnosed of COPD attending the Pulmonary Medicine outpatient department of Mahatma Gandhi Medical College and Research Institute, Pondicherry selected by series allocation from March 2013 to June 2014. All patients with acute exacerbation of COPD unable to perform spirometry and patients with contraindication for spirometry like history of recent myocardial infarction, congenital heart disease were excluded from the study. A volunteer written consent was taken from all the patients before the study. The selected patients were subjected to Pulmonary Function Test (PFT) with flow sensing PFT machine of MIR Spirobank 2 and assessed for severity and stage of COPD according to GOLD guidelines as per follows.

Classification of Severity of Airflow Limitation in COPD according to GOLD guidelines

Based on Post Bronchodilator Forced Expiratory Volume in first second (FEV1).In patients with FEV1/Forced Vital Capacity (FVC) < 0.70:

In the established cases of COPD and the newly diagnosed cases of COPD, blood pressure assessment, electrocardiography (ECG) and transthoracic Doppler echocardiography was done to assess for cardiac abnormalities. Blood pressure was measured using a calibrated sphygmomanometer. The study was done by taking two independent blood pressure measurements with 5 min pause after a rest of 5 min in a sitting position. In current analysis the mean of two measurements was taken. The blood pressure was classified according to the guidelines of Seventh Joint National Committee (JNC 7).

All the patients were subjected to Electrocardiography (ECG) using machine of Mortara ELI 250. A twelve lead ECG including 3 bipolar limb leads, 3 unipolar limb leads and 6 unipolar precordial leads was performed. All necessary precautions desired in ECG were observed. Various ECG parameters like rate, axis deviation, P-wave changes, QRS complex, T-wave changes, ST changes were observed. The axis of P-value and QRS complex was calculated by hexaxial reference system. All patients were then subjected to transthoracic Doppler echocardiography using machine of Philips iE33 with a multi frequency probe of 2- 4.3 MHz to assess for, right side chamber size, left ventricle function, valvular status and pulmonary artery systolic function according to American Society for Echocardiography (ASE) guidelines. Tricuspid regurgitant flow was identified by color flow Doppler technique and the maximum jet velocity was measured by continuous wave Doppler without the use of intravenous contrast. In the absence of right ventricular outflow obstruction the pulmonary artery systolic pressure equals the right ventricular systolic pressure (RVSP) in echocardiography. The Modified Bernoulli equation (?p=4V2) was used, where ?p is the pressure gradient between the right ventricle and right atrium and v is the velocity of the tricuspid regurgitant jet. Right ventricular systolic pressure was calculated as: right ventricular systolic pressure = 4TRV2 + RAP where v is the velocity of the tricuspid regurgitant jet and RAP the right atrial pressure. Right atrial pressure was estimated from the inferior vena cava imaged with two-dimensional echocardiography. RAP was estimated to be 5, 10, or 15 mmHg based on the variation in the size of inferior vena cava with inspiration as follows: complete collapse, RAP = 5 mmHg; partial collapse, RAP = 10 mmHg; and no collapse, RAP = 15 mmHg28. Pulmonary hypertension (PH) was defined in this study as Pulmonary Artery Systolic Pressure (PASP) ≥ 30 mmHg28. This value was chosen according to the definition of pulmonary hypertension. Pulmonary hypertension was classified into mild, moderate, and severe category as PASP 30–50, 50–70, >70 mmHg, respectively.

STATISICAL METHOD

SPSS version 19.0 (IBM SPSS, US) was used to analyze the data. The quantitative variables have been described as mean ± SD or Frequency analysis with numbers and percentage. The study was statistically analyzed by Pearson Chi- square test. Value of p< 0.05 was considered significant. RESULTS In a total of 44 patients with COPD enrolled in the study 42(95.5%) were males and 2(4.5%) were females. The minimum age observed was 42 years and maximum 79 years. The mean age group in our study was 61.25 with a standard deviation of 8.662. The distribution of patients with severity staging of COPD on the basis of GOLD guidelines described in Table 2

The ECG changes observed in our study were right axis deviation, p pulmonale, t wave inversion in V1 and V2 was dominant r wave in V1 lead, persistent S wave in V5 and V6. The changes of right axis deviation was seen in 11(25.0%) of which 5(45.5%) and 6(54.5%) was severe and very severe COPD respectively (p value 0.005). The presence of P pulmonale was observed in 19(43.2%) patients of which 2(10.5%), 10(52.6%), 7(36.8%) were moderate, severe and very severe COPD respectively (p value 0.004). The changes of T wave inversion in V1 and V2 lead was observed in 5(11.4%) of which 2(40.0%) and 3(60.0%) was severe and very severe COPD respectively. The changes of dominant R wave in V1 lead was seen in 12(27.3%) of which 1(8.3%), 4(33.3%) and 7(58.3%) was moderate, severe and very severe COPD respectively (p value0.003). The changes of persistent S wave in V5 and V6 lead seen in 11(25.0%) of which 4(36.4%) and 7(63.6%) was severe and very severe COPD respectively (p value 0.001). The echocardiography findings seen in our study were right atrium and ventricle dilatation, left ventricular dysfunction, tricuspid regurgitation, regional wall motion abnormality and increase in Pulmonary artery systolic pressure (PASP). The changes of right atrium and ventricle dilatation was seen in 18(40.9%) of which 1(5.6%), 10(55.6%) and 7(38.9%) was moderate, severe and very severe COPD respectively (p value 0.001). There was left ventricular dysfunction in 13(29.5%) of which 6(46.15%) and 7(53.85%) was severe and very severe COPD respectively (p value 0.001). The changes of tricuspid regurgitation was seen in 24(54.5%) of which 4(16.7%), 12(50.0%) and 8(33.3%) was moderate, severe and very severe COPD respectively (p value 0.003). The presence of regional wall motion abnormality was seen in 8(18.2%) of which 3(37.5%) and 5(62.5%) was severe and very severe COPD respectively (p value 0.013). The Pulmonary artery systolic pressure (PASP) observed were mild (30-50mmHg), moderate (50-70 mmHg) and severe (>70 mmHg) in 26(59.09%), 13(29.55%) and 5(11.36%) of patients respectively. The distribution of PASP on the basis of severity staging of COPD is depicted in Figure 1

The assessment of blood pressure in our study showed distribution in all stages as depicted in Figure 2.

The correlation of blood pressure with severity staging of COPD is depicted in Table3.

DISCUSSION

There are various cardiac manifestations in COPD which complicate its clinical course. In patients with COPD with associated cardiovascular diseases the morbidity and mortality is seen to be increased as shown in various studies29-31. COPD and cardiovascular diseases has various common risk factors, including smoking and aging. The presence of pro inflammatory mechanism and oxidative stress is seen in both diseases32-35. The sedentary lifestyle in COPD may also contribute to risk of developing cardiovascular diseases36. Among the 44 cases in our study all patients had ECG changes. The changes of right axis deviation in ECG were present in only severe and very severe COPD in our study. In a study by Padmavati et al the observation of right axis deviation in ECG of COPD patients were found to be 80%37. In concordance with our results, a study by D Holtzman et al reported high prevalence of right axis deviation inECG in COPD patients, increasing with severity of the disease38. P pulmonale is diagnosed when the amplitude of P wave in Lead II, III, and/or aVF is more than 2.5 mm. In a study by D.H Spodicks et al39, p pulmonale was observed in 13.9% of COPD patients. F. I Carid et al40 found the incidence of p pulmonale in 15.5% while R.C Scott et al41 and Pinto et al42 done a study on COPD patients showing the incidence of p pulmonale of 32.7%. In an Indian study by Aggarwal et al43 the incidence of p pulmonale was found to be 35.7%. In our study the p pulmonale was observed more in severe COPD 10(52.6%). However in our study the T wave inversion in V1 and V2 leads were not statistically significant but was seen in 2(40.0%) and 3(60.0%) patients of severe and very severe COPD respectively. Our study showed statistically significant changes in ECG like dominant R wave in V1 lead and persistent S wave in V5 and V6 increasing with the severity of COPD. The observed data shows that the features suggesting right ventricular hypertrophy increases with severity of COPD with more number of cases reported in severe and very severe stages of COPD. In our study echocardiography changes of right atrium and ventricle dilatation were seen increasing in severe cases of COPD. Soriano et al23 the overall prevalence of heart failure in COPD was observed as 7%. It was corresponding to the severity of airflow limitation. In a study by Higham M.A et al in which the presence of tricuspid regurgitation (TR) was observed in 56(77%) out of 73 COPD patients44. We also observed a significant number of patients in severe and very severe COPD with this abnormality. Our study showed that a significant number of patients also had regional wall motion abnormality and left ventricular dysfunction. In a study the prevalence of chronic obstructive pulmonary disease in patients with catheter diagnosed coronary artery disease by Ahmed A.H et al has shown that more than 1 in 4 patients with coronary artery disease had concomitant COPD45. In a study by Reed R.M et al prevalence of angiographically proven coronary artery disease in COPD was 59%46. Pulmonary hypertension (PH) was defined in this study as Pulmonary Artery Systolic Pressure (PASP) ≥ 30 mmHg28. This value was chosen according to the definition of pulmonary hypertension. Pulmonary hypertension was classified into mild, moderate, and severe category as PASP 30–50, 50–70, >70 mmHg, respectively. In our study the following was the distribution as depicted in Table4

In another study by M.A Higham et al the pulmonary artery systolic pressure was increased in 25%, 43%, and 68% of patients with mild, moderate, and severe COPD, respectively44. There is evidence suggesting that elevation of pulmonary arterial pressure is reported to occur in twenty to ninety percent of patients of COPD47-50. The presence of Cor pulmonale was seen in approximately 25% patients with COPD51. An autopsy study showed Cor pulmonale in 40% patients with COPD49,52. The Correlation of blood pressure with severity staging of COPD in our study is depicted in Table 5.

In a study by Engstrom et al it was found that lung function was inversely associated with future blood pressure increase53. Our study also showed that the mean distribution of patients with increased blood pressure were more in advance stages of COPD. The study has some limitations. First the sample size was less. Second, the absence of a control group limits a definite assessment of the role of COPD in the pathogenesis of cardiac disorders. Thirdly, the study had a cross-sectional design, so no causal relationships with clinical outcomes could be established. Studies with larger sample size with a longer duration will be required to assess the outcome. The other co morbidities in COPD should have to be taken for study with considering the individual as whole. The study indicates that COPD is associated with a higher risk for cardiovascular diseases and the risk of cardiovascular diseases increases with the severity of COPD.

CONCLUSION

The study showed that cardiac disorders are highly prevalent in patients with severe-to-very severe COPD. All COPD patients must be evaluated for cardiac co- morbidities, since it might help establish adequate treatment that may potentially improve patient prognosis.

ACKNOWLEDGEMENT

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/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Authors also acknowledge all the teaching and non teaching faculties and fellow postgraduates of Mahatma

Gandhi Medical College, Pondicherry who have helped in the completion of this study.

Source of funding- No funding received

Conflict of interest- The authors do not have any conflicts of interest to disclose.

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A Study by Muhammad Zaki et al. entitled "Effect of Hemoglobin Level on the Severity of Acute Bronchiolitis in Children: A Case-Control Study" is awarded Best Article for Vol 14 issue 09
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
A Study by Prabhu A et al. entitled "Awareness of Common Eye Conditions among the ASHA (Accredited Social Health Activist) Workers in the Rural Communities of Udupi District- A Pilot Study" is awarded Best Article for Vol 14 issue 07
A Study by Divya MP et al. entitled "Non-Echoplanar Diffusion-Weighted Imaging and 3D Fiesta Magnetic Resonance Imaging Sequences with High Resolution Computed Tomography Temporal Bone in Assessment and Predicting the Outcome of Chronic Suppurative Otitis Media with Cholesteatoma" is awarded Best Article for Vol 14 issue 06
A Study by Zahoor Illahi Soomro et al. entitled "Functional Outcomes of Fracture Distal Radius after Fixation with Two Different Plates: A Retrospective Comparative Study" is awarded Best Article for Vol 14 issue 05
A Study by Ajai KG & Athira KN entitled "Patients’ Gratification Towards Service Delivery Among Government Hospitals with Particular Orientation Towards Primary Health Centres" is awarded Best Article for Vol 14 issue 04
A Study by Mbungu Mulaila AP et al. entitled "Ovarian Pregnancy in Kindu City, D.R. Congo - A Case Report" is awarded Best Article for Vol 14 issue 03
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
A Study by Amol Sanap et al. entitled "The Outcome of Coxofemoral Bypass Using Cemented Bipolar Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fracture of Femur in a Rural Setup" is awarded Best Article Award of Vol 13 issue 24
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
A Study by Karimova II et al. entitled "Changes in the Activity of Intestinal Carbohydrases in Alloxan-Induced Diabetic Rats and Their Correction with Prenalon" is awarded Best Article of Vol 13 issue 22
A Study by Ashish B Roge et al. entitled "Development, Validation of RP-HPLC Method and GC MS Analysis of Desloratadine HCL and It’s Degradation Products" is awarded Best Article of Vol 13 issue 21
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
A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
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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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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