Article|International Journal of Current Research and Review

Search Articles

Track manuscript

Full Html

IJCRR - 6(23), December, 2014

Pages: 59-63

Date of Publication: 10-Dec-2014

Print Article Download XML Download PDF

A DETAILED STUDY TO KNOW ABOUT THE OCCURRENCE OF CHRONIC DIARRHEA IN ADDITION TO SEVERE ANAEMIA AND SEVERE EOSINOPHILIA IN PATIENTS HAVING HOOKWORMS IN DUODENUM WHILE DOING UPPER GASTRO-INTESTINAL ENDOSCOPY IN HEALTHCARE INSTITUTE

Author: Govindarajalu Ganesan

Category: Healthcare

Abstract:Objective: Severe anaemia and severe eosinophilia are commonly reported to occur in hookworm infection. But chronic diarrhea is not commonly reported to occur in hookworm infection. Hence a detailed study was done to know about the occurrence of chronic diarrhea in addition to severe anaemia and severe eosinophilia in patients having hookworms while doing upper gastro-intestinal endoscopy in our institute. Methods: A study of 1259 patients who had undergone upper gastro-intestinal endoscopy in our institute for a period of 5 years from May 2009 to April 2014 was carried out in order to find out the occurrence of chronic diarrhea in addition to severe anaemia and severe eosinophilia in patients having hookworms in duodenum while doing upper gastro-intestinal endoscopy. Results: Of these 1259 patients, as many as 18 patients were found to have hookworms in duodenum while doing upper gastrointestinal endoscopy. Of these 18 patients, 4 patients were lost for follow up and full details about their investigations were not available. Among the remaining 14 patients, one patient was found to have severe anaemia but without chronic diarrhea. Three patients were found to have severe eosinophilia or hypereosinophilia [absolute eosinophil count or aec more than 1000 cells/
cu.mm] but without chronic diarrhea. But interesetingly, one patient was found to have severe anaemia and severe eosinophilia [absolute eosinophil count or aec -1100 cells/cu.mm]along with chronic diarrhea . Hence full details about this patient with chronic diarrhea in addition to severe anaemia and eosinophilia is thoroughly analysed and discussed in detail in this article. Conclusion: Severe anaemia and eosinophilia are commonly reported to occur in hookworm infection. But chronic diarrhea also occurs rarely in hookworm infection. It is a well known fact that hookworm infection should be suspected strongly in patients with significant anaemia and eosinophilia. But hookworm infection should also be suspected in patients with chronic diarrhea, especially in tropical and subtropical countries.

Keywords: Severe anaemia, Severe eosinophilia, Chronic diarrhea, Hookworms in duodenum, Upper gastro-intestinal endoscopy

Full Text:

INTRODUCTION
There has been many reports of finding severe anaemia in patients with hookworm infection diagnosed by upper gastro -intestinal endoscopy (1-8). There has been also many reports of finding severe eosinophilia in patients with hookworm infection[(7-14). But chronic diarrhea is reported to occur only rarely in hookworm infection (9, 14). In our study also, only one patient with hookworm infection was found to have chronic diarrhea. This patient with chronic diarrhea was also found to have severe anaemia and severe eosinophilia and multiple hookworms in endoscopy. Hence upper gastro-intestinal endoscopy should always done in all patients with chronic diarrhea associated with eosinophilia or anaemia to confirm the presence of hookworms in tropical and subtropical countries.

MATERIALS AND METHODS
This study was conducted in the department of general surgery, Aarupadai Veedu Medical College And Hospital, Puducherry. A study of 1259 patients who had undergone upper gastro-intestinal endoscopy in our institute for a period of 5 years from May 2009 to April 2014 was carried out in order to find out the occurrence of chronic diarrhea in addition to severe anaemia and severe eosinophilia in patients having hookworms in duodenum while doing upper gastro-intestinal endoscopy. Severe eosinophilia or hypereosinophilia is defined as eosinophils>1000 cells/cu.mm(10). In each of these 1259 patients, the first and second part of duodenum were carefully examined to find out the presence of hookworms. Then a detailed study was made to know about the occurrence of chronic diarrhea in addition to severe anaemia and severe eosinophilia in patients having hookworms in duodenum and the results were found out as given below.

RESULTS
Of these 1259 patients, as many as 18 patients were found to have hookworms in duodenum while doing upper gastro-intestinal endoscopy. Of these 18 patients, 4 patients were lost for follow up and full details about their investigations were not available.

a. Severe anaemia but without chronic diarrhea
Among the remaining 14 patients, one patient was found to have severe anaemia [haemoglobin 2.1g%] but without chronic diarrhea.

b. Severe eosinophilia but without chronic diarrhea
Three patients were found to have severe eosinophilia or hypereosinophilia [absolute eosinophil count or aec1000,1260 and 1246] but without chronic diarrhea.

c. Severe anaemia, severe eosinophilia and chronic diarrhea all occurring together in one patient
But interesetingly, one patient was found to have severe anaemia [hb 3.2g%] and severe eosinophilia [absolute eosinophil count or aec-1100 cells/cu.mm] along with chronic diarrhea . Hence full details about this patient with chronic diarrhea in addition to severe anaemia and eosinophilia is thoroughly analysed and discussed in detail in this article. A 47 year old female patient was admitted in our hospital on 04/07/2012 with chronic diarrhea and upper abdominal pain for 6months. Her haemoglobin was 3.2g% [ normal range12-16g%], Absolute Eosinophil Count or AEC was 1100 cells/cu.mm [normal range 40- 440 cells/cu.mm], Red Blood Cells or RBC count 2.09 million cells/ cu.mm[normal range 4.2-5.4 million cells/ cu.mm], mean corpuscular volume or MCV50.7 femolitres or fl [normal range 82-92 fl] and mean corpuscular haemoglobin or MCH15 picograms or pg [normal range 27-32pg]. Her peripheral smear showed severe microcytic, hypochromic anaemia and severe eosinophilia. Her stool examination for ova and cyst was negative. She was treated with two pints of blood transfusion, haematinics and mebendazole 100mg twice daily for 3 days. Another course of mebendazole was given after 2 weeks. After one month her haemoglobin improved significantly to 9g%, but her chronic diarrhea persisted. After 6 months on 28/02/2013, she was again admitted with history of loose stools 5 times daily for one week. She was given intravenous fluids and antibiotics along with metronidazole for her diarrhea. Her haemoglobin was 9.2g%, but her severe eosinophilia persisted with absolute eosinophil count more than 1000 cells/cu.mm. But her stool examination for ova and cyst was again negative. But since she was having persistent severe eosinophilia along with chronic diarrhea for many months, she was subjected to upper gastro-intestinal endoscopy on 06/03/2013to rule out any worm infestation. Very interestingly, multiple hookworms were found in the first part of duodenum(Fig1 , 2) . Hence her severe iron deficiency anaemia at her initial admission was due to severe hookworm infection and the diagnosis of hookworm infection was completely missed at that time since upper gastro-intestinal endoscopy was not done at that time. The two full courses of mebendazole treatment given to her has failed to eradicate her hookworm infection and hence she was treated this time with a single dose of 400mg of albendazole along with haematinics and and she started showing much clinical improvement.

1. Haemoglobin
Our patient had very severe anaemia and her haemoglobin was only 3.2g%. Various other studies have also shown the presence of severe anaemia in patients with hookworm infection diagnosed by upper gastro-intestinal endoscopy (1-8). The haemoglobin of the patients in the first three studies were 3.4g%, 3.7g % and 6.5g% respectively.

2. Haemoglobin and iron deficiency anaemia
Hookworm infection produces iron deficiency anaemia and iron deficiency anaemia is defined by low haemoglobin (18-22). In our patient also with severe hookworm infection, haemoglobin is very low-3.2g% [ normal range12-16g%].

3. Mean corpuscular volume or mean red cell volume [MCV]
Our patient also had very low levels of mean red cell volume or MCV50.7 femolitres or fl [normal range 82- 92 fl] in addition to low levels of haemoglobin. In one study also, patients with hookworm infection had very low levels of mean red cell volume or MCV in addition to low levels of haemoglobin(22).

4. Mean corpuscular haemoglobin or MCH
Mean corpuscular haemoglobin or MCH was also very low 15 picograms or pg [normal range 27-32pg] in our patient . In one study also, patients with hookworm infection had low levels of mean corpuscular haemoglobin or MCH in addition to low levels of haemoglobin (23).

5. Severe eosinophilia or hypereosinophilia Eosinophilia means
Absolute Eosinophil Count or AEC more than 500 cells/cu.mm and hypereosinophilia means Absolute Eosinophil Count or AEC more than 1000 cells/cu.mm (10). The patient had severe eosinophilia or hypereosinophilia [Absolute Eosinophil Count or AEC – 1100 cells/cu.mm]. Various other studies have also shown the presence of severe eosinophilia in patients with hookworm infection (7-14). Eosinophilia is significantly associated with the presence of intestinal helminthes and especially with hookworm infection (11, 12) , but not with the presence of ecto parasites(10).

6. Chronic diarrhea
The patient also had chronic diarrhea. Chronic diarrhea is reported to occur only rarely in hookworm infection (9, 14). But other studies have shown the presence of acute diarrhea in patients with hookworm infection (13,15-17). In one study,the ova of necator americanus was found in the diarrheic stool. (17). In another study, hookworm constituted 10.2% of the intestinal parasites in diarrhoeal disease in children(16). In another study also, hookworm ova was found in addition to the ova or cyst of the intestinal parasites in diarrhoeal disease in children(15). In three studies, watery diarrhea was found in patients with hookworm infection (9,13,14). 7. Albendazole is more effective than mebendazole In the patient, the two full courses of mebendazole treatment given to her at her initial admission has failed to eradicate her hookworm infection and hence she was treated subsequently with a single dose of 400mg of albendazole and she started showing much clinical improvement. One very important study has also clearly shown that albendazole is more effective than mebendazole against hookworm infection (24). Other studies have also clearly shown that albendazole cleared hookworm infection completely (25, 26).

8. Anaemia, eosinophilia and diarrhea all occurring together
Anaemia and eosinophilia occur commonly in hookworm infection (7). Anaemia and eosinophilia occur commonly in many children with hookworm infection (8). Diarrhea along with eosinophilia is only rarely reported to occur in hookworm infection. But anaemia, eosinophilia and diarrhea all occurring together in a single patient with hookworm infection like in our patient is extremely rare and is only very rarely reported. In only one study, a 55 year old dutch male patient who has returned from Philippines with severe hookworm infection was reported to have chronic diarrhea, severe anaemia and extremely severe eosinophilia (9) almost like our patient. 9. Though anaemia and eosinophilia occur commonly in hookworm infection (7,8), anaemia, eosinophilia and diarrhea all occurring together in a single patient with hookworm infection like in our patient is extremely rare and is hence highlighted in this article.

DISCUSSION
a. Haemoglobin
Hookworm infection produces iron deficiency anaemia and iron deficiency anaemia is defined by low haemoglobin [18-22]. Anaemia is defined as the reduction in haemoglobin concentrations below the expected values [WHO,1972] [ref 20]. In our patient haemoglobin is very low 3.2g%[ normal range12-16g%] .

b. Mean corpuscular volume or or mean red cell volume [MCV]
Our patient also had very low levels mean red cell volume or MCV in addition to low levels of haemoglobin.

c. Mean corpuscular haemoglobin or MCH
Mean corpuscular haemoglobin or MCH was also very low 15 picograms or pg [normal range 27-32pg] in our patient.

d. Red blood cells or RBC count
Our patient had also undergone red blood cells or rbc count which was very low -2.09 million cells/ cu.mm [normal range 4.2-5.4 million cells/ cu.mm] . e. Peripheral smear Our patient had also undergone peripheral smear examination which showed severe microcytic, hypochromic anaemia and severe eosinophilia. Thus our patient had undergone 5 investigations to confirm her severe anaemia and the type of her anaemia namely

1. blood haemoglobin concentration, 2. mean red cell volume or mean corpuscular volume or MCV, 3. mean corpuscular haemoglobin or MCH, 4. red blood cells or RBC count- all of which showed very low values and 5. peripheral smear examination which showed severe microcytic, hypochromic anaemia. Thus our patient had undergone extremely detailed and thorough investigations to confirm her severe anaemia and the type of her anaemia and the interpretations of her various results are discussed below in detail. 1. Anaemia is defined as the reduction in haemoglobin concentrations below the expected values[WHO,1972] [20]. In our patient haemoglobin is very low 3.2g%[ normal range12-16g%]. 2. Mean corpuscular volume or MCVis the mean volume of all red blood cells or RBCs counted in the sample. Normocytic means blood with a normal mean corpuscular volume or MCV. When the mean corpuscular volume or MCV is low, the blood is said to be microcytic. 3. Mean corpuscular haemoglobin or MCH represents the mean mass of haemoglobin in the red blood cells or RBCs. Since small red blood cells [microcytic or low mean corpuscular volume] have less haemoglobin [low mean corpuscular haemoglobin] than large red blood cells, low mean corpuscular volume [ MCV] corresponds to low mean corpuscular haemoglobin [ MCH]. Thus variation in mean corpuscular haemoglobin [ MCH] corresponds to variation in mean corpuscular volume[ MCV] . 4. Our patient had also undergone red blood cells or RBC count which was very low. 5. Our patient had also undergone peripheral smear examination which showed severe microcytic, hypochromic anaemia.

CONCLUSION
Severe anaemia and eosinophilia are commonly reported to occur in hookworm infection. But chronic diarrhea is not commonly reported to occur in hookworm infection. In our study also, only one patient with hookworm infection was found to have chronic diarrhea. It is a well known fact that hookworm infection should be suspected strongly in patients with significant anaemia and eosinophilia. But hookworm infection should also be suspected in patients with chronic diarrhea, especially in tropical and subtropical countries. The patient with chronic diarrhea was also found to have severe anaemia and severe eosinophilia and multiple hookworms in endoscopy in our study. Hence upper gastro-intestinal endoscopy should always done in all patients with chronic diarrhea associated with eosinophilia or anaemia to confirm the presence of hookworms in tropical and subtropical countries.

ACKNOWLEDGEMENT
The author sincerely thanks Venkatachalapathy Arunkumar, Computer Programmer of our institue for the immense help he has offered in preparing the figures of this article. The author acknowledges the immense help received from the scholars whose articles are cited and included in references of this manuscript. The author is also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. The author is extremely grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript

References:

1. Hyun HJ, Kim EM, Park SY, Jung JO, Chai JY, Hong ST . A case of severe anemia by Necator americanus infection in Korea. J Korean Med Sci. 2010 Dec;25(12):1802-4.

2. Wu KL, Chuah SK, Hsu CC, Chiu KW, Chiu YC, Changchien CS. Endoscopic Diagnosis of Hookworm Disease of the Duodenum: A Case Report. J Intern Med Taiwan 2002;13:27- 30.

3. Kuo YC, Chang CW, Chen CJ, Wang TE, Chang WH, Shih SC. Endoscopic Diagnosis of Hookworm Infection That Caused Anemia in an Elderly Person. International Journal of Gerontology. 2010 ; 4(4) : 199-201.

4. Zaher, T. I., Emara, M. H., Darweish, E., Abdul-Fattah, M., Bihery, A. S., Refaey, M. M.,and Radwan, M. I. Detection of Parasites During Upper Gastrointestinal Endoscopic Procedures. Afro-Egypt J Infect Endem Dis 2012; 2 (2): 62-68.

5. Basset D, Rullier P, Segalas F, Sasso M. Hookworm discovered in a patient presenting with severe iron-deficiency anemiaMed Trop (Mars). 2010 Apr;70(2):203-4.

6. Lee TH, Yang JC, Lin JT, Lu SC, Wang TH. Hookworm Infection Diagnosed by Upper Gastrointestinal Endoscopy: —Report of Two Cases with Review of the Literature—. Digestive Endoscopy, 1994 6(1): 66–72.

7. Kato T, Kamoi R, Iida M, Kihara T.Endoscopic diagnosis of hookworm disease of the duodenum J Clin Gastroenterol. 1997 Mar;24(2):100-102.

8. Anjum Saeed, Huma Arshad Cheema, Arshad Alvi, Hassan Suleman. Hookworm infestation in children presenting with malena -case seriesPak J Med Res Oct - Dec 2008;47(4) ):98-100.

9. Verboeket SO1, van den Berk GE., Arends JE, van Dam AP, Peringa J, Jansen RR. Hookworm with hypereosinophilia: atypical presentation of a typical disease. J Travel Med. 2013 Jul-Aug;20(4):265-7.

10. Heukelbach J, Poggensee G, Winter B, Wilcke T, Kerr-Pontes LR, Feldmeier H Leukocytosis and blood eosinophilia in a polyparasitised population in north-eastern Brazil. Trans R Soc Trop Med Hyg. 2006 Jan;100(1):32-40. Epub 2005 Sep 23.

11. Nutman TB, Ottesen EA, Ieng S, Samuels J, Kimball E, Lutkoski M, Zierdt WS, Gam A, Neva FA. Eosinophilia in Southeast Asian refugees: evaluation at a referral center. J Infect Dis. 1987 Feb;155(2):309-

12. Triteeraprapab S, Nuchprayoon I. Eosinophilia, anemia and parasitism in a rural region of northwest Thailand. Southeast Asian J Trop Med Public Health. 1998 Sep;29(3):584- 90.

13. Lawn SD1, Grant AD, Wright SG Case reports: acute hookworm infection: an unusual cause of profuse watery diarrhoea in returned travellersTrans R Soc Trop Med Hyg. 2003 Jul-Aug;97(4):414-5.

14. Wang CH, Lee SC, Huang SS, Chang LC. Hookworm infection in a healthy adult that manifested as severe eosinphilia and diarrhea. J Microbiol Immunol Infect. 2011 Dec;44(6):484-7. Epub 2011 May 23.

15. Chavalittamrong B, Jirapinyo P. Intestinal parasites in pediatric patients with diarrhoeal diseases in Bangkok. Southeast Asian J Trop Med Public Health. 1984 Sep;15(3):385- 8.

16. Adedoyin MA, Awogun IA, Juergensen T Prevalence of intestinal parasitoses in relationship to diarrhoea among children in Ilorin. West Afr J Med. 1990 Apr-Jun;9(2):83-8.

17. Tinuade O, John O, Saheed O, Oyeku O, Fidelis N, Olabisi D. Parasitic etiology of childhood diarrheaIndian J Pediatr. 2006 Dec;73(12):1081-4.

18. Stoltzfus RJ1, Albonico M, Chwaya HM, Savioli L, Tielsch J, Schulze K, Yip R. Hemoquant determination of hookwormrelated blood loss and its role in iron deficiency in African children. Am J Trop Med Hyg. 1996 Oct;55(4):399-404.

19. S Pritchard DI, Quinnell RJ, … Keymer AE Hookworm (Necator americanus) infection and storage iron depletion Trans R Soc Trop Med Hyg 1991 Mar-Apr; 85(2):235-8.

20. Crompton DW1, Whitehead RR. Hookworm infections and human iron metabolismParasitology. 1993;107 Suppl:S137-45.

21. Stoltzfus RJ1, Chwaya HM, Tielsch JM, Schulze KJ, Albonico M, Savioli L. Epidemiology of iron deficiency anemia in Zanzibari schoolchildren: the importance of hookworms Am J Clin Nutr. 1997 Jan;65(1):153-9.

22. R M Hopkins, M S Gracey, R P Hobbs, R M Spargo, M Yates, R C Thompson The prevalence of hookworm infection, iron deficiency and anaemia in an aboriginal community in north-west Australia Med J Aust. 1997 Mar 3;166 (5):241- 4.

23. Watthanakulpanich D1, Maipanich W, Pubampen S, SaNguankiat S, Pooudouang S, Chantaranipapong Y, Homsuwan N, Nawa Y, Waikagul J Impact of hookworm deworming on anemia and nutritional status among children in Thailand. Southeast Asian J Trop Med Public Health. 2011 Jul;42(4):782-92.

24. Keiser J, Utzinger J Efficacy of current drugs against soiltransmitted helminth infections: systematic review and meta-analysisJAMA. 2008 Apr 23;299(16):1937-48.

25. R C Thompson, J A Reynoldson, S C Garrow, J S McCarthy, J M Behnke Towards the eradication of hookworm in an isolated Australian community. Lancet. 2001 Mar 10;357(9258):770-1.

26. J A Reynoldson, J M Behnke, L J Pallant, M G Macnish, F Gilbert, S Giles, R J Spargo, R C Thompson Failure of pyrantel in treatment of human hookworm infections (Ancylostoma duodenale) in the Kimberley region of north west AustraliaMed J Aust. 1993 Feb 1;158 (3):157-9.

Announcements

Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

COPE guidelines for Reviewers

SCOPUS indexing: 2014, 2019 to 2021

Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award:

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.

Women Researcher Award:

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.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

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

A Study by Monica K. entitled "Risk Predictors for Lymphoma Development in Sjogren Syndrome - A Systematic Review" is awarded Best Article for Vol 14 issue 13

A Study by Mokhtar M Sh et al. entitled "Prevalence of Hospital Mortality of Critically Ill Elderly Patients" is awarded Best Article for Vol 14 issue 12

A Study by Vidya S. Bhat et al. entitled "Effect of an Indigenous Cleanser on the Microbial Biofilm on Acrylic Denture Base - A Pilot Study" is awarded Best Article for Vol 14 issue 11

A Study by Pandya S. et al. entitled "Acute and 28-Day Repeated Dose Subacute Toxicological Evaluation of Coroprotect Tablet in Rodents" is awarded Best Article for Vol 14 issue 10

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

RSS feed