International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 05 Issue 18, September, 2013

Pages: 54-59

Date of Publication: 25-Sep-2013


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EVALUATION OF AGE RELATED MACULAR DEGENERATION AMONG PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN A TERTIARY HEALTH CARE CENTRE

Author: Somanath Dash, Satish K., Mishra S. K. , P.Harshavardhan V.

Category: Healthcare

Abstract:Chronic obstructive pulmonary disease (COPD) is one of the leading causes of human morbidity and mortality globally. Its significant extra pulmonary effects have been well evidenced by many studies by different researchers. Age related macular degeneration (ARMD) which is a very common cause of blindness in elderly people is a common occurrence in many COPD cases in our clinical practice. The present study was attempted to find the existence of age related macular degeneration (ARMD) in elderly COPD patients. The study was conducted in a medical college hospital of Andhra Pradesh which is a tertiary care centre. The study was conducted among 107 COPD patients above 50 years of age. All the patients were subjected to examination of the fundus of their eyes. All statistical analyses were performed by MS Excel 2007. In twenty three subjects evidence of age related macular degeneration was found. The ARMD was more in severe and very severe stage of COPD. It was also observed more in the current smokers, especially those who are smoking more number of cigars per day. Among all the smokers 22.6% were having ARMD. Even the ARMD was also found in 24% of former smokers, those who have already stopped smoking earlier. In two non-smoker COPD subjects also ARMD was detected. The present study attempted to establish a causal relationship between these two disease entities and many significant observations were made.

Keywords: COPD, GOLD Staging, ARMD.

Full Text:

INTRODUCTION

Chronic Obstructive Pulmonary Disease (COPD) is one of the major causes of chronic morbidity and mortality, worldwide. According to the Global Initiative for chronic obstructive lung diseases (GOLD) guideline updated in 2008, COPD is preventable and treatable disease of the lung with some significant extra pulmonary effect that mostly contributes to the severity of the disease 1. There are many significant extra pulmonary effects of COPD. Cardiovascular, mental and musculoskeletal co-morbidities are few in the list. The disease itself leads to decrease in physical activities of the patient and consequently causes systemic inflammation and left cardiac dysfunctions 2. Local and systemic inflammation, oxidative stress, and derangement in the neurohumoral mechanism are some of the probable reasons for development of these extra-pulmonary complications of COPD 3. Patients with COPD are at increased risk of developing cardiovascular diseases, anaemia, cachexia, osteoporosis, peripheral muscle weakness, cognitive dysfunction and many other systemic conditions. These systemic disorders contribute significantly to the morbidity and mortality in COPD patients. In our regular practice it is observed that many elderly COPD patients complains of defective vision. Along with co-morbidities like cataract we could detect age related macular degeneration (ARMD) in many such individuals.

Age Related Macular Degeneration (ARMD) is one of the leading causes of blindness in elderly people. It is characterized by pigmentary disturbances in the macula of retina. There is progressive degeneration of the retinal pigmentary epithelium (RPE), which is located between the retina and the choroid. International epidemiological age related macular study group defines ARMD as a degenerative disorder of the retina in individuals above 50 years of age 4. The pathogenesis of the disease is not clear. Oxidative stress or antioxidant deficiency may be one of the probable causes of ARMD 5. COPD, the disease itself also leads to increase oxidative stress. The activated leucocytes in COPD usually generate oxygen free radicals by induction of enzymes like NAPDH oxidase, superoxide dismutase, nitric oxide synthase and myeloperoxidase6. Rehman et al in a study found that COPD patients experience more oxidative stress in comparison to the control group 7.

In a study by Nadeem et al it was suggested that there is an imbalance between systemic oxidants and anti-oxidants in the COPD patients 8. There is multi-factorial aetiology for the oxidative burden in COPD. Hypoxemia, poor nutrition, inflammation, infection, and smoking have all been attributed. Smoking is a significant risk factor for the ARMD to develop (POLA Study) 9. Many of the patients in our study group were smokers also.

OBJECTIVE

The present study was conducted to establish causal relationship between these two disease entities, with a hypothesis that COPD may be associated with ARMD in elderly individuals.

MATERIALS AND METHODS       

All patients above 50 years diagnosed as COPD attending the department of Pulmonary medicine between February 2010 and January 2012 were sent to the Ophthalmology outpatient department for fundus examination. Fundus photograph was taken for those patients in whom relevant ARMD features were found. Patients having associated co-morbidities like diabetes mellitus and hypertension were excluded from the study. Patients having associated cataract and other maculopathies were also excluded from the study.

Out of the total 349 patients only 107 (86 males and 21 females) were made eligible for the study after exclusion. Ethical clearance from the Institutional Ethical Committee was obtained and Informed consent was also taken from all the participants before the study. The diagnosis of COPD was established in all the participants after a thorough clinical history, examinations, chest X-ray and spirometry. Spirometry was performed by computerized Superspiro spirometer in all the participants. Baseline and post bronchodilator spirometry was conducted. The post bronchodilator FEV1 values were taken into consideration for grading the participants as per the staging suggested by the GOLD guideline. The patients were divided into four stages of severity, according to the post-bronchodilator FEV1 values. Mild: FEV1 >80%; Moderate: FEV1 < 80% and > 50%; Severe: FEV1 < 50% and > 30 %; Very severe: FEV1 < 30 %. They were examined for visual acuity using Snellen’s Chart. All the study participants also underwent thorough dilated slit lamp and fundus examination. Those who were having dense cataract, which obstructed fundus examination were excluded from the study. Evidence of ARMD was confirmed during the fundus examination taking the following findings into account.

  1. Areas of hyperpigmentation
  2. Areas of depigmentation or hypopigmentation 
  3. Choroidal neovasculaization
  4. Fibrovascular disciform scarring

Drusens, hyperpigmentation and hypopigmentations are considered as dry ARMD. The size of the drusens was measured with the help of Zeiss fundus camera at 30° and 3X magnification. Findings like Choroidal neovasculaization, Fibrovascular disciform scarring was considered as findings of wet ARMD.

All statistical analyses were performed by Micro Soft Excel 2007. Values were presented as mean ± SD. Variables were expressed as percentages. Chi-square test (fisher’s exact test) was used for examining the qualitative data. For all statistical analyses, p <0.05 was considered statistically significant.

RESULTS

Out of total 107 study subjects majority i.e. 80.37% were male and only 19.63% were female. In our study, 59.81% were above 60 years of age. (Table -1)

All the participants were grouped into four groups according to their severity.  Each participant was put under one of the four severity stages according to the GOLD classification 1.    In this study group 53 members were current smokers, 37 members were former smokers who had given up smoking earlier and 17 members had never smoked. Almost all the smokers in the study group were habituated to the home made cigars, locally called as chutta. So instead of calculating the smoking index or pack years we classified the smokers according to the number of cigars smoked per day basing on the history given by the study participants. Among the current smokers only two participants were having mild COPD (both males), 21 participants were having moderate COPD (20 males and one female), 18 participants were having severe COPD (14 males and four females) and 12 participants were having very severe COPD (all males). Out of 37 former smokers four persons were having mild COPD (all males), eight were having moderate COPD (six males and two females), 11 were having severe COPD (eight males and three females) and 14 participants were having very severe COPD (nine males and five females). Amongst 17 non smokers 13 participants had mild COPD (11 males, two Females) and four participants (one males and three females) had moderate COPD. None of them had severe or very severe COPD.  In our study group we found age related macular degeneration (ARMD) in 23 individuals. There are nine persons with ARMD in each group of severe and very severe stage of COPD patients (Table- 2). The table shows that four severity stages were highly significantly associated with smoking groups.

ARMD was found to be more in the age group of > 60 years (61%) and followed by 56-60 years (22%). This also increases with GOLD severity III & IV (Table 3). In our study group we found age related macular degeneration (ARMD) in 23 individuals. There are nine persons with ARMD in each group of severe and very severe stage of COPD patients.  Severity status was significantly varied with age among ARMD study participants.

There were 12 ARMD cases among the current smokers group. Even among former smokers we got nine persons having ARMD. Majority among the current smokers (67%) are consuming > 10 cigars /chuttas per day. Smoking status was significantly associated with sex among ARMD study participants.(Table- 4)

Those who were smoking more than 10 cigars per day were more affected with ARMD (Figure- 1). Among the former smokers it was found that the number of ARMD is more in subjects who quitted smoking recently in comparison to those who quitted long back (Figure- 2). Among the non-smoker COPD patients also we found ARMD in two individuals and both of them are females.

DISCUSSION

The effect of COPD on different organ systems has been studied earlier by different authors. Many authors have confirmed the existence of cardiovascular, skeletal, neuromuscular and psychiatric disturbances as co-morbidities in COPD.2, 7, 10 O. KAYACAN et al in a study detected peripheral neuropathy in COPD patients.11According to study conducted by Murat Sezer et al the visual evoke potential (VEP) of patients with COPD, is altered probably due to hypoxemia caused by ventilation perfusion imbalance in COPD.12 In POLA (Pathologies Oculaires Lie´es a` l’Age) study conducted among 2196 participants it was confirmed that tobacco smoking is a causative agent for the ARMD. In our study we found ARMD in 12 out of 53 smokers. The POLA study also says that former smokers are vulnerable for development of the ARMD too9. In our study group out of the 37 former smokers nine persons were having features of ARMD. Among the former smokers those who had stopped smoking for more than 20 years are not having ARMD but there are good numbers of ARMD cases among recent quitters. Daisy Chan in a review article concluded that there is biologically and statistically plausible relationship between cigarette smoking and ARMD13. Hypoxia, microinfarction and degenerative changes are the contributing factors which are attributed to decreased HDL (High density lipoprotein), increased platelet aggregation and thrombosis in smokers. In our study we also found ARMD in two among 17 non-smoking COPD subjects, that to both of them are females. Though it is statistically not significant we can postulate the association of ARMD in non-smoking COPD cases also.

CONCLUSION

We conclude in this study that age related macular degeneration may be an associated systemic manifestation in elderly COPD patients and particularly among those who are continuing smoking. However a larger multicentric study with a bigger sample size may throw some light in establishing the hypothesis that the ARMD is one of the different co-morbidities in patients with COPD. A routine ophthalmological checkup may be suggested in this context for all COPD patients.

ACKNOWLEDGEMENT

We are grateful to Prof. K.V Ramana Rao for his advice and guidance. We are acknowledging the contribution of Mr. N. Lakshman Rao and Mr.Ganapathy Swamy, our statisticians for helping in statistical calculation. The authors are ever thankful to all the study participants who gave their consent for participating in the study. Authors acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript. The authors are 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.

References:

  1. KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P,Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007; 176:532–555.
  2. Henrik Watz, Benjamin Waschki, Corinna Boehme, Martin Claussen, Thorsten Meyer, and Helgo Magnussen. Extrapulmonary Effects of Chronic Obstructive Pulmonary Disease on Physical Activity  A Cross-sectional Study  American Journal Of Respiratory And Critical Care Medicine Vol 177 2008:743- 751.
  3. Jan Tkac, S. F. Paul Man, Don D. Sin Systemic consequences of COPD Therapeutic Advances in Respiratory Disease (2007) 1(1) 47–59.
  4. Stephen j. Ryan; Retina; 4th edition; Volume-2; Page 1041
  5. Christen WG Jr.; Antioxidants and eye disease Am J Med. 1994 Sep 26;97(3A):14S-17S; discussion 22S-28S.
  6. Ján Tká?c, S. F. Paul Man, Don D. Sin Systemic consequences of COPD Therapeutic Advances in Respiratory Disease (2007) 1(1) 47–59
  7. Irfan Rahman, Douglas Morrison, Kenneth Donaldson, And William MAcNEE; Systemic Oxidative Stress in Asthma, COPD, and Smokers AM J RESPIR CRIT CARE MED 1996;154:1055-60
  8. Nadeem A, Raj HG, Chhabra SK; Increased oxidative stress and altered levels of antioxidants in chronic obstructive pulmonary disease; Inflammation. 2005 Feb;29(1):23-32.
  9. Smoking and Age-related Macular Degeneration The POLA Study Arch Ophthalmol. 1998; 116:1031-1035
  10. Joan B. Soriano et al; Patterns of Co morbidities in Newly Diagnosed COPD and Asthma in Primary Care;CHEST 2005; 128:2099–2107.
  11. O. Kayacan, S. Beder, G. Deda, D. Karnak; Neurophysiological Changes In Copd patients with chronic respiratory insufficiency;  Acta neurol. belg., 2001, 101, 160-165
  12. Sezer Et Al ;Visual Evoked Potential Changes In Chronic Obstructive Pulmonary Disease; Eur J Gen Med 2007;4(3):115-118
  13. Daisy Chan OD ; Cigarette smoking and age related macular degeneration; Optometry and vision science, Vol. 75, No:7, July 1998; 476 – 48.

Abbreviations

COPD – Chronic Obstructive Pulmonary Disease

GOLD - Global Initiative for chronic obstructive lung diseases

ARMD - Age related macular degeneration  

RPE - Retinal pigmentary epithelium

NAPDH - Nicotinamide adenine dinucleotide phosphate (Reduced Form)

FEV1 - Forced Expiratory Volume in one second

SD - Standard Deviation

VEP - Visual Evoke Potential

POLA - Pathologies Oculaires Lie´es a` l’Age

HDL - High density lipoprotein

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 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


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