International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 05 Issue 16, August, 2013

Pages: 20-26

Date of Publication: 28-Aug-2013


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EFFICACY AND SAFETY OF ORAL TRIPLE DRUG COMBINATION (VOGLIBOSE, GLIMEPIRIDE AND METFORMIN) IN THE MANAGEMENT OF TYPE 2 DIABETES MELLITUS

Author: C. Rao, A. A. Faruqui

Category: Healthcare

Abstract:The prevalence of type 2 diabetes across the world has been described as a global pandemic. Despite the introduction of new agents, efforts for better management of diabetes are disappointing and the control of blood glucose level remains unsatisfactory. When antidiabetic therapy is initiated, it is now recommended that the selection of agents should be directed towards both fasting as well as postprandial hyperglycaemia. Material and method: This study was a post marketing surveillance (PMS) non-randomized, open, non-comparative, mono centric study. The drug administered was a fixed dose combination of Voglibose 0.2mg, Glimepiride 1/2mg and Metformin 500mg SR, 20 type 2 diabetic patients were given fixed dose combination twice daily with major meals for 3 months. Observation: Baseline value was recorded for glycated haemoglobin (HbA1c), fasting blood glucose and post prandial blood glucose level. There was significant decrease in glycated haemoglobin value (8.86 \? 0.7111 gm/dl vs. 8.0 \? 0.66 gm/dl), fasting (137\?17.64 mg/dl vs. 116.8 \? 6.129 mg/dl, P < 0.0001) and post prandial blood glucose level ((237.8 \? 59.22 mg/dl vs.173.4 \? 27.6 P < 0.0004) after 3 months of treatment. The combination was found to be effective in controlling both fasting and post prandial glucose level and was well tolerated. Investigator commented that the use of triple drug combination is a good option in the management of type 2 diabetes which controls both fasting as well as post prandial blood glucose. Conclusion: The triple drug fixed dose combination of Voglibose, Glimepiride and Metformin significantly decreased the HbA1c value, fasting plasma glucose level and post prandial glucose level at the end of the treatment.

Keywords: HbA1c, Fasting Plasma Glucose, Post Prandial Blood Glucose, PMS

Full Text:

INTRODUCTION
The prevalence of type 2 diabetes across the world has been described as a global pandemic despite the introduction of new agents to the armamentarium of hypoglycaemic agents; efforts for better management of diabetes are disappointing and the control of blood glucose levels remains unsatisfactory1 . Optimal management of type 2 diabetes requires a consideration on the relationship between glycosylated haemoglobin (HbA1c), fasting plasma glucose and postprandial glucose (the glucose triad). Early and sustained control of glycaemia remains important in the management of type 2 diabetes. The contribution of postprandial glucose levels to overall glycaemic control and the role of postprandial glucose targets in disease management are currently debated2 . However, many patients do not reach HbA1C targets set according to published guidelines.

Guidelines for good glycaemic control have been agreed upon and a patient is generally considered to have achieved successful disease control when their HbA1C is < 7% 3, 4, 5 . It is now more and more clear that physicians are likely to have to consider plasma glucose levels both after the overnight fast and after meals as well as the variability of glucose levels, in order to achieve optimal glycaemic control for each patient. When antidiabetic therapy is initiated, physicians may need to consider selection of agents that target both fasting and postprandial hyperglycaemia. Controlling the Glucose triad (HbA1c, fasting plasma glucose and postprandial glucose): Regardless of the HbA1C goal that is agreed upon, it is doubtful to be reached unless both fasting and postprandial glucose levels are adequately controlled, ideally through a combination of lifestyle modification and appropriate drug therapy2 . Routine measurement of postprandial glucose levels is not currently recommended or even practical for all patients with type II diabetes. However, improved understanding of the relative influence of fasting and postprandial glucose levels throughout the course of the disease might influence the class of drug that is prescribed. Recent research has suggested that intensification of glucose control with insulin therapy may not be advisable for all patients with type 2 diabetes and oral antidiabetic drugs should be used for as long as possible6 . International Diabetes Federation (IDF) guidelines for the management of post meal (postprandial) glucose state that the goal of diabetes therapy should be to achieve glycaemic status as near to normal as safely possible in all three measures of glycaemic control, namely HbA1C, fasting premeal glucose and post meal glucose7 . Treatment of both fasting and postprandial hyperglycaemia should be initiated simultaneously at all levels of HbA1C above agreed levels. Traditional treatments such as metformin and thiazolidinediones primarily lower fasting plasma glucose. As sulphonylureas are generally taken in the morning, they do lower postprandial glucose levels during the day and subsequently have an effect on overnight fasting levels. Therapeutic agents are available that preferentially lower postprandial glucose, including alphaglucosidase inhibitors, glinides, incretin mimetics, dipeptidyl peptidase (DPP)-4 inhibitors and rapid acting insulin. Current recommendations of the American Diabetes Association include a trial of diet and exercise as first line therapy for the treatment of patients with type 2 diabetes8 . If glycemic control is not achieved with diet and exercise within a three-month period, pharmacologic intervention is required. Moreover if adequate control is not obtained with the use of a single agent, combination therapy is an option. Several of the available oral agents have been studied in combination and have been shown to further improve glycemic control when compared to monotherapy.9 Some physicians now advocating the therapy combining three oral agents (sulfonylurea, metformin, alpha-glucosidase inhibitor or sulfonylurea, metformin, thiazolidinedione) in the management of type 2 diabetes 10 . This study was conducted to evaluate the safety of triple drug combination (i.e. Voglibose, Metformin and Glimepiride) and its impact on Glucose Triad.

MATERIALS AND METHOD
A total of 20 type 2 diabetic patients were enrolled and completed the treatment. At the time of entry into the study, base-line data were recorded. Patients were observed on 1st month of treatment, than subsequent 2nd and 3rd month of the treatment. The patients were asked for the determination of FPG and PPG regularly at the interval of each month. The HbA1C level was examined only before the treatment and after 3 months of treatment. The glycosylated haemoglobin determination was carried out by using BIORAD Micromat II HbA1C instrument, while FPG and PPG were determined in the laboratory.

INCLUSION CRITERIA
Known cases of type 2 diabetes patients with age more than 35 yrs, of either sex & glycosylated haemoglobin > 7% were included in the study. Clinical criteria for the evaluation included fasting blood glucose level, post prandial blood glucose level and glycated haemoglobin (HbA1c) value. Patients were prescribed to receive fixed dose combination of Voglibose 0.2mg, Glimepiride 1/2mg and Metformin 500mg SR, one tablet twice daily with major meals for three months.

EXCLUSION CRITERIA
Patients with current insulin therapy or received insulin for more than six weeks in last 3 months, who had known hypersensitivity to Biguanides and sulphonylurea, who are on chronic medication known to affect glucose metabolism were excluded from the study. Also the patients with renal disease or renal dysfunction, with congestive heart failure, hepatic insufficiency, alcoholic person and pregnant and lactating women were excluded from the study.

EFFICACY AND SAFETY EVALUATIONS
The primary efficacy variable was the change in HbA1C, FPG & PPG from baseline to 3 month. Safety outcomes included adverse events, particularly hypoglycaemic symptoms. The patients were interviewed and asked for any type of adverse events throughout the study. The patients were specially asked for the hypoglycaemic symptoms. The daytime hypoglycaemic episodes are usually recognized by sweating, nervousness, tremor, and hunger while night time hypoglycemia may be without symptoms or manifest as night sweats, unpleasant dreams, or early morning headache.

STATISTICAL ANALYSIS
The analysis of Glycosylated haemoglobin and fasting and post prandial glucose was carried out by using graph pad prism 6. Comparison between the baseline values with the value on the 1st, 2nd and 3rd month of treatment were made, as well as comparison in between these months was done by applying one way analysis of variance & the Turkeys multiple comparison test. Value of P<0.001 were considered significant.

RESULTS
A total of 20 patients were screened and randomized into the treatment groups and they completed the study. The baseline characteristics of all patients at randomization are summarized in the table 1. Evaluation of Glycaemic Control Glycosylated Haemoglobin Glycated haemoglobin value was significantly reduced from the baseline after using the triple combination of voglibose, glimepiride and metformin. During the study there was significant difference found in the value of HbA1c at the baseline to the value observed after the completion of the treatment (8.86 ± 0.7111 to 8.0 ± 0.66, 95% CI of diff. 0.2858 to 1.424) as shown in the figure 1. Evaluation of Fasting Plasma Glucose (FPG) level The FPG level was reduced throughout the study period of 3 month. The fasting plasma glucose (FPG) level was measured at base line and then subsequently at 1st, 2 nd and 3rd month of the treatment. The FPG level was 137±17.64 mg/dl at baseline. The Fasting plasma glucose level was significantly reduced just after 1month of the treatment from the baseline value (137 ± 17.64 mg/dl vs. 127.8 ± 11.29 mg/dl). But the level of significance was highest between the FPG at baseline and on 3rd months of the treatment (137±17.64 mg/dl vs. 116.8 ± 6.129 mg/dl, P < 0.0001).There was insignificant change between the 1st month and 2nd month of the treatment (127.8 ± 11.29mg/dl vs. 121.6 ± 5.549 mg/dl) and between 2 nd and 3rd month of the treatment (121.6 ± 5.549 vs. 116.8 ± 6.129). Overall the fasting plasma glucose level was significantly (p<0.0001) decreased by 20.2 ± 11.52 mg/dl from the baseline after the completion of the study of 90 days (Fig. 2). The comparative decrease in fasting plasma glucose level from the baseline to the subsequent month of treatment has been depicted in the figure no. 3.

Evaluation of Post Prandial Blood Glucose (PPHG) level
The post prandial blood glucose (PPBG) level was reduced throughout the study period of 3 month. The post prandial blood glucose level was measured at base line and then subsequently at 1st , 2 nd and 3rd month of the treatment. The PPBG level was 237.8 ± 59.22 mg/dl at baseline. The PPBG level was significantly reduced on 2nd month of the treatment vs. baseline (237.8 ± 59.22 mg/dl vs. 195 ± 43 mg/dl). But the level of significance was highest between the PPBG at baseline and to that on the 3rd months of the treatment (237.8 ± 59.22 mg/dl vs.173.4 ± 27.6 P < 0.0004). By applying the turkey’s multiple comparison it was observed that there was insignificant changes in post prandial blood glucose level between the 1st month of treatment to the 2nd month of treatment (215.6± 54.44 mg/dl vs. 195 ± 43mg/dl) and also in between 2nd and 3rd month of the treatment (215.6± 54.44 mg/dl vs. 173.4 ± 27.6 mg/dl ). Overall the post prandial blood glucose level was significantly decreased by 64.4 ± 31.62 mg/dl from the baseline after the completion of the study period of 90 days (Fig. No.5). The comparative post prandial blood glucose level at baseline and the subsequent month of treatment is shown in the figure no.4./figure no.5

Evaluation of Hypoglycaemic and other adverse effect
The patients were interviewed at the end of the study for the detection of any hypoglycaemic episode and about other side effects like nausea, vomiting, headache or flatulence. No patient complaint about any side effect including nausea, vomiting, headache or flatulence at the given doses of medication.

Evaluation of Global efficacy and tolerability
As per investigators assessment about efficacy and tolerability of fixed dose combination of Voglibose + Metformin + Glimepiride, 100% of patient tolerated the treatment very well.

DISCUSSION
Higher levels of post-prandial glucose and the disparity between fasting and post-prandial glucose are significantly associated with increased risk of cardiovascular and all-cause death, even after adjustment for established cardiovascular risk factors. However, higher fasting hyperglycaemia was not significantly associated with CVD risk. Post-prandial glucose, similar to post-challenge glucose, was related to CVD than fasting glucose 11-13. Previous analyses suggested that fasting hyperglycaemia tended to be associated with beta cell dysfunction, whereas post-challenge hyperglycaemia tended to be more strongly related to insulin resistance, higher blood pressure, obesity, and dyslipidemia 14. In clinical practice and in lifestyle and pharmacologic interventions, post-prandial glucose, should still be emphasized as a target to reduce diabetes incidence and CVD risk15 . But recently it is now recommended that for the optimal management of type 2 diabetes there is the requirement to understand the relationships between glycosylated haemoglobin (HbA1c), fasting plasma glucose and postprandial glucose (the glucose triad), and how these change takes place during development and progression of the disease. Early and sustained control of glycaemia remains important in the management of type 2 diabetes. The contribution of postprandial glucose levels to overall glycaemic control and the role of postprandial glucose targets in disease management are currently debated as previously understood. When antidiabetic therapy is initiated, physicians may need to consider selection of agents that target both fasting and postprandial hyperglycaemia. During the study there was significant differences found in the value of HbA1c at the baseline to the value observed after the completion of the treatment (8.86 ± 0.7111 to 8.0 ± 0.66, 95% CI of diff. 0.2858 to 1.424). Similarly fasting plasma glucose level was significantly (p<0.0001) decreased by 20.2 ± 11.52 mg/dl from the baseline after the completion of the study. The post prandial blood glucose level was decreased significantly by 64.4 ± 31.62 mg/dl from the baseline after 3 months of treatment.

CONCLUSION
The triple drug fixed dose combination of Voglibose, Glimepiride & Metformin significantly decreased the glycated HbA1c value, fasting plasma glucose level and post prandial glucose level after 3 months of treatment. Investigator observed that it is safe and well tolerated and an excellent option for the optimal management of Type II diabetes. Conflict of interest-Nil Abbreviations: HbA1c -Glycated haemoglobin IDF -International Diabetes Federation PPG-Post Prandial Glucose FPG-Fasting Plasma Glucose CVD-Cardiovascular Disease PMS -Post marketing surveillance




 

References:

1. Nathan DM, Kitrick C, Larkin M, Schaffran R, Singer DE. Glycemic control in diabetes mellitus: have changes in therapy made a difference? Am J Med 1996;100:157-63.

2. A. Ceriello. The glucose triad and its role in comprehensive glycaemic control: current status, future management: Int J Clin Pract, November 2010; 64(12): 1705–1711.

3. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2008; 31(Suppl. 1): S12–54.

4. Canadian Diabetes Association. Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 2008; 32(Suppl. 1): S1–201.

5. Ryden L, Standl E, Bartnik M et al. Guidelines on diabetes, prediabetes, and cardiovascular diseases: executive summary. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J 2007; 28: 88–136

6. Currie CJ, Peters JR, Tynan A et al. Survival as a function of HbA1c in people with type 2 diabetes: a retrospective cohort study. Lancet 2010; 375: 481–9

7. Ceriello A, Colagiuri S, Gerich J, Tuomilehto J. Guideline for Management of Postmeal Glucose. Brussels: International Diabetes Federation, 2007.

8. American Diabetes Association. The pharmacological treatment of hyperglycemia in NIDDM. Diabetes Care 1995;18:1510-8.

9. Riddle M. Combining sulfonylureas and other oral agents. Am J Med 2000;108 (suppl 6a):15S-22S.

10. Ovalle F, Bell DSH. Triple oral antidiabetic therapy in type 2 diabetes mellitus. Endocr Pract 1998;4:146-7

11. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. The DECODE study group. European Diabetes Epidemiology Group. Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in EuropeLancet 1999; 354: 617–621.

12. Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria, Arch. Intern. Med. 2001; 161 397–405.

13. F. Cavalot, A. Petrelli, M. Traversa, K. Bonomo, E. Fiora, M. Conti, et al., Postprandial blood glucose is a stronger predictor of cardiovascular events than fasting blood glucose in type 2 diabetes mellitus, particularly in women: lessons from the San Luigi Gonzaga Diabetes Study, J. Clin. Endocrinol. Metab. 91 (2006) 813–819.

14. Kuo-Liong Chien a,b, Bai-Chin Lee b, HungJu Lin b, Hsiu-Ching Hsu b, Ming-Fong Chen; Association of fasting and post-prandial hyperglycemia on the risk of cardiovascular and all-cause death among non-diabetic Chinese: Diabetes research and clinical practice 2009; 83:e4 7– e50

15. S. Yamagishi, K. Nakamura, M. Takeuchi, Inhibition of postprandial hyperglycaemia by acarbose is a promising therapeutic strategy for the treatment of patients with the metabolic syndrome, Med. Hypotheses 65 (2005) 152– 154.

Announcements

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

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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 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 situs slot and 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 et al. situs slot "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 situs slot 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 situs slot et al 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
Late to bed everyday? You may die early, get depression situs slot
Egg a day tied to lower risk of heart disease situs slot
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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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