International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 05 Issue 14, July, 2013

Pages: 49-54

Date of Publication: 29-Jul-2013


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A CASE OF HURLER SCHEIE SYNDROME, ATTENUATED FORM OF MUCOPOLYSACCHARIDOSIS TYPE I

Author: Manali Sinharay, Mousumi Mukhopadhyay

Category: Healthcare

Abstract:Mucopolysaccharidosis type Ι or MPS Ι is an autosomal recessive inborn error of metabolism due to deficiency of \a-L-iduronidase enzyme activity and is characterized by accumulation of incompletely degraded Glycosaminoglycans that generally lead to impairment of organ and body functions. In this report a three year old child with history of normal birth, delayed growth, noisy breathing specially during sleep and bulging abdomen noticed recently was examined and investigated thoroughly to reveal corneal clouding, coarse facial features, hepatosplenomegaly, multiple radiographic evidence of dysostosis multiplex, manifestations of mild valvular heart disease as per echocardiography, and abnormally increased excretion of Glycosaminoglycans in urine without any neurological abnormalities. The history, clinical examination and laboratory investigations confirmed the child to be suffering from attenuated form of Mucopolysaccharidosis type Ι (Hurler Scheie syndrome).

Keywords: ?-L-iduronidase, Glycosaminoglycans, Hurler Scheie syndrome.

Full Text:

INTRODUCTION
Mucopolysaccharidoses are autosomal recessive disorder of Glycosaminoglycans (GAGs) metabolism, caused by deficiency or absence of the lysosomal hydrolase activity. As a result, intralysosomal accumulation of GAGs occurs in various organs with significant excessive elimination of GAGs in urine. Inability to degrade these ubiquitous molecules results in progressive multisystem disorder with ocular, auditory, cardiac, respiratory, skeletal and sometimes neurological manifestations. Several types of Mucopolysaccharidoses are recognized depending on the type of lysosomal hydrolases that is deficient. Mucopolysaccharidosis type Ι or MPS Ι (Hurler's syndrome) arise due to deficiency of α-L-iduronidase (1). Historically, MPS I has been classified into 3 syndromes (Hurler, Hurler-Scheie and Scheie). The clinical spectrum of the disease ranges from severe (Hurler syndrome, presenting in infancy and characterized by relentless cognitive decline) to attenuated forms (Hurler-Scheie and Scheie syndromes, presenting in childhood with slower progression and moderate to absent CNS involvement) (2). The estimated incidence of MPS Ι is 1 per 100,000 live births, and 20% of the total MPS Ι population is represented by the attenuated type (3). Hurler's syndrome is considered the prototype of the mucopolysaccharidoses. The term "gargoylism" has been applied to this syndrome because of gross disfiguration resembling the gargoyles of Gothic architecture. Although this syndrome was first observed by Thompson in 1900, Hurler gave a more complete description in 1919. The term mucopolysaccharidosis was first used in 1952 by Brante(4) .

CASE HISTORY
A 3 year old male child was admitted with complains of bulging abdomen (figure 1), noisy breathing especially during sleep and short stature. No history of consanguinity or delayed milestones was obtained and neither of his two siblings was affected until symptoms started recently. Any incidence of umbilical or inguinal hernia at birth was not reported by his parents. There was no history suggestive of any bowel alterations, bleeding, jaundice, seizure, or chronic diseases like Tuberculosis. His bladder habit was normal. Physical examination revealed coarse facial features, frontal bossing (figure 2), open fontanelles, depressed nasal bridge, nasal flaring, corneal clouding and short neck. On oral examination a low arched palate and peg shaped teeth seen. His fingers were short, stubby and a gibbus (figure 3) was found in lower thoracic spine. Anthropometric examination showed him to be severely stunted with wasting (height 64 cm, weight 11kg). His head circumference was normal of his age. His abdomen was soft and slightly distended. His liver was 4 cm below the right costal margin in the mid-clavicular line, with a firm, sharp margin and a smooth surface. His spleen was 2 cm below the left costal margin in the mid-clavicular line. Cardiovascular examination revealed no audible murmur but there was tachycardia and the child was mild hypertensive. No abnormal breath sounds heard on auscultation, but there were evidence of obstruction in upper airways as suggested by noisy breathing. No hearing impairment was detected and Neurological examination was within normal limits. Suspecting MPS, various investigations were done. As per routine tests Hb was 11.2, TC WBC-11,400, DC (WBC) Lymphocytes-40%, rest was normal. Liver function test, Serum Calcium, Phosphorus, Thyroid profile were normal. Radiological investigations suggested– enlargement of the skull, a thick calvarium, a Jshaped sella turcica (figure 4), Chest X ray showed the ribs to be widened with the classic "oar shape" and the heart was seen to be markedly enlarged in transverse diameter. There was no evidence of pulmonary infiltration in either lung field. On the lateral film the anterior surface of the vertebral bodies exhibited the typical "hook-shaped" deformity and a thoracolumbar kyphosis or the gibbus deformity was seen. X ray of hands showed short, thin metacarpals with proximal tapering resulting in a bullet shape (figure 5). An electrocardiogram demonstrated right ventricular hypertrophy. A subsequent echocardiogram confirmed this finding, as well as a developing aortic stenosis. No hydrocephalus was detected on CT scan of brain. Routine urine examination was normal. The fresh urine sample was centrifuged and analyzed for inborn errors of metabolism as follows: dinitrophenylhydrazine test for alpha keto acids; cyanide nitroprusside test for homocystine and cystine; ferric chloride test for phenyl pyruvic acid; Millon’s test for tyrosine; Molisch test for carbohydrates; and Benedict’s test for reducing sugar. Urine sample was also tested for bilirubin and proteins to rule out liver or kidney dysfunction. Molisch test was positive. To confirm the presence of Mucopolysaccharides in urine of the patient, assay of Urinary GAGs (figure 6,7) of the child was done against a normal urine sample by Cetyltrimethyl ammonium bromide(CTAB)-which being a quaternary ammonium compound reacted with the negatively charged GAGs to produce heavy white precipitates-confirming the diagnosis of MPS (5). Five ml of fresh urine was added to 1 ml of cetyltrimethyl ammonium bromide (cetavilon) solution (50 g/l in citrate buffer (1 M) of pH 6. The amount of precipitate depends on the concentration of mucopolysaccharides. Depending upon their concentration, samples are classified as mild, moderate, and severe or negative for Mucopolysaccharides. Esbach’s test yielded negative result which suggested that the precipitate was not due to urinary protein. The particular subtype of MPS needed to be confirmed by enzyme assay which the patient was unable to afford, but the typical age of onset and progress of the clinical manifestations and radiological findings and investigations specially the urinary assay of GAGs clinches the diagnosis of attenuated MPS I (Hurler Scheie syndrome).

DISCUSSION
MPS Ι is caused by defective IDUA (α- L Iduronidase) gene, located on chromosome 4 at 4p16.3 site. Fifty two different mutations in the gene, IDUA have been shown to cause lysosomal enzyme, α-L-iduronidase deficiency leading to MPS Ι (6). MPS Ι has traditionally been classified into three categories: 1) Hurler disease for severe deficiency with neurodegeneration, cardio respiratory failure and severe skeletal disability causing early death, 2) Scheie disease for later onset without neurological involvement and less severe somatic manifestations, 3) Hurler Scheie disease for patients intermediate between the two. MPS Ι often presents in infancy and early childhood with chronic rhinitis, clouding of corneas and hepatosplenomegaly(7). As the disease progresses, nearly every organ system can be affected. Most patients with attenuated MPS Ι survive into adulthood, albeit with moderate to severe disability. However, cases of attenuated MPS Ι show wide variation with respect to age of presentation, symptoms and disease course (7, 8) . Children with MPS Ι may be normal at birth but may have inguinal or umbilical hernias. Growth begins to slow before the child’s first year ending and often ends at age three for severe variety. Many children may develop a short trunk leading to stature of less than four feet. Among the somatic manifestations, the child commonly presents with hepatosplenomegaly. A constellation of bony changes occurs such as severe and progressive joint deformities, dysostosis multiplex, kyphosis and joint contractures constellation, secondary to GAG deposition and fibrosis. Dysostosis multiplex radiographically consists of multiple abnormalities as enlargement of skull, a thick calvarium, and a J shaped sella turcica; hook shaped vertebrae and spatulate ribs, hypoplastic epiphyses and thickened diaphyses. The metacarpals are short and thin with proximal tapering resulting in bullet shape. The gibbus deformity or thoracolumbar kyphosis serves often as a key diagnostic clue. The severity and onset of these manifestations depend on the subtype of MPS Ι (9). Distinct facial features including bulging forehead, depressed nasal bridge and flat face become evident. The early ocular features that present in many children with MPS Ι include retinal degeneration, optic atrophy, optic disc swelling, ocular hypertension or glaucoma and corneal clouding (10) . Cardiac abnormalities are common in children with MPS Ι which worsen with age. Angina type symptoms secondary to arteriosclerosis and ischaemia may occur in the child. They can present with valvular dysfunctions, hypertension, arteriosclerosis and ischaemia, hypertrophy of cardiac chambers, congestive heart failure, sudden cardiovascular collapse and death (3) . Obstructive airways diseases resulting in frequent respiratory tract infections and noisy breathing are commonly seen in patients with MPS Ι causing sleep apnea, cor pulmonale and severe respiratory compromise. Deafness is reported in some cases of MPS Ι which has combined neurosensory and conductive origin. Hurler Schei disease is characterized by severe somatic disease without neurological deterioration (7) . Currrently there are two definitive treatments for MPS Ι(7). Stem cell transplantation is the standard treatment for patients with severe MPS Ι (Hurler disease). The second currently available therapy, enzyme infusion therapy with laronidase (human recombinant α L-iduronidase) is effective for attenuated MPS I (Hurler Scheie and Scheie disease) as the enzyme cannot penetrate the CNS but successfully addresses the hepatoslenomegaly, cardiac and respiratory disease. In the present instance where definitive treatment cannot be done, monitoring of patients with MPS I (Hurler Schei type) must include regular assessments, supportive care and treatment of a variety of systemic complications which is being done for this child. It has been recommended to undergo cardiac evaluation every 1 or 2 years after an initial diagnosis (11) . With the advent of hematopoietic stem cell transplantation and, more recently, enzyme replacement therapy, there exists a need for early diagnosis, better disease recognition and management (12). Early detection of the disease and appropriate management through a multidisciplinary approach is recommended to improve the quality of life.

CONCLUSION
The rarity of such a case of Hurler-Scheie syndrome has lured us to report it. Although most patients cannot afford definitive treatment, but early diagnosis, appropriate treatment and monitoring of the systemic complications will positively increase the life expectancy of these patients.

References:

1. Kliegman M. Robert, Muenzer L. Joseph. Mucopolysaccharidoses. In: Behrman ER, Kleigman MR, Jenson B Hal, eds. Nelson Textbook of Pediatrics.17 th ed. WB Saunders,2003:483-486.

2. Gabrielli O, Clarke AL, Bruni S, Coppa VG. Enzyme Replacement Therapy in a 5 month old boy with Attenuated Presymptomatic MPS I: 5-Year Follow-up. Pediatrics. 2010; 125(1): 183-187.

3. Bittar T, Washington III RE. Mucopolysaccharidoses [updated Aug 10, 2010]. Availablefrom: http://emedicine.medscape.com/article/12586 78- overview.

4. Kabnick ME, Adler L, Berner PT, Estrin HE, Serchuk L, Alexander LL. Diagnosis of Hurlers syndrome with Chest Roentgenogram. J Natl Med Assoc.1984; 76(5):515-18.

5. Varley Harold. Non Protein Nitrogen. In: Practical Clinical Biochemistry. 4 th ed.CBS Publishers and Distributers Pvt. Ltd. 2005: 224-225.

6. Banikazemi M. Mucopolysaccharidoses Type I. Emedicine pediatrics: Genetics and Metabolic diseases [updated on 2009 Apr 14].Available from http://emedicine.medscape.com/article/15993 74.

7. Hopkin JR, Grabowski AG. Lysosomal Storage Diseases. In: Fauci AS, Braunwald E, Kasper DL et al eds. Harrison’s Principles of Internal Medicine.17 th ed. Mc Graw Hill, 2008: 2456.

8. Neufeld EF, Muenzer J. The Mucopolysaccharidoses.In: Scriver C, Beaudet A, Sly W, et al, eds. The Metabolic and Molecular Bases of Inherited Disease.New York NY: Mc Graw Hill, 2001: 3421-52.

9. White K. Klane. Orthopaedic aspects of mucopolysaccharidoses. Rheumatology, 2011; 50: v26-v33.

10. Summers G.C, Ashworth L.J, Ocular manifestations as key features for diagnosing mucopolysaccharidoses.Rheumatology.2011; 50: v34-v40.

11. Tatapudi R, Gunashekhar M, Raju SP.Mucopolysaccharidoses type I Hurler Scheie syndrome: A rare case report.Contemp clin Dent. 2011;2(1):66-68.

12. Muenzer J, Wraith JE, Clarke LA. The International Consensus Panel on the management and treatment of Mucopolysaccharidoses.Pediatrics.2009; 123:19-29.

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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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