International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 4(7), April, 2012

Pages: 141-148

Date of Publication: 18-Apr-2012


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INTENSIVE CARE UNIT: A BREEDING GROUND FOR ANTIBIOTIC RESISTANT BACTERIA

Author: Silpi Basak, Monali N. Rajurkar, Ruchita O. Attal, Sanjay Kumar Mallick

Category: Healthcare

Abstract:Objective: The present study was undertaken to detect the prevalence of multiple antibiotic resistant
bacteria isolated from ICU patients and to study their antibiotic susceptibility profile. Method: The
organisms were isolated from different clinical specimens and antibiotic susceptibility tests were done as
per Clinical Laboratory Standard Institute (CLSI) guideline. The different tests for detection of
Methicillin Resistant Staohylococcus aureus (MRSA) and Gram negative bacilli producing Extended
spectrum beta-lactamases(ESBL), AmpC \?-lactamases and Metallobetalactamases(MBL) were performed
by standard methods. Results: A total number of 240 bacterial strains were studied. Out of which
105(43.8 %) were Gram positive isolates and 135(56.2%) were Gram negative isolates. 57(54.3%) MRSA
strains were isolated. Amongst Gram negative isolates 29(21.5%) strains were only ESBL; 13(9.6%) only
AmpC \?-lactamase, 18(13.3%) both ESBL and AmpC \?-lactamase and 21(15.6%) were MBL producers.
19 MBL producing strains were resistant to all antibiotics studied as per CLSI guideline. Conclusion:
Accurate detection of multidrug resistant bacteria by any Clinical Microbiology Laboratory should be
done for prompt and effective antimicrobial therapy to ICU patients and successful management of
infections.

Keywords: MRSA, Multidrug resistant organisms.

Full Text:

INTRODUCTION Intensive care units (ICUs) are unique patient care areas where severely ill patients are housed together in an environment of multiple invasive devices, drug resistant micro-organisms and few trained health care workers, especially in developing countries. Though ICU represents only 5% of the hospital beds, 25% of Hospital acquired infections occur in ICUs1 . In ICU patients the mortality ranges from 11% for surgical site infections (SSIs) to 20% for bloodstream infections (BSIs)2 . Though Carbapenems, Vancomycin and Linezolid are reserved antibiotics and are used as a last resort for treating severe infections with multiple drug resistant bacteria but bacteria have developed resistance to these drugs also. The ICUs are breeding ground of several drug resistant micro-organisms e.g. Methicillin Resistant Staphylococcus aureus (MRSA), newer B-lactamases i.e. Extended Spectrum BetaLactamases(ESBL), AmpC β-lactamase and Metallobetalactamases(MBL) producing Gram negative bacilli, Vancomycin resistant Enterococci (VRE), Vancomycin resistant Staphylococcus aureus (VRSA) and Vancomycin intermediate sensitive Staphylococcus aureus (VISA) etc. ICUs usually have a higher prevalence of infection with Multidrug Resistant Organisms (MDRO) than do non-ICU settings. MDROs are defined as micro-organisms predominantly bacteria, that are resistant to one or more classes of antimicrobial agents. The key to success in controlling infections in ICU patients are prompt and accurate detection of these microorganisms.3 Hence, the present study was undertaken to detect the prevalence of multiple antibiotic resistant bacteria isolated from ICU patients and to study their antibiotic susceptibility profile. In this study simple phenotypic methods for detection of MRSA and newer β-lactamases were used, which can be routinely and easily carried out in any Clinical Microbiology Laboratory. MATERIAL AND METHODS A total number of 240 bacterial strains isolated from clinical samples of ICU patients were studied from January 2008 to January 2011 and were identified by conventional methods4 . The clinical samples collected were blood, endotracheal tube aspirate, pus and wound swab, urine, urinary catheter tip, body fluids etc. Antibiotic sensitivity testing was done by using Kirby Bauer disk diffusion method according to Clinical Laboratory Standard Institute (CLSI) guidelines5 . All antibiotic disks and culture media used were procured from HiMedia Pvt Ltd.(India). Staphylococcus aureus strains were tested for Methicillin resistance by using Cefoxitin (30 µg) disc as per CLSI guidelines5 . Inducible Clindamycin resistance was detected by D-Zone test as per NCCLS guideline 20046 . To detect VRE, VRSA and VISA, Vancomycin disk were put and for confirmation Vancomycin E test strip (AB biomeriux) was used4 . In 135 Gram negative bacterial isolates antibiotic susceptibility test was done with Ceftazidime, Cefotaxime, Cefoxitin, Cotrimoxazole, Aztreonam, Ciprofloxacin, Amikacin and Imipenem as per CLSI guideline5 . In Gram negative bacterial isolates, for detection of ESBL producing strains combined disk method using Ceftazidime (CA 30 μg) and Ceftazidime-Clavulanic acid (CAC 30/10 μg) disk for Enterobacteriaceae as per CLSI guideline and for Pseudomonas aeruginosa combined disc using Piperacillin (Pc 100μg) and Piperacillin-Tazobactum (PIT 100/10μg) was used. Confirmation of ESBL production was determined by ESBL E-test strip (AB Biomeriux)4 . ? ESBL DETECTION For ESBL detection, Combined disk method and ESBL E-test were used. Combined disk method Broth cultures of test strains adjusted to McFarland 0.5 standard and inoculated on Mueller Hinton(MH) agar plates. Ceftazidime (CAZ) 30 µg and Ceftazidime plus Clavulanate (CAC) 30µg plus 10µg were used. After overnight incubation at 370C increase in zone diameter of ≥5mm with CAC disk as compared to CAZ disk alone was considered positive for ESBL detection. ESBL E-test4 Lawn culture of test strain was done on a MH agar plate and ESBL E-test strip was placed. After overnight incubation at 370C, MIC ratio of ceftazidime/Ceftazidime Clavulanic acid (TZ/TZL) ≥ 8 or deformation of ellipse or phantom zone present was considered positive for ESBL production. DETECTION OF AmpC β- LACTAMASE For detection of AmpC β-lactamase producing stains substrate inducer combination of Imepenem(10 μg) / Ceftazidime(30 μg) disks and for confirmation disk potentiation test using 3 aminophenyl boronic acid (100 μg/ml) was used7 . Confirmatory test : Disk potentiation test Two ceftazidime(30µg) disks with centre to centre distance of 30mm were placed on lawn cultured MH plate. 3-aminophenylboronic acid (APB) was dissolved in DMSO at a concentration of 100mg/ml. 10µl of this APB solution was added to one of the ceftazidime disk. After overnight incubation at 370C, an increase in zone size of ≥5mm around the Ceftazidime - APB disc compared to ceftazidime only disk was recorded as a positive result. ? DETECTION OF METALLOBETALACTAMASES (MBL) All Imipenem resistant strains were tested for MBL production by disk potentiation (DP) test using Imipenem and Imipenem-EDTA disk and were confirmed by MBL E test strip (AB biomeriux)8,9 . Disk Potentiation Test (DP): The IMP-EDTA combined disk test was performed for detection of metallobetalactamases. Test strains (turbidity adjusted to 0.5 McFarland standard ) were inoculated on to MH agar plate. Two imipenem disk (10 µg) were placed on the plate wide apart and 10 μl of 50mM zinc sulphate solution was added to each of the imipenem disks. Then 10µl of 0.5M EDTA solution was added to one of the disk and the plates were incubated at 350 C for 16-18 hrs.If the increase in inhibition zone with the Imipenem and EDTA disk was ≥7 mm than the imipenem disk alone, it was considered as MBL positive. MBL E-Test : Confirmatory test: The MBL E-test was done and interpreted using test strains and Quality control strains according to manufacturer‘s instructions. Overnight broth culture of test strain (turbidity adjusted to 0.5 McFarland standard) was used to inoculate MH agar plate. The MBL E-test strip was put on that inoculated MH plate with a sterile forceps and plates were incubated at 370C for 18-20 hrs. After incubation, MIC ratio of Imipenem /Imipenem-EDTA (IP/IPI) of ≥8 or deformations of ellipse or phantom zone indicate MBL production. The Candida albicans strains were detected by growth on Sabouraud‘s Dextrose agar (SDA), Gram‘s staining, germ tube formation, chlamydospore formation, growth on CROME agar and Hi-Candida identification kit. The antifungal drug sensitivity test with Fluconazole and Voriconzole for Candida albicans was done as per CLSI guideline10 . The control strains used in this study were Staphylococcus aureus ATCC 25923, Enterococcus faecalis ATCC 29212, Escherichia coli ATCC 25922, Klebsiella pneumoniae ATCC 700603, Pseudomonas aeruginosa ATCC 27853 and Candida albicans ATCC 90028. RESULTS Out of 240 bacterial stains isolated from ICU patients, 105 (43.8%) were Gram positive cocci and 135 were Gram negative bacilli. From 2 ICU patients Candida albicans was isolated. Maximum number of bacterial strains isolated were from Neonatal ICU (NICU) 123(51.3%), followed by Medicine ICU (MICU) 58(24.2%), Paediatrics ICU (PICU) 32(13.3%) and Operation theater ICU (OT ICU) 27(11.3%). The prevalence of MRSA, ESBL, AmpC, both ESBL and AmpC and MBL producing strains from different ICUs is shown in Figure 1. Amongst 96 Staphylococcus aureus strains isolated, 57 (59.4%) were MRSA and most of the MRSA strains 44(77.2%) were isolated from blood. All (100%) MRSA strains were resistant to Penicillin and sensitive to Vancomycin and Linezolid. 20(35.1%) MRSA strains were resistant to 08 antibiotics commonly used for treating Staphylococcal infections as per CLSI guideline5 . Amongst 57 MRSA isolates, resistance to Ciprofloxacin, Erythromycin, Clindamycin and Pristinamycin was found to be 51(89.5%), 46(80.7%), 26(45.6%) and 39(68.4%) respectively. 11(19.3%) and 14(24.6%) MRSA strains were even resistant to rifampicin and mupirocin respectively. 19(33.3%) MRSA strains belonged to iMLSB phenotype i.e. inducible Clindamycin resistant. Out of 5 Coagulase negative Staphylococci isolated 2 (40%) were Methicillin resistant but 4 Enterococcus faecalis strains isolated were Vancomycin sensitive. Amongst 135 Gram negative bacterial isolates 57(42.2%) were Pseudomonas aeruginosa, 30(22.2%) were E.coli, 43(31.9%) were Klebsiella pneumoniae and rest 5(3.7%) include others i.e. Proteus vulgaris(2), Citrobacter freundii(1), Acinetobacter baumanii(2). 29(21.5%) were only ESBL producers 13(9.6%) were only AmpC β-lactamase producers, 18(13.3%) were both ESBL and AmpC producers and 21(15.6%) strains were MBL producers. 19(90.5% ) MBL producing strains were resistant to all 08 antibiotics used as per CLSI guideline5 and 2 were only sensitive to Amikacin. Confirmation of MBL production by E-test is shown in Figure 2. Out of 21 MBL producing strains 12(57.1%) strains were Pseudomonas aeruginosa. Maximum 7(53.8%) strains producing AmpC β-lactamases were Klebsiella pneumoniae and 11(37.9%) ESBL producing strains were E.coli. All (100%) MBL producing strains were sensitive to Polymyxin B. Amongst 18 strains producing both ESBL and AmpC β-lactamase, 7(38.9%) were resistant to all 8 antibiotics used as per CLSI gudeline5 , but were sensitive to Imipenem and Amikacin. None of the MBL producers also produced ESBL or AmpC β- lactamase. 143 (59.6%) bacterial strains were isolated from blood samples, followed by 27(11.3%) from endotracheal tube aspirate. In 2 cases, Candida albicans was isolated from blood and from urine respectively. Candida albicans was isolated on two repeat culture from the same sample. The two Candida albicans strains were sensitive to fluconazole and Voriconazole10 . DISCUSSION According to World Health Organization(WHO) guidelines, 2002 more than 1.4 million people at any time suffer from Health care associated infections (HAI)11. The highest rates of HAIs occur in ICUs, and the crude mortality rates of HAI in the ICUs of the developed countries range from 12 to 80%12. Though no nationwide surveillance data are available, Rosenthal et al in 2006 had reported that the rates of HAI in ICUs range from 12.3% in few ICUs in India to 88.9% in a Turkish ICU13. The ICUs are the highest consumers of antimicrobials in any Health care set up. Moreover, ICUs have an unusually high rate of antimicrobial resistance14 . Antibiotic resistance in ICU acquired infections is responsible for increase in mortality, morbidity and prolonged hospital and ICU stay15 . Ventillator-associated pneumonia (VAP), Cather-associated urinary tract infection(CAUTI), Catheter-related bloodstream infections(CRBSIs), Surgical site infections(SSI), Clostridium difficile-associated diarrhoea(CDAD), Paranasal sinusitis especially maxillary sinusitis are common infections occurring in ICUs. In the present study, out of 23 bacterial strains isolated from urine, 13(56.5%) were isolated from CA-UTI. To consider CA-UTI, no minimum time period for which the catheter is to be in place is required16 . CA-UTI account for 30-40% of health care associated infections17. Richards et al had reported that 95% of UTI cases in hospitals are catheter associated18 .

Our hospital is a tertiary care hospital, which is situated in a rural set-up and patients from surrounding villages of Vidarbha and the adjoining states come to our hospital for treatment. Lack of awareness, indiscriminate use of antibiotics before attending the hospital, might be the contributory factors for high prevalence of MRSA and Gram negative bacilli with production of newer β-lactamases i.e. ESBL, Amp C and MBL production, leading to multiple drug resistant organisms. Infection in the ICU patients can be successfully managed by prompt institution of effective antimicrobial therapy. But in an era of multidrug resistance, selecting the appropriate antibiotic is a significant challenge. Thus, every health care set up with ICU facility must have Clinical Microbiology Laboratory where different organisms isolated can be studied for antimicrobial resistance mechanisms and prompt communication of urgent Microbiology reports, help to modify the antimicrobial prescribing guidelines. ?Bundled approach or interventions‘ comprise of ?small straightforward set of best practices‘ which should primarily aim at the prevention of cross transmission and control or elimination of reservoirs or sources of infection should be followed. These ?Bundled approach when followed collectively can significantly reduce infection rates and improve patient‘s outcome in ICU19. Standard precautions, contact precautions, antimicrobial stewardship programmes etc., SMART i.e. (Specific, Measurable, Achievable, Relevant and Time bound) objectives and educating the health care workers, especially the nursing staffs are need of the hour19. Proper hand hygiene between every patient contact itself reduces the infection rate. Hence to conclude, detection of multidrug resistant bacteria by simple phenotypic methods should be done by any Clinical Microbiology Laboratory for effective antimicrobial therapy to ICU patients. Active efforts should be taken by all health care personnel to prevent antibiotic resistance as WHO has already mentioned ?‘No action today, No cure tommorow‘‘. ACKNOWLEDGEMENTS The authors highly acknowledge Datta Meghe Institute of Medical Sciences (MS), India for funding this project.Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where literature of this article has been reviewed and discussed.

References:

1. Eggimann, P. and D.Pittet. Infection control in the ICU. Chest. 2001;120:2059-93. 2. Klevens, R.M. , Edwards J.R. , Richards Jr. C.L. et al. Estimating health care-associated infections and deaths in U.S. hospitals, Public Health Rep. 2007;120:160-6. 3. Siegel J.D., E. Rhinehart, M. Jackson and L. Chiarello. Management of Multidrug Resistant Organisms in Health care settings. The Health care Infection control Practices Advisory Committee.CDC, Department of Health and Human Services, USA. 2006;1-73. 4. Washington C.W. Jr., Stephen D.A., William M.J., Elmer W.K., Gary W.P., Pant C.S., Gait L.W. Koneman‘s color Atlas and Textbook of Diagnostic Microbiology. 6th ed. Lippincott Williams and Williams USA. 2006. 5. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial disk diffusion tests; Approved standards. 9th ed. CLSI Document M2- M9.Wayne PA: Clinical and Laboratory Standards Institute. 2006. 6. National Committee for Clinical Laboratory Standards. Performance standards for 146 International Journal of Current Research and Review www.ijcrr.com Vol. 04 issue 07 April 2012 antimicrobial susceptibility testing; 14th Informational supplement. M100-54. Wayne PA : NCCLS. 2004. 7. Yagi T., J. Wachino, H. Kurokanz and S.Suzuki et al. Practical methods using boronic acid compounds for identification of class C B-lactamase producing Klebsiella pneumoniae and Escherichia coli. J. of Clin Microbiol. 2005;43(6):2551-8. 8. Attal, R.O., S. Basak, and S.K. Mallick. Metallobetalactamase producing Pseuodomonas aeruginosa: An emerging threat to clinicians. Journal of Clinical and Diagnostic Research. 2010;4:2691-6. 9. Walsh, T.R., A. Bolmstrom, A. Quarmstorm and A.Gals . Evaluation of a new E test for detecting metallobetalactamases in clinical testing J. Clin. Microbiol. 2002;40:2755-9. 10. Clinical and Laboratory Standards Institute (CLSI). Antifungal disk diffusion susceptibility testing of yeasts ; Approved guideline M-44 A, CLSI, USA. 2006. 11. WHO: Guidelines on Prevention and Control of Hospital Associated Infections. World Health Organisation. South East Asian Region. Geneva: WHO. 2002. 12. Vincent, J. L. Nosocomial infections in adult intensive care units. Lancet. 2003;361:2068-77. 13. Rosenthal, V.D., D.G. Maki and R. Saloman et al. Device associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann. Intern. Med. 2006;145:582-91. 14. Kollef M.H. Time to get serious about antimicrobial susceptibility testing; 14th Informational supplement. M100-54. Wayne PA : NCCLS. 2004. 7. Yagi T., J. Wachino, H. Kurokanz and S.Suzuki et al. Practical methods using boronic acid compounds for identification of class C B-lactamase producing Klebsiella pneumoniae and Escherichia coli. J. of Clin Microbiol. 2005;43(6):2551-8. 8. Attal, R.O., S. Basak, and S.K. Mallick. Metallobetalactamase producing Pseuodomonas aeruginosa: An emerging threat to clinicians. Journal of Clinical and Diagnostic Research. 2010;4:2691-6. 9. Walsh, T.R., A. Bolmstrom, A. Quarmstorm and A.Gals . Evaluation of a new E test for detecting metallobetalactamases in clinical testing J. Clin. Microbiol. 2002;40:2755-9. 10. Clinical and Laboratory Standards Institute (CLSI). Antifungal disk diffusion susceptibility testing of yeasts ; Approved guideline M-44 A, CLSI, USA. 2006. 11. WHO: Guidelines on Prevention and Control of Hospital Associated Infections. World Health Organisation. South East Asian Region. Geneva: WHO. 2002. 12. Vincent, J. L. Nosocomial infections in adult intensive care units. Lancet. 2003;361:2068-77. 13. Rosenthal, V.D., D.G. Maki and R. Saloman et al. Device associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann. Intern. Med. 2006;145:582-91. 14. Kollef M.H. Time to get serious about infection prevention in the ICU. Chest. 2006;130:1293-6. 15. Kollef M.H. and V.J. Fraser. Antibiotic resistance in the intensive care unit. Ann. Intern. Med. 2001;134:298-314. 16. Gould, C V, Umscheid C.A. and Agarwal R.K. et al.HI.AAC/CDC Guideline for Prevention of Catheter Associated Urinary Tract Infection.HICPAC,2009. Available at: http://www.cdc.gov.nhsn/pdfs/pscManual/tp sc CAUTIcurrent.pdf.(Online) 17. Johnson J R, M.A.Kuskowski and T.J.Wilt. Systematic review: Antimicrobial urinary catheters to prevent catheter-associated urinary tract infection in hospitalized patients. Ann Intren Med. 2006;144:116-26. 18. Richards M., J. Edwards, D. Culver and R. Gaynes. Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit. Care. Med. 1999;27:887-92. 19. Lachman P. and S. Yuen. Using care bundles to prevent infection in neonatal and pediatric ICUs. Curr. Opin. Infect. Dis. 2009;22(3):224-8.

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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.

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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.

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


Best Article Award

A study by Dorothy Ebere Adimora et al. entitled \"Remediation for Effects of Domestic Violence on Psychological well-being, Depression and Suicide among Women During COVID-19 Pandemic: A Cross-cultural Study of Nigeria and Spain\" is awarded Best Article of Vol 14 issue 23
A study by Muhas C. et al. entitled \"Study on Knowledge & Awareness About Pharmacovigilance Among Pharmacists in South India\" is awarded Best article for Vol 14 issue 22
A study by Saurabh Suvidha entitled \"A Case of Mucoid Degeneration of Uterine Fibroid with Hydrosalphinx and Ovarian Cyst\" is awarded Best article of Vol 14 issue 21
A study by Alice Alice entitled \"Strengthening of Human Milk Banking across South Asian Countries: A Next Step Forward\" is awarded Best article of Vol 14 issue 20
A study by Sathyanarayanan AR et al. entitled \"The on-task Attention of Individuals with Autism Spectrum Disorder-An Eye Tracker Study Using Auticare\" is awarded Best article of Vol 14 issue 19
A study by Gupta P. et al. entitled \"A Short Review on \"A Novel Approach in Fast Dissolving Film & their Evaluation Studies\" is awarded Best Article of Vol 14 issue 18.
A study by Shafaque M. et al. entitled \"A Case-Control Study Performed in Karachi on Inflammatory Markers by Ciprofloxacin and CoAmoxicillin in Patients with Chronic Suppurative Otitis Media\" is awarded Best Article of Vol 14 issue 17
A study by Ali Nawaz et al. entitled \"A Comparative Study of Tubeless versus Standard Percutaneous Nephrolithotomy (PCNL) \? A Randomized Controlled Study\" is awarded Best Article for Vol 14 issue 16.
A study by Singh R. et al. entitled \"A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)\" is awarded Best Article for Vol 14 issue 15
A Study by Humaira Tahir et al. entitled "Comparison of First Analgesic Demand after Major Surgeries of Obstetrics and Gynecology between Pre-Emptive Versus Intra-Operative Groups by Using Intravenous Paracetamol: A Cross-Sectional Study" is awarded Best Article for Vol 14 issue 14
A Study by Monica K. entitled "Risk Predictors for Lymphoma Development in Sjogren Syndrome - A Systematic Review" is awarded Best Article for Vol 14 issue 13
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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
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A Study by Zahoor Illahi Soomro et al. entitled "Functional Outcomes of Fracture Distal Radius after Fixation with Two Different Plates: A Retrospective Comparative Study" is awarded Best Article for Vol 14 issue 05
A Study by Ajai KG & Athira KN entitled "Patients’ Gratification Towards Service Delivery Among Government Hospitals with Particular Orientation Towards Primary Health Centres" is awarded Best Article for Vol 14 issue 04
A Study by Mbungu Mulaila AP et al. entitled "Ovarian Pregnancy in Kindu City, D.R. Congo - A Case Report" is awarded Best Article for Vol 14 issue 03
A Study by Maryam MJ et al. entitled "Evaluation Serum Chemerin and Visfatin Levels with Rheumatoid Arthritis: Possible Diagnostic Biomarkers" is awarded Best Article for Vol 14 issue 02
A Study by Shanthan KR et al. entitled "Comparison of Ultrasound Guided Versus Nerve Stimulator Guided Technique of Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries" is awarded Best Article for Vol 14 issue 01
A Study by Amol Sanap et al. entitled "The Outcome of Coxofemoral Bypass Using Cemented Bipolar Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fracture of Femur in a Rural Setup" is awarded Best Article Award of Vol 13 issue 24
A Study by Manoj KP et al. entitled "A Randomized Comparative Clinical Trial to Know the Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block Against Multimodal Analgesia for Postoperative Analgesia Following Caesarean Section" is awarded Best Article Award of Vol 13 issue 23
A Study by Karimova II et al. entitled "Changes in the Activity of Intestinal Carbohydrases in Alloxan-Induced Diabetic Rats and Their Correction with Prenalon" is awarded Best Article of Vol 13 issue 22
A Study by Ashish B Roge et al. entitled "Development, Validation of RP-HPLC Method and GC MS Analysis of Desloratadine HCL and It’s Degradation Products" is awarded Best Article of Vol 13 issue 21
A Study by Isha Gaurav et al. entitled "Association of ABO Blood Group with Oral Cancer and Precancer – A Case-control Study" is awarded Best Article for Vol 13 issue 20
A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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