International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 4(17), September, 2012

Pages: 52-58

Date of Publication: 14-Sep-2012


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PSYCHOLOGICAL STRESS AND ORAL DISEASES - A LINK ?

Author: Little Mahendra, Ravi David Austin, Jaideep Mahendra, S.Senthil Kumar

Category: Healthcare

Full Text:

INTRODUCTION
Epidemiologic studies and clinical observations suggest that negative life events and psychological factors may contribute to an increased susceptibility to periodontal disease. Stress a term continually being redefined in the scientific study of disease and illness, is nevertheless a confirmed and important factor in the etiology and maintenance of many inflammatory diseases, including periodontal disease. stress is an attempt to understand how the body regulates itself to maintain smooth, adaptive and homeostatic functioning when confronted with disruptive endogenous or exogenous forces. Hippocrates thought of health as a harmonious balance of the elements comprising the quality of life while disease represented disruption or disharmony among those elements. In the seventeenth century, Sydenharm suggested that pathological states represented diseases of adaptation failure of the adaptive processes to restore wellbeing. Cannon elaborated how fight or flight mechanisms represented adaptive efforts by the body to reestablish homeostasis, a term he introduced to describe a dynamic internal physiological equilibrium which the body sought to maintain along both physical and emotional dimensions. Hans Selye, the father of stress theory, describes stress as, “Everybody knows what it is, no one knows what it is. It is the nonspecific response of the body to any demand put upon it and stress is the spice of life” (1). While Stress is defined as a state induced by a stimulus that manifests itself by virtue of one?s cognitive interpretation (2), the stimulus itself is considered a stressor. Accordingly, a stressor is any stimulus that evokes stress, whereas stress reactions are the observable consequences of the stressors. Several studies have demonstrated the relationship between psychological stress and diseases, from common cold (3) to cardiovascular disorders (4); from asthma (5) to rheumatoid arthritis (6). Periodontal disease being multifactoral with a complex interaction between bacterial infection and host responses, there is a reasonable amount of research indicating the association between periodontitis with psychosocial stress, distress, and depression (7, 8). When demands imposed by events exceed a person?s ability to cope, a psychological stress response composed of negative cognitive and emotional state is elicited (9). Substantial literature both in humans and animals support association between psychological stress and suppression of immune responses (10). While stress can directly influence immune function through the activation of neuro-endocrinal pathways that lead to release of hormones and neurotransmitters, such as cortisol and catecholamines (11); it can also alter immune responses through the adoption of coping behaviors, such as smoking or drinking alcohol, which are known to compromise immunity (12).

Pathways between Stress and the Immune System:
How can stress affect the immune response? In 1936, Hans Selye defined stress physiologically as the state in which the sympatho-adreno-medullary system and the limbic-hypothalamic-pituitary-adrenal axis (HPA) are co-activated (13). A bidirectional communication pathway exits between the CNS and the immune system that modulates both the cellular and humoral immunity (14). First, stress induces the sympathetic fibers which descend from the brain into both primary (bone marrow and thymus) and secondary (spleen and lymph nodes) lymphoid tissues (15) to release a wide variety of substances that influence immune responses by binding to receptors on white blood cells (14, 15). Though all lymphocytes have adrenergic receptors, differential density and sensitivity of adrenergic receptors on lymphocytes may affect responsiveness to stress among cell subsets. For example, natural killer cells have both high-density and high affinity β2-adrenergic receptors, B cells have high density but lower affinity, and T cells have the lowest density (16, 17).Second, the stress activates the hypothalamic–pituitary–adrenal axis, the sympathetic–adrenal–medullary axis or locus coeruleus-norepinephrine system, to induce secretion of adrenal hormones epinephrine, norepinephrine, and cortisol (13, 15); and also the pituitary hormones prolactin and growth hormone; and the brain peptides melatonin, β-endorphin, and enkephalin. These substances bind to specific receptors on white blood cells and have diverse regulatory effects on their distribution and function (18).Communication between the neuroendocrine (hypothalamic-pituitary-adrenal) and immune inflammatory systems functions as a feedback loop that regulates the immune components of the inflammatory response. For example, a negative feed back loop functions such that activation of the immune system, associated with increases in levels of circulating cytokines (e.g. interleukin-1 and interleukin-6), increases activity in the corticotrophin releasing hormone/hypothalamic-pituitary-adrenal system yielding increased levels of circulating adrenocorticotropic hormone and cortisol – major modulators of the stress system (19).

Connection between Stress and Periodontitis:
Stress can be viewed as a process with both psychological and physiological components. Pollman and Dietrich (1979), Moulton et al (1952) pointed out that stress may affect periodontium directly or indirectly (7). While the psychosocial stressors initiate cascade of events through the hypothalamic-pituitary-adrenal axis, the autonomic nervous system and the central nervous system, it enhances the likelihood of infection and specifically, periodontal disease (8, 20).While cortisol has been called the hormone of stress, serum cortisol level increases during challenging or unpleasant situation (21, 22). Cortisol being an immunosuppressant influences not only the inflammatory cells, chemotaxis etc., but also the pro-inflammatory cytokines like interleukin-6 (IL-6), interleukin-1 receptor antagonist (IL-1ra) (23, 24, 25). It is always being studied that stress causes activation of neuro-endocrinal pathways with release of cortisol, which in turn suppresses the immunity. And in such an environment the progression of periodontal infection by the pathogen is unhampered (7). Though this relation gives a link between stress and periodontal disease, this holds good for other inflammatory diseases as well. Though the periodontitis is initiated by the pathogens, the mediators of connective tissue breakdown are produced by hostderived enzymes called Matrix metalloproteinases (MMPs) (26). They are zinc and calcium dependent proteolytic enzymes responsible for remodeling and degradation of extracellular matrix (27). The homeostasis of extracellular matrices depends on the release of MMPs from cells such as fibroblasts and macrophages, and the presence of tissue inhibitors of matrix metalloproteinases (TIMPs), which are distributed widely in tissues and fluids (28). While the MMP gene family encodes nine or more metal-dependent endopeptidases, eight human MMPs have been cloned and sequenced, of which MMP-1 cleaves fibrillar collagen types I, II, and III (27) that constitute the gingival and periodontal connective tissue. While MMP-1 is implicated to play an important role in the initiation of collagen degradation in periodontal disease, MMP-8 is thought to play an important role in periodontal tissue destruction (29). Very few in-vitro studies, using exogenous steroids, have shown the effects of corticosteroids on the expression of MMPs and TIMPs in fibroblasts (30, 31). A study by Cury PR et al. (31) showed that hydrocortisone produced a dose-dependent regulation of MMP and TIMP expression, by significantly up-regulating mRNA expression of MMP-1, -2, -7, and -11 and TIMP-1 in human gingival fibroblasts. When Pubmed was searched for studies where endogenous cortisol, due to stress, induced expression of MMPs and TIMPs in fibroblasts, none were found.

Significant Reviews:
Several studies have demonstrated a relationship between psychological stress and inflammatory diseases such as rheumatoid arthritis, osteoarthritis etc., (20, 32, 33) and periodontitis (7, 8).Gerard J. Linden et al. (34) examined the association between occupational stress and the progression of periodontitis in employed adults and suggested that occupational stress may have a relationship to the progression of periodontitis. Torbjørn Breivik et al. (35) reviewed studies to find effects of emotional stress on immunity, gingivitis and periodontitis, and noted that emotional stressors and the nervous and neuroendocrine responses to psychological stressors may modulate the immune response to bacteria, and thus expected stress to influence the progression and course of gingivitis and periodontitis.In a case-control study, Moss et al. (36) explored the association between social factors and adult periodontitis by comparing selfreported information for daily strains and symptoms of depression. They found that an elevated Depression score may be a marker for social isolation, which could play a role in immune function during periods of social strain. Croucher R et al. (37) also in a casecontrol study investigated the role of lifeevents in periodontitis. The results showed that periodontitis was associated with the negative impact of life-events, the number of negative life-events, high levels of dental plaque, tobacco smoking and unemployment. Genco RJ, Ho AW, Jeffrey Kopman et al. (38), Genco RJ, Ho AW, Grossi SG et al. (8) evaluated the association of stress, distress, and coping behaviors with periodontal disease. They found that subjects with financial strain and inadequate coping had greater attachment and alveolar bone loss, in contrast to subjects with financial strain and good coping. Salivary cortisol levels were higher in a test group exhibiting severe periodontitis, as compared to a control group consisting of those with little or no periodontal disease. Renate Deinzer et al. (39, 40) analyzed the effects of academic stress on periodontal health of medical students and found that psychological stress was a significant risk factor for periodontal inflammation. Elter et al. (41) found that clinical depression may have a negative effect on periodontal treatment outcome in health maintenance organization (HMO) patients. Study by Hugoson A, Ljungquist B, Breivik T (42) revealed that, in addition to increased age, oral hygiene status, and smoking, the negative life events like, loss of a spouse (being a widow or widower) and the personality trait of exercising extreme external control were also associated with severe periodontal disease. Aleksejuniené t al. (43) tested the hypothesis that psychosocial stress and lifestyle are related to periodontal status. Although the pathway between psychosocial stress and remaining periodontal support was not empirically supported, the researchers concluded that there was reason to believe that such link was likely. Wimmer G et al. (44) examined the influence of different coping behaviors on a non-surgical periodontal therapy and on the course of periodontal disease. They found patients with a defensive coping style had statistically significant poorer attachment values (P= 0.000) after 2 years compared to patients with other coping behaviors. The number of sites with severe advanced CAL (>5mm) was significantly correlated with a suppressive coping style (P=0.0001).Alexander Saletu et al. (45) investigated the relationship between periodontitis and psychopathology utilizing psychometry, both observer-rating scales and self-rating scales. Partial correlation analyses between psychometric measures and dental variables revealed positive correlations of periodontal disease severity/CAL with the depression/anxiety, subjective well-being and complaints scores, and a negative correlation with quality of life. R. Akhter et al. (46) designed a study to identify possible relationship between stress and periodontal disease in residents of a rural Japan and found subjects who felt job stress and those who felt stress due to self health were more prone to have periodontal disease than were those who never or only rarely felt such stress. Vettore et al. (47) in a case-control study investigated the relationship of stress and anxiety with periodontal clinical characteristics. They found the frequency of moderate clinical attachment loss (4-6 mm) and moderate probing pocket depth (4-6 mm) significantly associated with higher trait anxiety scores, after adjusting for socioeconomic data and cigarette consumption. J.B. Hilgert, F.N. Hugo D.R. Bandeira and M.C. Bozzetti (48) evaluated the extent and severity of chronic periodontitis and its association with the levels of salivary cortisol and the scores obtained with a stress questionnaire in a population aged 50 years. They found that the cortisol levels were positively associated with the extent and severity of Periodontitis. Fernando N. Hugo, Juliana B. Hilgert et al (49) evaluated the effects of stress, depression, and cortisol levels in dental plaque accumulation and gingivitis in a population of individuals aged ≥50 years. They found that stress was a significant risk indicator of elevated levels of plaque and gingivitis, whereas cortisol was a risk indicator of plaque. Amy E Rosania (50) did a cross-sectional pilot study to explore the associations between psychological factors, markers of periodontal disease, psychoneuro-immunologic variables, and behavior. She found that stress, depression, and salivary cortisol correlated with measures of periodontal disease. In addition, oral care neglect during periods of stress and depression was associated with loss of attachment and missing teeth.

CONCLUSION
Stress can be a risk factor for periodontitis, on one hand in stress the person?s oral hygiene habits are altered causing accumulation of plaque and on the other it reduces the immunity of person through its endocrinal connections. Many studies have shown a positive relationship was observed between stress and periodontal disease, further representative research is needed to determine the impact of stress/psychological factors as risk factors for periodontal disease.

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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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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
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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
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A study by Gupta P. et al. entitled \"A Short Review on \"A Novel Approach in Fast Dissolving Film & their Evaluation Studies\" is awarded Best Article of Vol 14 issue 18.
A study by Shafaque M. et al. entitled \"A Case-Control Study Performed in Karachi on Inflammatory Markers by Ciprofloxacin and CoAmoxicillin in Patients with Chronic Suppurative Otitis Media\" is awarded Best Article of Vol 14 issue 17
A study by Ali Nawaz et al. entitled \"A Comparative Study of Tubeless versus Standard Percutaneous Nephrolithotomy (PCNL) \? A Randomized Controlled Study\" is awarded Best Article for Vol 14 issue 16.
A study by Singh R. et al. entitled \"A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)\" is awarded Best Article for Vol 14 issue 15
A Study by Humaira Tahir et al. entitled "Comparison of First Analgesic Demand after Major Surgeries of Obstetrics and Gynecology between Pre-Emptive Versus Intra-Operative Groups by Using Intravenous Paracetamol: A Cross-Sectional Study" is awarded Best Article for Vol 14 issue 14
A Study by Monica K. entitled "Risk Predictors for Lymphoma Development in Sjogren Syndrome - A Systematic Review" is awarded Best Article for Vol 14 issue 13
A Study by Mokhtar M Sh et al. entitled "Prevalence of Hospital Mortality of Critically Ill Elderly Patients" is awarded Best Article for Vol 14 issue 12
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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
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
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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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