International Journal of Current Research and Review
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IJCRR - Vol 10 Issue 10, May, 2018

Pages: 19-26

Date of Publication: 30-May-2018


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Demographic, Clinical and Etiological Profile of Young Dystonia Less Than Forty Years of Age \? A Hospital Based Study

Author: S. Bashir Ahmad, Bashir Z., Tak S., Goyal V., Behari M.

Category: Healthcare

Abstract:Objective: To study the demographic, clinical and etiological profile of dystonia in patients less than forty years of age.
Material and Methods: In this study two hundred and nineteen patients with different dystonia were included. Data on demographic profile, clinical and etiological profile was recorded and statistical analysis was done by using descriptive analysis (frequency distribution).
Results: Out of two hundred and nineteen patients, one hundred thirteen (51.7%) were < 26 years of age of onset and one hundred six (48.4%) had >26 years of age of onset with mean age of onset 22.3 years, one hundred seventy six were males and forty four females. Mean duration of illness was 4.4 years. Frequency of different dystonia was focal dystonia 57.72%, multifocal 1.36%, segmental 10%, generalized 29.09%, hemidystonia 3.63% and paroxysmal kinesigenic dystonia 2.72%. Among focal dystoniaWriter's cramp was most common (63%) followed by cervical dystonia (17.32%), and blepharospasm (7%). Among generalized dystonia Wilson's disease was most common etiological factor in 31.25% cases. Primary generalized dystonia was seen in 17.2% cases. MRI was abnormal in all eight cases of hemidystonia. SPECT brain was abnormal in 1 out of four cases of paroxysmal kinesigenic dystonia. DYT1 was positive in four out of eleven patients of primary generalized dystonia.
Conclusion: Present study showed that focal dystonia were more common even in younger age group with Writers cramp most common among all dystonia followed by cervical dystonia. In hemidystonia structural lesion should always be ruled out.

Keywords: Dystonia, Paroxysmal kinesigenic dystonia, Writer’s cramp

Full Text:

INTRODUCTION

          There have been only few studies on demographic, clinical and etiological profile of young dystonia in less than forty years of age group from India in English literature. Dystonia is defined as a syndrome of sustained muscle contraction, frequently causing twisting and repetitive movements or abnormal postures. It can be jerky, rhythmic or tremulous1.

          In 1911, Oppenheim introduced term dystonia and used two different names for this syndrome, dysbasialordotica progressive and dystonia muscularamdeformens1. Flater and Sterlig emphasized its organicity and likely to be hereditary2. Since dystonia can have so many etiologies, the true prevalence is unknown.

          Epidemiological survey of dystonia has shown that it is the third most prevalent movement disorder after Parkinson's disease and essential tremor3. Marsden estimated that one fourth of patients have a secondary dystonia and rest are primary or idiopathic4.

          Due to clinical and etiological heterogeneity of dystonia and in recent years their classification has been reviewed leading to an etiological approach where they are classified on the basis of age of onset, by distribution, temporal pattern, associated features and cause5. Clues to secondary dystonia are, associated features, begin suddenly, occur at rest, environmental causes, cranial onset in young and lower limb onset in adults, drug or toxin exposure, past history of encephalitis, trauma, cerebral palsy, meningitis and abnormal cranial imaging6.

Primary dystonia is a complex network disorder arising from the dysfunction of one or more parts of the brain including the basal ganglia, thalami, cortex, cerebellum, pons and dentate nuclei. Distorted proprioceptive propricephic feedback from muscle spindle to central process of structures7.

This was confirmed by Magayar-Lehman et al on PET studies8. Fahn et al found that the yield of investigate in childhood, adolescent and adult onset dystonia was 41%, 32% and 13% respectively9. Majority of hemidystonia has secondary cause10. Clinical presentation, demographic and etiological profile is different in younger age group patients as compared to adults11.

OBJECTIVES

          Objectives of the present study was to study the demographic, etiological and clinical profile in different dystonia and in patients of <40 years of age of onset.

MATERIAL AND METHODS

This prospective study was conducted in the Departments of Neurology, Superspeciality Hospital of Government Medical College Srinagar and AIIMS New Delhi and includes patients from outpatient and inpatients departments. Enrollment of patients was done from May 2003 to January 2014. Patients of less than forty years of age with diagnosis of dystonia were included in the study. Patients enrolled in the study were subjected to detailed clinical history and general physical examination to look for the evidence for KF ring, telangiectasias and signs of chronic liver disease. Directed systemic examination was done to look for any evidence of organomegaly, contractures and abnormal postures. Detailed neurological examination was done in all patients to look for any associated neurological deficits.

Investigations included hemogram, liver function tests, kidney function tests, uric acid, peripheral blood film for acanthocytes (3 consecutive samples and more than 10% was taken significant), Wilson profile (24 hour urinary copper and serum ceruloplasmin) and MRI brain. Genetic analysis for DYT1 was done in patients with primary generalized dystonia and less than twenty six years of age. Vasculitic profile was done in selected cases. MRI could be done also hundred patients and were discussed with neuro-radiologist. Any abnormality on MRI was recorded. Interictaland ictal SPECT brain was done in six paroxysmal kinesigenic dyskinesia patients. Dystonia was graded as per the dystonia rating scale described by Fahn (Appendix A).12

All variables were entered into the standard proforma designed at the start of the study. Data was collected of all patients enrolled for the study and was subjected for final analysis.

Statistical Methods

Descriptive analysis (frequency distribution) was used for final data analysis and results were depicted as percentage.  

RESULTS

          Total of six hundred cases of dystonia were registered out of which three hundred thirty (55%) were less than forty years of age and two hundred seventy (45%) were more than forty years of age. We could evaluate two hundred nineteen (66%) patients with different dystonia with age of onset less than 40 years. One hundred and fourteen (51.6%) had onset <26 years of age and the rest 48.7% had onset >26 years of age. Mean age at presentation was 22.3 years. One hundred seventy six (80%) patients were males and forty four (20%) were females. Mean duration of symptoms was 4.4 years (range 3-30 years). Onset in two hundred and fifteen (98.17%) was insidious and four (1.83%) had sudden onset. All these 4 patients had hemidystonia and were due to ischemic stroke, seven (3.2%)patients had diurnal variation and six of these had clinical suspicion of dopa responsive dystonia. One patient had primary generalized dystonia. One hundred five (42.7%) patients had only action/posture induced dystonia, three (1.4%) had at rest and hundred twelve (50.9%) had both at rest and during action (Table 1).

Ten (4.5%) patients had family history in 10 and 20 relatives (eight had dystonia in siblings, one in mother and one in father). Four patients (1.8%) with generalized dystonia had significant delayed milestones and among them three had onset before 26 years of age and one had after 26 years of age. Twenty five (11%) had significant past history in the form of stroke (twelve cases), trauma (six cases), chronic meningitis (three cases) and encephalitis (four cases). Ten patients (4.5%) had exposure to drugs like antiepileptics including (phenytoin) and 7 (3.9%) patients had exposure to neuroleptics including (risperidone, haloperidol and thioridazone). Six patients (2.7%) had history of orolingualself mutilation and only one patient showed evidence of acanthocytosis (Flow chart).

Ten patients (4.5%) had deranged liver function tests. Twenty five (11.4%) had abnormal copper studies. Out of these twenty five cases, twenty were diagnosed clinically as Wilson disease.

MRI was done in hundred patients (41.3%) and was abnormal in thirty seven patients showing abnormal signal changes in basal ganglia including striatum. Out of twenty patients of Wilson disease eighteen were having T2w signal changes in basal ganglia, thalami, dentate nucleus and cerebral white matter. In five patients with hemidystonia MRI showed infarcts in the basal ganglia region on the opposite side. Four patients with Hallervordenspatz disease had on MRI  “eye of tiger sign” positive. Four patients had vascular malformation in the brain stem. Three patients with history of head injury had evidence of cortical scars on MRI brain. One patient with hypoxic brain insult had periventricular white matter abnormalities. One patient with history of tubercular meningitis had mild ventriculomegaly and T2w signal changes in bilateral basal ganglia.

Among one hundred twenty seven cases of focal dystonia (57.99%), nine cases (7%) were secondary (Wilson disease = three, Trauma = two, Drugs = two, Vascular malformation = one, head injury = one). Of these writers cramp was seen in one, torticollis four, oromandibular dyskinesia two, tardive dystonia two.

Eight had hemidystonia and four were due to stroke on the opposite side, one had Wilson disease, two were post encephalitic and 1 was post head injury. Six patients (2.7%) had paroxysmal kinesgenic dyskinesia and one patients showed lesion in the contralateral frontal lobe on inter-ictal and ictal SPECT. Four patients (1.8%) had clinical and radiological evidence of Hallervordenspatz disease and all presented with generalized dystonia. Eleven patients (5%) had clinical suspension of idiopathic torsion dystonia and out of these four were DYT1 positive.

DISCUSSION

Present study was designed to see the demographic, clinical and etiological profile of dystonia in young age group (less than 40 years of age). This study is first of its kind in Indian population till date where all factor like demographic, clinical etiological and genetic profile has been studied in younger dystonia population less than forty years. Genetic analysis was done in patients who were less than twenty six years of age and who gave consent for the DYT1 gene estimation. Gene estimation at present is costly and most of our patient could not afford. So we stressed more on the demographic and clinical aspect of the dystonia. In  present study focal dystonia were more common in<40 years age group (57.72%), followed by generalized dystonia in 29.9% cases,segmental 10%, hemodystonia 3.63%, paroxysmal kinesigenic dystonia (2.7%) and multifocal dystonia (1.36%) cases. Writers cramp was more common comprising 63% of all focal dystonia followed by torticollis 17% and blepharospasm in 7%. Primary dystonia was seen in 25% and secondary in 75%. Wilson disease was etiological factor in 41.7% of secondary generalized dystonia cases followed by drugs in 10.4%, Hallervorden Spatz disease in 8.4%, rest causes were less common. In 74.55% of focal dystonia and 25.45% generalized dystoniano cause could be found. Among one hundred thirteen patients with age of onset < 26 years, Fifty eight (50.87%) were focal dystonia, forty eight (42.10%) had generalized dystonia, four (3.5%) had hemidystonia and four (3.5%) segmental dytonia. Among one hundred six patients with age of onset > 26 years seventy five (70.75%) had focal dystonia, eighteen (16.48%) had generalized dystonia, seven (6.60%) had segmental dystonia, five (4.71%) had hemidystonia and one (0.94%) had multifocal dystonia.

          Genetic analysis DYT1 estimation was possible in ten cases of 11 suspected idiopathic torsion dystonia and in four cases it was positive. Strong family history of dystonia was in ten cases.

          According to an earlier study by Nutt JF et al13 cervical dystonia was the most common form of all the focal dystonia. This is contrary to our study where most common type of all focal dystonia was writer's cramp. The reason could be referral bias as patient with writer's cramp, are usually students and earning members of family. Disability due to writer's cramp, compels them to come for treatment at higher centers whereas patients with torticollis may not come for treatment. Also the population in the study reported included all groups of patients with focal dystonia whereas in our study we included patients < 40 years of age. Idiopathic or sporadic primary dystonia is the most common form of dystonia in most epidemiological or clinical population-based surveys. The multiple classification schemes for dystonia reflect clinical heterogeneity as well as the incomplete understanding of many of the underlying causes. When confronted with a new patient with dystonia, it is often helpful to consider first the descriptive feature of the condition before proceeding to identify genetic or other factors that may be causative (Bressman SB et al)14.

          The most common cause of early onset generalized dystonia is DYT1 dystonia caused by a three base pair deletion (GAG deletion) in the TORIA gene. This mutation accounts for roughly 90% of early onset generalized dystonia in patients of Ashkenazi Jewish descent and approximately 40-60% in the non-Jewish population (Ozelius LJ et al)15. In our study, we could not perform genetic study in all patients with primary generalized dystonia due to high cost factor.

          Chuang C et al16 evaluated the natural history in hemidystonia. One hundred ninety cases were identified and collected data on aetiology, age of onset, latency, lesion location and response to treatment. They found most common etiologies of hemidystonia were stroke, trauma and perinatural injury and mean age of onset was twenty years and mean latency from the insult to dystonia was 4.1 years and basal ganglia was the site of lesion in 48%. In present study with 8 cases of hemi-dystonia, six had stroke, one was post trauma and 1 post encephalitic.

          Defazio G et al17 studied the risk factors for primary adult dystonia in two hundred and two cases (seventy three men and one hundred twenty nine women) with age range of 20-70 years. Focal dystonia was found in one hundred and fifty eight (78%) cases, forty four had cervical dystonia, twenty three with arm dystonia and one with leg dystonia, forty four with segmental and multifocal dystonia, thirty two cases with bleparospasm, twenty two with oromandibular, fifteen with cervical and five with laryngeal dystonia and one with leg dystonia. In thirteen cases of cervical dystonia had associated tremor. Six patients had dystonia at more than two sites. In one hundred twenty two patients cranial imaging was available which were normal. In the present study also there were more cases of focal dystonia, however writer’s cramp formed the majority.

          Pettigrew L et al18 studied three hundred and nine patients of dystonia and observed twenty two with hemidystonia. All twenty two patients had acquired hemidystonia due to structural brain lesion, storage disease or degenerative neurological disorder. Bressman SB et al19 studied forty Ashkenazi patients with secondary dystonia with age of onset < 28 years and clinical features resembling primary generalized dystonia who had normal neurological examination. Only ten patients had perinatal hypoxic insult or static encephalopathy and one patient tested positive for DYT1. Maniak S et al20 analyzed one hundred thirty index patients (age 30-81 years) with focal or segmental dystonia, of which one hundred twenty had focal dystonia. Of these eighty nine (74%) had cervical dystonia, sixteen (13%) had writer’s cramp and fifteen (13%) had blepherospasm/Meige’s syndrome. Twenty (17%) had dystonic tremor. Ten cases had segmental dystonia.

          Benecke R et al21 found a defect of complex-1 of mitochondrial respiratory chain proteins in primary dystonia and most of them had troticollis, however server deficiency was found in those patients who had generalized dystonia. In present study single case of dystonia due to mitochrondrial disease was suspected due to associated proximal muscle weakness, ptosis, recurrent vomiting and headache. MRI brain showed bilateral, subcortical and basal ganglia signal intensity changes on T2 weighted images. Though muscle biopsy for ragged red fibers was negative. Genetic study could not be done.

          Behari M et al22 reported sporadic case of choreo-acanthocytosis in whom laryngeal dystonia and dysphagia were the dominant symptoms. In Indian literature there are not much of the reported cases of acanthocytosis. In present study one patient had evidence of neuro-acanthocytosis and presented with oromandibular dystonia.

          Nemeth A et al23 reported a family in which five members over three generation had abnormal movements. Five had dystonia and three had tic disorder, thus, suggesting that these two disorders can have common genotype. In our study there was one cases of Tourette's syndrome with dystonia who presented with complex tic disorder and generalized dystonia. Family history was traced upto third generations and no other member was having tics or dystonia. Cranial imaging was normal.

Singh S et al24 reported a twenty three year old male patient who presented with two years history of torticollis with sleep benefit. Levodopa with carbidopa (100 + 25 mg) twice a day improved his torticollis completely. In present study none among seven patients with dopa responsive dystonia had cervical involvement.

Goyal V et al25 reported a thirteen year girl with ataxia telangiectasia who presented with generalized dystonia and had conjunctival telangiectasia and mental subnormality, choreoathetosis, myoclonic, jerks and bilateral cerebellar signs. Serum alfa fetoproteins, IgG and IgA level were raised. MRI showed bilateral mild cedrebellar atrophy. In present study there was one male patient of same age group with similar presentation with diagnosis of ataxia telangiectasia.

BehariM et al26 conducted a pilot case-control study for identifying possible risk factors for Meige' syndrome. They found that betalnut with tobacco chewing was a significant predictor for Meige's syndrome. The role of local irritation or the effect of some chemicals in tobacco and betal nuts need further evaluation. In present study there was a single case of Meige's syndrome in whom no cause could be found.

Das SK et al27 conducted a community based study on dystonia from India reported crude prevalence rate of primary dystonia 43.91/100,000 and age standardized rate 99.06. All cases were focal type and predominantly Writers cramp. Mean onset of dystonia was earlier in women as compared to men.

Kalita J et al28 reported clinical and MRI findings of seventeen patients with oromandibular dystonia due to Japanese encephalitis and non-specific encephalitis. Their median age was fourteen (2-53) years and nine were females. Cranial imaging was abnormal in thirteen patients and SPECT was abnormal in fifteen patients.

Tufan N et al29 reported that three novel mutations in GCH1 gene have been found and were shown to be associated with variable clinical phenotypes mostly within the spectrum of dopa responsive dystonia. Severity of clinical phenotype and the age of onset varied among family members harbouring the same mutations.

Koukouni V et al30 reported that young onset primary cervical dystonia is uncommon and in seventy six patients with young onset primary cervical dystonia mean age of onset was twenty one years. Family history of dystonia was noticed in 26.3%. Preceding injury or surgical intervention was noted in 17.1%.

Skogseid IM31 reported that the discovery of the first two gene mutations causing primary generalized dystonia [(DYT1-TORIA) and (DYT16-THAP1)] has facilitated studies on pathogenesis and pathophysiology of primary dystonia.

Brian D et al32 reported that using latest technologies in human genetics, new genetic links are being discussed and expands our knowledge of the disorders complex pathogenesis.

Fung VS et al33 reported that in sporadic isolated dystonia, the chance of finding a genetic cause in less than 1-2%, so genetic testing usually is not cost effective. The diagnostic approach in younger individuals with isolated sytonia in quite different, because there is much higher likelihood of disclosing a cause.

CONCLUSION

          This study gives details of demographic and clinical features of dystonia in less than forty years age group of Indian population. This study concluded focal dystonia are more common (57.73%) than generalized dystonia. Torticollis which is considered to be most common dystonia in previous studies, was second common focal dystonia in this study. Wilson's disease was the most common cause for secondary generalized dystonia (9.09% of all dystonia).

          In sixty four out of two hundred nineteen (29.22%) cases with dystonia, we were able to make an etiological diagnosis.

          The limited facilities for investigations (biochemical and genetic) did not help to establish diagnosis after clinical diagnosis was made. Imaging in two cases both with brain tem AVM established the cause of dystonia. All of six patients of dopa responsive dystonia responded to small doses of levodopa (100mg/d). Hemidystonia usually occurs in the setting of a structural lesion of the contralateral basal ganglia with stoke being the commonest, followed by trauma and perinatal insults.

A systematic approach to dystonia helps to ensure that patients with this disorder receive optimum care and describe how to apply the clinical information for selection of appropriate laboratory investigations.

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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
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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
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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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