International Journal of Current Research and Review
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IJCRR - Vol 11 Issue 14, July, 2019

Pages: 01-05

Date of Publication: 23-Jul-2019


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Central Corneal Thickness and Diabetes Mellitus - A Study of Correlation in Terms of Duration and Glycemic Control in North Indian Hilly Population

Author: Shanti Pandey, Vivekanand Satyawali, Dipti Joshi, Govind Singh Titiyal

Category: Healthcare

Abstract:Introduction: Retinopathy is one of major micro vascular complication in long standing diabetes, but diabetic keratopathy has potential to decompensate following stress. The central corneal thickness is a sensitive indicator of health of cornea and may influence outcome in cataract, refractory surgeries and may lead to fallacy in Intraocular pressure measurement. Present study was cross sectional observational study, undertaken to determine the correlation between central corneal thickness (CCT), and diabetes control and duration in hilly north Indian patient.
Material and Methods: This is a cross-sectional study conducted in the department of ophthalmology of a tertiary care centre in Kumaon region. 400 subjects from age group 40 to 80 years were studied. An ultrasound pachymeter was used to measure CCT. The subjects were divided into two groups, 200 of them were non-diabetic subjects, and 200 were diabetic patients. The collected data was transformed into variables, coded and entered in Microsoft Excel. Data was analysed and statistically evaluated using SPSS-PC-17 version.
Results: The average central corneal thickness in diabetic patients was 527.01\? 25.57 microns. The average central corneal thickness found in non-diabetic patients was 513.38 \? 27.01 microns. The statistically significant (p< 0.001) increase in central corneal thickness found in diabetic patients compared to non-diabetic patients.CCT tends to increase significantly (p value< 0.05) in uncontrolled diabetes (HbA1C level > 7%) and longer duration of diabetes.
Conclusion: Diabetic patients had an increased central corneal thickness when compared with non-diabetic patients. And this is more in patient with longer duration of uncontrolled diabetes.

Keywords: Central Corneal Thickness, Diabetes

Full Text:

Introduction: Type II diabetes mellitus is a major public health concern in this modern day.[1]In the year 2000, India had 31.7 million diabetics and became the diabetic capital of the world, with the highest number of people with diabetes mellitus, followed by China with 20.8 million diabetics and the United States with 17.7 million diabetics, in the second and third places respectively.[1]Diabetes mellitus (DM) occurs when the pancreas is not able to produce enough insulin, or the body becomes resistant to insulin, or both, resulting in increased blood glucose levels. Although diabetic retinopathy is major concern and may lead to severe vision loss, keratopathy should also be kept in the mind in diabetics as diabetic cornea has higher potential to decompensate following stress. The central corneal thickness is a sensitive indicator of health of cornea and serves as an index for corneal hydration and metabolism. Measurement of CCT is essential to take decisions regarding cataract and refractive surgeries and avoiding fallacy during estimation of IOP in diabetics. There are functional changes in diabetic cornea as a result of increased central corneal thickness. There are two theories behind increased central corneal thickness, firstly in diabetics, sorbitol accumulation within corneal endothelial cells[2] and a decrease in Na+/K+ ATPase activity [3] induce dysfunction of the corneal endothelium cell layer leading to corneal hydration which translates to increased CCT measurements. Thus, corneal thickness indirectly indicates the functioning of the endothelial layer. Secondly, changes occur in corneal stroma in diabetics, which include structural alterations produced by collagen cross linking. Advanced glycation products accumulate in collagen proteins, resulting in the formation of covalent cross-linking bonds, and may lead to increased corneal thickening and biomechanical changes[4,5]Central corneal thickness is an important indicator of patency of corneal endothelium pump and can be objectively measured by variety of techniques like optical pachymetry, ultrasound pachymetry, confocal microscopy, ultrasound biomicroscopy, optical ray path analysis or scanning slit corneal topography and optical coherence tomography.[6] Ultrasound pachymetry is the current standard for corneal thickness measurement.[7]This study aimed to evaluate the effect of diabetes mellitus on corneal thickness (CCT) by comparing the CCT of diabetic and non-diabetic patients and association of CCT with duration of diabetes mellitus as well as serum level of HbA1c.              Subjects and Methods: Ethical clearance was obtained from the institutional ethical committee and a cross sectional study was designed in tertiary eye care centre. Two hundred diabetic patients (previously diagnosed by medical practitioners), whether on treatment or not, who gave consent were enrolled irrespective of level of blood sugar. Two hundred age matched controls (non diabetic by history and blood sugar level) were also enrolled. Informed consent was taken from all the participants in the study. After taking detailed history, complete routine anterior and posterior segment evaluation was done. The corneal thickness assessment was done for 400 eyes of 200 diabetic and 400 eyes of 200 non diabetic patients with the help of ultrasound pachymeter, in multiple reading single point mode by a single person between October 2016 to September 2018 at department of ophthalmology Government Medical College, Haldwani.

 (1) Eyes with corneal pathologies like pterygium, corneal dystrophies

 2) Any prior history of ocular surgeries

3) Active or any previous eye infection or inflammation

4) contact lens users

Results: Four hundred patients included in this study were in age group of 40 to 80 year. Majority of the patients belonged to age group 51-60 years (33.75%) whereas the least common age group was 71 -80 years (9%). Mean Age of diabetic and non-diabetic patients was 58.23±9.77 years and 56.59±9.85 years respectively (Table 1)

In non-diabetic group 99 (49.5%) were males and 101 (50.5%) were females with M: F ratio of 0.98. However, in diabetic group, 96 (48.0%) cases were males and 104 (52.0%) were females with M: F ratio of 0.91. Diabetic females had slightly higher preponderance 52.2%.

 The mean CCT   in 400 eyes of 200 diabetic patients was 527.01µm with SD of 25.57, and in 400 eyes of 200 non- diabetics mean CCT was 513.38 µm with SD 27.09. Mean CCT was significantly higher in diabetics as compared to non- diabetics i.e. p value (Table 2 and Figure 1)

 

Maximum number of patients had diabetes for less than 5 year i.e. 95(47.5%), followed by patient who had diabetes >10 year i.e. 72 subjects (36.0 %) and least were patients who had diabetes between 5-10 years duration i.e. 33(16.5%).

CCT tends to increase significantly with duration of diabetes (p value <0.001). Highest mean CCT was found in patients with longer duration of diabetes >10 year i.e. 542.92 µm,

followed by 5-10-year duration i.e. 528.27 µm and least mean CCT was found among diabetics having duration less than 5 years i.e.514.19 µm.(Table 3 and Figure 2)

 

Table 4 depicts that diabetics having HbA1c more than 7% had higher mean CCT i.e. 540.01µm as compared to those having HbA1c upto 7% had mean CCT of 522.46µm. It was significant with p value<0.01(Table 4)

Discussion: This study elucidates the influence of diabetes on central corneal thickness. Central corneal thickness has become an important indicator of corneal health status and decisions involving refractive surgery and estimation of intraocular pressure. In present study the  central corneal thickness was 527.01± 25.57 microns in diabetic patients and 513.38 ± 27.01 microns, in non-diabetic patients,  which is similar to another study done on Indian eyes by Nangia et al with average central corneal thickness (514±33.0µ).[8] They reported that Indians from rural central India have markedly thinner corneas than do Caucasians or Chinese.

There are two different hypothesis suggesting higher CCT in diabetics

  • Glucose can act as collagen cross linking agent with the help of advanced glycosylation end products. Advanced glycation products accumulate in collagen proteins result in the formation of covalent cross- linking bonds and may lead to increased corneal thickening and biochemical changes.[9]    

  • In addition to this there is decrease in Na+/K+ activity in corneal endothelium.

Rashmi Kumari et al [10] conducted case control study in Max Eye Hospital, Patna,( from May 2015 to April 2016)  measured Central corneal thickness in 100 patients out of which 50 were diabetic and 50 were non-diabetic and concluded that the Diabetic patients had thicker cornea as compared to the non–diabetics.

Prem pal Kaur et al [11] conducted cross sectional study at Amritsar on 240 eyes, in which 120 eyes of diabetic patient and 120 eyes of non -diabetic patient taken at Government Medical College, Amritsar, and found that in the diabetic group, the mean CCT and mean endothelial cell density varies significantly from non diabetic controls . They also concluded that CCT was significantly thicker for diabetics with duration of >10 years and HbA1c >7.

In contrast Kenji Inoue et al [12] in Japan, compared the endothelial structure and thickness of the cornea in diabetic and non diabetic patients. They found no significant difference between CCT in the diabetic group to non -diabetic individuals. Corneal endothelial cell structure was damaged, but CCT was not increased in type II diabetic patients however, Allan Storr?Paulsen et al[13] establish that Type II diabetic subjects did not differ from the non?diabetic control subjects with regards to endothelial cell density, hexagonality or variation in CV, but showed a significant increase in CCT.

Su et al.[14]also observed that among 3280 Malay adults aged 40 to 80 years, those with diabetes and hyperglycemia showed significantly thicker central corneas, which was independent of age and IOP levels

Abdul ghani et al [15] in Sudanese population and Busted et al [16], reported similar results as present study.

Central corneal thickness was observed higher in diabetic patient having duration more than 10 year that was 541±22.41µm as compared with diabetics having duration <5 year that was      

514.71±19.61µm  this is positively correlated with the study done by Rashmi Kumari et al [10], Lee et al[17] where they  found positive relation of higher CCT with longer duration of diabetes.       

The present study depicts that patient having HbA1c more than 7% have significantly higher CCT [i.e. 540.01µm] as compared to the non diabetic subjects [i.e. 522.46µm].

This study correlates with other studies done by Rashmi et al [10] Su et al [14] Stella Briggs et al [18] where they found association of higher CCT with uncontrolled hyperglycemic level.     

Possible limitations of this study are that corneal endothelial density and hexagonility associated with the hypertension and dyslipidemia were not measured. Ultrasound pachymetry is most common and gold standard for central corneal thickness measurement but it has its own disadvantages like it yields slightly thinner measurements as a result of tissue indentation. Mild patient discomfort and risk of infection are some additional concerns with this method.

However, newer non- contact technologies for the measurement of corneal thickness allows better repeatability and reproducibility.[19] These include the Pentacam, the Orbscan and optical coherence tomography.

Conclusion: Retinopathy is one of major microvascular complication in long standing diabetes, but diabetic keratopathy has potential to decompensate following stress. Diabetic patients had an increased central corneal thickness when compared with non-diabetic patients. And this is more in patient with longer duration of uncontrolled diabetes. The central corneal thickness is a sensitive indicator of health of cornea and may influence outcome in cataract, refractory surgeries and may lead to fallacy in Intraocular pressure measurement

Acknowledgement: 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 the literature for this article has been reviewed and discussed.

 

References:

 (1) Kaveeshwar SA, Cornwall J. The current state of diabetes mellitus in India. The Australas Med J. 2014;7(1):45.    

(2) O'Donnell C, Efron N, Boulton A. J. M. A prospective study of contact lens wear in diabetes mellitus[J] Ophthalmic Physiol Opt. 2001;21:127–138.

(3) Ziadi MZ, Moiroux P, D'Athis P, et al. Assessment of induced corneal hypoxia in diabetic patients[J] Cornea. 2002;21:453–457. 

(4) Sady C, Khosrof S, Nagaraj R. Advanced Maillard reaction and crosslinking of corneal collagen in diabetes. BiochemBiophys Res Commun. 1995;214:793–797.

(5)Kaji Y, Usui T, Oshika T, et al. Advanced glycation end products in diabetic corneas. Invest Ophthalmol Vis Sci. 2000;41:362–368. 18. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2004;27(suppl 1):S5–S10

(6)V Yaylali, SC Kaufman, HW Thompson, Corneal thickness measurement with orbscan topography system and ultrasonic pachymetry, J Cataract Refract Surg. 1997;23: 1345-50.

(7) JJ Salz, SP Azen, J Berstein, P Caroline, RA Villasenor, DJ Schanzlin et al, Evaluation and comparison of sources of variability in the measurement of corneal thickness with ultrasonic pachymeter, Ophthal Surg. 1983;14:750-4.

(8)Nangia V, Jonas JB, Sinha A et al. Central corneal thickness and its association with ocular and general parameters in Indians; The Central India Eye and Medical Study. ophthalmology. 2010;117:700-4.      

(9)Sahin A, Bayer A, Ozge G, Mumcuoglu T. Corneal biomechanical changes in diabetes mellitus and their influence on intraocular pressure measurements. Investigative ophthalmology & visual science. 2009 Oct 1;50(10):4597-604.                                                                                                                     

(10) Kumari R, Saha BC. Central Corneal Thickness and Diabetes–A Study of Correlation in Terms of Duration and Glycemic Control. world.;1:2.

(11) Kaur P, Singh B, Bal BS, Kaur I, Brar V. Central Corneal Thickness in Type 2 Diabetic Patients And its Correlation with Duration, Hba1c Levels And Severity of Retinopathy. group (NPDR). 2016;47(569.4):15-04.

(12) Inoue K, Kato S, Inoue Y, Amano S, Oshika T. The corneal endothelium and thickness in type II diabetes mellitus.Japanese journal of ophthalmology. 2002 Jan 1;46(1):65-9.

(13)Storr?Paulsen A, Singh A, Jeppesen H, Norregaard JC, Thulesen J. Corneal endothelial morphology and central thickness in patients with type II diabetes mellitus. Actaophthalmologica. 2014 Mar;92(2):158-60.

(14) DH, Wong TY, Wong WL, Saw SM, Tan DT, Shen SY, Loon SC, Foster PJ, Aung T, Singapore Malay Eye Study Group. Diabetes, hyperglycemia, and central corneal thickness: the Singapore Malay Eye Study. Ophthalmology. 2008 Jun 1;115(6):964-8.       

(15).Abdulghani YS, Ali TO. Correlation between central corneal thickness and diabetes in sudanese patients. Natl J Med Res. 2013;3(4):309-11.

(16) Busted N, Olsen T, Schmitz O. Clinical observations on the corneal thickness and the corneal endothelium in diabetes mellitus. Br J Ophthalmol. 1981;65(10):687-90. 

(17) Lee JS, Oum BS, Choi HY, Lee JE, Cho BM. Differences in corneal thickness and corneal endothelium related to duration in diabetes. Eye. 2006 Mar;20(3):315

(18) Briggs S, Osuagwu UL, Al Harthi EM. Manifestations of type 2 diabetes in corneal endothelial cell density, corneal thickness and intraocular pressure.Journal of biomedical research. 2016 Jan;30(1):46  (19) Rio-Cristobal A , Martin R. Corneal assessment technologies: Current status. Surv Ophthalmol. 2014;59:599–614. PMID: 25223496, http://dx.doi.org /10.1016/j.survophthal.2014.05.001

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

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Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

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


Best Article Award

A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by situs slot and Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh et al. situs slot "Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma situs slot entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by situs slot et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
Late to bed everyday? You may die early, get depression situs slot
Egg a day tied to lower risk of heart disease situs slot
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List of Awardees

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


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


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