International Journal of Current Research and Review
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IJCRR - 12(12), June, 2020

Pages: 30-36

Date of Publication: 16-Jun-2020


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Bacteriological and Antimicrobial Sensitivity Profile of Burn Wound Infections in a Tertiary Care Hospital of Uttarakhand

Author: Shalabh Jauhari, Shekhar Pal, Mohit Goyal, Rajat Prakash, Deepak Juyal

Category: Life Sciences

Abstract:Introduction: Burn wound injuries are one of the most common, invasive and devastating forms of trauma. Despite the recent advances in burn wound management, bacterial infections persist as an important complication and leading cause of morbidity and mortality among burnt patients. Identification and antimicrobial susceptibility pattern of bacterial pathogens associated with burn wounds can help clinicians to plan patient management effectively and efficiently.
Materials & Methods: This prospective study was conducted for a period of one year (July 2016- June 2017). A total of 160 specimens (wound swabs and pus exudates) from burn wound patients received at microbiology department for culture and sensitivity were included in the study. Once received the samples were processed immediately as per the standard operating procedures of our laboratory. Identification and antimicrobial sensitivity testing of the bacterial isolates was performed on VITEK\?2 COMPACTautomated identification and antimicrobial susceptibility testing (ID/AST) system (bioMerieux, France) and interpreted as per Clinical Laboratory Standards Institute guidelines. The use of automated VITEK\?2 COMPACT system for ID/AST ensures accurate results for most of the clinical isolates and eliminates the requirement of human analysis and error of results.
Results: A total of 160 samples were received from burn wound patients, out of which 113 (70.6%) were culture positive. P.aeruginosa, A.baumannii and Proteus mirabilis were the most predominant gram-negative isolates whereas S.aureus, Coagulase-negative staphylococcus and Str.pyogenes were the most commonly isolated gram-positive organisms.
Antimicrobial sensitivity profile of bacterial isolates revealedPiperacillin-tazobactam, imipenem, cefoperazone-sulbactam and colistin to be the most effective antimicrobials against gram-negative isolates, whereas linezolid, teicoplanin, vancomycin and amikacin were the most effective drugs against gram-positive isolates.
Conclusion: Due to the increased morbidity and mortality associated with the burn wound infections, early detection of the causative agents and the intervention are a prerequisite for better clinical outcomes of burnt patients. Data extrapolated from our study can be helpful for primary care physicians to optimize the treatment modalities, articulating policies for empiric antimicrobial therapy and to minimize the rate of infection among burn wound patients.

Keywords: Multi drug resistant, Pseudomonas aeruginosa, Staphylococcus aureus, Total body surface area, VITEK

Full Text:

Introduction

Burns injury, one of the most common, invasive and devastating forms of trauma is a global public health concern. It causes damage to the largest organ in the human body, the skin, which functions to provide homeostasis, thermoregulation, sensation, immunological defense and acts as a formidable barrier against various infections.World Health Organization (WHO) has estimated that burn injury results in 265,000 deaths annually, with nearly half of these occurring in the WHO Southeast Asia Region, 2more so in low and middle-income countries, which are least equipped to provide timely and comprehensive care. 3 Millions of those who survive are left with lifelong disabilities and disfigurements, often with resulting social stigma and rejection. In India, over 1,00,000 people are affected by burns annually and over 20,000 of them die.4

Different cultural and social factors and the availability of healthcare facilities result in diverse epidemiology of the burn wound injury.5 The most common cause of the burns are due to chemicals, hot liquids followed by electricity and molten or hot metals.6 The severity of a burn depends on the degree of heat, duration of exposure, and thickness of the involved skin. The treatment of burns requires a multidisciplinary approach and it is often cost-intensive. Of note, majority of burn injuries in India occur in rural areas where the unavailability of quality healthcare facilities and financial constraints can further complicate the effective and efficient management of such cases.

Despite the recent advances in burn wound management, microbial infections persist as an important complication and leading cause of morbidity and mortality among burn patients.1,7 Most of the times such infections are the reason for a prolonged hospital stay which eventually account for overwhelming pharmacotherapeutic and pharmacoeconomic implications not only on patients but on healthcare facility as well. Predominant risk factors for burn wound infection are the size of burn wound, i.e., the percentage of total body surface area (TBSA) burnt and the duration of hospitalization.8 Burn wound itself provides a conducive environment for the microorganisms to colonize, which eventually leads to infection. The primary insult from a burn is the wound itself with three characteristic areas of involvement, a) Zone of coagulation: first associated area of the wound, nearest to the heat source and includes dead tissue forming the burn eschar; b) Zone of stasis: is the area adjacent to the zone of coagulation and is viable but at risk of ischemia due to perfusion defects; c) Zone of hyperemia: it is the third area, which consists of relatively normal skin, with increased blood flow and vasodilatation and minimal cellular injury.8Primarily the burn wound injuries have the moist, protein-rich eschar, which is an ideal environment for microbial colonization and infection. The avascular zone of coagulation diminishes the immunological defenses, particularly neutrophils, from attacking pathogens via their respiratory burst mechanisms, which requires oxygen.9The inflammation also impairs wound healing due to the release of proteases from macrophages.

Typically the burn surface is sterile immediately after the thermal injury and after a period of about 48-72 hrs (relative sterility), the wound is initially colonized by the surrounding microbes from the skin, hair follicles and sebaceous glands (endogenous flora),10 which are usually gram-positive bacteria. After around fifth to sixth day the gram-positive organisms are often replaced by gram-negative organisms 11 which are either present in hospital environment or are transmitted from the hands of healthcare workers and fomites (exogenous flora). Moreover, the gastrointestinal tract is also one of the predominant potential reservoirs for endogenous gram-negative organisms that colonize the burn wound surface.8Among the gram-positive organisms, Staphylococcus aureus and Streptococcus pyogenes, and among the gram negativeorganismsPseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Proteus spp. and Citrobacter spp. are the most predominant organisms involved in burn wound infection. These pathogens, particularly the gram-negative organisms are known for their increasing resistance to a variety of broad-spectrum antibiotics and can further complicate the clinical outcome of the patients. Moreover, infection with multi drug-resistant organisms or polymicrobial infections are associated with worse clinical outcomes. Nearly 73% of post-burn deaths occurring within five days have been reported to be sepsis-related.12

The use of prophylactic antibiotics is common practice with burnt patients.13 Drug resistant bacteria with intrinsic resistance towards antibiotics, the ability to survive longer in the hospital environment and hand-to-hand transmission of bacteria reflect their easy spread and the possible causes of outbreak.14,15 The bacterial infections in burnt patients vary both with time and place.16,17Thus, continuous surveillance and update of antibiotic resistance pattern of microorganisms is imperative for infection control programs and accurate antibiotic treatment in the burnt patients. With the above background, the present study was undertaken to identify the bacteriological profile of infected burn wounds and their antimicrobial sensitivity pattern among the patients admitted in a tertiary care hospital of Uttarakhand. This study will be helpful to determine the predominant bacterial agents causing burn wound infection in our healthcare setup and their antimicrobial profile will be helpful to tailor the existing guidelines for better patient management and care.

Materials and Methods

This prospective study was conducted in Dept. of Microbiology of Shri Mahant Indiresh Hospital Dehradun for a period of one year (July 2016- June 2017). A total of 160 specimens (wound swabs and pus exudates) from burn wound patients received at microbiology department for culture and sensitivity were included in the study.

Following aseptic conditions, all the samples were collected and transported to the microbiology laboratory without delay. Once received the samples were processed immediately as per the standard operating procedures of our laboratory. Samples were plated on 5% sheep blood agar (BA) and Mac Conkey’s agar (MA), and were incubated at 37°C for 48 hours before being reported as sterile. Plates were examined for the growth and the preliminary identification was made based on colony morphology, gram staining, and the battery of biochemical tests (catalase, coagulase and oxidase tests). Based on the aforesaid tests the organisms were broadly classified as gram-positive cocci (in clusters or chains) and gram-negative bacilli (oxidase positive or oxidase negative). Further identification (ID) and antimicrobial sensitivity testing (AST) was done using VITEK®2 COMPACTautomated ID/AST system (bioMerieux, France). The use of automated VITEK®2 COMPACT system for ID/AST ensures accurate results for most of the clinical isolates and eliminates the requirement of human analysis and error of results.

For gram-negative bacteria, ID-GNB, AST-N280 and AST-N281 cards (bioMerieux, France)and for gram-positive bacteria ID-GPB, AST-P628 (bioMerieux, France) were used following the manufacturer's instructions. Briefly, a single bacterial colony (pure growth) was taken and the suspension was made in normal saline. The optical density of the bacterial suspensions was adjusted to 0.5 McFarland. Finally, the Vitek Tubes were shaken well before putting into the Vitek machine to maintain homogenous suspension. The AST card contained following antibiotics: ampicillin, amoxicillin/clavulanic acid, amikacin, ceftriaxone, ciprofloxacin, clindamycin, co-trimoxazole, cefoperazone/sulbactam, colistin, cefuroxime, erythromycin, gentamicin, imipenem, linezolid, piperacillin/tazobactam, teicoplanin, tigecycline, and vancomycin. E.coli ATCC 25922, S. aureus ATCC 25923 and P. aeruginosa ATCC 27853 were used as controls. Results were interpreted as recommended by the Clinical and Laboratory Standards Institute (CLSI) guidelines (M100-S24 and M100S, 26th Ed.). The MIC breakpoint used to identify bacteria susceptible for colistin was 2 mg/l and tigecycline was 1 or 2 mg/l.18

Results

Out of total 160 patients, the majority of the cases were seen in age group between 31 years to 40 years (27.5%). Males (60.7%) were more commonly affected than females (39.3%) and the male: female ratio was 1.5:1. Table 1 depicts the gender and age-wise distribution of burn wound patients. Among the causes of burn, thermal burns (36.2%) were found to be the most predominant followed by electric burns (26.9%) and scald burns (16.2%). Table 2 shows the distribution of the type of burns. 

Out of total 160 samples, processed bacterial growth was seen in 113 (70.6%) samples while 47 (29.4%) samples showed no growth. Among the 113 samples with bacterial growth, gram-negative organisms (68; 60.2%) outnumbered the gram-positive organisms (45; 39.8%). P. aeruginosa, A. baumannii and Proteus mirabilis were the most predominant gram-negative isolates whereas S.aureus, Coagulase-negative staphylococcus (CONS) and Str. pyogenes were the most commonly isolated gram-positive organisms. Table 3 shows the distribution of various bacterial isolates grown from burn wounds of the patients.

Antimicrobial sensitivity testing was carried out for all 113 bacterial isolates. Piperacillin-tazobactam, imipenem, cefoperazone-sulbactam and colistin showed maximum activity for gram-negative isolates, whereas linezolid, teicoplanin, vancomycin and amikacin were the most effective drugs against gram-positive isolates. Table 4 depicts the antimicrobial sensitivity profile of all the bacterial isolates.

Discussion

In the present study a total of 160 samples were collected, out of which, 113 samples showed growth with an isolation rate of 70.6%, a finding which was in tandem with the previous studies by Srinivasan et al., Dutta et al., and Richcane et al. who reported the isolation rate to be as high as 86.28%, 88.23% and 90.7% respectively.8, 19, 20

Regarding the sex distribution of the patients in the present study, males (60.7%) outnumbered the females (39.3%) with male: female ratio of 1.5: 1. The possible reasons for this male preponderance can be related to socio-economic and cultural habits of earning the livelihood primarily by males and also to their adventurous nature and the greater desire to be active in comparison to their female counterparts.21,22  Our findings were in concordance with previous studies by Aali et al., Ghaffaret al. and Richcane et al. 20,23,24 but were in contrast to the studies by Khurram et al. and Latikasharmaet al.25,26

Among the causes of burn, thermal burns (36.2%) were found to be the most predominant followed by electric burns (26.9%) and scald burns (16.2%). A study by Shahzadet al. also reported thermal burns to be the most common cause of burn injuries.27Various other studies by Richcane et al., Agbenorku et al., and Mahalakshmyet al., have reported scald burns as the most common cause of burn injuries.20,28,29The most affected age group in our study was between 31 to 40 years (27.5%) of age, a finding that is in parallel to the various other studies.8,25,26,30,31 The probable reasons for this are, the active involvement of this age group in outdoor work and more common exposure to fire-related work (household and occupational). In contrast to our findings, various other studies reported age group of 0-5 years as the most common age group suffering from burns.20,28,32,33Underdevelopment of the cognitive function, tendency of being more active during early developmental stages and to pull or push objects containing hot liquids have been reported to be the common reasons for the same.28

Nosocomial infection in burnt patients is a major challenge for clinicians. A previous study reported that 75% of all deaths among burnt patients were associated with infection.19 Our study results revealed a high isolation rate of about 70.6% with gram-negative isolates comprising the predominant bacterial etiology. The presence of gram-negative organisms in the majority of the cases suggests that most of such wounds may either have resulted due to prolonged hospital stay or due to prolonged time between the injury and the hospital admission. The predominance of gram-negative bacteria in burns has been documented in several studies where they have been shown to be an independent predictor of mortality among burnt patients.34,35 Studies by Bessa et al. and Hwee et al. also support our view by stating that the long hospital stay is directly proportional to high incidence of burn wound infections particularly of gram-negative etiology and is inversely proportional to the positive clinical outcome of the patients.36, 37 One of the major factors adding to the complication of burn wound patients is a multi drug resistant (MDR) organism. Any MDR strain if sets in the hospital environment, can persist for months. Robust microbiological surveillance as well as restrictive antibiotic policy can be helpful in prevention and treatment of such MDR isolates. Moreover, overcrowding in burn ward is an important cause of cross-infection and must be avoided to prevent any nosocomial infection among patients.

In the present study, P.aeruginosa was the most commonly isolated gram-negative bacteria followed by A.baumannii and Pr.mirabilis. Similar findings, with P.aeruginosa being the predominant isolate among burn wound patients have been reported previously. 25,38,39 High prevalence of these pathogens is associated with their ability to flourish well in a moist environment and their prolonged persistence in hospital environment,40 which eventually can result in a high level of antibiotic resistance among such pathogens, particularly in Pseudomonas spp.41 Moreover, the local practices like application of cow dung, toothpaste, fountain pen ink and mud paste over the burn wound can also be the possible reason for isolation of these organisms from the burn wound patients.25

Among the gram-positive organisms, S.aureus was the most predominant followed by CONS and Str.pyogenes. Although various other studies have shown S.aureus to be the most predominant etiological agent in burn wound patients,42 but in the present study it was found to be the second most common isolate after P.aeruginosa. Similar observations have been reported by previous studies as well.38, 39, 43 CONS accounted for 8.9% of the total organisms isolated from the burn wounds, a finding which is in tandem with previous studies by Mama et al. and Richcane et al. who reported CONS in 14.5% and 2.3% respectively from the burn wound infections.20, 44  CONS, although is a normal skin flora, but is a common contaminant of the burn wounds.

The antimicrobial profile of our study indicates the emergence of MDR strains in our hospital set up. The gram-negative isolates exhibited a high degree of resistance to the commonly used antibiotics like ampicillin, amoxy-clav, ceftriaxone, ciprofloxacin, cefuroxime, gentamicin and penicillin, the observation which was in contrast to the previous studies.15,16,41,42Various predisposing factors documented for the acquisition of MDR strains include prolonged/previous hospitalization, invasive procedures, comatose state and advancing age. In addition to the above, indiscriminate use of broad-spectrum antibiotics and poor compliance with hospital antibiotic policy can also provide a conducive environment for MDR strains.  Piperacillin-tazobactam, imipenem and cefoperazone-sulbactam showed maximum activity against gram-negative isolates. Similar findings were reported by Mundhada et al. and Guggenheim et al. who also observed imipenem and meropenem to be the most effective drugs against gram-negative isolates.42,45 Colistin and tigecycline are among the antibiotics used as last resort for the treatment of MDR or extensively drug resistant (XDR) isolates, and both these drugs were found to be effective against majority of the gram-negative isolates in our study. However, resorting to both these drugs can impose a considerable financial burden on the patient. In comparison to gram-negative isolates, the degree of resistance observed among gram-positive organisms was less. In addition to vancomycin, teicoplanin and linezolid, which showed 100% sensitivity to gram-positive isolates, amikacin and co-trimoxazole, were also found to be effective against gram-positive organisms.

The use of automated VITEK®2 COMPACT system for identification and antimicrobial susceptibility testing ensures accurate results for most of the clinical isolates and eliminates the requirement of human analysis and error of results.

Conclusion

The most common isolate from burn wound patients in our study was P.aeruginosa, S.aureus and A.baumannii, majority of them being resistant to commonly prescribed antimicrobials. The emerging drug-resistant strains and the scarcity of any newer antibiotic in the pipeline make active microbial surveillance in the clinical settings more imperative. Due to the increased morbidity and mortality associated with the burn wound infections, early detection of the causative agents and the intervention are a prerequisite for better clinical outcome of burnt patients. Although completely eliminating such infections seems to be difficult, but reducing the rate of burn wound infections to minimal will surely be beneficial in reducing patient morbidity and mortality, as well as in preventing the pharmacotherapeutic and pharmacoeconomic losses.

A multidimensional approach in this regard ensuring close clinical liaison between the surgical team, the microbiologist and the infection control team can surely turn the tide in favor of the patients as well as the clinicians. We realize that data extrapolated from our study may not be representative of the whole Indian scenario and must be interpreted cautiously. However, the findings of our study can serve as a template to optimize hospital antimicrobial policy and antimicrobial prescribing guidelines. The relevant and regular policy and protocol changes can definitely overcome the burn wound infection rate in any healthcare facility. Given the considerable clinical and economic consequences of burn wound infections, the goal of a healthcare system should be “zero tolerance” to such infections and the associated adverse events.

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.

Financial Support: None, Conflict of Interest: Nil

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A study by Dorothy Ebere Adimora et al. entitled \"Remediation for Effects of Domestic Violence on Psychological well-being, Depression and Suicide among Women During COVID-19 Pandemic: A Cross-cultural Study of Nigeria and Spain\" is awarded Best Article of Vol 14 issue 23
A study by Muhas C. et al. entitled \"Study on Knowledge & Awareness About Pharmacovigilance Among Pharmacists in South India\" is awarded Best article for Vol 14 issue 22
A study by Saurabh Suvidha entitled \"A Case of Mucoid Degeneration of Uterine Fibroid with Hydrosalphinx and Ovarian Cyst\" is awarded Best article of Vol 14 issue 21
A study by Alice Alice entitled \"Strengthening of Human Milk Banking across South Asian Countries: A Next Step Forward\" is awarded Best article of Vol 14 issue 20
A study by Sathyanarayanan AR et al. entitled \"The on-task Attention of Individuals with Autism Spectrum Disorder-An Eye Tracker Study Using Auticare\" is awarded Best article of Vol 14 issue 19
A study by Gupta P. et al. entitled \"A Short Review on \"A Novel Approach in Fast Dissolving Film & their Evaluation Studies\" is awarded Best Article of Vol 14 issue 18.
A study by Shafaque M. et al. entitled \"A Case-Control Study Performed in Karachi on Inflammatory Markers by Ciprofloxacin and CoAmoxicillin in Patients with Chronic Suppurative Otitis Media\" is awarded Best Article of Vol 14 issue 17
A study by Ali Nawaz et al. entitled \"A Comparative Study of Tubeless versus Standard Percutaneous Nephrolithotomy (PCNL) \? A Randomized Controlled Study\" is awarded Best Article for Vol 14 issue 16.
A study by Singh R. et al. entitled \"A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)\" is awarded Best Article for Vol 14 issue 15
A Study by Humaira Tahir et al. entitled "Comparison of First Analgesic Demand after Major Surgeries of Obstetrics and Gynecology between Pre-Emptive Versus Intra-Operative Groups by Using Intravenous Paracetamol: A Cross-Sectional Study" is awarded Best Article for Vol 14 issue 14
A Study by Monica K. entitled "Risk Predictors for Lymphoma Development in Sjogren Syndrome - A Systematic Review" is awarded Best Article for Vol 14 issue 13
A Study by Mokhtar M Sh et al. entitled "Prevalence of Hospital Mortality of Critically Ill Elderly Patients" is awarded Best Article for Vol 14 issue 12
A Study by Vidya S. Bhat et al. entitled "Effect of an Indigenous Cleanser on the Microbial Biofilm on Acrylic Denture Base - A Pilot Study" is awarded Best Article for Vol 14 issue 11
A Study by Pandya S. et al. entitled "Acute and 28-Day Repeated Dose Subacute Toxicological Evaluation of Coroprotect Tablet in Rodents" is awarded Best Article for Vol 14 issue 10
A Study by Muhammad Zaki et al. entitled "Effect of Hemoglobin Level on the Severity of Acute Bronchiolitis in Children: A Case-Control Study" is awarded Best Article for Vol 14 issue 09
A Study by Vinita S & Ayushi S entitled "Role of Colour Doppler and Transvaginal Sonography for diagnosis of endometrial pathology in women presenting with Abnormal Uterine Bleeding" is awarded Best Article for Vol 14 issue 08
A Study by Prabhu A et al. entitled "Awareness of Common Eye Conditions among the ASHA (Accredited Social Health Activist) Workers in the Rural Communities of Udupi District- A Pilot Study" is awarded Best Article for Vol 14 issue 07
A Study by Divya MP et al. entitled "Non-Echoplanar Diffusion-Weighted Imaging and 3D Fiesta Magnetic Resonance Imaging Sequences with High Resolution Computed Tomography Temporal Bone in Assessment and Predicting the Outcome of Chronic Suppurative Otitis Media with Cholesteatoma" is awarded Best Article for Vol 14 issue 06
A Study by Zahoor Illahi Soomro et al. entitled "Functional Outcomes of Fracture Distal Radius after Fixation with Two Different Plates: A Retrospective Comparative Study" is awarded Best Article for Vol 14 issue 05
A Study by Ajai KG & Athira KN entitled "Patients’ Gratification Towards Service Delivery Among Government Hospitals with Particular Orientation Towards Primary Health Centres" is awarded Best Article for Vol 14 issue 04
A Study by Mbungu Mulaila AP et al. entitled "Ovarian Pregnancy in Kindu City, D.R. Congo - A Case Report" is awarded Best Article for Vol 14 issue 03
A Study by Maryam MJ et al. entitled "Evaluation Serum Chemerin and Visfatin Levels with Rheumatoid Arthritis: Possible Diagnostic Biomarkers" is awarded Best Article for Vol 14 issue 02
A Study by Shanthan KR et al. entitled "Comparison of Ultrasound Guided Versus Nerve Stimulator Guided Technique of Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries" is awarded Best Article for Vol 14 issue 01
A Study by Amol Sanap et al. entitled "The Outcome of Coxofemoral Bypass Using Cemented Bipolar Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fracture of Femur in a Rural Setup" is awarded Best Article Award of Vol 13 issue 24
A Study by Manoj KP et al. entitled "A Randomized Comparative Clinical Trial to Know the Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block Against Multimodal Analgesia for Postoperative Analgesia Following Caesarean Section" is awarded Best Article Award of Vol 13 issue 23
A Study by Karimova II et al. entitled "Changes in the Activity of Intestinal Carbohydrases in Alloxan-Induced Diabetic Rats and Their Correction with Prenalon" is awarded Best Article of Vol 13 issue 22
A Study by Ashish B Roge et al. entitled "Development, Validation of RP-HPLC Method and GC MS Analysis of Desloratadine HCL and It’s Degradation Products" is awarded Best Article of Vol 13 issue 21
A Study by Isha Gaurav et al. entitled "Association of ABO Blood Group with Oral Cancer and Precancer – A Case-control Study" is awarded Best Article for Vol 13 issue 20
A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

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


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


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