International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 12(20), October, 2020

Pages: 66-69

Date of Publication: 27-Oct-2020


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Role of C Reactive Protein in Acute Appendicitis: A Cross-Sectional Study

Author: Lamture Yeshwant Ramrao, Varsha Gajbhiye, Vikram Panjabrao Vaidya, Md. Jawed Akther, Mangesh Padmawar

Category: Healthcare

Abstract:Introduction: The diagnosis of acute appendicitis is still difficult and probably the commonest difficulty in the emergency surgical department. Raised levels of inflammatory markers like C reactive protein (CRP) in a clinically suspected case of acute appendicitis suggest early exploration. Appendicitis is an inflammatory process in the appendix. There is no confirmatory tool to detect this inflammation and its sequelae. C-reactive protein is synthesized in the liver in the response of any sort of insult to the body including inflammation lead to the rise of a level. Diagnostic accuracy of CRP is a more than ESR and leucocyte count in detecting inflammatory processes. Hence this study was conducted to know the significance of CRP to detect acute appendicitis. Material and Method: This Prospective cross-sectional study was inclusive of 100 Patients of acute appendicitis with no age bar. Subjected for appendicectomy and resected specimen for histopathological examination, CRP was measured before surgery. Result: C-reactive protein was raised in 62 out of 100 patients. The sensitivity and specificity of was 81.28% and 92.86% with negative and positive predictive values were 26.26% and 99.37% respectively. Higher levels of CRP more than 15/dl were suggestive of complicated appendicitis like perforation and gangrene. Conclusion: CRP is a valuable investigation in acute appendicitis. CRP is a valuable tool to rule out acute appendicitis and complications but its value to detect or diagnose acute appendicitis is low.

Keywords: Inflammation, Gangrenous appendicitis, Perforation, C reactive protein, Erythrocyte sedimentation rate

Full Text:

Introduction

The typical presentation of acute appendicitis was first-time described by Reginald Haber Fitz in the late seventeenth century. From that time, it was the most frequent presentation of emergency surgery patients. Around 6 % of the peoples will be affected by acute appendicitis during their lifetime; hence, very strong efforts are already delivered for correct identification of appendicitis and its treatment. Due to this, decreases the death rate and morbidity significantly even with complications. The detection of appendicitis sometimes a hard task, hence doubtful atypical patients need admission and repeated examinations. This can lead to delay in diagnosis ultimately affect to raise the possibility of complications1.
A negative appendectomy means a normal histopathology specimen. Various tools have been suggested to help in atypical cases to lower the negative appendectomy rates (NAR). Many scoring systems have been used to detect early acute appendicitis and its surgery. These scores are based on clinical findings and blood investigations. In all patients, but, a final diagnosis is only by histopathological examination of the appendix. Without removal, the diagnosis of acute appendicitis is not correct in most cases, and being bad in females than in males. 2.
C-reactive protein (CRP) is quite a routine laboratory test performed, to assess and identify the inflammatory process. But, the functions of CRP in normal health is not distinctly understood but increases its level by many folds during the event of insult to the body. Hence it is used as a tool to identify inflammatory disease process3.
Increased levels of C reactive protein (CRP) in a clinically suspected case of acute appendicitis suggest early exploration. C- reactive protein is synthesized in the liver in the response of any sort of insult to the body including inflammation lead to the rise of the level. Diagnostic accuracy of CRP is a more than ESR and leucocyte count in detecting inflammatory processes. Hence investigation like an estimation of CRP in suspected appendicitis may help to improve the diagnostic ability of clinician4.
Many studies have proved the role of CRP in increasing the accuracy of the diagnosis of acute appendicitis5,6. It is a more specific and a good parameter of inflammation than ESR and white cell count. The CRP levels rise faster than that of ESR and decrease quickly when the inflammation subsides. A false-negative test can get usually early in infective episodes
Birchley D in his study results stated that in suspected cases of acute appendicitis posted for surgery based on clinical examination total leucocyte count and granulocyte count differentiate acute appendicitis from normal appendices but do not suggest the presence of appendicular perforation or abscess. C-reactive protein not able to differentiate appendicitis from normal, but suggests the presence of appendicular abscess at higher levels only. A study conducted by Lateef et al.8 suggested that it is possible to get inflamed appendix even inflammatory markers not raised.
.Looking at this confusing scenario, we undertake this study to assess the significance of this inflammatory marker, CRP in a diagnosis of acute appendicitis.
Methodology

The present study was undertaken in the department of surgery, Jawaharlal Nehru Medical College, Wardha in collaboration with Datta Meghe Medical College Hingana, Nagpur, Datta Meghe Institute of medical science (DMIMS), Sawangi, Meghe, Wardha,
 Maharashtra India. This study was a prospective interventional. The duration of this study was from September 2019 to June 2020. The numbers of patients were 100.
Sample size- 100

Type of study (research design): Prospective cross-sectional study.

Period of study: September 2019 to June 2020

Inclusion criteria:

Clinically diagnosed cases of Acute Appendicitis.

Exclusion criteria:

•    Pregnancy

•    Appendicular lump.

•   Inflammatory Disease and connective tissue disorders like inflammatory bowel diseases or sickle cell disease
•    HIV positive,

•    Patients on corticosteroid therapy,

•    Patient of interval appendectomy

Data collection tools and process, variables, definitions, analysis plan:

Informed consent was obtained before enrollment. Approval of the institutional ethical committee was sought. After careful examination and appropriate imaging and blood investigations including estimation of CRP. The diagnosis of appendicitis was confirmed by a senior consultant. An appendectomy was performed and a specimen was sent for histopathological examination.
 The data analysis was done by using the SPSS 17.0 statistical software, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of CRP was calculated.
Ethical approval for the study was got from the Ethics committee of DMIMS University

Result:

Around 100 subjects were included in the study, consists of 60 males and 40 from the female gender. All patients were operated by the laparoscopic appendicectomy method(figure 1).


 

In the present study, we found the sensitivity and specificity of C-reactive protein  was 81.28% and 92.86% with negative and positive predictive values were 26.26% and 99.37% respectively ( Figure 2).
 

The present study, figure 1 & 2 suggest normal appendix in 32 patients out of 100 patients, 38 patients have catarrhal appendicitis, 16, 10 and 4 patients were diagnosed suppurative, gangrenous and perforated appendicitis respectively as per of histopathological examination.
Discussion

An inflammatory marker, C-reactive protein (CRP) studied in the present research. It is an important parameter to help in detecting acute appendicitis in an early course of this disease process. If it is normal, the diagnosis of appendicitis must be reconfirmed by repeated clinical examination reinforced with ultrasonography or diagnostic laparoscopy. The typical combination of three, a history, clinical examination, and CRP has a higher accuracy power to detect appendicitis in most of the patients 9.
In the present study, including more males than females (3:2), the sensitivity and specificity of C-reactive protein was 81.28% and 92.86% with negative and positive predictive values were 26.26% and 99.37% respectively (see fig. 1 and 2). In the present study, CRP was positive in 62 out of 100 patients. A study conducted by Giorgio Stefanutti et al10 proves that if CRP levels are normal in a child with even high clinical suspicion of acute
 
appendicitis, the presence of an inflamed appendix is extremely rare and re-examination with appropriate investigations are required before attempting removal of the appendix. Results of a study done by Giorgio Stefanutti et al.10 are similar to the present study.
In a present study, a high negative appendectomy rate of 32% was observed (see (figure 3) Wani et al2 also suggested a NAR of 20-40% has been documented and many surgeons consider a rate of 30% as inevitable. Removal of a normal appendix is an economic loss on both the patients and the hospital. Misdiagnosis and delay in surgery can lead to complications like perforation and finally peritonitis2.
The present study suggest normal appendix in 32 patients out of 100 patients, 38 patients have catarrhal appendicitis, 16, 10 and 4 patients were diagnosed suppurative, gangrenous and perforated appendicitis respectively as per of histopathological examination. All complicated appendicitis were associated with higher levels of CRP more than 15 mg /dl. Choudhary SK et al. suggested that CRP useful to correctly predict the severity of acute appendicitis. higher CRP has a high sensitivity for complications of acute appendicitis than specificity. He also suggests the cut off level at 6mg/dL requires to be used. If clinical presentations and imaging suggestive of appendicitis, a person with high CRP should undergo surgery urgently 4.
Alvarado A6 in his review article depicts that a few inflammatory parameters, alone or combined, do well to help the detection of acute appendicitis in the late stages. But, not superior to the clinical examination of patients suspected of acute appendicitis. The duration of pain and other symptoms easily suggest that whether the inflammatory process is early or late. Hence clinical examination has a higher place to do a correct diagnosis.
D Birchley et al.7 suggested that: ‘components of the history, clinical presentation and laboratory investigation are poor identifiers of acute appendicitis. But if combined, they provide high diagnostic ability.’ Hence it is wise to say that in combination, CRP has a raised diagnostic accuracy and more effective in helping a clinical diagnosis of acute appendicitis.
Very high levels of CRP either alone or coupled with raised TLC warrants mandatory explorations. The present study recommends that CRP should be done as a routine laboratory test in the doubtful diagnosis of acute appendicitis.
Conclusion

In conclusion, CRP is an important inflammatory marker in acute appendicitis. Because it is not specific, hence it has limitations. The simultaneous presence of other inflammatory disease processes, and the effect of non-inflammatory agents, like tobacco chewing and smoking, high body mass index, and psychological stress, decreases the correctness of CRP significantly. Because of these factors, clinical correlation with imaging is required in atypical cases., Hence CRP is a valuable tool to rule out acute appendicitis and complications but its value to detect or diagnose acute appendicitis is low.

References:

  1. Ahmed M et al. Appraisal of the modified Alvarado score for acute appendicitis in adults. Saudi Medical    Journal  2004; 25 (9): 1229-1231.

  2. Wani, M et al. Usefulness Of The Alvarado Scoring System Concerning Age, Sex And Time Of Presentation, With Regression Analysis Of Individual Parameters. The Internet Journal of Surgery.2007; 11(2).

  3. Chandrashekara S. C-reactive protein: An inflammatory marker with a specific role in physiology, pathology, and diagnosis. IJRCI. 2014;2(S1): SR3.

  1. Khairy G. et al. acute appendicitis: Is removal of a normal appendix still existing and can we reduce its rate? Saudi J Gastroenterol 2009; 15:167-70.

  2. Choudhary S et al. Diagnostic value of C-reactive protein as a predictor of complicated appendicitis like perforated/gangrenous appendicitis. Int Surg J 2019; 6:1761-6.

  3. Alvarado A. In?ammatory Markers in Acute Appendicitis: Are We Still Looking for the Philosopher’s Stone? J Surg, 2018; 02: JSUR-1104.

  4. Birchley D, Patients with clinical acute appendicitis should have pre-operative full blood count and c-reactive protein assays, Ann R Coll Surg Engl. 2006;88(1):27-32.

  5. Ibrahim, M et al. Ultrasonography in the Diagnosis of Clinically Equivocal Acute Appendicitis: A Prospective Study Kuwait Medical Journal 2003, 35 (3): 271-274

  6. Lateef A et al. Role of leucocyte count in the diagnosis of acute appendicitis, Gomal Journal of Medical Sciences. 2009, 7(2): 140-142.

  7. Stefanutti G et al. Inflammatory markers for acute appendicitis in children: Are they helpful? Journal of Paediatric Surgery. 2007; 42, 773–776

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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 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
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A Study by Pandya S. et al. entitled "Acute and 28-Day Repeated Dose Subacute Toxicological Evaluation of Coroprotect Tablet in Rodents" is awarded Best Article for Vol 14 issue 10
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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
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
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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
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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
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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
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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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