International Journal of Current Research and Review
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IJCRR - Vol 08 Issue 06, March, 2016

Pages: 22-29

Date of Publication: 22-Mar-2016


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BIOCHEMICAL ASSESSMENT OF HOMOCYSTEINE AND LIPID PROFILE IN PEDIATRIC STROKE: AN EGYPTIAN STUDY

Author: Tahia H. Saleem, Mohammed H. Hassan, Ahmed El-Abd Ahmed, Abdallah M. A.A. El-Ebidi, Heba M. Qubaisy, Omayma A. Hasan

Category: Healthcare

Abstract:Introduction: Stroke and cerebrovascular disorders are already amongst the top 10 causes of childhood death. Patients with homocysteinemia may present with vascular thrombotic events, with or without the traditional risk factors for a stroke. Objectives: The aim of this study was to measure plasma homocysteine levels and lipid profile (serum cholesterol, triglycerides, HDL and calculation of LDL) in pediatric patients with ischemic or hemorrhagic stroke. Assess the role of homocysteinemia as an associated risk factor in pediatric ischemic stroke. Correlate the results with the clinical data of the patients. Materials and Methods: Across-sectional case control study was carried out on 60 pediatric patients, divided into two groups: group A contained 30 pediatric patients with ischemic stroke and group B contained 30 pediatric patients with hemorrhagic stroke, they were recruited from outpatient clinics or admitted to PICU (pediatric intensive care unit) in Assiut university children hospital and Qena university hospital, Upper Egypt, after approval of the university hospital ethical committee. The control group \"group C\" contained 30 healthy age and sex matched subjects. Biochemical assay of plasma homocysteine and lipid profile among the previously mentioned groups were done. Results: The plasma homocysteine level showed statistically significantly higher levels among group A when compared with group B and group C (P-Value 0.0001). There was no significant difference in plasma homocysteine among group B when compared with group C (P-Value 0.9). Regarding the lipid profile assay in the studied groups, serum triglyceride level, cholesterol and low density lipoprotein (LDL) were significantly high among group A in comparison with group B and group C (P-Value< 0.0001), while high density lipoprotein (HDL) level was significantly low among group A in comparison with group B and group C( PValue< 0.0001). There was a positive correlation between plasma homocysteine level and both LDL and triglyceride levels while a negative correlation between plasma homocysteine level and HDL level. Conclusion: Elevated plasma homocysteine can be considered as an associated risk factor among pediatric patients with ischemic stroke that could be explained by its atherogenic and thrombotic effects. This was associated with hyperlipidemia.

Keywords: Homocysteine, Lipid profile, Pediatric stroke, Egyptian study

Full Text:

INTRODUCTION Stroke and cerebrovascular disorders are already amongst the top 10 causes of childhood death 1 . Considering the onset of impairment during childhood and the effect on quality of life for the child and family, the economic and emotional costs to society are amplified 2. There are two main types of stroke. Ischemic strokes are caused by a blockage in the blood supply to the brain. Hemorrhagic strokes occur when blood leaks from a burst blood vessel into the brain3 . The majority of signs and symptoms of stroke are nonspecific, and can be easily attributed to other causes. One way to avoid delays or misdiagnoses would be to identify risk factors for stroke that would prompt more aggressive and timely inves tigation. Multiple risk factors are often present in as many as 25% of children with stroke, which means further investigations are warranted even when one risk factor has been identified 4. Homocysteine (Hcy) is a sulfur containing amino acid. Hcy is formed through demethylation of methionine, which donates a methyl group in many biochemical reactions. It is metabolized through two enzymatic pathways; trans-sulfuration and remethylation, but not in all tissues. Vitamin B6 is important in Hcy trans-sulfuration, whereas folate and vitamin B12 play significant role in Hcy re-methylation5 .

Patients with homocysteinemia could be presented with vascular thrombotic events, in presence or absence of the traditional risk factors for the occurrence of a stroke. This group of patients may already have a history of strokes and myocardial infarctions in the third or fourth decade of life 6 . From a pathophysiologic point of view, homocysteinaemia is associated with atherogenesis and increased thrombogenicity 7 . Transient and chronic endoplasmic reticulum (ER) stress elicited by homocysteine has been shown to adversely affect several cellular functions involved in the development and progression of atherosclerosis, including lipid dysregulation, programmed cell death and inflammation8 . Both in animal models and humans, homocysteinaemia is characterized by platelet aggregation and formation of thrombi rich in platelets at the sites of injured endothelium. The increased risk of vascular thrombosis may be derived from the vascular oxidative injury and the modification of physiological antithrombotic mechanisms7 .

MATERIALS AND METHODS Study design: This study is across-sectional case control study and it was carried out on 60 children with CNS stroke (38 males and 22 females). This is in addition to 30 apparently healthy age and sex matched children. The study was carried out during the period from May 2014 to July 2015.Prior to initiation of the study; every subject was informed about the aim of the study and gave a written consent. They were recruited from outpatient clinics or admitted to PICU (Pediatric intensive care unit) in Assiut university children hospital and Qena university hospital, Upper Egypt, after approval of the university hospital ethical committee and according to the inclusion criteria that x old who presented with clinical history and signs suggestive of stroke and documented by brain C.T or M.R.I, the clinical signs included (neurological deficit e.g. hemiparesis, seizures, ataxia or altered levels of consciousness, manifestations of increased intracranial tension e.g. headache, projectile vomiting and blurred vision, signs of meningeal irritation e.g. neck rigidity, spinal rigidity, photophobia, headache, and positive Kernig’s sign and Brudzinski’s sign, cranial nerve affection e.g. ptosis (cranial nerve III affection), facial palsy(cranial nerve VII affection), or bulbar palsy (cranial nerve IX, X, XI, XII affection).The study was carried out during the period from May 2014 to July 2015. Prior to initiation of the study; every subject was informed about the aim of the study and gave a written consent.

Data collections: History taking for all included pediatric patients, including: Personal history/ Family History: age, sex, residence, history of consanguineous marriage among the patients’ parents. History of associated risk factors e.g. infection, diabetes mellitus, rheumatic heart disease, receiving certain drugs e.g. anticoagulant therapy, history of recurrence (recurrent stroke), history of having any metabolic disorders or collagen disease, epilepsy, history suggestive of disseminated intravascular coagulation “DIC”, history of vaso-occlussive crisis. Family history of early coronary heart disease. Thorough Clinical examination for: vital signs. Anthropometric measurement. Skin examination: purpuric eruptions, echemotic patches or abnormal rash. Cardiac examination: murmurs, arrhythmias, cardiomegaly. Neurological examination: level of consciousness assessed by Glasco coma scale (GCS), motor and sensory system examination, and cranial nerves examination. Radiological evaluation including Computed tomography (CT) was done to every patient.

Methodology: Two milliliters venous blood was drawn which were divided into: 1 ml on EDTA for assay of plasma homocysteine, 1 ml on plain tube for lipid profile assay, among the previously mentioned groups. Samples were centrifuged at 2000 rpm for 10 minutes. Serum and plasma were transferred into 1 ml cryotubes and stored at -20 0C for later analysis. Plasma homocysteine levels were measured according to the manufacture protocol using an enzyme-linked immune-sorbent (ELISA) assay kit, provided by Chongqing Biospes Co., Ltd. Paradise Walk, Jiangbei District, Chongqing, 400020, China. Standard curve for homocysteine was done (Figure 1). Serum lipids (HDL, triglycerides and total cholesterol) were measured according to the manufacture protocol using a spectrophotometric assay kit provided by BIOLABO SAS, Les Hautes Rives 02160, Maizy, France. The serum level of LDL cholesterol was determined by the Friedewald formula (9). Triglycerides

LDLc (mg/dl) = Total cholesterol - (------------------ + HDL).

Statistical analysis: Values are given as means ± SD, range, or as the number of patients and proportions. The chi square test was used to compare proportions. Correlation coefficients were used to describe associations between variables. P < 0.05 was considered significant. Analyses were performed using the SPSS software package (SPSS V 17 for Windows).

RESULTS Table 1 presents the demographic data of the studied cases: As regard sex, the ?/? ratio was 2:1 in group A, and 3:2 in group B. Age range for group A was 0.33-18 years (mean age 7.1±6.8 SD years), and for group B age range was 0.17-17 years (mean age 8.3±5.9 SD years). According to the age at presentation, we divided the patients included in the study into 4 groups. Regarding group A, the highest age groups were (above 12 years age group, and 1-<6 years age group, 33.33% for each) followed by (<1 year age group, 23.33%) and (6-<12 age group, 10%).

Regarding group B, the highest age group was (above 12 years age group, 36.67%) followed by (6-<12 age group, 26.67%), (<1 year age group, 23.33%) and (1-<6 years age group, 13.33%). The frequency distribution of the associated risk factors among patients of group A and group B are shown in table 2; among patients of group A, infection was the most common risk factor (36%), followed by dehydration (23%), history of recurrence (20%), rheumatic heart disease (13%), and diabetes mellitus (3%). Among patients of group B, infection was the most common risk factor (30%), followed by cerebral aneurysm (13%), thrombocytopenia (10%), and anticoagulant therapy (3%). Table 3 presents the frequency distribution of the main clinical findings of the studied cases; in group A, the most frequent presentation was hemiparesis which was present in (60%) of cases, followed by both convulsions and disturbed conscious level (40% each ), (27%), increased intracranial tension (17%), cranial nerve affection (7%), loss of vision (1%), and ataxia (1%). In group B, the most frequent presentation was disturbed conscious level which was present in (50%) of cases, followed by convulsions (47%), increased intracranial tension (40%), hemiparesis (33%), fever (23%), and meningeal signs (17%).

Table 4 showed frequency distribution of the final diagnostic CT brain findings; among group A: multiple infarctions was the most common diagnosis (23%), followed by right parietal infarction (20%), right temproparietal infarction (13%),parietal infarction and left temproparietal infarction (10% for each), left temproparietooccipital infarction ( 7%), right cerebellar infarction(3.5%), and the CT was not conclusive for diagnosis of stroke in 13% of patients and group B: intracranial hemorrhage was the most common diagnosis (33%), followed by subdural haematoma and intraventricular hemorrhage(20% for each), subarachnoid haemorrhage (13%), intracranial and intraventricular hemorrhages (7%), intracranial and subarachnoid hemorrhages (3.5%) and intraventricular and subarachnoid haemorrhages (3.5%).

Comparison between serum lipid profile and plasma homocysteine levels among the studied groups was done which revealed that; the plasma homocysteine level showed statistically significant higher levels among group A when compared with group B and group C (P-Value 0.0001). Regarding the lipid profile assay in the studied groups, serum triglyceride level, cholesterol and low density lipoprotein (LDL) were significantly high among group A in comparison with group B and group C (P-Value<0.0001), while high density lipoprotein (HDL) level was significantly low among group A in comparison with group B and group C (P-Value<0.0001) (Table 5). The correlation coefficient between plasma homocysteine level and serum lipid profile in ischemic stroke patients (Group A): There was a positive correlation between plasma homocysteine level and both LDL (r=0.34, p=0.03) and triglyceride levels(r=0. 4, p=0.01) while a negative correlation between plasma homocysteine level and HDL level (r= -0. 4, p=0.009) (Table 6). Figure 1 showed Standard curve for ELISA assay of human homocysteine concentration (y= 0. 2, R2 =0.9).

DISCUSSION Stroke is a neurological injury caused by the occlusion or rupture of cerebral blood vessels. Stroke can be ischemic, hemorrhagic, or both (10). In the present study, according to the age at presentation, regarding group A, the highest age group was above 12 years age group, and 1-<6 years age group, (33.33% for each). Regarding group B, the highest age group was (above 12 years age group, 36.67%) followed by (6-<12 age group, 26.67%) as shown in table-1.These findings were in agreement with Ogeng’o et al 11, Chung and Wong12 and Salih et al13. Regarding the frequency of the associated risk factors among patients of group A, infection was the most common risk factor (36%), followed by dehydration (23%). history of recurrent ischemic stroke (20%), rheumatic heart disease (13%), and diabetes mellitus (3%) as shown in table -2.While among patients of group B, infection was the most common risk factor (30%), followed by cerebral aneurysm (13%), thrombocytopenia (10%), and anticoagulant therapy (3%) as shown in table -2.

This is in agreement with Kalita et al 14 and Saima et al 15.As regard the main clinical findings of the studied cases, , the most frequent presentation among group A was hemiparesis which was present in (60%) of cases, followed by both convulsions and disturbed conscious level (40% for each), fever (27%), increased intracranial tension (17%), cranial nerve affection (7%), loss of vision (1%), and finally ataxia (1%). While the most frequent presentation among group B was disturbed conscious level which was present in (50%) of cases, followed by convulsions (47%), increased intracranial tension (40%), hemiparesis (33%), followed by fever (23%), and finally signs of meningeal irritation (17%) as shown in table-3. In agreement with these results, a study done by Salih et al 13 on Saudian children with stroke showed that hemiparesis/ hemiplegia was the most common presenting symptom. Another study was done by Parakh et al16 who evaluated the clinical profile of pediatric stroke in Western Rajasthan and found that disturbed conscious level and convulsions were most common presentations among pediatric patients with hemorrhagic stroke.

As regard the CT brain final diagnostic findings among group A patients involved in this study: multiple infarctions was the most common diagnosis (23%), followed by right parietal infarction (20%) as shown in table-4 and the CT was not conclusive for diagnosis in 4 patients (13%), for whom MRI brain was done and revealed that 3 patients (10%) had cerebral venous sinus thrombosis (CVST), and 1 patient (3.33%) had brain stem and cerebellar infarctions. While the CT brain final diagnostic findings among group B patients involved in this study: intracranial hemorrhage was the most common diagnosis (33%), followed by Subdural haematoma and intraventricular hemorrhage(20% for each) as shown in table -4. In agreement with these findings a study done by Ogeng’o et al 11 who found that more than half of cases had cortical lesions, distributed fronto-parietal (most common), followed by parietal, temporal, occipital and one frontal lesions. In the present study, the plasma homocysteine level showed a statistically significantly higher levels among group A (mean 5.1± 3.9 SD, μmol/L) when compared with group B (mean 1.9±1.3 SD, μmol/L) and group C (mean 1.9±0.9 SD, μmol/L), P-Value0.0001 as shown in table-5.

In agreement with these results, Vijaya et al 17, Ashjazadeh et al 18 and Naranget al 19, all of they found that levels of serum homocysteine were significantly higher in the cases with ischemic stroke than in the control group. Regarding the lipid profile in the studied groups, the present study showed that low density lipoprotein ( LDL) level was significantly high among group A (mean130.8±35.3 SD mg/dl) in comparison with group B (mean 107.6±31.8 SD, mg/dl) and group C (mean72±25.2 SD, mg/dl), PValue<0.0001. High density lipoprotein (HDL) level was significantly low among group A (mean 32.3±11.7 SD, mg/ dl) in comparison with group B (mean 38.1±7.2 SD, mg/dl) and group C (mean51.5±7.2 SD, mg/dl), P-Value<0.0001. Serum triglyceride level was significantly high among group A (mean 203± 75.2SD, mg/dl) in comparison with group B (mean 177.6±83.9 SD, mg/dl) and group C (mean 99.6±22.6 SD, mg/dl), P-Value<0.0001. Serum cholesterol level was significantly high among group A (mean 211.3± 34.4SD, mg/ dl) in comparison with group B (mean 174.3±41.9 SD, mg/ dl) and group C (mean 136±30 SD, mg/dl), P-Value<0.0001 as shown in table -5.

In agreement with these findings, a study done by Vijaya et al 17 who found that LDL level was significantly higher among ischemic stroke patients than controls. High density lipoprotein (HDL) level was significantly lower among ischemic stroke patients than controls. Serum triglyceride level was significantly higher among ischemic stroke patients than controls. Serum cholesterol level was significantly higher among ischemic stroke patients than controls. Another study done by García et al 20 who found that patients with ischemic stroke had significantly higher total cholesterol levels, low-density lipoprotein (LDL), and triglycerides than those in the control group. In the present study, among the ischemic stroke pediatric patients (group A), there was a positive correlation between plasma homocysteine level and LDL level, r was 0.34, and P-value was 0.03. Also, there was a positive correlation between plasma homocysteine level and triglyceride level, r was 0.4 and P-value was 0.01.But there was a negative correlation between plasma homocysteine level and HDL level, r was -0.4 and P-value was 0.009. There was no significant correlation between plasma homocysteine level and serum cholesterol level as shown in table -6. In agreement with these findings: A study done by Xiao et al 21 who found a negative correlation between homocysteine level and HDL and also in that there was no significant relation between homocysteine level and serum cholesterol level, but he found that there was no significant relation between homocysteine level and each of LDL level and triglyceride level. Also another study done by Elshorbagy et al 22 who found that there was a negative relation between homocysteine level and HDL, and a positive correlation between homocysteine level and serum cholesterol level. Also another study done by Elkhairy et al 23 who found that there was a positive correlation between homocysteine level and each of LDL, triglyceride level and serum cholesterol level.

CONCLUSION Elevated plasma homocysteine proved to be an associated risk factor among pediatric patients with ischemic stroke and this may explain the associated hyperlipidemia due to the atherogenic and thrombotic effect of high plasma homocysteine, so, plasma homocysteine assay should be routinely.done to any pediatric patients with ischemic stroke and folic acid, vitamin B6 and vitamin B12 therapy to those patients may have a beneficial effects, as they enhance the metabolism of homocysteine leading to lowering of its plasma level.

ACKNOWLEDGMENTS Authors would like to acknowledge the team work of the Metabolic and Genetic Disorders Unit- Faculty of MedicineAssiut University, where the laboratory work of this study has been done. Also, authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this research article. 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. Ethical approval: The Research Committee at Qena Faculty of Medicine, South Valley University approved this study (R. Nr. 10/01/015). Funding: This research was funded by Qena faculty of Medicine- South Valley University. Competing interests: The authors declare that they have no competing interests.

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3. Timothy J, Warren L and Mark T. Towards a consensus-based classification of childhood arterial ischemic stroke. Stroke 2012; 43:371-377.

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5. Djuric D, Jakovljevic V, Rasic-Markovic1 A, Djuric A, Stanojlovic O. Homocysteine, folic acid and coronary artery Disease: Possible Impact on Prognosis and Therapy. The Indian Journal of Chest Diseases and Allied Sciences 2008; 50: 39-48.

6. Richard E, Desviat L, Ugarte M, Pérez B. Oxidative stress and apoptosis in homocystinuria patients with genetic remethylation defects. J Cell Biochem 2013; 114(1):183-91.

7. Antoniades C, Alexios S. Antonopoulos, Dimitris T, Kyriakoula M, Christodoulos S. Homocysteine and coronary atherosclerosis: from folate fortification to the recent clinical trials. European Heart Journal 2009; 30: 6–15

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12. Chung B, Wong V. Pediatric stroke among Hong Kong Chinese subjects. Pediatrics 2004;114(2): 206–212.

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14. Kalita J, Goyal G, Misra U. Experience of pediatric stroke from a tertiary medical center in North India. Journal of the neurological sciences 2013; 325(1): 67-73.

15. Saima B, Gilani S, Shah S, Siddiqui T: Childhood strokes: epidemiology, clinical features and risk factors. J Ayub Med Coll Abbottabad 2011; 23(2): 69-71.

16. Parakh M, Arora V, Khilery B. A Prospective Study Evaluating the Clinical Profile of Pediatric Stroke in Western Rajasthan. Journal of Neurological Disorders 2014; 2 (6) :1-4.

17. Vijaya B, Vennela D, Suma P. Study of homocysteine, lipoprotein (a) and lipid profile in ischemic stroke. Sch. J. App. Med. Sci. 2014; 2(4):1247-1250.

18. Ashjazadeh N, Fathi M, ShariatA. Evaluation of homocysteine level as a risk factor among patients with ischemic stroke and its subtypes. Iranian journal of medical sciences 2013; 38(3): 233-9.

19. Narang A, Verma I, Kaur S, Narang A, Gupta S, Avasthi G . Homocysteine- Risk factor for ischemic stroke?Indian J PhysiolPharmacol 2009; 53(1): 34-8.

20. García S, Concepción O, Carriera R, Zuaznábar M. Association between Blood Lipids and Types of Stroke. MEDICC Review 2008; 10(2): 27-32.

21. Xiao Y, Zhang Y, Lv X, et al. Relationship between lipid profiles and plasma total homocysteine, cysteine and the risk of coronary artery disease in coronary angiographic subjects. Lipids in Health and Disease 2011; 10(137): 1476-511.

22. Elshorbagy A, Nurk E, Gjesdal C, Tell G, Ueland P, Nygård O, Refsum H. Homocysteine, cysteine, and body composition in the HordalandHomocysteine Study: does cysteine link amino acid and lipid metabolism?.The American journal of clinical nutrition 2008; 88(3): 738-746.

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

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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.

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‘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.


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

List of Awardees

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


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


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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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