International Journal of Current Research and Review
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IJCRR - 13(3), February, 2021

Pages: 33-42

Date of Publication: 03-Feb-2021


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Efficacy of Unani Formulation in Cervical Ectopy (Quruhal Rahim) - An Open Observational Study

Author: Shamim Ansari, Wajeeha Begum, Kouser Fathima Firdose

Category: Healthcare

Abstract:Introduction: Cervical ectopy (quruhal Rahim) is a benign and common gynaecological condition in India with 19% of the total population. About 80-85% of women suffer from Cervical Erosion. Cervical erosion is diagnosed by per speculum examination. Considering these facts methi, alsi,babuna, nakhuna, karamkalla, has been selected to evaluate the efficacy in the form of Abzan in Quruhal Rahim. Objective: To evaluate the efficacy of Abzan in Quruhal rahim with unani formulation. Methods: This is an open observational clinical study in clinically diagnosed woman (n=30) in the age group of 18-45 yrs having symptoms of vaginal discharge, normal or inflammatory changes in pap smear were included and patients with malignancy, Pelvic inflammatory disease, systemic illnesses & Sexually transmitted disease, oral contraceptive Pills and Intrauterine contraceptive device, pregnancy and lactation were excluded. Joshanda of methi 5gms, alsi 5gms, babuna 3gms, nakhuna 5gms, karmkalla 10 gms in 2 litres of warm water. After menses use daily one time for sitz bath for 15minuts for 21 days. The primary and secondary outcome was assessed. Cervical ectopy by arbitrary grading scale and SF-12 for Quality of life were health-related quality of the life is measured by SF-12 Questionnaire. To provide easily interpretable scales for physical and mental health. Results: Vaginal discharge mean score before and after treatment is 2.37\?0.57 and0.367\?0.49 respectively with p< 0.0001. In cervical erosion, grading means score before and after treatment is 1.7\?0.65 and 0.47\?0.58 respectively with a p< 0.0001. Highly significant improvement is found in subjective and objective parameters. Conclusion: This data suggests that the test drugs were safe, effective in improving and relieving symptoms of cervical erosion. Further, research in a larger sample size for longer duration is recommended.

Keywords: Quruhalrahim, Cervical ectopy, Abzan, Arbitrary grading scale, SF-12 for QOL, Vaginal discharge

Full Text:

INTRODUCTION

Cervical erosion is also known as cervical ectopy. It is a benign lesion and a common gynaecological condition seen in outpatient departments.1,2 About 80-85% of women suffer from cervical erosion.3 It is the commonest finding in routine pelvic examinations during the fertile age group 1.1 Pathologically cervical erosion is a condition where squamous epithelium of the ectocervix is replaced by the columnar epithelium of the endocervix.3 The exposed columnar epithelium looks red because of the blood vessels just below the surface.4 A single layer of glandular cells that reside in close association with the underlying vascular cervical stroma appear. It is thin and vascularized epithelium fragile tissue. With easy access to the blood and lymphatic systems, there are decreased mucosal barriers to sexually transmitted infections (STIs), including HIV. Prior observational epidemiological studies have suggested that cervical ectopy can increase the risk of acquiring diseases like chlamydia trachomatis, human papillomavirus, and cytomegalovirus, but not Neisseria gonorrhoea.5

The common causes of ectopy are trauma by multiple childbirths, tampon use of intrauterine contraceptive device chemicals, infections, hormones (oral contraceptive pills) or carcinoma etc. Cervical ectopy is more common in women of lower socioeconomic groups, poor general hygiene, early marriage and multiple pregnancies.6 Clinically, the patient may present with vaginal discharge, low backache, contact bleeding in the form of post-coital bleeding or intermenstrual bleeding, dyspareunia, etc.7 Cervical erosion is diagnosed by per speculum examination. It reveals a bright red area surrounding and extending beyond the external os in the ectocervix. The outer edge is demarcated. It may be smooth or having small papillary folds. It is neither tender nor bleeds to touch.7 It is asymptomatic and physiological then needs no treatment but when it is symptomatic and infected then the treatment is needed.3,7 Cryo-cauterization, electrocoagulation and cautery with laser is the treatment of choice.  Side effects like prolonged excessive mucoid discharge per vagina, seldom cervical stenosis, accidental burns, bleeding and recurrence are associated with this treatment.6 In classical Unani literature which is caused by external factors such as wound due to trauma, instrumentation, the drug which is caused by external  factors such as  wounds  due  to trauma, instrumentation, drug-induced i.e use of  haad drugs in the form of  humool, or internal factors  like difficult labour or mismanagement  of labour, sometimes, it may be because of acute yellow bile causing gradual erosion of cervix due to its acute  nature or inflammation and rupture of pustules.8,9 In symptoms like backache, pelvic pain, abnormal vaginal discharge, excessive tiredness etc. Use of (relaxant) drugs is harmful while qabiz  (astringent) drugs are beneficial in its treatment.8-10

Unani system of medicine has several drugs available for healing of cervical ectopy as a local treatment in the form of a sit bath, which is safe and cost-effective. In present study research drug comprises of Methi (Trigonella foenum graeceum) 5 gms, alsi (Linum usitatissimum) 5gms, babuna (Matricaria chaemomilla) 3gms, nakhuna ((Trigonella uncata) 5gms, karmkalla ka dant’hal (Brassica oleracea)10 gms  Joshanda is prepared in 2 lots of warm water. After menses use daily one-time forsitz bath for 15minuts for 21 days.11 In unani system of medicine various drugs with medicinal properties like munzij, muhallilawram (anti-inflammatory), jaali (detergent), muqawiebadan, mushil ( laxative), mujaffif, mudammilquruh, dafi-i-taffun, mullayan, mussakinetc are used locally to treat this disease.

Materials and Methods

Study design:  An open observational study.

Study duration: One and a half years from March 2019 to January 2020

Study centre: OBG Dept. National Institute of Unani Medicine Hospital, Bangalore.

Sample size:  30 patients

Ethical clearance No.: Ethical clearance was obtained from the institutional ethical committee vide no NIUM/ IEC/2017-18/013/ANQ/05; and CTRI registration done vide no.CTRI//2019/03/024426.

Informed consent: all participants gave written informed consent before study

Drugs Identification: was done at FRLHT Bengaluru. with an acc. No. 5510-5514

Participants: Total 60 patients were screened for the study, 10 patients refused participation and 20 patients didn’t meet the inclusion criteria, hence were excluded. 30 patients were allocated in- an open observational study.

Selection criteria: Married women between the age group of 18-45 yrs.  Having symptoms of vaginal discharge, low backache, dyspareunia, post-coital bleeding, normal or inflammatory changes in pap smear were included and patients with malignancy, PID, systemic illnesses like Hypertension, diabetes mellitus & STIs, OC Pills and IUCD’s, pregnancy and lactation were excluded.

Study procedure: The patients fulfilling the inclusion criteria were enrolled after explaining the study in detail and receiving informed consent. In each patient, history was evaluated and a complete physical examination including breast, abdominal examination and per vaginal examination was performed. Personal details, history, clinical features and investigations were recorded in the Case record form structured for the study.

Criteria for selection of drug: the research drug possess properties like muhallilewaram, mujaffif, mudammilequruh, dafi-i- ta’ffun,qabid, musakkin, 12-17 properties. Moreover, pharmacological studies show that research drug exhibit anti microbial, anti-inflammatory, anti oxidant, anti-cancer, anti-ulcer, analgesic, hepatoprotective wound healing activities., 13,14,18-20,  Further methi, alsi, nakhoona, baboona, karamkallacontains flavonoids, saponins (glycosides), alkaloids (terpenoids, steroids) arachidonic acid, ethanol, histamine, leukotriens, polysaccharides, saponins (glycosides), carbohydrates, tannins, triglisoraletc; 13,14,18, which are considered as the active principle of anti-ulcer activity. Flavonoids are a group of a polyphenolic compound having anti-ulcerogenic, anti-inflammatory, anti-bacterial, antioxidants properties4 which provide strength to the mucosal barrier & promote the ulcer to heal fast. 20The wound healing activity of Unani formulation as abzan might protect against microbial invasion by providing better tissue formation. Further, it enhances the rate of wound healing & tissue epithelization4 Thus, research Unani formulation is anticipated to be effective in the healing of cervical ectopy and relieving the associated symptoms.

Method of preparation

The best quality of methi, alsi, babuna, nakhuna, and karmkalla was provided by the pharmacy of NIUM, and was further authenticated by FRLHT Bengaluru. with an acc. No. 5510-5514. All the drugs were finely powdered. Drugs were weighed and mixed. The powdered drugs were dispatched in plastic self-lock bags. To avoid any confusion regarding dosages one lock bag was used to dispatch 28gm of the drug for a single day which was to be used daily for one measure for sitz bath. So every patient was given 7 packets of the drug for one week at each visit and continued for 3 weeks.

Route of administration: Locally

Initial assessment and laboratory screening

  1. Baseline Laboratory investigations like haemoglobin percentage, total leucocyte count, differential leucocyte count, erythrocyte sedimentation rate, Veneral Disease Research Laboratories test and random blood sugar were done to exclude general diseases. Ultrasonography of pelvis was done to exclude pelvic pathology. Pap smear was done to exclude genital malignancy in each case.

  2. Assessment of the extent of erosion was graded as 0, 1, 2 and3; as follows. Grade 0: No erosion Grade 1: covering 1/3rdof cervix Grade 2: from 1/3rd to 2/3rd area of the cervix, and Grade 3: overs 2/3rd of the cervix. The assessment was done before treatment, at .each follow up during treatment and after treatment. Patients were also enquired for any side effects during the trial.

  3. Assessment of Health-related quality of life (HRQol) was assessed by the SF-12 questionnaire.

  4.  Assessment of low backache is done by using the Visual Analogue Scale (VAS)

  5. Assessment of vaginal discharge was graded from 0 to 4 grade: score: 1-No discharge; 2- Mild ( No staining or moistness of undergarments); 3-Moderate (stain on undergarments); Score:4- severe (using pads).

  6. Dyspareunia and post-coital bleeding were based on the arbitrary four-point scale (0= None,1=Mild,2= Moderate, 3= Severe ).

Treatment was subsequently started in patients fulfilling the inclusion criteria.

Intervention

Joshanda of methi (Trigonella foenum graceum) 5gms, alsi (Linum usitatissium graceum) 5gms, babuna (Matricaria chaemomilla) 3gms, nakhuna (Trigonella uncata) 5gms, karmkalla ka danthal (Brassica oleracea) 10gms was prepared by soaking the drugs in 400ml of water for the whole night. Next day in the morning the soaked drugs with water was boiled until it was concentrated to 180 ml.  Abzan were prepared according to the standard method of preparation. It was used for 15minuts daily for 21 days after menses. Assessment of erosion and health-related quality of life (HRQol) was done at baseline, each follow up during treatment (weekly) and after treatment (once in 15 days for a month). Patients were also enquired for any side effects during the trial. Patients were advised to maintain personal hygiene and avoid intercourse during the treatment.

Subjective parameters

Vaginal discharge, low backache, contact bleeding, dyspareunia

Objective parameters:

  • Changes in Cervical ectopy assessed by the arbitrary grading scale

(Direct visual assessment of the appearance of cervix, healing of erosion and vaginal discharge).

  • SF-12  score to assess for QOL

Outcome measures:

Primary outcome measure: changes in white discharge and low backache.

Secondary outcome measure: Improvement in cervical ectopy grading and SF-12 (12 items short-form survey) Health Questionnaire score ( Figure 1).

Statistical analysis

Descriptive and inferential statistical analysis has been carried out in the present study. Results on continuous measurements are presented on Mean ± SD (Min-Max) and results on categorical measurements are presented in Number (%). Significance is assessed at 5 % level of significance. The Statistical software namely SPSS 22.0, and R environment ver.3.2.2 were used for the analysis of the data and Microsoft Word and Excel have been used to generate graphs, tables etc.22,23

RESULTS and Discussion

Demographic characteristics

Age: Majority of the patients (63.3%) were in the age group of 31-40 years & remaining 30% were in 21-30 years and 6.7% in 41-50 years of age. Hashmi et al24, Mirza et al25, Patil et al 26 and Latafat et al.27 40% and 44% in two groups in 31-35 yrs, reported 39.2% in 31-40 yrs., reported 40% &37.8% in 26-30 yrs. respectively. The result of present study correlates with the above studies. Evidence suggests that cervical ectopy is common in women of reproductive age group.4,7 Mean±SD of age of patients was 33.93±5.37, which is in accordance with the study of Jindal et al.2 who reported 31.32 and 33.7 in two groups, Al- Kaseer reported28 27.1 ± 5.9, Cekmez et al.29 reported 34.4±4.3.

Socioeconomic status: In present study, 23.3% patients belongs to upper middle class, 63.3% to lower middle class; and 13% to lower class. Hashmi S et al.24 reported 43.3% patients in upper lower, 36.6% in upper middle, 16.6% in lower middle and 13.3% in lower class. Mirza et al.25 reported  42.2% patients in upper lower class, 40% in lower middle, 11.1% in upper middle & 6.7% in upper class. Shivanna et al. 30 reported 72% and 75% patients respectively from low Socioeconomic status. Gautam et al.31 reported majority of the patients belong to lower middle class. Bengal et al.32 reported that maximum patients having cervical ectopy belong to low socioeconomic class, low literacy level, poor personal hygiene and poor health awareness. Literature report says that low socio economic status predispose to poor nutrition, poor personal hygiene leading to infection which may cause cervical ectopy.32,33

Literary status: Most of the patients had low educational level i.e.; 36.7% patients had primary school education, while 13.3% were illiterate, 23% & 16.7% had education up to secondary and higher secondary school while graduate and post graduate are 6.7% and 3.3 % respectively. Mirza et al.25 reported 20% illiterate, 33.3% had middle school education, 10% each in primary school and high school & 13.3% graduate. Hashmi S et al.24 reported 44.44% illiterate, 20% had middle school education & 13.3% had education in each primary, secondary and higher secondary. Gautam et al.31reported 40% of the patients had high school education. Al-Kaseer et al.28 reported low educational level among patients of cervical ectopy.

Occupation: In this study house wife are more affected than the working class. Out of 30 patients 73.3% of patients are of house wife affected with cervical erosions where as 26.7% are working women.

Dietetic habit:  In this study out of 30, 20 (66.7%) patients are of mix diet. Whereas 10 (33.3 %) are vegetarian.  In Unani system of medicine importance has been given to dietetics in health and disease.34 Unani physicians mentioned certain foods which are to be taken and to be avoided according to age, season, place, and mizaj of the person. The temperament of meat is har, when consumed in excessive quantity; it causes increase production of khilte dam, and can lead to amrazedamvi. As, mentioned earlier that cervical erosion with cervicitis  is a damvi marz,35 it may be assessed that non vegetarian diet has its impact on this disease as per the mizaj and akhlat theory.

Mizaj: Most of the patients, 86.7 % possessed damwimizaj, while 13.3% had balghamimizaj, none of the patients had safrawi or saudawimizaj, which is in consonance with the studies of Hashmi et al.24 reported 66.67 % patients with damwimizaj, Mirza et al.25 reported 53.3% with damwimizaj. Moreover, it coincides well with the theories of eminent Unani Scholars in etiopathogenesis of quruh, who states that hararat and ratubat are essential component of ufunat which forms an inflammatory swelling and when it get secondarily infected, it result in rupture of this swelling which in turn leads to ulcer formation.10,36.

Subjective parameters

Vaginal discharge: At baseline, all patients were complaining of vaginal discharge. During treatment, on 1st & 2nd follow up, it persists in 96.3% and was absent in 3.3% patients respectively. After treatment, it persists in 36.7% with mild discharge. & was absent in 63.3%.At baseline, vaginal discharge was mild, moderate & severe in 3.3%, 56.7% & 40% patients respectively. During treatment, on 1st follow up vaginal discharge was mild & moderate and severe in 3.3% , 70%  and 26.7% patients respectively, whereas none of the patients had severe vaginal discharge; on 2nd follow up, vaginal discharge was not present in 3.3% and 26.7% and 70% patients had mild and moderate vaginal discharge respectively. After treatment, vaginal discharge was mild in 36.7% & absent in 63.3% patients, though no patient had moderate and severe vaginal discharge. After treatment, vaginal discharge  with mean of 2.37±0.57  and 0.367±0.49 before and after intervention with P<0.001, considered as highly significant, which is consistent with the study of Gupta P et al.,37 Monroy OL38 & Anees S, 39 studies who reported vaginal discharge in 100% patients before treatment and relief in 86.6% after treatment. Cekmez Y et al.29reported vaginal discharge in 91.9% patients with complete relief in 89.5%.Kamini D3 reported 93.45% and Hashmi S et al.24reported 100% improvement in vaginal discharge. Moreover, research drug possess muhallilewaram, daffi-i- tafun, anti-microbial, anti-fungal, anti-viral activities, which might resolve the inflammation after removing the infection and thus improves the vaginal discharge (Table 2).14,16,17,19,40-43

The unani formulation was most successful in managing white discharge as all 30 patients presenting with vaginal discharge were having no discharge after the treatment. Other associated symptoms of cervicitis like low backache, lower abdominal pain, and dyspareunia were significantly relieved. Pharmacological studies reported that methi, alsi, babuna, nakhunaand karamkalla12 are proved for antimicrobial effect that may have inhibit the growth of organism and also these drugs are having anti-inflammatory property.,18,40,45 The improvement in these symptoms is most probably because of the effect of the test drugs having musaffikhoon, muhallil, dafetaffun, qabiz, mujaffifqurooh properties and baridwayabismiz.46 As discussed earlier in etio-pathogenesis zoefequwateghazia is one of the main causes of saylanurrahim that leads to this disease and baridwayabismizaj of drugs tone up the quwateghazia of rahim10 and thereby rectifying the quality and quantity of khilte dam. Further, astringent drugs have been reported to decrease the secretions, which may have inhibitory effect.

Low backache: After treatment, compared to baseline low backache was relieves in 90% patients with mean of 1.93±0.37 and 0.1±0.36 before and after intervention respectively, with P<0.0001 considered as highly significant. Anees39 reported 100% patient’s with complaining of low back pain and relief in 66.7%. Mirza et al25 reported 53.3%, Hashmi et al.24 reported 30%, Kamini3 reported 64 %, and Al-Kaseer et al.28 reported 65% improvement in low backache. low backache at baseline, after treatment was nil, mild, moderate, and severe, ie 90%, 10%,0%,0% respectively with P<0.001, considered as highly significant, which is in accordance with the studies of Kamini et al.3 reported1.26±0.4 and 0.46±0.4, Sharma et al.44reported 1.90±0.60 and 0.95±0.60 & Gautam et al.31reported 1.12±0.169 and 0.75±0.619 as Mean ±SD of low backache before and after treatment. Moreover, research drug possess muhallilewaram, musakkin, anti-inflammatory, analgesic, sedative activities which might resolve the inflammation and hence improves low backache (Table 3).14,16,17,19,40-43

Dyspareunia: Dyspareunia in 70% of patients with mild and moderate 46.7% and 23.4% respectively was observed. Whereas 30% of patients are free of dyspareunia. In first follow-up of treatment 36.7% are free with dyspareunia in mild and 20%in moderate dyspareunia patients. Where as in second follow up 46.7% patients were free of dyspareunia where as 53.3% were having mild dyspareunia. Where as in third follow up it is improved to 80% with dyspareunia  free and 20% with mild Dyspareunia. The mean is 0.93±0.734and 0.03±0.18 before and after treatment respectively with p<0.0001 which is highly significant. After treatment 96.7% patients are free of this symptom with a % difference of 66.7, and 3.3% with mild dyspareunia with a% difference of -43.4 (Table 4).

Contact bleeding: In this study out of 30 patients 25 (83.4%) had contact bleeding. with mild in 14(46.7%), moderate in 9 (30%) and severe in 2 (6.7%) patients. In first follow up of treatment one severe case of contact bleeding responded well. Where as in second follow up 43.3% are free of contact bleeding. Whereas 46.7% had mild type and 6.7% had moderate and 3.3% has severe contact bleeding. In third follow up 70% got relieved totally from contact bleeding and only 26.7% had mild contact bleeding and 3.3% had moderate bleeding in patients of cervical erosion.  The mean is 1.27±0.83 and 0.03±0.18 before and after intervention with p<0.0001 which is highly significant. After treatment 96.7% of patients are free of contact bleeding and 3.3 % with mild contact bleeding. This show the effect of abzan of unani formulation as mentioned in unani literature (Table 5).

Objective parameters

Cervical ectopy grading: At base line, cervical ectopy was observed in 100% patients, which remains in 43.3% patients after treatment. Cervical ectopy was in grade I in 40% patients, grade II in 50% & grade III in 10%; during treatment, After treatment, on 1st follow up, 40% patients had cervical ectopy in grade I, 3.3% in grade II and none of the patient had cervical ectopy in grade III; Thus, cervical ectopy was reduced in 43.3% and cured in 56.7% patients with P=0.0054, considered as highly significant. The mean is 1.7±0.66 and 0.47±0.58 before and after intervention with p<0.0001 which is highly significant. Shivana et al.30 reported healing of cervical ectopy in 60% patients after 7 days, 30% after 14 days and 10% after 21 days of treatment. Sharma et al.44 reported improvement in 65.85% patients, Cekmez et al.29 reported in 95.9% patients after 6 weeks. Gautam et al31reported improvement in 53.4%patientsafter 7days. Hence, complete healing of cervical ectopy as observed in 20% patients only after 2 weeks of treatment. Moreover, research drug possess mussakin, muhallil- i- auram mullayan, mujaffif, mudammillequruh, qabid, antiulcer, antioxidant & wound healing activities, which might be helpful in healing of cervical erosion (Table 6).14,16,17,19,40-43

QOL by SF-12 score: Cervical erosion with its symptoms has a broad impact on HRQoL and puts a heavy economic burden on society.47 The mean± SD before intervention was 382.73± 52.33 and after it was 910.17±56.30 with  mean difference 0f 910.17 and p value <0.0001. It shows strongly significant improvement in the quality of life (Table.7).

Primary outcome measures

Vaginal discharge: the mean of vaginal discharge before and after treatment is 2.37±0.57and 0.37±0.49 respectively with a P<0001. Improvement in vaginal discharge was nted in 90% patients; while it persist in 10% patients after 2 weeks of treatment; Anees S31reported 86.6% after 1 week, Jindal M 2 reported 100% and 92% in two groups after 4-6weeks of treatment (Table 8).

Low backache: The mean± sd of low back ache before intervention was 1.93±0.37and after it was 0.1±0.36 with mean difference 0f 90.0% and p value <0.0001. Absence of low back ache was noted in 90% patients, where it was in mild in 10% of patients after 3 weeks of treatment, which correlating with the study of Jindal M 2 reported relief in 96% & 76% in two groups after 4-6weeks of treatment (Table 8).

Dyspareunia: The mean is 0.93±0.74and 0.03±0.18 before and after treatment respectively with p<0.0001 which is highly significant. This study shows dyspareunia is absent in the 96.7% of patients with mild in 3.3%.. In first follow-up of treatment 36.7% are free with dyspareunia 43.3 in mild and 20%in moderate had dyspareunia.  Where as in second follow up 46.7% patients were free of dyspareunia where as 53.3% were having only mild dyspareunia.  In third follow up in80% were dyspareunia free and 20% with mild Dyspareunia. After treatment 96.7% patients are free of this symptom with a % difference of 66.7, and 3.3% with mild dyspareunia with a% difference of -43.4. It show that unani formulation having muhallileawram, jail, mussakinealam etc. properties helps in relieving pain (Table 8).

Contact bleeding: The mean is 1.27±0.83 and 0.03±0.18 before and after intervention with p<0.0001 which is highly significant. In this study patients with contact bleeding, mild in 14(46.7%), moderate in 9(30%) and severe in 2(6.7%) patients. In first follow up of treatment one severe case of contact bleeding responded well. In second follow up43.3% are free of contact bleeding. Whereas 46.7% had mild type and 6.7% had moderate and 3.3% has severe contact bleeding. In third follow up 70% got relieved totally from contact bleeding and only 26.7% had mild contact bleeding and 3.3% had moderate bleeding. After treatment 96.7% of patients are free of contact bleeding and 3.3 % are with mild contact bleeding with % difference of 80.0% (Table 8). This show the effect of abzan of unani formulation as mentioned in unani literature.

Secondary outcome measure

Cervical ectopy grading: complete healing of cervical ectopy was observed in56.7% patients & no improvement in 43.3% patients after 3 weeks of treatment. The mean is 1.7±0.65 and 0.47±0.58 before and after intervention with p<0.0001 which is highly significant. Hashmi S et al.24 reported cure in 26.66% patients after 9 weeks of treatment. Shivanna S et al.30 reported in 60% patients after 1week and in 40% after 3 weeks of local application of albothyl solution. Jindal M et al.2 reported 92% & 76% respectively in two groups (electro cautery/ cryocautery) after 4-6weeks. Cekmez et al.29reported in 95.9% patients after 6 weeks of cryocautery (Table 8).

QOL by SF-12 score: The eight domains of SF-12 measures are as follows: physical functioning role: role limitations due to physical health, role limitation due to emotional problems, energy /fatigue, emotional wellbeing social functioning, pain general health.47The mean± sd before intervention was 382.73± 52.33 and after it was 910.17±56.30 with  mean difference 0f 910.17 and p value <0.0001. It shows strongly significant improvement in the quality of life. Cervical erosion with its symptoms has a broad impact on HRQoL and puts a heavy economic burden on society (Table 7). Hence the unani formulation makes a strongly significant change in SF-12 score hence improvement in quality of life (Table 8).

Discussion

The present study entitled “Efficacy of Abzan with Unani formulation in Quruhal Rahim - An open observational study” was effective in the healing of cervical erosion and relieving the symptoms. In the present study, it was demonstrated that complete healing of cervical ectopy was achieved in 56.7% of patients with mean of 1.7±0.66 & 0.47±.57before and after respectively. Vaginal discharge was improved in 63.3% patients with mean of 2.37±0.56 and 0.37±0after treatment respectively (Table 1 and 2). While it persists in mild form in 36.7%. Low backache was relieved in 90% patients, and remains 10% in mild form, with mean of 1.93±0.37 and 0.1±0.36 (Table 3).  Highly significant improvement in vaginal discharge and low backache was might be due to healing of cervical ectopy, which cause relief in these symptoms. No adverse effect of research unani formulation was reported during the study.

              Hence, marked improvement in outcome measures with just 3 weeks of intervention with research unani formulation as topical application was due to the effect of research drug which possess muhallilewaram, mujaffif, mudammilequruh, dafi-i-ta’ffun, qabid, musakkin, 12,13,14,15,16,17  properties. Moreover, pharmacological studies shows that research drug exhibit anti microbial, anti-inflammatory, anti oxidant, anti cancer, anti ulcer, analgesic, hepato protective wound healing activities.13,14,18,19,20 Further methi, alsi, nakhoona, baboona, karamkalla contains flavonoids, saponins (glycosides), alkaloids (terpenoids, steroids) arachidonic acid, ethnol,histamine, leukotriens, polysachorides, saponins (glycosides), carbohydrates, tannins, triglisoraletc,13,14 which are considered as the active principle of anti ulcer activity. Flavonoids are group of polyphenolic compound having anti ulcerogenic, anti inflammatory, anti bacterial, antioxidants properties4 which provide strength to the mucosal barrier & promote the ulcer to heal fast.21 The wound healing activity of unani formulation as abzan might protect against microbial invasion by providing better tissue formation. Further, the it enhance the rate of wound healing & tissue epithelization.4

Thus, research unani formulation was effective in healing of cervical ectopy and relieving the associated symptoms. Moreover, significant improvement would be expected if duration of treatment was at least 6-8 weeks. Hence, it can be inferred that research unani formulation shows potent wound healing action, the recovery of wound might be due to the presence of chemical constituents which might favored wound healing action. Hence, it serves as an effective alternative in patients with cervical ectopy, particularly in those patients who are either not willing for cryotherapy or in whom cryotherapy is contraindicated.

This study was first of its kind; where treatment was given as abzan form which directly affects the eroded cervical area. However, small sample size, short duration of intervention, short follow up, colposcopy was not done during the study are some limitations.

Future recommendation:

  • Use of research unani formulation as abzan for longer duration (6-8 weeks) on large number of patients with long follow up for better therapeutic outcome.

  • To conduct RCT’s with abzan of research formulation with standard treatment i.e.r electrocautery or cryo cautery.

  • Future trial with use of this research formulation in patients with abnormal cervical cytology or Cervical intraepithelial neoplasia

Conclusion

It can be inferred that Abzan of unani formulation is effective in healing of cervical erosion and the inflammatory response due to associated cervicitis. It was found to be safe drugs when used as abzan for 21 days. Thus, the formulation may be effective and safe for the management of cervical ectopy.  Hence, it serves as an effective alternative in patients with cervical erosion.

Acknowledgement: We are thankful to the Director, National Institute of Unani Medicine, India for providing all the facilities required for the completion of research work and Dr. K. P. Suresh, Biostatician and Scientist, National Institute of Veterinary Epidemiology and Disease informatics (NIVEDI) for performing the statistical analysis.

Conflict of interest: None

References:

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  2. Jindal M, Kaur S, Sharma S, Gupta KB, Pandotra P. What is better: cryocautery or electrocautery for cervical erosion? Int J Reprod Contracept Obstet Gynecol 2014; 3(3):715-719.

  3. Kamini D, Meena.P. Kampillakadighrita in Garbhashaya Greeva Gata Vrana (Cervical Erosion). IJARP 2012;3(2):203-209.

  4. Solanki SK, Sharma S. Role of  Kshara  Karma in the  Management of  Cervical Erosion. Ayurpharm Int J Ayur Alli Sci 2016;5(6):77-82.

  5. Kartik K, Venkatesh, Uvin S. Assessing the relationship between cervical ectopy and HIV susceptibility: implications for HIV prevention in women. Am J Reprod Immunol 2013;69:68-73.

  6. Yogesh M, Hetal B, Shachi P. Effect of Udumber-Sar in Garbhashaya Grivamukhagata Vrana (Cervical erosion)- A case study. IJAAR GAU J. Int J Appl Ayur Res 2017 Oct;3(4):781-784.

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  8. Khan A. Al Akseer (Urdu trans. by Kabeeruddin). 1sted. New Delhi: Idarae Kitabul Shifa; 2011:788-90.

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  10. Ibn Sina. Al Qanoon Fil Tib (Urdu trans. by Kantoori GH).Vol ΙΙΙ. New Delhi: Idarae Kitabul Shifa; 2010:1092,125-126.

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  13. Swaroop A, Jaipuriar AS, Gupta SK, Bagchi M, Kumar P, Preuss HG, et al. Efficacy of a novel fenugreek seed extract (Trigonellafoenum-graecum, FurocystTM) in polycystic ovary syndrome (PCOS). Int J Med Sci 2015;12(10):825.

  14. Umer KH, Zeenat F, Ahmad W, Ahmad I, Khan AV. Therapeutics, phytochemistry and pharmacology of Alsi (Linumusitatissimum Linn): An important Unani drug. J Pharmacog Phytochem 2017;6(5):377-383.

  15. Khan ZJ, Khan NA, Naseem I, Nami SA. Therapeutics, phytochemistry and pharmacology of Tukhm-e-Katan (Linumusitatissimum L.). Int J Adv Pharm Med Bioallied Sci 2017; 2017:1-

  16. Rashid N, Dar PA, Ahmad HN, Rather SA. Alsi (Linum Usitatissimum (Linn.): A potential multifaceted Unani drug. J Pharmacog Phytochem 2018;7(5):3294-3300.

  17. Hakim A. Tajudlin. Ahmed G. Jahan N. Evaluation of anti-infllammatory activity of the pods of iklil-ul-Malik (Astraogalushamosus. Linn). Indian J Natl Prod Reso 2010;(I):34-37.

  18. Jabeen A, Khan AA, Alam T, Maaz M, Mohmad SH. J Pharmac Sci Innov 2014;3(5):401-409.

  19.  Umer KH, Zeenat F, Ahmed W. Khan VK. Theraputics phytochemistry and pharmacology of Iklilul Malik (Astragalus hamosus Linn) A natural unani remedy. Int J Herb Med 2017;5:1-4.

  20. Khan MA. Asmaul Advia (Edited hy S. Z. Rehman). Aligarh: Publication Division. AMU: 2002:45

  21. Gur CS, Onbasilar I, Atilla P, Genc R, Cakar N, Gurhan ID, et al. In vitro growth stimulatory and in vivo wound healing studies on cycloartane-type saponins of Astragalus genus. J Ethnopharmacol 2011;134: 844-850.

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  34. Zulkifle M, Ansari AAH, Shakir M, Kamal Z, Alam T. Management of non-healing leg ulcers in Unani system of medicine. Int Wound J 2012; 366-372.

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  37. Gupta P, Sharma S. Clinical evaluation of the efficacy of Kashara Karma with ApamargaKashara and Jyatyaditailapichu in the management of cervical erosion (Karniniyonivyavada).WJCPMT. 2015; 1(3): 43-49.

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  47. Larson CO, Schlundt D, Patel K, Hargreaves M, Beard K. Validity of the SF-12 for use in a low-income African American community-based research initiative (REACH 2010). Prev Chronic Dis Public health Res Pract Policy 2008;5(2):01-11.

Announcements

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

COPE guidelines for Reviewers

SCOPUS indexing: 2014, 2019 to 2021


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
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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