International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 2nd Wave of COVID-19: Role of Social Awareness, Health and Technology Sector, June, 2021

Pages: 02-05

Date of Publication: 11-Jun-2021


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Venous and Arterial Thrombosis in COVID-19 Era; Risk and Management

Author: Kharaba Ayman, Hussein Mohamed, Albeihany Amal

Category: Healthcare

Abstract:Since its discovery in December 2019, SARS-CoV-2 has resulted in more than 23 million infected cases worldwide with more than 800.000 deaths with a mortality rate of about 3.47%. The respiratory system seems to be the primary target system for SARS-CoV-2, and infected patients may develop acute lung injury and Adult respiratory distress syndrome (ARDS). However, severe COVID-19 is a multi-systemic disease associated with a hypercoagulable state affecting the microvascular, venous, and arterial system. Severe COVID-19 infection is characterized by coagulation derangement and hyperinflammatory state that may lead to overt disseminated intravascular coagulopathy (DIC), a status termed Covid-19 Induced Coagulopathy (CIC). This can result in multi-organ involvement with microvascular, arterial, and venous thrombosis. In this article, we review the incidence of thrombosis in severe covid-19 patients, the mechanisms of Covid-19 induced thrombosis, and recommendations regarding anticoagulation in hospitalized Covid-19 patients.

Keywords: COVID19, Incidence, Arterial, Venous, Thrombosis, Management

Full Text:

Introduction

Since its discovery in December 2019, SARS-CoV-2 has resulted in more than 23 million infected cases worldwide with more than 800.000 deaths with a mortality rate of about 3.47%.1 The respiratory system seems to be the primary target system for SARS-CoV-2, and infected patients may develop acute lung injury and Adult respiratory distress syndrome (ARDS). However, severe COVID-19 is a multi-systemic disease associated with a hypercoagulable state affecting the microvascular, venous, and arterial system.2,3

Hospitalized COVID-19 patients appear to have a high incidence of venous thromboembolism (VTE)compared to other critically ill patients with other severe medical conditions like sepsis or septic shock.4,5 COVID-19 associated coagulopathy affects arterial, venous, as well as microvascular systems. In a meta-analysis by  Porfidiaa et al. in May 2020, the overall incidence of VTEwas around26%, including pulmonary embolism (PE)with or without deep venous thrombosis (DVT) in 12% and DVT alone in 14%. In another meta-analysis by Chi Zhang et al., the incidence of VTE was 25% (the incidence of PE 19%and the incidence of DVT 7%), with 35% in severe COVID-19 patients and 6% in non-severe cases.6

Klok et al. reported a cohort of 184 patients admitted to the ICU with proven COVID-19 pneumonia and assessed for the Netherlands' thrombotic events. He found a thrombotic incidence of 31%: 27%venousand 3, 7% arterial thrombotic events.PE was the most typical thrombotic complication occurring in 81% of the reported cases. Thrombotic complications were higher in older age and patients having prolonged prothrombin time > 3 s and or extended activated partial thromboplastin time > 5 s.17

There was a higher incidence of Arterialthrombosis among severe Covid-19 hospitalized patients, with an average acute ischemic stroke rate between 3%and 5%.7,8        

Mechanism of Covid-19 induced coagulopathy

Angiotensin-converting enzyme 2 (ACE-2) receptors in alveolar cells arethe portal of entry of SARS-COV-2. Infected cells release inflammatory mediators as danger-associated molecular patterns (DAMPs), which signal the release of pro-inflammatory cytokines and chemokines.10 ACE-2 receptors were also found in endothelial cells. The activated damaged endothelium up-regulates the release of VWF (von Willebrand factor) and endothelin-1, which is a potent vasoconstrictor. The release of those inflammatory mediators with sub-endothelial collagen exposure leads to the recruitment of leukocytes and platelets and complement activation, leading to platelet aggregation and thrombus formation.11

The hypoxic environment aids in thrombus formation by releasing HIFs (hypoxia-inducible factors) that lead to up-regulation of endothelial TF expression. So far, D-dimer, which is a fibrin degradation product and a marker of coagulation activation, seems to be a strong prognostic marker of high mortality in patients with COVID-19.11 Laboratory findings in severe caseswithCovid-19 showed prolonged PT, high CRP, lymphocytopenia, leucopenia, mild thrombocytopenia, high D-dimers and low fibrinogen.2,3

Endothelial injury, low flow circulation and hypercoagulability are all present in COVID-19 infections. In terms of endothelial injury, there is clear evidence that the SARS-CoV-2 virus invades endothelial cells leading to cell injury.12 Other sources of endothelial injury may include intravascular catheters, acute phase reactants, and other inflammatory mediators.13  On the other hand, blood flow stasis due to immobilization during intensive care unit hospitalizations is an additional risk factor for VTE. In terms of hypercoagulability, many changes in circulating prothrombotic factors have been observed in COVID -19 patients that include loss of the protective endothelium with its glycocalyx layer, low levels of tPA, and the inhibition of the clot-lysing system that lead to a prothrombotic state; this can be augmented by platelet dysfunction, complement activation, and systemic immune reactions.13

Acute coronary syndrome and myocardial injury are common complications of severe COVID-19 clinical course and were found in up to 20% of COVID-19 hospitalizations with an adverse impact on mortality. 9 The underlying cause of myocardial injury is suggested to be due to direct damage of myocardial tissue by SARS-CoV-2. In addition to macrovascular complications, SARS-COV2 also causes microvascular thrombosis. Patients who died with severe ARDS were found to have pulmonary microvascular thrombosis in autopsies.14 Although this pulmonary thrombosis was found in MERS-COV infection and SARS-COV1 infection; this feature appears more prominent in severeSARS-CoV-2 infection. The lung histology from patients withCOVID-19 demonstrates a 9-fold increase in the prevalence of alveolar-capillary microthrombi compared with patients having other types of influenza. In this regard, autopsy findings have shown that, in addition to the usual features of diffuse alveolar damage found in ARDS, microthrombi was found in about 100% of cases in an autopsy.14 Indeed, considering other reported thrombotic events, the emerging microvascular thrombotic complications is a strong indication of interaction between the SARS-CoV-2 and coagulation.14

Management of thrombosis in Covid-19 patients

Evidence suggests that low molecular weight heparin treatment may be associated with lower mortality in COVID-19 patients with an elevated-dimer and/or elevated sepsis-induced coagulopathy score.15 In addition to its main action that inhibits coagulation by binding the antithrombin, which accelerates the inhibition of FXa or thrombin, heparin appears to have pleiotropic effects which provide special advantages in viral infection context, including antiinflammatory effects by their ability to bind to the inflammatory molecule, such as HMGB-1and pro-inflammatory cytokines.15

Based on currently limited evidence, there is a suggestion for the use of anticoagulants for a hospitalized patient with COVID-19 infection.16 Lin et al. investigate the role of therapeutic anticoagulant inpatient with raised inflammatory markers and D-dimer on day 7 and 14, Given the risk of sepsis-induced coagulopathy (SIC), the authors suggest anticoagulation for COVID-19 patients with increased D-Dimer levels four times above the normal limit, using a dose of 100 IU/kg of LMWH twice a day, for at least 3–5 days.18

Tang et al. investigated 449 patients with severe COVID-19; 99of them received LMWH for seven days or longer.15 D-dimer, prothrombin time, age, and low platelet count were positively correlated with 28-day mortality. But in a subgroup of patients with increased SIC score ≥4 or D-dimer >6-fold of the upper limit of normal, patients treated with heparin had lower 28-day mortality than those who were not treated with heparin (40.0% vs. 64.2%, P = .029), (32.8% vs. 52.4%, P = .017) respectively. The study suggested that anticoagulant therapy with low molecular weight heparin may be associated with a better prognosis in severe COVID-19 patients meeting criteria or with markedly elevated D-dimer.17 Based on previous studies Oxford University Press, on behalf of the European Society of Cardiology, published a recent algorithm/protocol for the management of coagulopathy in COVID-19 patients which recommended that

  • All hospitalized patients with covid-19 should receive anticoagulant according to the risk of thrombosis and D-dimer level.

  • If a patient is at a high risk of thrombosis or D-dimer level more than or equal to 3mcg/ml, the patient should receive enoxaparin 1mg/kg twice a day.

  • Low-risk patients with D-dimer between 0.5 -3 mcg/ml should receive enoxaparin 40 mg twice a day.

  • Low-risk patients with d dimer less than 0.5 mcg/ml should receive 40 mg once daily enoxaparin.

  • For high-risk patient admitted to ICU should receive heparin infusion with target aPTT 60-85 seconds.16

Discussion

Since the discovery of COVID19, there were many reports of venous, arterial and microcirculatory thromboembolic complications with higher incidence among critically ill patients.4,6 The incidence ranging from 20% to 31% in various reports.6,17 Pulmonary embolism is the most frequent reported thrombotic complications in critically ill patients with COVID 19 pneumonia.17 Elderly patients with prolonged prothrombin time  >3s and activated partial thromboplastin time > 5 s were at higher risk of thromboembolic complications.17

Angiotensin-converting enzyme 2 (ACE-2) receptors in alveolar cells, proinflamtory cytokines and chemokines have a major role in the pathophysiology of thrombus formations.10 Indeed, the damaged endothelium increase the release VWF (von Willebrand factor) and endothelin-1 which augment vasoconstrictions, together with inflammatory mediators leads to platelet aggregation and clot formation.10,11 The triad of endothelial injury, low flow circulation and hypercoagulability are all present in COVID -19 infections.12 COVID 19 causes both macrovascular and microvascular thrombosis as shown in the pulmonary autopsies of severe ARDS cases. The lung histology from patients withCOVID-19 demonstrates a 9-fold increase in the prevalence of alveolar-capillary microthrombi compared with patients having other types of influenza.14

Treatment with low molecular weight heparin has been suggested to lower mortality in COVID-19 patients.15 Besides its major action of coagulation inhibition, it has anti-inflammatory action by its ability to bind to the inflammatory molecule, such as HMGB-1and pro-inflammatory cytokines.15

Based on current evidence, there is a suggestion for the use of anticoagulants for a hospitalized patient with COVID-19 infection.16

Conclusion

Severe COVID-19 disease is associated with features of disseminated intravascular coagulation (DIC) and hypercoagulable state, which can manifest as venous thromboembolism (VTE), arterial ischemia, and/or micro thrombosis. Data on anticoagulation at present based mainly on observational studies, but high-risk patients may benefit from an intensified prophylactic regimen.

Acknowledgement: The authors would like to acknowledge the dedicated work of Mohammed Kharabah, Mohammed Alyamiand  RehamKharabah for their great  effort and contribution in website review and language editing

Source of Funding: No Fund

Conflict of Interest: Authors declare no conflict of interest

Authors’ Contribution: All Authors contribute equally in writing and reviewing the review article

References:

  1. COVID Live Update. Worldmeters.info/coronavirus/ august 26 2020

  2. Zhang Z, Ge W-H, Lin H-W. Incidence of Venous Thromboembolism in Hospitalized Coronavirus Disease 2019 Patients: A Systematic Review and Meta-Analysis. Front Cardiovasc Med. 2020;7:151.

  3.  3. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18:844–847.

  4. 4. Zusman O, Paul M, Farbman L, Daitch V, Akayzen Y, Witberg G, et al. Venous thromboembolism prophylaxis with anticoagulation in septic patients: A prospective cohort study. QJM. 2015;108:197–204.

  5. 5. Lloyd NS, Douketis JD, Moinuddin I, Lim W, Crowther MA. Anticoagulant prophylaxis to prevent asymptomatic deep vein thrombosis in hospitalized medical patients: A systematic review and meta-analysis. J Thromb Haemost. 2008;6:405–414.

  6. 6. Porfidiaa A. Venous thromboembolism in patients with COVID-19: Systematic review and meta-analysis. Thromb Res 2020;196:67–74

  7. 7. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77:1–9.

  8. 8. Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, et al. Large-vessel stroke as a presenting feature of COVID-19 in the young. N Engl J Med. 2020;382:e60.

  9. 9. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020: e200950.

  10. 10. Walls AC, Park YJ, Tortorici MA, Wall A, McGuire AT, Veesler D, et al. Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein. Cell. 2020;181:281–292.e6.

  11. 11. Jose RJ, Manuel A. COVID-19 cytokine storm: The interplay between inflammation and coagulation. Lancet Respir Med. 2020;8:e46–e47.

  12. 12. Varga Z, Flammer AJ, Steiger P.  Endothelial cell infection and endothelins in COVID-19. Lancet. 2020;(20):30937–30935

  13. 13. Begbie M, Notley C, Tinlin S, Sawyer L, Lillicrap D. The Factor VIII acute phase response requires the participation of NF-kappa B and C/EBP. Thromb Haemost. 2020;84(2):216–222

  14. 14. Ding Y, Wang H, Shen H, Li Z, Geng J, Han H, et al. The clinical pathology of the severe acute respiratory syndrome(SARS): a report from China. J Pathol. 2003;200:282–289.

  15. 15. Tang N, Bai H, Chen X, Gong J, Li D, Sun Z, et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18:1094–1099.

  16. 16. Atallah B, Mallah SI, AlMahmeed W. Anticoagulation in COVID-19. Eur Heart J Cardiovasc Pharmacother. 2020;6(4):260–261,

  17. 17. Klok FA, Kruip MJ, van der Meer NJ, ArbousMS, Gommers DA, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145-146.

  18. 18. Lin L, Lu L, Cao W, Li T. Hypothesis for potential pathogenesis offers-CoV-2 infection–a review of immune changes in patients with viral pneumonia. Emerg Microb Infect. 2020;9(1):727–32.

Announcements

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

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Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

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

Women Researcher Award:

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

Emerging Researcher Award:

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


Best Article Award

A Study by 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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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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