International Journal of Current Research and Review
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IJCRR - 7(23), December, 2015

Pages: 08-13

Date of Publication: 10-Dec-2015


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CLINICAL STUDY ON THE PREVALANCE OFFUNGAL INFECTIONS IN DIABETIC FOOT ULCERS

Author: Abilash S., N.S. Kannan, K.V. Rajan, M. Pramodhini, M. Ramanathan

Category: Healthcare

Abstract:Introduction: Diabetic lower limb wounds account for one of the commonest forms of complications with diabetes. These ulcerated lesions are easily susceptible to infections. Several studies have concluded the presence of varied microbial flora associated with the wounds. The mycology of the lesion is not given equal importance when compared to its bacterial aspect. Recent studies have shown the presence of wide range of fungal strains present in an infected foot ulcer of a diabetic patient, with Candida species accounting for the most commonly isolated strain. Aim: This study was done in an attempt to study the prevalence and spectrum of fungal infection in diabetic foot ulcers and to compare our findings with those of previous studies. Methodology: This hospital based prospective study. A total number of 100 patients with diabetic foot ulcers were included in this study. Patients already treated with anti-fungal therapy, chemotherapy, immunosuppressant, radiotherapy and corticosteroids were excluded. Detailed history of all patients was taken. These patients were evaluated with reference to clinical symptomatology and biochemical profile for diabetes mellitus. Two tissue samples, which were taken from the bed of the diabetic foot ulcer from each patient, one for microscopic examination and the other for culture sensitivity both bacterial and fungal. The patients were treated with regular dressing and antifungal therapy in addition to appropriate antibiotics as per bacterial culture sensitivity. The results were compared with other studies in literature and discussed. Results: Out of the 100 patients, evaluated 18% had positive fungal cultures, among them most common fungal strain was C albicans and secondly was C tropicalis
Conclusion: Management of diabetic foot ulcers must include antifungal antibiotics as per fungal culture sensitivity report in addition to routine bacterial culture sensitivity and other modalities.

Keywords: Diabetic foot ulcer, Fungal infection, Culture and sensitivity, Antifungal antibiotics

Full Text:

INTRODUCTION
Diabetic lower limb wounds account for one of the commonest forms of complications with diabetes. These ulcerated lesions are easily susceptible to infections. Several studies have concluded the presence of varied microbial flora associated with the wounds. The microbiology associated with diabetic foot ulcers studied from samples taken from deep tissue bed is varied. In addition, several studied have shown the researched evidence of presence of both aerobic and anaerobic bacteria associated with the infections. Even though bacteriological infections associated with diabetic foot ulcers are given prime importance, the opportunistic fungal infections are ignored. The mycology of the lesion was not given equal importance in the past when compared to its bacterial aspect due to lack of literature. However, re cent studies have shown the presence of wide range of fungal strains in an infected foot ulcer of a diabetic patient, with Candida species accounting for the most commonly isolated strain. Ideal treatment of an infected diabetes foot ulcer should encompass all the possible microbiological causes, to provide efficient and specific treatment to the surgical patient. Aims and Objectives 1. To study the prevalence of fungal infection in diabetic foot ulcers. 2. To study the spectrum of fungal strains isolated from the wounds. 3. To compare our findings with those of previous studies. MATERIALS AND METHODS This hospital based prospective study was carried out in Mahatma Gandhi Medical College and Research institute, Pondicherry during the period February 2013 to June 2014. A total number of 100 cases were studied. The study was carried out after obtaining clearance from institutional human ethics committee. All patients with diabetic foot ulcers coming to our hospital were included in this study. Patients already treated with anti-fungal therapy, chemotherapy, immunosuppressants, radiotherapy and corticosteroids were excluded. After duly obtaining an informed consent, detailed history of all patients was taken. These patients were evaluated with reference to clinical symptomotology, biochemical profile for diabetes mellitus (FBS, PPBS and HbA1C) .Two tissue samples which were taken from the bed of the diabetic foot ulcer from each patient is put in a sterile container containing normal saline and is sent to the microbiology laboratory and Microscopic examination of collected tissues were done. One of the tissue bit is soaked in 10% KOH, the other tissue bit is used for fungal culture sensitivity with Sabourauds dextrose agar supplemented with chloramphenicol and cycloheximide, incubated at 30°C and 37°C for 4 weeks. The patients were treated with regular dressing, appropriate antibiotics according to bacterial culture sensitivity till the fungal culture reports. Antifungal therapy was started as per the culture sensitivity report. The data were tabulated in a master chart using MS EXCEL. The results were compared with other studies in literature and discussed. RESULTS Among the 100 patients, the youngest patient was a 31 year old and the eldest was a 72 year old. There were seven patients in the age group of 30-39 years, 25 patients in the age group of 40-49, 35 patients in the age group of 50-59, 28 patients in the age group of 60 to 69 and 5 patients in the age group of 70 to 79 (Table 1). The highest incidence was in the age group of 5th decade. There were total of 18 female and 82 male patients (Table 2). Among the 100 patients, 18 had positive fungal cultures-12 males and 6 females (Table 3). Among the 18 fungal cultures, Candida species of fungal isolates were predominant; specifically strains of Candida albicans-16 samples and Candida tropicalis-2 samples (Table 4). Sex distribution of patients positive for C. albicans strains is shown in Table 5. Sex distribution of patients positive for C. tropicalis strains is shown in Table 6. In all patients both the strains cultured were sensitive to Fluconazole. Among the 100 patients studied, 13 patients had type 2 diabetes mellitus for less than 5 years and 32 patients had diabetes mellitus for 5 – 10 years, 10 patients had diabetes for 10 – 15 years, 12 patients had diabetes mellitus for 16-20 years and 33 patients had diabetes mellitus for more than 20 years (Table 7). Among the 100 patients, 76 were smokers and 68 were alcoholics (Table 8).

DISCUSSION
According to International Diabetes Federation’s atlas, there are about 65.1 million people in India suffering from diabetes with an alarming mortality rate of 55%1 . Approximately a quarter of all people with diabetes will develop sores or ulcers at some point during their lifetime2 . Diabetic foot ulcers (DFU) are one of the most dreaded and common complications of diabetes, which is associated with lower limb amputation and account for majority of non-traumatic amputations conducted3 . This is also associated with high morbidity and substantial health care costs4 . According to the World Health Organization and the international working group on the diabetic foot, ‘Diabetic foot is defined as the foot of diabetic patients with ulceration, infection and/or destruction of deep tissues, associated with neurological abnormalities and various degrees of peripheral vascular diseases of the lower limb’. Aetiology though being multi factorial, peripheral neuropathy and ischemia are the major factors for DFU along with several other contributing risk factors5 . Diabetes is one of the most common causes of multifocal peripheral neuropathy, which further gives rise to diabetic foot ulcers. Neuropathy in diabetic patients is manifested in the motor, autonomic and sensory components of the nervous system5,6,7,8.

Based on epidemiological study by Dyck et al, 60% 0f DFUs occur due to underlying diabetic neuropathy7 . Ischemic ulcers without significant associated neuropathy accounts for 15 to 20% of foot ulcers, and another 15-20% have a mixed neuropathic-vascular causative factor. In people with diabetes, atherosclerosis is very common. Peripheral arterial disease is responsible for the initiation of foot ulcers in up to 50% of the cases making it one of the major causative factors8 . Diabetic foot is one of the most feared complications of diabetes, which may result in repeated hospitalizations leading to amputations. It is common affecting up to 30% of Indian patients with diabetes in their lifetime9 . Another study conducted by Shahi et al in northern India claim that the prevalence of DFUs in patients with diabetes was 14.30%10. Diabetic foot ulcers associated infections are the most common cause of amputation. According to a multicenter study from India, conducted to determine the pattern and causes of amputation in diabetic patients from a sample size of 1985, 90% of the amputations were due to infection arising in the diabetic foot11. Diabetic foot lesions are responsible for more hospitalizations than any other complications of diabetes, increasing the burden on health care infrastructure and the cost of care. Among patients with diabetes, roughly about 15% develop a foot ulcer. Diabetes is the major cause of non-traumatic lower extremity amputation in our country and across the world. Foot infections in diabetic patients usually begin in skin ulceration. Most infections remain superficial, but 25% will spread contiguously from the skin to deeper subcutaneous tissues and/or bone. An infected foot ulcer precedes 60% of amputations, making infection perhaps the most important proximate cause of this tragic outcome. Because all skin wounds contain microorganisms, infection must be diagnosed clinically, that is, by the presence of systemic signs (e.g., fever, chills, and leukocytosis), purulent secretions (pus), or local classical signs or symptoms of inflammation (warmth, redness, pain or tenderness, and induration). In chronic wounds, additional signs suggesting infection may include delayed healing, abnormal coloration, friability, or foul odour12. Pathare et al13 in their ‘Microbiology of diabetic foot: Indian studies’, analysed 775 diabetic foot patients and found the infections are Polymicrobial. Averages of 3.07 organisms were isolated per case, 71.09% aerobic and 28.91% anaerobic. The fungal infection is difficult to diagnose and is a serious cause of morbidity or mortality in diabetes8 . Fungal infection among immuno-compromised patients is now a global major health concern, but the species of fungi infecting diabetic foot infections and its pathogenicity has not yet been researched thoroughly. As a result, clinicians and surgeons treating diabetic foot wounds suspect only the bacterial infections and prescribe accordingly. The deep tissue from the wound bed is not usually sent for fungal culture and sensitivity, either due to lack of literature substantiation or due to the belief that there would not be any fungal infections in the diabetic foot ulcers as they are rare occurrences. In the study conducted in India by Chellan et al14, enrolled 518 patients, among whom 382 were males and 136 females with type 2 diabetes admitted due to infections in the lowerlimb wounds. Samples from the ulcer bed of approximately 0.5 - 0.5 cm size were taken from the wound bed and cultured for fungi. Fungi were found in 27.2% (141/518) of the study population. Candida parapsilosis (25.5%), Candida tropicalis (22.7%), Trichosporonasahii (12.8%), Candida albicans (10.6%), and Aspergillus species (5.0%) were the most predominant fungal isolates. In a study by Chincholikar et al15,swabs were collected from 105 diabetic foot ulcer patients, which revealed that the fungal isolates accounted for 20.8%. Among this yeasts were predominant accounting for 94.55% and moulds comprised 5.46%. Candida tropicalis [54.55%] were most common followed by candida albicans [12.73%] among the yeasts. A study by Bansal et al16 in government medical college and hospital, Chandigarh demonstrated polymicrobial infection in 35% of the patients. In this, Pseudomonas aeruginosa [22%] and Staphylococcus aureus [19%] were predominantly isolated. Among fungal isolates candida species were most predominantly isolated. Subha et al17 conducted a study in Mysore Karnataka on 120 patients with diabetic foot infections and found that 66.66% of the isolates indicated candida sp. Yet another study was carried out by Nair S et al18 to assess the incidence of mycotic pathogens in diabetic foot ulcers. A total of 74 Type II diabetic patients with non-healing diabetic foot infections were recruited for the study. Among the diabetic patients, 65 % had yeast and mold infections. Pathogenic yeasts were noted in 77 % of the patients of which Candida species was predominant (93 %). The major Candida species isolated were C. albicans (49 %), C. tropicalis (23 %), C. parapsilosis (18 %), C. guillermondi (5 %) and C. krusei (5 %). The other yeast species isolated were Trichosporon cutaneum and T. capitatum. Trichophyton spp. was the only dermatophytic fungus found. Molds were isolated from 38 % of the infected patients of which Aspergillus species predominated (72 %). The other molds isolated were Fusarium solani, Penicillium marneffei and Basidiobolus ranarum. The duration of diabetes also plays a role in the formation of ulcer and the incidence of lower extremity amputation was more in patients who have diabetes for more than 5 years. Longer the duration of diabetes, higher are the chances of developing a non-healing ulcer. Mehamud et al19 reported that out of 120 patients, majority of patients who underwent amputation had diabetes more than 10 years (p<0.05). Among our patients, 13% had diabetes for less than 5 years, 32% of them had from 5 to 10 years, 10% had from 11 to 15, 12% had from 16 to 20 years, and 33% had for more than 20 years. The incidence of diabetic foot increases with increasing age20,21,22,24,25. . The youngest patient in our study was 31 years old and the oldest was 72 years of age. The peak age incidence of diabetic foot ulcer in our study was in the 5th decade. Many studies revealed that the mean age group was in the 6th and 7th decade. We found that the incidence of diabetic foot ulcers was higher in males, when compared to females. Even though it was not statistically significant, most authors agree that the males are at higher risk to develop foot ulcers. This may be explained, as males are at a higher risk for trauma to feet. In our study, 76% were smokers and 68% were alcoholics. Smoking and alcohol consumption were linked to higher incidence of foot ulcers in diabetics, and was a statistically significant risk factor for amputation in patients with diabetic foot ulcers. This could be attributed to vasculopathic effects of tobacco smoking. Alcohol consumption is known to increase risk of making the patients prone to trauma. Risk factors such as smoking and consumption of alcohol, favour poor wound healing. Many studies have indicated these factors as risk factors for poor wound healing and amputation. The risk of foot ulceration and limb amputation in people with diabetes is lessened by patient education stressing the importance of routine preventive podiatric care, appropriate shoes, avoidance of cigarette smoking, and control of hyperlipidemia and adequate glycemic control26,27,28,29. Risk factors associated with adverse outcomes in a population based prospective cohort study of people with their first diabetic foot ulcer by Winkley et al28 of UK explained the variables which were age, male gender, smoking, ulcer site, size, severity of neuropathy, ischemia and presence of vascular complications. Microvascular complications were the only explanation for recurrent ulceration. In our study, of all the 100 samples sent for microbiological examination only 18 samples were found to be positive for fungal strains, which are lower than a similar study, which was conducted in India by Chellan et al14, which reported positive Fungal isolates in 27.2% of the total number of samples. The same study reported that the most predominant fungal species, which was isolated, was found to be Candida species, which coincides with our study. The most common Candida species was found to be C albicans [88.8%] followed by C tropicalis [11.11%] of the total fungal isolates substantiated by a study conducted by Nair S et al18 to assess the incidence of mycotic pathogens in diabetic foot ulcers. Summary of our study being: 1. In our study foot ulcers were more among patients in the 5th decade. 2. Diabetic foot ulcers were more common among males. 3. Duration of diabetes as more than 5 years in majority of the patients. 4. Among the 100, 76 % were smokers and 68% alcoholics. 5. Most common fungal strains found were C albicans and C tropicalis.

CONCLUSIONS
Management of diabetic foot ulcers must include antifungal antibiotics as per fungal culture sensitivity report in addition to routine bacterial culture sensitivity and other modalities. This study may not reflect all the aspects of management of diabetic foot ulcers, further , the study was among a small group of 100 patients in a short period . A larger study spanning over longer period and a bigger sample size is required to draw definitive conclusions.

ACKNOWLEDGEMENT
Authors duly thank the department of general surgery, Mahatma Gandhi Medical College and Research institute and Sri Balaji Vidyapeeth University, for permitting us to publish the contents of PG Dissertation of Dr. Abilash.S as an article in IJCRR. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

Source of funding:
Nil.
Conflict of interest:
All authors declare that there is no conflict of interest.

References:

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2. Reiber, G., Lipsky, B., and Gibbons, G.The burden of diabetic foot ulcers. The American Journal of Surgery, 1998;176(2):5S– 10S.

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4. Bowering CK Diabetic foot ulcers. Pathophysiology, assessment, and therapy. Can Fam Physician. 2001 May;47:1007-16.

5. Crawford F, Inkster M, Kleijnen J, Fahey T. Predicting foot ulcers in patients with diabetes: a systematic review and metaanalysis QJM. 2007 Feb;100(2):65-86.

6. Gerassimidis T, Karkos CD, Karamanos D, Kamparoudis A Current endovascular management of the ischaemic diabetic foot. Hippokratia. 2008 Apr;12(2):67-73.

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10. Shahi, S. K., Kumar, A., Kumar, S., and Singh, S. K.. Gupta S K, Singh T.B. Prevalence of Diabetic Foot Ulcer and Associated Risk Factors in Diabetic Patients From North India.. The Journal of Diabetic Foot Complications, 2012;4(3):83-91.

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28. Winkley K, Stahl D, Chalder T, Edmonds ME, Ismail K. Risk factors associated with adverse outcomes in a population-based prospective cohort study of people with their first diabetic foot ulcer. J Diabetes Complications. 2007;21(6):341–349.

29. Chaturvedi N, Abbott CA, Whalley A, Widdows P, Leggetter SY, Boulton AJ. Risk of diabetes-related amputation in South Asians vs. Europeans in the UK. Diabet Med. 2002;19(2):99- 104.

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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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