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: 98-100

Date of Publication: 11-Jun-2021


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Association of CRP Levels as an Inflammatory Marker in Prognosis of COVID-19 Cases

Author: Sharanya K, Lakshmi K, Vinod K, Chitralekha S

Category: Healthcare

Abstract:Introduction: The pandemic COVID-19 is an important global threat because of its high infectivity and case fatality rate in high-risk patients. The studies related to physiological mechanisms, pathogenesis, effective laboratory diagnostic methods are still in investigative stages. Several studies on COVID-19 report that inflammatory reactions play a vital role in disease progression. Objective: In this study, we evaluated the association between the C-Reactive Protein (CRP) and the severity of COVID-19 pneumonia. This study would help the clinicians to monitor the prognosis and severity of the disease. Methods: A Retrospective study conducted in the Department of Microbiology over 3 months with 336 laboratories confirmed Corona positive patients. Blood samples were collected from these patients and CRP was estimated by the Latex Agglutination test. Results: Of the 336 patients, 142 (42.2) showed positive results for CRP. Among CRP positive cases, 67 showed high CRP(>24mg/L) and 75 showed low CRP(≤24mg/L). High CRP was found to be associated with increased severity of the illness. Conclusion: CRP may be a marker of disease severity and may be a valuable indicator for determining the severity of patients with COVID-19. Continuous CRP monitoring may also predict the prognosis of cases. Further investigations are required to demonstrate the mechanisms by which increased CRP is seen in patients suffering from SARS- CoV-2.

Keywords: CRP, Covid-19, Inflammatory marker, Corona Virus, Pandemi

Full Text:

INTRODUCTION

Coronavirus belongs to the family Coronaviridae and order Nidoviridales. An unknown viral outbreak has been reported in December 2019, which was later diagnosed to be SARS – CoV2.  The pandemic COVID-19   is an important global threat because of its higher infectivity and case fatality rate in high-risk patients.1The studies related to physiological mechanisms, pathogenesis, effective laboratory diagnostic methods are still in investigative stages. Appropriate monitoring and proper follow up of treatment strategies are important in the clinical improvement of the cases. Computerized Tomography (CT) scan plays an important role in the assessment of the disease. However, some patients do not show any hypoxemia or respiratory distress which further indicates that the disease is multifaceted.

Several studies on COVID-19 report that inflammatory reactions play a vital role in disease progression.2,3 Several inflammatory markers have been studied to detect the severity and fatality of COVID-19.4 Some of the inflammatory markers such as Procalcitonin, serum ferritin, C reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR) are associated with the severity of COVID-19 disease.5,6 Many studies in the recent past have reported that CRP is positively associated with dengue infection indicating that CRP monitoring is one of the reliable biomarkers in predicting the severity of viral infections.7,8

We assume that CRP can be used in monitoring the prognosis of the COVID-19 patients. CRP levels help in the early diagnosis of the cases. Patients with severe infection are often associated with high levels of CRP. In this study, we evaluated the association between the CRP and the severity of COVID-19 pneumonia. This study would help the clinicians to monitor the prognosis and severity of the disease.

MATERIALS AND METHODS

Study design and participants

This is a retrospective study of 336 adult patients (males and females) admitted with laboratory-confirmed COVID-19. The study was conducted in the Department of Microbiology, Sree Balaji Medical College and Hospital (Bharath Institute of Higher education & Research), Chennai, Tamil Nadu, India over 3 months (June 2020 to August 2020). Institutional ethical committee approval was obtained.

Procedure

On admission, the patients with complaints of cough, chest pain and other respiratory or digestive symptoms with or without fever were screened by RT PCR for SARS- CoV-2. Only those who were RT PCR positive for SARS-CoV-2 were included in the study. 2-3ml of Venous blood samples were collected from all these patients in a sterile tube without anticoagulant for estimation of CRP. The blood was allowed to clot at room temperature. Serum was separated after centrifugation at 3500 rpm for 10 min. The test was performed immediately using the Qualitative and Semi-Quantitative Rapid Latex slide agglutination test.

Qualitative slide test

The test serum was placed within the circled area on the special slide provided in the kit to which a drop of CRP latex agent was added. Both were mixed well and the slide was gently rocked for 2 minutes and noted for macroscopic agglutination.

Interpretation

Coarse agglutination - Strongly positive

Finer agglutination – Weakly positive

Smooth suspension without any noticeable change – Negative

Semi-Quantitative Slide test

A series of dilutions of a test serum in normal saline (eg:1:2,1:4,1:8 etc) was prepared. One drop of CRP latex reagent was added to them and observed for agglutination for 2 minutes. The highest dilution which shows agglutination is taken as the CRP titre of the test serum.

Interpretation

The highest dilution that gives agglutination was multiplied with a factor of 6 (sensitivity of antigen 6 microgram/ml)

Once CRP was positive, they were categorized into High (>24mg/L) and low CRP (<=24mg/L). The patients were followed up until discharge or until they were shifted to higher centres due to deterioration of vitals.

RESULTS

Of these 67 high positive CRP patients around 65 cases eventually improved with treatment, only 2 cases were shifted to higher centres due to a decrease in saturation (Table 1). All 75 Low positive CRP patients improved well with treatment and got discharged (Table 2).

DISCUSSION

The number of patients with COVID-19 is increasing globally with increasing case fatality. Early monitoring of key indicators was an important basis to guide treatment strategies, and early assessment of the severity of the patient condition was of great value.9 Level of CRP correlated well with the level of inflammation. Factors such as age, sex, and physical condition do not affect the concentration of CRP.10 The production of C-reactive protein activates complement and increases phagocytosis. Hence it reduces the pathogenic microorganisms that attack the body. The level of C-reactive protein is already used for the early diagnosis of pneumonia.11  Patients with severe pneumonia had high CRP levels. It is considered a significant marker in the diagnosis and assessment of severe pulmonary infections.12

Our study shows that increasing CRP levels are positively correlating with the progression of the disease. The low positive cases seemed to have a better prognosis than High CRP positive cases. Among the 67 high CRP positive cases, almost 50 per cent of the cases experienced prolonged hospital stay when compared to the low positives. Two of the high positives were shifted to higher centres due to worsening of symptoms. Our study was comparable to a study conducted by Wang et al. which showed that CRP levels increased with the disease progression.9 Hence early stage inclusion of CRP levels could reflect on lung lesions and disease prognosis.13 Another study conducted by Matsumoto et al. also showed similar findings.13

 Studies show an increase in CRP levels even before critical CT findings are visualized in COVID-19 patients. Hence it acts as an early predictor of severity. Some studies reported other inflammatory markers like Erythrocyte sedimentation rate to be positively associated with CT severity scores. Immunological marker like IL-6 is also found to be increased in non-survivors than survivors. Another important inflammatory marker like increased Procalcitonin also shows a fivefold higher risk of severe SARS CoV2 infection in few studies but it may not be considered as a prognostic marker as it may be influenced by preexisting comorbid conditions.14

Another study by Cheng B et al. showed higher neutrophil count: lymphocyte count ratio (NLR) and CRP at admission were good predictors for critical condition and death.15A study by Qilin Li et al. suggests a combination of eosinopenia (<0.02 109/L) and elevated hs-CRP (>4mg/L) can help in effectively triaging COVID-19 cases from other respiratory diseases in a centre with limited resources.16 Another study conducted by Weichenet al. also correlated with our study findings.17

Other biomarkers such as high ferritin levels have been described as a predictor of acute respiratory distress syndrome.18 Recent studies show decreased lymphocyte counts and increased D-dimer concentrations point out a negative prognosis. Several other biomarkers such as decreased albumin levels, elevated creatine kinase levels and higher LDH levels were also associated with poor prognosis. 19

CONCLUSION

         Our study shows that CRP may be a marker of disease severity and may be a valuable indicator for determining the severity of patients with COVID-19. Continuous CRP monitoring may also predict the prognosis of cases. Further investigations are required to demonstrate the mechanisms by which increased CRP is seen in patients suffering from SARS- CoV-2.

CONFLICT OF INTEREST: Nil

FUNDING: Nil

CONTRIBUTION: Study concept, Data collection, Manuscript writing, Final review and approval- Dr Sharanya K.
Manuscript writing, Manuscript editing and review: Dr.Lakshmi K, Dr.Vinod K,

Study design and final approval: Dr. Chitralekha Saikumar.

References:

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  2. Mehta P, McAuley DF, Browne D, Sanchez E, Tattersall RS, Manson JJ, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;10223(395):1033-1034.

  3. Stebbing J, Phelan A, Griffin I, Tucker C, OechsleO, Smith D, et al. COVID-19: combining antiviral and anti-inflammatory treatments. Lancet Infect Dis. 2020;20(4):400-402.     

  4. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-943.

  5.  Cheng K, Wei M, Shen H, Wu C, Chen D, Xiong W, et al. Clinical characteristics of 463 patients with common and severe type coronavirus disease 2019. Shanghai Med J. 2020;1-15.

  6. Gao Y, Li T, Han M, Li X, WuD, Xu Y, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol. 2020;92(7):791-796.

  7. Chen CC, Lee IK, Liu JW, Huang SY, Wang L. Utility of C-reactive protein levels for early prediction of dengue severity in adults. Biomed Res Int. 2015;2015:936062.

  8. Eppy E, Suhendro S, Nainggolan L, Rumende CM. The differences between interleukin-6 and c-reactive protein levels among adult patients of dengue infection with and without plasma leakage. Acta Med Indones. 2016;48(1):3–9.

  9. Wang L. C-reactive protein levels in the early stage of COVID-19. Med Mal Infect. 2020;50(4):332–334.

  10. Bilgir O, Bilgir F, CalanM,CalanOG,Yuksel. Comparison of pre-and post-levothyroxine high-sensitivity C-reactive protein and fetuin-A levels in subclinical hypothyroidism. Clinics(Sao Paulo) 2015;70(2):97–101.

  11. Warusevitane A, Karunatilake D, Sim J, Smith C, Roffe C. Early diagnosis of pneumonia in severe stroke: clinical features and the diagnostic role of C-reactive protein. PloS One. 2016;11(3):e0150269.

  12. Chalmers S, Khawaja A, Wieruszewski PM, Gajic O, Odeyemi Y. Diagnosis and treatment of acute pulmonary inflammation in critically ill patients: the role of inflammatory biomarkers. World J Crit Care Med. 2019;8(5):59-71.

  13. Matsumoto H, Kasai T, Sato A, Ishiwata S, Yatsu S, Shitara J, et al. Association between C-reactive protein levels at hospital admission and long-term mortality in patients with acute decompensated heart failure. Heart Vessels 2019;34(12):1961–1968.

  14. Giovanni Ponti, Monia Maccaferri, CristelRuini, Aldo Tomasiand TomrisOzben.Biomarkers associated with COVID-19 disease progression.Crit Rev Clin Lab Sci. 2020;57(6):389-399.

  15. Cheng B, Hu J, Zuo X, Chen J, Li X, Chen Y, et al. Predictors of progression from moderate to severe coronavirus disease 2019: a retrospective cohort. Clin Microbiol Infect. 2020;26(10):1400-1405.

  16. Li Q, Ding X, Xia G, Chen H, Chen F, sGeng Z. Eosinopenia and elevated C-reactive protein facilitate triage of COVID-19 patients in fever clinic: a retrospective case-control study. E Clin Med. 2020;23:100375. 

  17. Chen W, Kenneth I, Zheng S, Liu S, Yan Z, Xu C, et al.Plasma CRP level is positively associated with the severity of COVID-19. Ann Clin Microbiol Antimicrob. 2020; 19:18.

  18. Connelly KG, Moss M, Parsons PE, Moore EE, Moore FA, Giclas PC, et al. Serum ferritin as a predictor of the acute respiratory distress syndrome. Am J Respir Crit Care Med. 1997;155:21–25.

  19.  Shen L,Li S, Zhu Y, Zhao J, Tang X, Li H, et al.Clinical and laboratory derived parameters of 119 hospitalized patients with coronavirus disease 2019 in Xiangyang, Hubei Province. China. J Infect. 2020;81(1):147-178.

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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 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 situs slot and 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 et al. situs slot "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 situs slot 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 situs slot et al 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
Late to bed everyday? You may die early, get depression situs slot
Egg a day tied to lower risk of heart disease situs slot
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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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