International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 13 Issue 13, July, 2021

Pages: 97-100

Date of Publication: 05-Jul-2021


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Acid-Base Imbalance and Electrolyte Abnormalities in Acute Alcoholic Intoxication

Author: M Girish, B Nivedana Lakshmi, Bhat Sonal, Hejamady Ismail Mohammed

Category: Healthcare

Abstract:Background: Alcohol intoxication contributes to more than 10 million hospital admissions in a year. It is known to cause impairment in cognition and decline in neurological functions as the blood alcohol levels increase. A series of acid base and electrolyte disturbances have been documented in individuals with alcohol use disorder. Alcoholic ketoacidosis is a common manifestation that is known to occur. Aims: This study was done to study the pattern of acid base and electrolyte abnormalities that were seen in acute alcoholic intoxication and to establish an association between the blood alcohol levels and the abnormalities in acid base and electrolytes. Methods: 200 patients in acute alcohol intoxication who satisfy the inclusion criteria were chosen and blood alcohol levels were estimated for them. Blood samples for ABG, Electrolytes were drawn. Results: Of the electrolytes statistically significant negative association with BAC was seen only with serum bicarbonate. A variety of acid base disturbances were seen the most common being compensated respiratory alkalosis \? 56 patients (28%) followed by metabolic acidosis with partial compensation seen in 46 patients (23%).

Keywords: Acid, Base, Imbalance, Electrolyte, Acute, Alcoholic, Intoxication

Full Text:

INTRODUCTION

Alcoholism is a global issue. 5.9% (3.3 million) of the total deaths globally and 5.1% of the burden of disease(139 million DALYs) are primarily due to alcohol consumption.1

Acute alcohol intoxication is a clinically harmful condition that usually follows the ingestion of a large amount of alcohol. Alcohol causes harm in three ways- intoxication, toxicity, and alcohol use disorder. Symptoms correspond to the blood alcohol concentration (BAC). In alcohol nontolerant individuals BAC of more than 300mg/dl is associated with a higher chance of respiratory depression and cardiorespiratory arrest. BAC levels exceeding 500 mg/dl (108.5 mmol/l) may cause death. However, the fatal dose varies with nontolerant and tolerant individuals. In nontolerant individuals death has been known to occur at relatively lower BACs (300mg/dl). In alcohol-dependent patients who have developed tolerance to alcohol owing to repeated exposure, these effects reduce. This is attributed to compensatory changes occurring in the excitatory neurotransmitters like NMDA (N-methyl-D-aspartate) and inhibitory neurotransmitters like GABA (gamma-aminobutyric acid). 1, 2

Acute alcohol intoxication is known to produce various metabolic disturbances like hypoglycaemia, lactic acidosis, hypokalaemia, hypomagnesemia, hypoalbuminemia, hypocalcaemia, and hypophosphatemia.2,3 Normal body homeostasis undergoes alterations with alcohol intake both acutely and with chronic alcohol use. Metabolic derangement occurs either as a result of its chemical by-products directly or through alcohol-induced tissue or organ injury.3,4,5

There is variation in the pattern of alcohol consumption in India and across the world1. There is a paucity of studies that correlate alcoholic intoxication and metabolic derangements, especially in the Indian setup. Our study thus focuses on the prevalence and pattern of acid-base and electrolyte abnormalities in acute alcohol intoxication.

AIMS AND OBJECTIVES

Our study aimed to study acid-base imbalance and electrolyte abnormalities in acute alcohol-intoxicated individuals and to investigate the association of blood-alcohol levels to disturbances in acid-base balance and electrolyte levels.

METHODS:

This was a cross-sectional study conducted in hospitals associated with KMC (Kasturba Medical College), Mangalore. This was a time-bound study conducted from September 2017 to September 2019. The sample size was 200. The study population was selected using convenient sampling.

Method of study:

After clearance from the institutional ethics committee, KMC Mangalore, the study sample collection was started in September 2017. Informed consent obtained from the patient or patient’s relatives. The blood sample was drawn for complete blood counts, renal function tests, liver function tests, ABG, electrolytes after ruling out hypo/ hyperglycemia. A blood sample obtained for estimation of blood alcohol levels. Inclusion criteria being age 18 years or more, Satisfying DSM IV-TR criteria for acute alcoholic intoxication, Blood alcohol concentration 80mg/dl All patients who fit the inclusion criteria were enrolled into the study. Informed consent obtained from the patient or patient’s relatives. Exclusion criteria included sugar levels at presentation < 70mg/dl or >200 mg/dl, concomitant acute intoxication with other poisons/ psychoactive substances, patients on treatment with drugs causing electrolyte/ acid-base disturbances, pregnant/ lactating women, known diabetics, recent use of alcohol-containing mouthwash/cologne and patients with a known psychiatric disorder.

Blood alcohol levels were estimated using test kits that were based on the enzymatic method with alcohol dehydrogenase. The NADH produced as a result of the action of ADH on alcohol was measured photometrically based on the principle that the rate of change in absorbance is directly proportional to the ethanol concentration

Analysis:

Collected data were coded and entered into and analyzed using SPSS (statistical package for social sciences – version 17)

Results expressed in terms of descriptive statistics – mean, median and percentages

Categorical variables were presented as numerical data statistical comparison was done using ANOVA. the p-value of less than or equal to 0.05 was considered statistically significant.

RESULTS:

A total of 200 patients were studied. The majority of the patients were <50 years of age. Of the 200 patients, 197 were males and 3 were females. Estimated blood alcohol levels were predominantly between 101-200 (62.5%). Low serum sodium was found in 89(44.5%) patients

Serum sodium was normal in 110 patients (55%) and high in 1 patient (0.5%).

 Serum potassium levels were normal in 47 patients(71.5%), low in 143 patients (23.5% ) and was high in 7 patients (5%)

Chloride levels were Normal in 126 patients (33.5%), Hypochloremia was seen in 73 patients (63%) and hyperchloremia was seen in 1 (0.5%) of the study population

Bicarbonate levels were normal in 18 patients (9%), low in 180 patients (90%) and were high in 2(1%) patients.

Serum calcium level was normal in 164 patients (82%), hypocalcemia was seen in 36 patients(18%) and hypercalcemia was not seen in the study population.

The serum magnesium level was normal in 140 patients(70%), hypomagnesemia was seen in 46 patients(23%) and was hypermagnesemia was seen in 14 patients(7%) of the study population.

Serum phosphorus level was normal in 132 patients (66%), hypophosphatemia was seen in 25 patients(12.5%) and hyperphosphatemia was seen in 43 patients(21.5%) of the study population

Acidosis was seen in 33% of the patients. Alkalosis was seen in 21%.

pH was normal in 46% (92 patients) of the study population. There was a significant negative association between pH levels and BAC with a p-value <0.005 ( Table 1)

Statistically significant association with BAC was seen with pCo2, base excess and bicarbonate

DISCUSSION

This study was done to assess the pattern of electrolyte and acid-base imbalances occurring in individuals with acute alcohol intoxication. It was conducted in KMC Mangaluru and included a study population of 200. This study also aimed at establishing an association between the electrolyte and acid-base disturbances and the Blood Alcohol Levels.2, 3

In a previous study done by Elisaf M et al.4 to study the acid-base and electrolyte abnormalities in alcoholics and to establish the pathogenetic mechanisms involved. 40.5% had acid-base disturbances.52% had electrolyte abnormalities in the study

Another study was done by Adewale et al.3, to analyze the consequences of alcohol ingestion on the kidney, fluid, electrolyte and acid-base abnormalities in both acute and chronic ingestion of alcohol. It was found that alcohol ingestion leads to a multitude of deleterious effects on the kidney. It was noticed that effects like tubular dysfunction to acute renal failure occurred with alcohol ingestion.4

In a study done in 2015 by Moses Elisaf and RigasKalaitzidis,5 which was carried out for investigating the most commonly occurring metabolic abnormalities in alcoholics and the effect of these disturbances in the patients’ morbidity and mortality, it was concluded that the most common electrolyte abnormalities that occurred were hypomagnesaemia with its consequences (hypokalemia and hypocalcemia) and hypophosphatemia.

In a study done by Chandini et al.6  serum electrolyte abnormalities in alcohol dependant, patients were studied. Clinical variables of alcohol dependence were correlated with the serum electrolytes in this study. Hyponatraemia, hypochloraemia, hypokalaemia was noted in 46%,24%,67% of the individuals with alcohol dependence syndrome who participated in the study respectively. The amount of alcohol consumption had a statistically significant correlation with hypokalaemia. However, this study was done on alcohol dependant individuals, unlike our study which was done on intoxicated individuals.

Among the electrolytes, even though hyponatremia, hypernatremia, hypocalcaemia, hypophosphatemia, hyperphosphatemia, hypokalaemia, hyperkalaemia, hypomagnesemia, hypermagnesemia, hypochloraemia, hyperchloremia were seen among the study population, none of these had statistical significance.4, 5, 6

A statistically significant electrolyte abnormality that was observed was the low bicarbonate value.

In arterial blood gas analysis, all forms of acid-base abnormalities were observed, the predominant ones being partially compensated metabolic acidosis and compensatory respiratory alkalosis. Statistically, a significant correlation was seen between BAC levels and pH, pCO2, base deficit and bicarbonate

LIMITATIONS:

As it was a cross-sectional study, follow up on the prognosis of the patients based on the severity of acid-base and electrolyte disturbances could not be established

Lactic acidosis was not ruled out as serum lactate values were not measured as a part of the study.

Consumption of other substances was ruled out as per history. But biochemical investigation to rule out the same was not performed.

Some per cent of the study population possibly had a component of chronic liver disease which was not ruled out by questionnaires or imaging modalities.

CONCLUSION:

Acute alcohol intoxication is clinically deleterious manifesting in multiple systems.

Our study shows that electrolyte and acid-base abnormalities have been noted in individuals with acute alcohol intoxication.

The most common acid-base abnormality in our study was compensated respiratory alkalosis followed by metabolic acidosis with partial compensation.

In our study, various electrolyte abnormalities were seen, but only serum bicarbonate levels showed a statistically significant negative association with blood alcohol concentration levels.

Alcoholic ketoacidosis can be corrected and treated if detected. Rapid identification of the serum electrolyte disturbances is of major importance for their appropriate management. Hence it is warranted to check for acid-base imbalance and electrolyte disturbances in intoxicated individuals.

CONFLICT OF INTEREST: Nil

SOURCE OF FUNDING: Self

AUTHOR CONTRIBUTION:

  1. M Girish: Principal investigator

  2. B Nivedana Lakshmi: Principal investigator

  3. Bhat Sonal: Principal investigator

  4. Hejamady Ismail Mohammed: Principal investigator and guide.

References:

1.            Vladimir P, Dag RG, Jürgen R, Kevin S, Gretchen S. Status report on alcohol and health 2014. Int J Clin Pract. 2014; 1 (1): 51-52.

2.        Rosato V, Abenavoli L, Federico A, Masarone M, Persico M. Pharmacotherapy of alcoholic liver disease in clinical practice. Int J Clin Pract. 2016;70(2):119–31.

3.            Heidland A, Horl WH, Schaefer RM, Teschner M, Weipert J, Heidbreder E. Role of alcohol in clinical nephrology. Klin Wochenschr 1985; 63: 948-58

4.            Elisaf M, Merkouropoulos M, Tsianos EV, Siamopoulos KC. Acid-base and electrolyte abnormalities in alcoholic patients. Miner Electrolyte Metab.  1994; 20: 274-81.

5.            Elisaf M, Kalaitzidis R. Metabolic abnormalities in alcoholic patients: focus on acid-base and electrolyte disorders. J Alcohol Drug Depend. 2015; 3: 185.

6.            Mathai PJ. Serum Electrolytes Levels in Patients with Alcohol Dependence Syndrome. Int J Clin Pract. 2017; 4 (5):992–997.

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

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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

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A Study by Monica K. entitled "Risk Predictors for Lymphoma Development in Sjogren Syndrome - A Systematic Review" is awarded Best Article for Vol 14 issue 13
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
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A Study by Vinita S & Ayushi S entitled "Role of Colour Doppler and Transvaginal Sonography for diagnosis of endometrial pathology in women presenting with Abnormal Uterine Bleeding" is awarded Best Article for Vol 14 issue 08
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A Study by Ajai KG & Athira KN entitled "Patients’ Gratification Towards Service Delivery Among Government Hospitals with Particular Orientation Towards Primary Health Centres" is awarded Best Article for Vol 14 issue 04
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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
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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
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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
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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
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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
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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
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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
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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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