International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
logo
slider
slider
slider
slider
Bootstrap Slider

Indexed and Abstracted in: Crossref, CAS Abstracts, Publons, Google Scholar, Open J-Gate, ROAD, Indian Citation Index (ICI), ResearchGATE, Ulrich's Periodicals Directory, WorldCat (World's largest network of library content and services)

Search Articles

Track manuscript

Full Html

IJCRR - 13(14), July, 2021

Pages: 79-84

Date of Publication: 20-Jul-2021


Print Article   Download XML  Download PDF

Urinary Tract Infections Among Patients of Bladder Outlet Obstruction

Author: Shakya BK, Jindal RP, Sahota SK, Jindal N

Category: Healthcare

Abstract:Background: Bladder outlet obstruction (BOO) is defined as blockage at the neck of the urinary bladder. This is one of the most common conditions in elderly men. BOO results from several etiologies, which may be functional or anatomic. However, the main cause of BOO remains benign prostatic hyperplasia (BPH), secondary to BOO and carcinoma prostate. The complication of BOO can be devastating and long term. The resulting obstruction frequently produces lower urinary tract symptoms (LUTS) and becomes the main cause of lower urinary tract infections (LUTI). Material and Methods: In this cross-sectional study, a total of 100 consecutive patients of BOO who presented to our tertiary care hospital were enrolled in this study. After recording the demographic profile their mid-stream urine samples were collected and cultured for bacterial pathogens. The bacterial isolates were identified using standard microbiological methods and tested against a wide spectrum of antimicrobial agents using Kirby Bauer's method following the Clinical & Laboratory Standards Institute (CLSI) guidelines. Results: Out of the 100 patients studied, 78% had BPH, and urine culture was positive in 74%. Most of these patients were more than 50 years of age group (90.5%) (Mean age= 61.2 years). There were 97.3% males and 2.7% of females. BPH was the most common cause of UTI as compared to the other causes of BOO (p=0.00001). Escherichia coli 46(62.1%) was the most common uropathogen causing UTI followed by Klebsiellapneumoniae 12(16.2%), Pseudomonas aeruginosa 10(13.5%), and the gram-positive organisms (Staphylococcus aureus, CoNS, Enterococcus faecalis 2.7% each). The study of their antimicrobial susceptibility showed that antimicrobial resistance to two or more drugs was present in the gram-negative (68/74) and grampositive (6/74) isolates. Conclusion: The present study shows that BPH continues to be the most frequent cause of BOO. There is a high prevalence of UTI in these patients which is caused by multidrug-resistance organisms. This study has important implications in the treatment of urinary tract infections among BOO patients in our region.

Keywords: Bladder outlet obstruction (BOO), Benign prostatic hyperplasia (BPH), Multidrug-resistant (MDR), Urinary tract infection (UTI), Lower urinary tract syndrome (LUTS), Uropathogens

Full Text:

INTRODUCTION

Bladder outlet obstruction (BOO) is defined as blockage at the neck of the urinary bladder. This is one of the most common conditions in elderly men.1As the age expectancy is increasing the number of men affected by BOO is expected to rise. The greatest increase is anticipated in developing countries like India.2 BOO results from several etiologies, which may be functional or anatomic. The various reported causes of BOO are benign prostatic hyperplasia (BPH), carcinoma prostate, bladder stone, bladder carcinoma, posterior urethral valve, dysfunctional voiding, neurogenic-based detrusor-sphincter dyssynergia (DSD), bladder neck stenosis and obstruction from stress urinary incontinence surgery.3-4 However, the main cause of BOO remains benign prostatic enlargement, secondary to BPH and carcinoma prostate. BPH is a condition inevitably associated with ageing. Fifty per cent of men over the age of 40 develop BPH.5-6 In contrast, BOO is a poorly understood condition in females. It is much rare in them as compared to males and has the aetiology of bladder neck stenosis, urethral stricture, urethral diverticulum and retroverted uterus.7

The Complication of BOO can be devastating and long term.  BOO can permanently damage all parts of the urinary system.8The obstruction frequently produces lower urinary tract symptoms (LUTS) which can have a significant negative impact on the quality of life.9-11 There is urine stasis from incomplete voiding and the resultant residual urine serves as the medium for bacterial growth which leads to urinary tract infection (UTI). Lower UTI involves infections from the urinary bladder downward and includes urethritis, cystitis and prostatitis. Asfo-Adjeiet al. reported a 76.6 % incidence of urinary tract infections among their BOO patients and the main risk factor identified was catheterization.12 Most of these infections are caused by a few genera of the family Enterobacteriaceae and the common uropathogens reported are Escherichia coli, Pseudomonas spp., Staphylococcus aureus, Enterococcus species, Klebsiella spp. and Proteus spp.13-15 The microbes causing infection differ in their susceptibility towards various antimicrobial drugs from place to place and time to time. The emergence of multiple drug resistance strains causing UTI is also escalating. It is a big challenge in our country because of the irrational use of antibiotics.

Hence, the present study was undertaken with aim of determining the proportion of UTI and various uropathogens causing it in the clinically suspected patients of BOO attending the urology department of our tertiary care centre. There is a paucity of such studies from this area of Punjab (North India).

MATERIAL AND METHODS

This prospective cross-sectional study was conducted on a total of 100 consecutive patients of   BOO who were attending the urology department of our tertiary care centre. Ethical approval of this study was obtained from the institutional review committee (BFUHS/2K19p-TH/8906). After recording the demographic profile of the patients in the prescribed Performa, their urine samples were collected, using all the sterile precautions.

The patients were asked to collect midstream urine samples in sterile containers, which were transported to the microbiology department within 2 hours of collection. The urine specimen was processed within 30 minutes of arrival in the laboratory. Specimens were initially inoculated on a standard culture media, Cystine–Lactose–Electrolyte-Deficient (CLED) agar, using a standard calibrated loop. Following incubation in an ambient air incubator at 35-370 C for 18 hours colonies were counted and counts of ≥105 CFU/mL were assessed as significant bacteriuria. The bacterial growth was identified based on their colonial morphology, Gram’s staining, and biochemical reactions which included the Catalase test, slide and tube Coagulase test, Oxidase test, Indole test, MR test, Citrate utilization test, Triple sugar iron test (TSI). Oxidation/fermentation test, Urease test, Nitrate reduction test, VP (Voges-Proskauer) test.16-17The isolated and identified colonies were then tested for antimicrobial susceptibility on Mueller Hinton agar using the Kirby-Bauer disc diffusion method according to Clinical Laboratory Standard Institute (CLSI) guidelines.18 The antibiotic discs and their concentration used in the study were Ampicillin (2µg), Cefoxitin (30µg), Cefotaxime (30µg), Ceftriaxone (30µg), Ceftazidime (30µg), Cefepime (30µg), Gentamicin (10µg), Amikacin (30µg), Imipenem (10µg), Norfloxacin (10µg), Ciprofloxacin (10µg), Levofloxacin (10µg), Piperacillin-Tazobactam (100/10µg), Amoxicillin-Clavulanic acid (30µg/10µg), Nitrofurantoin (300µg), Vancomycin (30µg), Linezolid (30µg), High-level Gentamicin (120µg), Colistin/Polymyxin B (100 unit) for Staphylococci, MIC (minimum inhibitory concentration) of Vancomycin was determined and value of ≤2 µg/ml was considered as sensitive.

Data so obtained was analyzed using Microsoft Excel software and Statistical Package for the Social Sciences (SPSS). The Chi-square test was employed to study the association of current LUTI status with other factors. The variables were compared using cross-tabulation statistical methods and the p-value <0.05 was considered statistically significant.

RESULTS

Table-1 summarizes the demographic profile of 100 patients who were suspected to have clinical evidence of BOO by the treating urologist. The mean age of the study population was 61.2 years (9-83 years). The maximum patients 83(83%) were more than 50 years of age followed by 5-15 years (9%). Most (93%) of them were males and the females constituted only 7% of the study population. A total of 73% were literate and had education up to 5th standard or more. In terms of occupation, pensioners were predominant (54%) followed by those in jobs (employed) (34%). In the present study, the most common cause of BOO was found to be benign prostatic hyperplasia (78%) followed by prostate cancer (14%), bladder neck stenosis (4%), and posterior urethral valve (2%) (Table-1). There was a history of acute and chronic retention and chronic urinary catheterization in 69%. The most common comorbidity among the patients of BOO observed was hypertension (43%) followed by diabetes (9%).

On culture, significant bacterial growth was obtained in 74(74%). Of these 67(90.5%) were more than 50 years of age. The culture positivity in this age group showed a statistically significant difference from in the 5-15 years of age group (p-value: a and b= 0.02). Out of 74 culture-positive patients, 72(97%) were males and 2(2.7%) were females and the difference was statistically significant (p-value: c and d= 0.01). BPH 67(90.5%) was the main cause of LUTI followed by various other causes which also showed a statistically significant difference (p-value: e and f= 0.000001) (Table 1).

 Of the 74 positive bacterial cultures, 68(91.9%) showed the growth of gram-negative bacteria while only 6(8.1%) were gram-positives. E. coli found to be the most frequent 46(62.1%) isolate followed by K. pneumonia 12(16.2%) and P. aeruginosa 10(13.5%). The gram-positive bacteria isolated were S. aureus, coagulase-negative staphylococci (CoNS) and Enterococcus faecalis 2(2.7%) each (Figure-1). The result of antimicrobial susceptibility testing of the 74 isolated organisms is shown in (Table-2). E.coliwhich was the most prevalent organism causing UTI in the present study was found to be 100% resistant to Amikacin, all the three 3rd generation and 4th generation cephalosporins (Cefotaxime, Ceftriaxone, Ceftazidime, cefepime) and Ciprofloxacin. This was followed by resistance to Imipenem (73.9%), Norfloxacin and Levofloxacin (60.8% and 54.3% respectively). Resistance to aminoglycosides (Gentamicin and Amikacin) was less than 50%. While Nitrofurantoin was effective in more than 80%, no strain was found to be resistant to colistin.  The 12 isolates of K. pneumoniae showed an almost similar pattern of resistance as that of E. coli. The exception was that K. pneumoniae strains were more resistant to Imipenem (83.3%) and even Nitrofurantoin (50%) than those of E. coli. All the 10 strains of P. aeruginosa showed 100% resistance to Ampicillin, cephalosporins, Norfloxacin and Ciprofloxacin, and more than 80% resistance to Gentamicin, Amikacin, and Imipenem. Amongst the gram-positive cocci, the resistance to Ampicillin, Aminoglycosides (Amikacin and Gentamicin), and fluoroquinolones (Levofloxacin, Ciprofloxacin, and Norfloxacin) was 100%. But all the strains were sensitive to Vancomycin, and Linezolid. Resistant to two or more drugs was observed in all the gram-negative and gram-positive isolates. Thus, the overall prevalence of multidrug resistance was 100% in our study (Table-2).

DISCUSSION

The focus of the present study was to determine the important causes of BOO and the common uropathogen causing LUTI among patients of BOO in our region (North India). We observed that the mean age of our study participants was 61.2 years and 83% were more than 50 years of age. This is similar to the findings of two studies of Gyasi-Sarponget al.9,19In both studies, the mean age was 62 years.Shettyet al. observed it to be 57 years and the range was between 18-80 years.8There was a predominance of males (93%) and the male, the female ratio was 13.2 in our study. Other authors have also reported that BOO, more commonly affects men especially those of the old age group.9,12,19 male and female ratio in the study of Katakwar and Thakur was 15.6 which is similar to that of the present study.20 The most frequent cause of BOO in the present study was BPH (78%) which corroborates the findings of Asafo-Adjeiet al. and other authors.12,20Shettyet al. had reported that the most common cause of BOO was BPH in males and bladder neck stenosis in females.8 Four of the 7 females of our study were suffering from bladder neck stenosis (Table-1).

The prevalence of UTI among the patients of BOO in our study was 74% and the maximum positive cultures were obtained in patients of more than 50 years of age followed by 5-15 years (age group). Statistically, the difference between the two age groups was significant (p-value: a and b= 0.0003) Table 1. In a study, Gyasi-Sarpong et al. reported a 76% prevalence of UTI among BOO patients of more than 70 years of age.19 Jarvis et al. also observed that the prevalence of UTI was often indicative of BOO secondary to BPH, especially in elderly men.21

A wide range of bacterial organisms was observed to cause UTI in the present study. There was a predominance of members of the family Enterobacteriaceae and E. coli was the most frequent (62.1%). The other isolates identified were Klebsiella spp. (16.2%), Pseudomonas spp. (13.5%) and Staphylococcus spp. (5.4%) and Enterococci (5.4%). This is similar to the studies of Asafo-Adjeiet al. and Ahmed et al.12,22 However, Enterococcus faecalis which was found to be an important gram-positive uropathogen in our study was not isolated in the study of Asafo-Adjeiet al.12 In another study Klebsiella spp. (36.6%) and P. aeruginosa (27%) were the most prevalent organisms.23 This variation in the aetiology of UTI could be because of differences in the periods of the studies, in the places/regions/countries of the study, and the study population.

All the gram-positive and gram-negative organisms causing UTI in the present study were found to be resistant to two or more drugs. The alarming finding was that all (100%) strains of E. coli resistant to Ampicillin, Cefotaxime, Ceftriaxone, Cefepime and Ciprofloxacin. They also showed very high resistance to Imipenem (73.9%). Only Colistin and Nitrofurantoin were found to be effective with the sensitivity of 100% and 80.5% respectively. Hussain et al. also reported the maximum resistance of E.coli to Ampicillin, 3rd generation cephalosporins, Norfloxacin and Gentamycin.24 Asfo-Adjeiet al observed high resistance of E. coli to fluoroquinolones.12 The strains of K. pneumoniae of the present study had shown an even higher level of resistance as compared to those of E. coli which also corroborates the findings of Hussain et al.24 However, a reverse trend was observed by Ranbeeret al. They found 89% sensitivity to Gentamycin, 93% to Imipenem and 98% to Nitrofurantoin.25The isolated strains of P. aeruginosa also showed a very high level of resistance to all antimicrobials agents including Imipenem (80%). A similar pattern was observed in the study of Asfo-Adjeiet al.12 This could be because UTI is often treated empirically which results in inappropriate and non-judicious use of these high-end antimicrobial agents leading to MDR (multiple drug resistance) infections in patients with UTI.

In our study, there were only four strains of Staphylococcus species and two of them were resistant to Cefoxitin. These two methicillin-resistant Staphylococcus aureus(MRSA) strains were showed resistance to Ampicillin and aminoglycosides. However, these were found to be sensitive to Vancomycin and Linezolid. Thus, we were left with the option of treatment of these infections by Linezolid or Vancomycin. Enterococci are an important cause of UTI and in the present study, Enterococcus faecalis was found to be causing significant bacteriuria in two patients. Both these strains were highly resistant. They showed sensitivity only to only Vancomycin and Linezolid. It is an alarming situation as Vancomycin-Resistant Enterococcus (VRE) causing UTI are difficult to manage. Linezolid, the oral drug could be used but only 30% of each dose of it is excreted in the urine.26

CONCLUSION

The present study confirms that BPH continues to be the most common cause of BOO and UTI caused by multi drug-resistant organisms is highly prevalent in these patients for the adequate treatment of these patients, appropriate antibiotics selected after urine culture and antimicrobial susceptibility testing should be used. This could also help to contain the problem of drug resistance. The drug monitoring system that augments drug administration and associates a more personalized methodology to recommended treatment may also help.

Conflict of interest

The authors declare no conflicts of interest.

Acknowledgement

We are very thankful to all the study participants for being a part of this study. We have many thanks to lecturers and friends who helped us during this research. We would like to thanks the microbiology department of Guru Gobind Singh Medical College and Hospital,Faridkot.

Funding

No funding was received to perform this study.

Author’s contribution

Study conception and design: Jindal N. Data collection: Shakya BK and Sahota SK. Laboratory work: Shakya BK. Analysis and interpretation of data: Jindal RP, Shakya BK and Sahota SK. Final drafting of manuscript: Jindal RP, Shakya BK, Jindal N and Sahota SK. All authors commented and approved the final manuscript.

References:

  1. Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. The J Urolo. 1984 Sep 1;132(3):474-9.

  2. Irwin DE, Kopp ZS, Agatep B, Milsom I, Abrams P. Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. Bri J Urol Int. 2011 Oct;108(7):1132-8.

  3. Wein AJ, Levin RM, Barrett DM. Voiding function: relevant anatomy, physiology and pharmacology. In: Gillenwater JY, Grayhack JT, Howards SS, Duckett JD editors. Adult and Pediatric Urology.1st ed. Chicago: Yearbook Medical Publishers; 1987. p.800-62.

  4. Dmochowski RR. Bladder outlet obstruction: etiology and evaluation. Rev Urol. 2005;7Suppl 6:S3-13.

  5. Hølund B. Latent prostatic cancer in a consecutive autopsy series. Scand J Urol Nephrol. 1980 Jan 1;14(1):29-35.

  6. Franks LM. Benign nodular hyperplasia of the prostate- a review. Ann R CollSurg Engl. 1953;14(2):92-106.

  7. Carr LK, Webster GD. Bladder outlet obstruction in women.  Urol Clin Nor Ame. 1996 Aug 1;23(3):385-91.

  8. Shetty A, Pandit A, Majeed A. Incidence and aetiology of bladder outlet obstruction in Mangalore, Karnataka. Ame Health Ssc. 2014;1(1):65-7.

  9. Gyasi-Sarpong CK, Nkrumah B, Yenli EM, Appiah AA, Aboah K, Azorliade R et al. Resistance pattern of uropathogenic bacteria in males with lower urinary tract obstruction in Kumasi, Ghana. Afr J Microbiol Res. 2014 Sep;8(36):3324-9.

  10. Coyne KS, Sexton CC, Irwin DE, Kopp ZS, Kelleher CJ, Milsom I. The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study. Bri J Urol Int. 2008;101:1388-95.

  11. Irwin DE, Milsom I, Kopp Z, Abrams P. Symptom bother and healthcare-seeking behaviour among individuals with overactive bladder. Eur Urol. 2008;53:1029–37

  12. Asafo-Adjei K, Mensah JE, Labi AK, Dayie NT, Donkor ES. Urinary tract infections among bladder outlet obstruction patients in Accra, Ghana: aetiology, antibiotic resistance, and risk factors. Dis. 2018 Sep;6(3):65.

  13. Behzadi P, Behzadi E, Yazdanbod H, Aghapour R, Cheshmeh MA, Omran DS. A survey on urinary tract infections associated with the three most common uropathogenic bacteria. Medica. 2010 Apr;5(2):111.

  14. Beyene G, Tsegaye W. Bacterial uropathogens in urinary tract infection and antibiotic susceptibility pattern in Jimma university specialized hospital, southwest Ethiopia. Ethiop J Health Sci. 2011;21(2):141-6.

  15. Gupta V, Yadav A, Joshi RM. Antibiotic resistance pattern in uropathogenic. Ind J Med Microb. 2002 Apr 1;20(2):96.

  16. Collee JG, Miles S, Watt B. Tests for identification of bacteria. In: Collee JG, Marmion BP, Fraser AG, Simmons A editors. Mackie and McCartney practical medical microbiology. 14th ed. London: Churchill Livingstone; 2015;131-50.

  17. Koneman EW, Allen SD, Janda WM, Schreckenberger PC, Winn WC Jr. The Enterobacteriaceae. In: Color atlas and textbook of diagnostic microbiology. 7th ed. Philadelphia: Wolters Kluwer. 2017.p.214-80.

  18. CLSI. Performance standards for Antimicrobial Susceptibility Testing. 30th ed. supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2020.

  19. Gyasi-Sarpong CK, Yenli EM, Idriss A, Arhin  AA,  Aboah K,  Azorliade R et al. Bacterial urinary tract infections among males with lower urinary tract obstruction at KomfoAnokye. Open J Urol. 2012;2:131-6.

  20. Katakwar P, Thakur R. Clinical study and management of bladder outlet obstruction. Int Surg J. 2017 Mar 25;4(4):1272-5.

  21. Jarvis TR, Chughtai B, Kaplan SA. Bladder outlet obstruction and BPH. Curr Blad Dysf Rep. 2014 Dec 1;9(4):372-8.

  22. Ahmad S. Pattern of urinary tract infection in Kashmir and antimicrobial susceptibility. Bangladesh Med Res Coun Bull. 2012;38(3):79-83.

  23. Taiwo SS, Aderounmu AO. Catheter-associated urinary tract infection: aetiologic agents and antimicrobial susceptibility pattern in LadokeAkintola University Teaching Hospital, Osogbo, Nigeria. Afr J Biomed Res. 2006;9(3): 472.

  24. Hussain S. Increasing Antibiotic Resistance in the Uropathogens. Asi J Phar. 2019 Feb 9;13(01).

  25. Singh RK, Haque SS. antibiotic susceptibility patterns in commonly isolated pathogens in east Indian population. Adv Biochem Biotechn. 2019 Mar 20.

  26. Pontefract B, Madaras-Kelly K.  Linezolid for Treatment of Urinary Tract Infections Caused by Vancomycin-resistant Enterococci. Open Forum Infect Dis. 2019 Oct 23;6(2):537.

Announcements

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

COPE guidelines for Reviewers

SCOPUS indexing: 2014, 2019 to 2021


Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

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

Women Researcher Award:

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

Emerging Researcher Award:

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


Best Article Award

A study by Dorothy Ebere Adimora et al. entitled \"Remediation for Effects of Domestic Violence on Psychological well-being, Depression and Suicide among Women During COVID-19 Pandemic: A Cross-cultural Study of Nigeria and Spain\" is awarded Best Article of Vol 14 issue 23
A study by Muhas C. et al. entitled \"Study on Knowledge & Awareness About Pharmacovigilance Among Pharmacists in South India\" is awarded Best article for Vol 14 issue 22
A study by Saurabh Suvidha entitled \"A Case of Mucoid Degeneration of Uterine Fibroid with Hydrosalphinx and Ovarian Cyst\" is awarded Best article of Vol 14 issue 21
A study by Alice Alice entitled \"Strengthening of Human Milk Banking across South Asian Countries: A Next Step Forward\" is awarded Best article of Vol 14 issue 20
A study by Sathyanarayanan AR et al. entitled \"The on-task Attention of Individuals with Autism Spectrum Disorder-An Eye Tracker Study Using Auticare\" is awarded Best article of Vol 14 issue 19
A study by Gupta P. et al. entitled \"A Short Review on \"A Novel Approach in Fast Dissolving Film & their Evaluation Studies\" is awarded Best Article of Vol 14 issue 18.
A study by Shafaque M. et al. entitled \"A Case-Control Study Performed in Karachi on Inflammatory Markers by Ciprofloxacin and CoAmoxicillin in Patients with Chronic Suppurative Otitis Media\" is awarded Best Article of Vol 14 issue 17
A study by Ali Nawaz et al. entitled \"A Comparative Study of Tubeless versus Standard Percutaneous Nephrolithotomy (PCNL) \? A Randomized Controlled Study\" is awarded Best Article for Vol 14 issue 16.
A study by Singh R. et al. entitled \"A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)\" is awarded Best Article for Vol 14 issue 15
A Study by Humaira Tahir et al. entitled "Comparison of First Analgesic Demand after Major Surgeries of Obstetrics and Gynecology between Pre-Emptive Versus Intra-Operative Groups by Using Intravenous Paracetamol: A Cross-Sectional Study" is awarded Best Article for Vol 14 issue 14
A Study by Monica K. entitled "Risk Predictors for Lymphoma Development in Sjogren Syndrome - A Systematic Review" is awarded Best Article for Vol 14 issue 13
A Study by Mokhtar M Sh et al. entitled "Prevalence of Hospital Mortality of Critically Ill Elderly Patients" is awarded Best Article for Vol 14 issue 12
A Study by Vidya S. Bhat et al. entitled "Effect of an Indigenous Cleanser on the Microbial Biofilm on Acrylic Denture Base - A Pilot Study" is awarded Best Article for Vol 14 issue 11
A Study by Pandya S. et al. entitled "Acute and 28-Day Repeated Dose Subacute Toxicological Evaluation of Coroprotect Tablet in Rodents" is awarded Best Article for Vol 14 issue 10
A Study by Muhammad Zaki et al. entitled "Effect of Hemoglobin Level on the Severity of Acute Bronchiolitis in Children: A Case-Control Study" is awarded Best Article for Vol 14 issue 09
A Study by Vinita S & Ayushi S entitled "Role of Colour Doppler and Transvaginal Sonography for diagnosis of endometrial pathology in women presenting with Abnormal Uterine Bleeding" is awarded Best Article for Vol 14 issue 08
A Study by Prabhu A et al. entitled "Awareness of Common Eye Conditions among the ASHA (Accredited Social Health Activist) Workers in the Rural Communities of Udupi District- A Pilot Study" is awarded Best Article for Vol 14 issue 07
A Study by Divya MP et al. entitled "Non-Echoplanar Diffusion-Weighted Imaging and 3D Fiesta Magnetic Resonance Imaging Sequences with High Resolution Computed Tomography Temporal Bone in Assessment and Predicting the Outcome of Chronic Suppurative Otitis Media with Cholesteatoma" is awarded Best Article for Vol 14 issue 06
A Study by Zahoor Illahi Soomro et al. entitled "Functional Outcomes of Fracture Distal Radius after Fixation with Two Different Plates: A Retrospective Comparative Study" is awarded Best Article for Vol 14 issue 05
A Study by Ajai KG & Athira KN entitled "Patients’ Gratification Towards Service Delivery Among Government Hospitals with Particular Orientation Towards Primary Health Centres" is awarded Best Article for Vol 14 issue 04
A Study by Mbungu Mulaila AP et al. entitled "Ovarian Pregnancy in Kindu City, D.R. Congo - A Case Report" is awarded Best Article for Vol 14 issue 03
A Study by Maryam MJ et al. entitled "Evaluation Serum Chemerin and Visfatin Levels with Rheumatoid Arthritis: Possible Diagnostic Biomarkers" is awarded Best Article for Vol 14 issue 02
A Study by Shanthan KR et al. entitled "Comparison of Ultrasound Guided Versus Nerve Stimulator Guided Technique of Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries" is awarded Best Article for Vol 14 issue 01
A Study by Amol Sanap et al. entitled "The Outcome of Coxofemoral Bypass Using Cemented Bipolar Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fracture of Femur in a Rural Setup" is awarded Best Article Award of Vol 13 issue 24
A Study by Manoj KP et al. entitled "A Randomized Comparative Clinical Trial to Know the Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block Against Multimodal Analgesia for Postoperative Analgesia Following Caesarean Section" is awarded Best Article Award of Vol 13 issue 23
A Study by Karimova II et al. entitled "Changes in the Activity of Intestinal Carbohydrases in Alloxan-Induced Diabetic Rats and Their Correction with Prenalon" is awarded Best Article of Vol 13 issue 22
A Study by Ashish B Roge et al. entitled "Development, Validation of RP-HPLC Method and GC MS Analysis of Desloratadine HCL and It’s Degradation Products" is awarded Best Article of Vol 13 issue 21
A Study by Isha Gaurav et al. entitled "Association of ABO Blood Group with Oral Cancer and Precancer – A Case-control Study" is awarded Best Article for Vol 13 issue 20
A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


RSS feed

Indexed and Abstracted in


Antiplagiarism Policy: IJCRR strongly condemn and discourage practice of plagiarism. All received manuscripts have to pass through "Plagiarism Detection Software" test before Toto Macau forwarding for peer review. We consider "Plagiarism is a crime"

IJCRR Code of Conduct: To achieve a high standard of publication, we adopt Good Publishing Practices (updated in 2022) which are inspired by guidelines provided by Committee on Publication Ethics (COPE), Open Access Scholarly Publishers Association (OASPA) and International Committee of Medical Journal Editors (ICMJE)

Disclaimer: 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.



ABOUT US

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

Contact

148, IMSR Building, Ayurvedic Layout,
        Near NIT Complex, Sakkardara,
        Nagpur-24, Maharashtra State, India

editor@ijcrr.com

editor.ijcrr@gmail.com


Copyright © 2024 IJCRR. Specialized online journals by ubijournal .Website by Ubitech solutions