International Journal of Current Research and Review
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IJCRR - Vol 13 Issue 17, September, 2021

Pages: 04-09

Date of Publication: 12-Sep-2021


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Effect of Carbon Dioxide Fractional Laser on the Levels of Regulated Upon Activation Normal T-Cell Expressed and Secretedserum Chemokines and Vitiligo Clinical Scoring in Stable Non-Segmental Vitiligo: A Case-Control Study

Author: Shokeir HA, Soliman MM, Emam HM, Abdel Latif Y, Abou Zeid OO

Category: Healthcare

Abstract:Introduction: Vitiligo is an acquired disorder that is recurrent with certain chemokines that were found to play a significant role in its complex pathology. Objective: This study aimed to evaluate carbon dioxide (CO2 )fractional laser efficacy on serum RANTES (regulated upon activation, normal T-cell expressed and secreted) and clinical scoring in vitiligo patients. Case Report: Sixty participants, selected from Kasr Al-Ainy teaching hospital dermatology outpatient clinic, Cairo University from August 2017 till March 2019 were assigned into a control group (A), including 30 age and gender-matched healthy volunteers and a study group (B) including 30 adult stable non-segmental vitiligo patients. All participants in group (A) were exposed to daily sunlight for 3 months, while patients in group (B) received 3 CO2 fractional laser monthly sessions with a wavelength of 10600nm along with sunlight exposure starting on the 5th day after every session for 3 months. Assessment of serum RANTES in all participants was done before and after interventions in both groups and vitiligo area severity index (VASI) score was taken before and after the intervention in all patients of the group (B). Discussion of Results: There was a significant difference (p < .001) in the serum RANTES levels when comparing pre to post-study results in the patients 'group, while there was no significant difference (p = .72) in serum RANTES levels when comparing pre to post-study results in the control group. For the VASI score, there was a significant difference (p < .001) in scores when comparing pre to post-study results in the patients 'group. Conclusion: Adding fractional CO2 laser to sun exposure surpasses sun exposure alone in improving stable non-segmental vitiligo patients' outcomes.

Keywords: Vitiligo, RANTES, CO2 Laser, sunlight, Laser Ablation, Patient-Relevant Outcome

Full Text:

INTRODUCTION

Vitiligo is known as the most prevalent multi- dimensional depigmenting disorder that represents a global incidence of 0.8% reaching up to 8%, specially recorded in African females.1,2Being a visible skin condition, vitiligo could be a source of great psychological distress as it limits social interactions, resulting in affected quality of life and increased liability for more serious psychiatric disorders. However, it does not reflect a life-threatening case causing the case to be underestimated.3

Vitiligo has a complex aetiology where a variety of underlying genetic, autoimmune, autotoxicity, neural and environmental theories lead eventually to melanocytes’ destruction causing vitiligo in inherently susceptible persons.4

The hallmark of the pathogenesis is the oxidative stress produced that affects defected melanocytes causing them to release reactive oxygen species and chemokines especially, chemokine ligand 5 (CCL5) or regulated upon activation, normal T-cell expressed and secreted (RANTES), leading to a vast imbalance between pro-oxidants and antioxidants, which compromises cell functioning.1,5

As vitiligo is a multifaceted disorder, its management remains a challenge with the available options being inconclusive. The first treatment line, aside from topical ointments and oral medication, is phototherapy, a relatively effective but with a high rate of patient’s dissatisfaction.6

That fact raises the need for more efficient alternatives as laser therapy. Carbon dioxide (CO2) lasers are commonly known to be effective in managing some cutaneous lesions, mild scars, and photoaging.7 Treatment using fractional CO2involves dividing the single beam of laser into multiple microbeams, producing microscopic ablative zones encircled by normal intact skin, thus it gives the same benefits as a full ablative treatment but with fewer side effects. Skin normally contains an elevated percentage of water, making CO2 laser perfect for accurate and safe ablation in the dermatology field, as its energy is highly absorbed in water.8 Fractional CO2 laser has demonstrated better efficiency in treating vitiligo, especially stable non- segmental form when combining with conventional treatments than when using the latter alone.9

Nevertheless, there is a scarcity of research regarding the effect of fractional treatment using CO2 laser on serum RANTES levels and clinical vitiligo outcomes. Thus, the present study aimed to evaluate the efficacy of CO2 laser on serum RANTES levels and clinical outcomes in stable non-segmental vitiligo patients.

MATERIALS AND METHODS:

The present study was designed as a non-randomized, comparative study, using a non-probability, consecutive, sampling technique for recruiting participants. The trial was conducted at Kasr Al-Ainy teaching hospital dermatology outpatient clinic, Cairo University, including 60 participants equally assigned into two groups from August 2017 till March 2019. Thirty age and gender-matched healthy volunteers were included as a control group (A), while thirty vitiligo patients have been included in the group (B) when they met the eligibility criteria of having stable non-segmental vitiligo, with stable refractory lesions and no response to conventional treatments. Pregnant, breastfeeding women, individuals with an active infection, or other autoimmune diseases were excluded. A total of 60 participants was determined using Stats Direct statistical software version 2.7.2 for MS (Windows, Stats Direct Ltd., Cheshire, UK), and the effect size was obtained from Yang et al.10

Ethical approval was obtained from the local ethics and research committee of Dermatology, Venereology and Andrology Department, of the National Research Centre. The study ran in concordance with the Declaration of Helsinki principles and other ethical guidelines and written informed consent was taken from every participant before the study enrollment.

All healthy participants in the control group (A) were exposed to sunlight daily for three months, whereas vitiligo patients in the study group (B) received three sessions of CO2 fractional laser therapy ‎(Microxel MX7000, Daeshin Enterprise, ‎, Korea), with a wavelength of 10600nm, the power output of 15 Watts, 1 millisecond as pulse width, 0.5 density and 15 mJ energy/point, at a monthly basis, together with sun exposure to the affected areas starting at the 5th day after each session, with the intact areas protected by sunscreen. Before the laser session, each patient applied topical anaesthetic on the areas to be treated for pain reduction. For ocular safety, laser-protective goggles were required for both the patients and the operator.

For the procedure of data collection and before starting the interventions, demographic characteristics, and serum RANTES level of every participant in both groups, clinical types and/or patterns of vitiligo as well as Vitiligo Area Severity Index (VASI) were attained from every patient in the group (B). Assessment of both RANTES and VASI was repeated after three months for all participants of both groups and the patients’ group, respectively.

Measuring serum RANTES in all participants was done using enzyme-linked immunosorbent assay (ELISA) technique based on the manufacturer’s guidelines,11 through a kit supplied by Glory Science Co., Ltd, Del Rio, TX 78840, USA, in the medical Biochemistry department in the National Research Center. To detect serum RANTES level, venous serum samples of 3-5 cc were withdrawn from the anti-cubital fossa of each participant and were left to clot for 30 minutes at room temperature, then the samples were subjected to centrifugation for 10 minutes at 5000 rotation per minute (rpm).  The supernatant serum was separated in Eppendorf tubes and stored at -80°c till the tie of analysis. Repeated freeze and thaw cycles were avoided. 

To evaluate clinical vitiligo patients’ outcomes, VASI was selected as it is a well-defined performance metric used to detect the level of depigmentation and can be relied on as an indicator of disease incidence and patient management.12 The patient’s body is divided into five distinctive regions, while the face and neck are independently examined. VASI is determined for each body region according to the vitiligo area in the hand units (the palm plus the volar digit surface) and the depigmentation pattern within each hand-unit patch (no pigment=100%, specks of pigment=90%, vitiligo> pigment=75%, vitiligo=pigment=50%, vitiligo< pigment=25%, specks of vitiligo=10%). The whole body VASI score is then calculated using a specific formula.13

Data entry, processing, and statistical analysis were carried out using Microsoft Excel 2007 (Microsoft Corporation, NY, USA) and SPSS (Statistical Package for the Social Science; SPSS Inc., Chicago, IL, USA) version 22 for Microsoft Windows. Quantitative data were described in terms of mean ±standard deviation (±SD), while qualitative data were expressed as frequencies (number of cases) and relative frequencies (percentages). Comparison of numerical variables between the two groups was done using the Mann Whitney U test for independent samples when comparing the two groups of non-normal data. Correlation between various variables was done using the Spearman rank correlation equation. A probability value (p-value ≤ 0.05) was considered statistically significant.

RESULTS:

In the present study, 30 patients with vitiligo and 30 age and sex-matched controls were included. As shown in table 1of the participants’ demographic data, the mean age of the patients and the controls were 33.3 ±14.3 36 and 31.96 ±12.21 years, respectively, with 60% of patients were females. Almost 33% of the patients had a positive family history. There were no statistically significant differences between the patients’ group and the control group in terms of age (p=.75) and gender (p =.81). On contrary, there was a statistically significant difference between the patients’ group and the control group in terms of family history (p<.001). As illustrated in table 2, the mean patients’ disease duration was 8.17 ±6.4 years and the age at the disease onset was 22.9 ±15.9 years old, and all lesions were stationary. As indicated in table 3, the clinical type of vitiligo was focal in 40% of the cases, generalized in 36.7%, and universal in 20% of cases, with the face, was the most common site of the initial lesion (table 4). Before the interventions, the patients’ mean VASI score was 23.03 ±12.7 and the mean RANTES level was 1223.4 ±588.6 ng/L, while post-intervention, as shown in table 5, mean VASI score was 12.7 ±8.2 (Figure 1) and the mean RANTES level was 980.483±1957 (Figure 2), indicating statistically significant differences in both values in the patients’ group when comparing pre to post-study results (p <.001). Regarding the control group (A), there was no statistically significant difference when comparing results before and after 3 months of sun exposure (Table 6).

DISCUSSION

In the current study, the effect of fractional treatment using CO2 laser on the expression of circulating RANTES and vitiligo clinical outcomes in the form of VASI score in stable non-segmental vitiligo patients was explored. The study findings indicated a significant reduction in the serum RANTES level and a noticeable decrease in VASI score of vitiligo patients when they were treated using fractional CO2 laser, combined with sun exposure, 3 months after treatment, while sun exposure alone was not associated with a significant reduction in the serum RANTES level in the control group.

To the best of the current knowledge, several studies used fractional ablative CO2 laser in the treatment of vitiligo. Also, earlier studies have evaluated chemokines in the serum and tissues of vitiliginous patients and showed their importance in vitiligo pathophysiology. Still, no studies have been conducted to understand and correlate the relationship between the beneficial effect of fractional Co2 laser in treating vitiligo and both the chemokines’ level in the serum as well as improved vitiligo clinical outcomes.

To explain the underlying mechanism by which CO2 laser could positively affect vitiligo outcomes, various theories are proposed. For instance, First, a CO2 laser causes an immediate shrinkage of the tissue contraction that produces narrowing the vitiligo lesions’ size. Also, the wound healing process involves the secretion of multiple cytokines and growth factors from nearby intact tissues and hair follicles, serving as proteins to help melanocytes’ division. Another explanation is that laser fractional treatment enhances the penetration of both ultraviolet rays and other topical agents through the epidermal layer, boosting their effects.14

The results of this work matched those from a study with a similar design done by Shin et al.15 which showed vitiligo lesions’ improvement, but with a longer duration of the application. Also, many studies approved that fractional CO2 laser was better to be combined with other approaches as narrowband ultraviolet B and medications for more effective treatment outcome.16,17,18

However, the exact effect of a fractional CO2 laser remains elusive, as contradicting results were reported by Esme et al.19 who suggested that treating non-segmental vitiligo lesions using combined therapy of both phototherapy and CO2 laser is not superior to phototherapy alone in terms of their effectiveness in re-pigmentation, as they found non-significant differences between the two modalities when used separately in treating the patients’ lesions, with one half of the body treated by phototherapy and the other half with  CO2 fractional laser, three times/ week for 4 months.

Regarding the effect of laser therapy added to sun exposure, it was previously studied by Helou et al.20 who examined the effects of fractional CO2 laser followed by sun exposure on generalized stable vitiligo and found a greater recovery of the lesions, when treated with both fractional CO2 laser beside sun exposure compared to sun exposure alone.

Concerning the findings of the current study, patients’ group (B) showed a significant decrease in RANTES levels. Previous reports demonstrated that the laser reduced the oxidative stress markers and increased the antioxidant capacity as well.21 Also, the laser was proved to enhance cytokine and chemokine expression via mitochondrial biogenesis, thus it could be considered as an efficient boosting agent for immunity in vitiligo treatment.22

The findings of the present study regarding the decrease in VASI score also agreed with the results from Abu Zeid et al.23 who found that treating patients with stable vitiligo with the fractional laser before applying tacrolimus ointment yielded significant improvement in form of decreased VASI scores, especially for acral areas and newly affected patches.

Having a controversial view about the exact role the fractional CO2 laser plays in vitiligo treatment,23,24,25 the current study provides evidence on its positive effect in the circulating chemokines and clinical measures of vitiligo. Also, using blood sampling to assess the serum RANTES was more convenient and easily accepted by patients than taking skin biopsy, though the latter could provide direct evidence for local skin immune responses. Moreover, the results of the present study are not affected as any change of the immune cells in circulation reflects the status of homeostasis of the peripheral immune system.

The current study provides objective data with statistically significant differences. Still, there are some limitations to it. While the study achieved the desired effect size, a larger sample would be more suitable for generalizing the results. Also, additional studies for RANTES (CCL5), their receptor CCR5, and other cytokines present in the circulation as well as skin are needed to provide better insight into the role of RANTES chemokine in the pathogenesis of vitiligo and other autoimmune disorders, and how inhibiting its production may provide therapeutic benefits via disruption of the chemokine-receptor axis. Similarly, the validation of factors associated with RANTES concentrations in vitiligo patients requires further investigation.

CONCLUSION

Based on the findings of that work, we can conclude that fractional treatment of vitiligo using CO2 laser could effectively decrease the serum RANTES level, a key chemokine in the vitiligo pathology, as well as reduce VASI score leading to better clinical outcomes in vitiligo patients after three months of treatment.

ACKNOWLEDGEMENTS: All the authors want to thank all individuals who participated in this study.

Conflict of Interest: All authors confirm that there are no conflicts of interest regarding this article.

Funding sources: None (this work did not receive any funding).

References:

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  5. Said-Fernandez SL, Sanchez-Domínguez CN, Salinas-Santander MA, Martinez-Rodriguez HG, Kubelis-Lopez DE, Zapata-Salazar NA, et al. Novel immunological and genetic factors associated with vitiligo: a review. Exp Ther Med. 2021; 21(4): 312. doi:10.3892/etm.2021.9743

  6. Kandaswamy S, Akhtar N, Ravindran S, Prabhu S, Shenoi SD. Phototherapy in vitiligo: assessing the compliance, response and patient's perception about disease and treatment. Indian J Dermatol. 2013; 58(4): 325. doi: 10.4103/0019-5154.113944

  7. Yasmeen S, Khan T. Laser Carbon Dioxide Resurfacing. [Updated 2020 Aug 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021.

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  9. Kim WI, Kim S, Lee SH, Cho MK. The efficacy of fractional carbon dioxide laser combined with narrow-band ultraviolet B phototherapy for non-segmental vitiligo: a systematic review and meta-analysis. Lasers Med Sci. 2021; 36(1): 165-73. doi: 10.1007/s10103-020-03069-0. 

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  12. Vrijman C, Linthorst Homan MW, Limpens J, van der Veen W, Wolkerstorfer A, Terwee CB, et al. Measurement properties of outcome measures for vitiligo: a systematic review. Arch Dermatol. 2012; 148(11): 1302-9. doi: 10.1001/archdermatol.2012.3065. 

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  14. El-Zawahry MB, Zaki NS, Wissa MY, Saleh MA. Effect of combination of fractional CO2 laser and narrow-band ultraviolet B versus narrow-band ultraviolet B in the treatment of non-segmental vitiligo. Lasers Med Sci. 2017; 32(9): 1953-8. doi: ‎10.1007/s10103-017-2290-y

  15. Shin J, Lee JS, Hann SK, Oh SH. Combination treatment by 10 600 nm ablative fractional carbon dioxide laser and narrowband ultraviolet B in refractory nonsegmental vitiligo: a prospective, randomized half-body comparative study. Br J Dermatol. 2012; 166(3): 658-61. doi: 10.1111/j.1365-2133.2011.10723.x. 

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  19. E?me P, Gür Aksoy G, Elçin G. No additional benefit of combining fractional carbon dioxide laser with narrow-band ultraviolet b phototherapy for vitiligo: a randomized prospective study with half-body side comparison. Dermatol Surg. 2019; 45(12): 1627-34. doi: 10.1097/DSS.0000000000001890.

  20. Helou J, Maatouk I, Obeid G, Moutran R, Stéphan F, Tomb R. Fractional laser for vitiligo treated by 10,600 nm ablative fractional carbon dioxide laser followed by sun exposure. Lasers Surg Med. 2014; 46(6): 443-8. doi: 10.1002/lsm.22260

  21. De Oliveira HA, Antonio EL, Arsa G, Santana ET, Silva FA, Júnior DA, et al. Photobiomodulation leads to reduced oxidative stress in rats submitted to high-intensity resistive exercise. Oxid Med Cell Longev. 2018; 2018: 5763256. doi: 10.1155/2018/5763256. 

  22. Chen W, Zhou Y, Huang FR, Luo D, Wang DG. Preliminary study on the treatment of vitiligo with carbon dioxide fractional laser together with tacrolimus. Lasers Surg Med. 2018; 50(8): 829-36. doi: 10.1002/lsm.22821

  23. Abu Zeid OM, Omar N, El Sharkawy D. The efficacy of combining fractional CO2 laser and tacrolimus ointment in the treatment of vitiligo. J Egypt Women's Dermatologic Soc. 2020; 17(1): 25-30. doi:10.4103/JEWD.JEWD_41_19

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  25. Kim HJ, Hong ES, Cho SH, Lee JD, Kim HS. Fractional carbon dioxide laser as an "add-on" treatment for Vitiligo: a meta-analysis with systematic review. Acta Derm Venereol. 2018; 98(2): 180-4. doi: 10.2340/00015555-2836.

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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
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
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A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

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


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


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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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