International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 13 Issue 17, September, 2021

Pages: 61-64

Date of Publication: 12-Sep-2021


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Clinical and Microbiological Profile of Diabetic Foot Infections in Inpatients at a Tertiary Care Hospital

Author: Dhanaleha P, Anand MR, Jayapradha S, Abarna V

Category: Healthcare

Abstract:Introduction: Chronic foot infections in patients with diabetes mellitus are a common and difficult problem. The optimal management of these diabetic foot infections requires isolation and identification of the various pathogens and selection of appropriate antibiotic therapy according to the sensitivity patterns. Aims and Objectives: To determine the prevalence of various bacterial pathogens in diabetic foot infections (DFIs). Materials and Methods: A retrospective analysis of the culture of bacterial isolates of pus, pus swabs and tissue samples obtained from diabetic patients admitted in surgical wards at SLIMS, were carried out over 4 years from August 2016 to September 2020. Results: Total growth constituted 131(95%) monomicrobial growth was 107 (78%) and polymicrobial growth was 24(17.5%). In our study, Gram-negative isolates were 77 (79%) with Pseudomonas spp being the most predominant. Most of the Gram-negative bacteria were found to be sensitive to amikacin (56.9%), imipenem (66.6%) and piperacillin-tazobactam (47.1%). Gram-positive isolates were 11 (11.3%) with Staphylococcus aureus being the most predominant. In our study Gram, positive isolates were sensitive to erythromycin (81.8%), ciprofloxacin (81.8%) and cotrimoxazole (54.5%). 100% sensitivity was observed with linezolid, teicoplanin and vancomycin. A total of 21 (27.3%) patients who presented with gangrene were amputated. Conclusion: There is an increase in the prevalence of organisms as Wagner's grade increased with Gram-negative growth being more predominant. Frequent surveillance of antibiotic-resistant patterns would be useful for deciding empiric antibiotic therapy.

Keywords: Clinical and microbiological profile, Diabetic foot infections (DFI), Polymicrobial, Retrospective study, Sensitivity pattern, Wagner’s Grading

Full Text:

Introduction: Chronic foot infections in patients with diabetes mellitus are common and difficult to treat.  Diabetic individuals have at least a 10-fold greater risk of being hospitalized for soft tissue infections of the foot than normal individuals. The diabetic population in India will be expected to increase to 57 million in 2025. 1The subcutaneous wounds have a likely chance of spreading into deeper tissues thus resulting in complications like gangrenous changes and amputations.3They usually complicate the initially uninfected ulcerations that follow minor trauma in patients with neuropathy resulting in chronic neuropathic ulcers and tissue necrosis or osteomyelitis with draining sinus.

Infection plays a major role in the development of moist gangrene. Pseudomonas spp, Enterococcus spp and Proteus spp are organisms that are responsible for extensive tissue destruction as there is poor blood circulation of the foot.

The optimal management of these diabetic foot infections requires isolation and identification of the various pathogens and selection of appropriate antibiotic therapy according to the sensitivity patterns. A retrospective study is carried out to find out the various bacterial pathogens in diabetic foot infections and their impact on the outcome of the patients.

Aims and Objectives: To determine the prevalence of various bacterial pathogens in diabetic foot infections (DFIs) and their susceptibility to antimicrobial agents. To investigate the microbiological profiles of DFIs concerning different grades of Wagner classification and outcome for DFIs.

Materials and Methods: A retrospective analysis of bacterial isolates from pus, pus swabs and tissue samples from diabetic patients admitted for surgical care was done covering a period of 4 years from August 2016 to September 2020. Processing of the samples for culture, bacterial identification and antimicrobial susceptibility pattern was done as per standard procedures.2A record of all samples received, details of the organism isolated along with its antibiotic sensitivity pattern for the first line and second-line agents are being maintained in the Microbiology laboratory analysis of grading of ulcers, risk factors and outcome of patients will be done from the records maintained in Medical Records Department. The results are represented in percentages.

Results: In this study among 137patients with DFI, 108 were male and 29 were female, the mean age distribution is 61-70 years. Total growth constituted 131(95%) monomicrobial growth was 107 (78%) and polymicrobial growth was 24(17.5%). The distribution of bacterial isolates according to Wagner’s grades were 10.3% in me, 14.4% in II, 25.7% in III,24.7% in IV and 24.7% in V(Table1, Fig1). In our study, Gram-negative isolates were 77 (79%) with Pseudomonas spp being the most predominant. Most of the Gram-negative bacteria were found to be sensitive to amikacin (56.9%), imipenem (66.6%) and piperacillin-tazobactam (47.1%)(Fig 2,3). Gram-positive isolates were 11 (11.3%) with Staphylococccus aureus being the most predominant. MRSAbeing 5.1%.  In our study Gram-positive isolates were sensitive to erythromycin (81.8%), ciprofloxacin (81.8%) and cotrimoxazole (54.5%) (Fig 4).100%sensitivity was observed with linezolid, teicoplanin and vancomycin. A total of 21 (27.3%) patients who presented with gangrene were amputated. The level of amputation ranged from toes (n=16) to below-knee (n=5). Empirical antibiotics used in these patients were third-generation cephalosporins.

Discussion:

In this study, males were more predominant than females, with the mean age distribution being 61-70 years which corresponds to a retrospective study in DFI patients conducted by Mc Donald et al.3

In the present study among 137 patients with DFI, monomicrobial growth was 107(78%) and polymicrobial growth was 24(17.5%), which is similar to the study conducted by Hadadi.4

Mohd Zubai,5Anandi,6Ramakant,7 Pappu K,8 and Citron,9have reported 56.6%, 19%, 23 %, 92% and 16.2 % monomicrobial infections and 33%, 67%, 66%, 7.7% and 83 % of polymicrobial infections respectively.

The distribution of bacterial isolates according to Wagner’s grades were 10.3% in me, 14.4% in II, 25.7% in III,24.7% in IV and 24.7% in V, which coincides with the study conducted by Mahmoud B.Ahmedwhere bacterial growth was predominant in grade IV and V.10

In our study, Gram-negative isolates were 77(79%) with Pseudomonas spp being the most predominant (26.8%), followed by Escherichia coli (12.3%), which is in concordance with findings of Bansal and Jayashree Kona which is 76% and 72.36% respectively with Pseudomonas aeruginosa being predominant.11,12Zubair and Hadadireported Escherichia coli (26.6%) and 28%  which is lower in the present study.5,4Goh et aland Hadadireported Pseudomonas 18% and 8%.13,4

Gram-negative bacteria were found to be sensitive to amikacin (56.9%), imipenem (66.6%) and piperacillin-tazobactam (47.1%). Bansalobserved 100% sensitivity to imipenem, 96% to piperacillin-tazobactam and 90% to Amikacin similarly Mahmoud B.Ahmedobserved sensitivity of 98.3% to imipenem and 89.8% to amikacin which is much higher when compared to the present study.11,10

Gram-positive isolates were 21% with Staphylococcus aureus(11.3%)being the most predominant whereas MRSA being 5.1%. This is similar to the study conducted by Bansal.11Alavireported a single microorganism, mainly Staphylococcus aureus, as the most frequently isolated bacteria from diabetic foot patients.14Whereas Macdonald et al also reported higher distribution of Staphylococcus aureus(32.5%) among Gram-positive organisms.3Global prevalence of MRSA is found to be 15-30% but in our study, it is much lower.16,17In our study Gram-positive isolates were sensitive to erythromycin (81.8%), ciprofloxacin (81.8%) and cotrimoxazole (54.5%).3 Alva observed cotrimoxazole to be 53.8% and ciprofloxacin to be 58.3% which is similar to the present study.18100 % sensitivity was observed with vancomycin, teicoplanin and linezolid which is similar to studies by M.B Girish  and Jayashree Konar.15,12

A total of 21 (27.3%) patients who presented with gangrene were amputated. The level of amputation ranged from toes (n=16) to below-knee (n=5). Hadadi and Alva reported 45.5% and 34.4% amputations in their studies.4,1Empirical antibiotics used in these patients were third-generation cephalosporins. Treatment initiation with broad-spectrum antimicrobials including carbapenems and piperacillin-tazobactam for more extensive chronic moderate and severe infections is a safety measure as suggested by a study.19 However definitive treatment should be initiated following antibiogram and clinical correlation. In deeper infections surgical as well as medical intervention is necessary management of DFIs.

Conclusion: There was an increase in the prevalence of bacteria as the Wagner’s grade increased with Gram-negative growth being more predominant. Frequent surveillance of antibiotic resistance patterns would be useful in deciding empiric antibiotic therapy.

Further, the findings of this study emphasize the need to select the antimicrobial treatment which should be guided by proven culture results and antimicrobial sensitivity patterns exhibited by isolates.

Acknowledgement:

The authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript. The authors are also grateful to authors/

editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.”

Conflict of Interest: There is no conflict of interest.

Source of Funding: No funding has been received for this study.

Authors’ Contribution

Dr . Dhanaleha P: Clinical Study

Dr Jayapradha.S: Study Design, Literature Review

Dr Aparna V: Manuscript preparation

Dr Anand M.R: Manuscript editing

Ethical Clearance: Obtained from the SLIMS NO.IEC/C-P/04/2020 dated 30.10.20

References:

  1. Alva KA, Aithala PS, Rai R, Rekha B. Clinical and microbiological profile of diabetic foot in patients admitted at a tertiary care centre in Mangalore. Muller J Med Sci Res. 2013;4:3–7.

  2. Clinical Laboratory Standards Institute (CLSI) Performance Standards for Antimicrobial Susceptibility Testing Eighteenth informational supplement: M-100-S-2008,18: 28.

  3. Macdonald, K.E., Jordan, C.Y., Crichton, E. et al. A retrospective analysis of the microbiology of diabetic foot infections at a Scottish tertiary hospital. BMC Infect Dis 20218 (2020). https://doi.org/10.1186/s12879-020-4923-1

  4. Hadadi A, Omdeh Ghiasi H, Hajiabdolbaghi M, Zandekarimi M, Hamidian R. Diabetic foot: infections and outcomes in Iranian admitted patients. Jundishapur J Microbiol. 2014 Jul;7(7):e11680. doi: 10.5812/jjm.11680. Epub 2014 Jul 1. PMID: 25368803; PMCID: PMC4216583.

  5. Zubair M, Malik A, Ahmad J. Clinico-bacteriology and risk factors for the diabetic foot infection with multidrug-resistant microorganisms in North India. Biol Med. 2010;2(4):22–34.

  6. Anandi C, Alaguraja D, Natarajan V. Bacteriology of diabetic foot lesions. Indian J Med Microbiol. 2004;22(3):175–78.

  7. Ramakant P, Verma AK, Misra R, Prasad KN. Changing Microbiological profile of pathogenic bacteria in diabetic foot infections: time to rethink on which empirical therapy to choose? Diabetologica. 2011;54(1):58–64.

  8. Pappu AK, Sinha A, Johnson A. Microbiological profile of diabetic foot ulcer. Calicut Med Journal. 2011;9(3):e1–4.

  9. Citron DM, Goldstein EJC, Merriam VC, Lipsky BA. Bacteriology of moderate to severe diabetic foot infections and in-vitro activity of antimicrobial agents. J Clin Microbiol. 2007;45(9):2819–28.

  10. Mahamoud BA, Al-Mallah I, Said Eissa AN, Asif JF, Eed ME, Infection in the diabetic foot, Menoufia Medical Journal 2013,26:49-53.

  11. Bansal E, Garg A, Bhatia S, Attri AK, Chander J. Spectrum of microbial flora in diabetic foot ulcers. Indian J Pathol Microbiol 2008;51:204-8

  12. Jayashree K, Sanjeev D. “Bacteriological profile of diabetic foot ulcers, with a special reference to antibiogram in a tertiary care hospital in eastern India”. JEMDS 2013; (2)48,9323-9328

  13. Goh, TC, Bajuri MY, Nadarajah C,  et al. Clinical and bacteriological profile of diabetic foot infections in tertiary care. J Foot Ankle Res 13, 36 (2020).

  14. Alavi A, Sanjari M, Haghdoost A, Sibbald RG. Common foot exami­nation features of 247 Iranian patients with diabetes. Int Wound J. 2009;6(2):117–22

  15. Girish MB, Kumar TN, Srinivas R. Pattern of antimicrobials used to treat infected diabetic foot in a tertiary care hospital in Kolar. Int J Pharm Biomed Res. 2010;1(2):48–52.

  16. Eleftheriadou I, Tentolouris N, Ariana V, Jude E, Boulton AJ. Methicillin-resistant Staphylococcus aureus in diabetic foot infections. Drugs. 2010;70(14):1785–97.

  17. Stacey HJ, Clements CS, Welburn SC, Jones JD. The prevalence of methicillin-resistant Staphylococcus aureus among diabetic patients: a meta-analysis. Acta Diabetol. 2019;56:907–21.

  18. Alva K A, Aithala P S, Rai R, Rekha B. Clinical and microbiological profile of diabetic foot in patients admitted at a tertiary care centre in Mangalore. Muller J Med Sci Res 2013;4:3-7

  19. Bajuri MY, Abdul Razak KA. Chronic osteomyelitis of the femur with a segmental bone defect: concepts and treatment. J Krishna Inst Med SciUniv. 2017;6(2):127–30.

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 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


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