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

Pages: 140-142

Date of Publication: 12-Sep-2021


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Fetus Papyraceous with Successful Outcome of Other Twin at Term

Author: Kandela Nirmala, P. Yamini Shoba Vani

Category: Healthcare

Abstract:Introduction: In multiple gestations, Fetus papyraceous is a rare obstetric complication, the occurrence of which in twin cases is 1 in 12,500. It may be associated with elevated maternal and foetal complications, including death caused by disseminated intravascular coagulation and organ damage. Objective: To record a case of uniovular twin pregnancy in the early third trimester with one twin foetus papyraceous, and the pregnancy continued until term with a good outcome of co-twin survival. Method: A 25-year-old Gravida 2, Para 1, Living 1 woman with a previous usual vaginal delivery and twin pregnancy with Fetus papyraceous was referred to our hospital at 39 weeks for healthy institutional delivery. Results: She was admitted and induction of labour was done with the stripping of membranes and watched the progression of labour along with strict maternal and fetal monitoring. She was monitored by serial ultrasounds with doppler, coagulation profile throughout the pregnancy once the fetus papyraceous was diagnosed which was showing within normal limits. She delivered vaginally of an alive healthy male baby of birth weight 2.5kg with APGAR score- at 1min-8 and 5min-10. Conclusion: Routine ultrasound testing with improved training and the use of modern ultrasound machines with the good resolution is needed for the detection of multiple gestations. This would allow for early detection of papyraceous foetuses during pregnancy, potentially avoiding obstetric complications and lowering the risk of mortality.

Keywords: Fetus papyraceous, Uniovular twins, Third trimester, Obstetric complications, Maternal coagulopathy, Twin pregnancy

Full Text:

INTRODUCTION

Fetus papyraceous ( the paper doll fetus ) is a desiccated or mummified fetus, without signs of maceration, that has been flattened by a twin fetus and lies within the membranes of the surviving twin.1Fetus papyraceous is a rare condition but in recent times, with the increase in Assisted Reproductive Techniques, the incidence of multiple pregnancies is rising, which in turn also increased the incidence of fetal papyraceous. The reported incidence of fetus papyraceous is one in 12,000 pregnancies compared to 1:190 in twin pregnancies.2

If a foetus papyraceous is diagnosed antenatally, the surviving foetus should be evaluated serially using sonography, biophysical profile, doppler, and maternal coagulation factors. Antenatal zygosity and chorionicity testing are recommended. The maturity of the foetus and the type of the placenta decide the timing and protocol for terminating a pregnancy with a surviving twin. In many cases of fetus papyraceous, there are no complications to the mother or the surviving twin. Expectant management with close maternal and fetal surveillance is advised.

There can be maternal complications like pre-eclampsia, Disseminated intravascular coagulation, Thrombotic thrombocytopenic purpura and fetal complications like Low birth weight babies, prematurity, Hypoxic-ischemic encephalopathy, during labour: the prolonged second stage of labour, arrest of descent. Other complications can be aplasia cuties, microcephaly,  hydrocephalus, eye anomalies, cleft lip, cleft palate, cardiac anomalies.

CASE HISTORY 

A 25-year-old Gravida 2, Para 1, Living 1 with previous normal vaginal delivery with twin pregnancy with Fetus papyraceous referred to our hospital at 39 weeks for safe institutional delivery and need of SNCU facility. She conceived spontaneously, her regular antenatal check-ups done in another hospital.  According to her medical records, this pregnancy was monochorionic diamniotic twin intrauterine gestation with one twin fetus papyraceous at 22 weeks of gestational age. Her LMP was on 18.03.2020, EDD on 25.12.2020. Her first and second trimesters were uneventful. She was monitored by serial ultrasounds with doppler, coagulation profile throughout the pregnancy once the fetus papyraceous was diagnosed which was showing within normal limits.

She was admitted to our hospital on 21.12.2020. At the time of admission, she was conscious, coherent, cooperative. Her temperature is normal, pulse rate 86 per min, Bp-110/70 mmHg. Heart and lungs within normal limits. On per abdomen examination uterus was Term gestation, relaxed, cephalic presentation,    FHS- 142/min regular, On per vaginal examination cervix soft, long, Os was 1.5-2 cm dilated

INVESTIGATIONS: 

Her Hb-10.7gm%, TWBC-9700/cu mm, platelet-2.9lakh/cu mm, Blood

Group: B+ve, HIV, HbsAg, VDRL- nonreactive, Complete urine examination-within normal limits, Random blood sugar-89mg/dl, PT-11.6, APTT-30, On admission doppler study done it was normal, twin-1: cephalic presentation, placenta-Fundo posterior, liquor-adequate for twin-1, FHR-148/min, BPD-8.78cm, HC-33.87cm, AC-31.88cm, FL-7.04cm, GA-36 wks 4 days, weight-2812 grs, twin2: intrauterine demise, CRL-8.31cm corresponding to 14-16 wks.

PROVISIONAL DIAGNOSIS:  Gravida2, Para1, Living1 with 39 wks 3 days with fetus papyraceous with previous vaginal delivery she was admitted and induction of labour done with stripping of membrane and watched the progression of labour along with strict maternal and fetal monitoring, delivered vaginally of an alive healthy male baby of birth weight 2.5kg with APGAR score- at 1min-8 and at 5min-10.

DISCUSSION:                                                                         

If antenatal visits with obstetric ultrasound are not carried out, any condition is difficult to detect, so diagnosed several times only after delivery. It is possible to detect multifetal childbirth with Transvaginal Sonography as soon as 4 weeks after conception. It is not always possible to detect papyraceous foetuses by ultrasound testing in the late second and third trimesters. The papyraceous foetus results from the failure of early twin pregnancy to fully reabsorb the dead foetus, with preservation of the foetus for at least 10 weeks, resulting in mechanical compression of the tiny foetus and fluid loss to resemble parchment paper. It can occur in uniovular and binovular twins. Because of the high level of vascular contacts (85-95%) and TTTS in the monochorionic placenta, intrauterine death is three times more frequent in uniovular twins.3

The loss of one twin in the first trimester does not appear to affect the development of the surviving twin, but the loss of one twin after the mid-trimester may increase the risk of IUGR, cerebral palsy, preterm labour, preeclampsia, haemorrhage, sepsis, consumptive haemorrhage, labour dystocia, and perinatal mortality in the surviving twin.4

Placental or fetal analysis frequently reveals chromosomal abnormalities. Chromosomal analysis of the surviving twin is generally normal. If fetus papyraceous is diagnosed antenatally, close monitoring of both maternal and fetal is of utmost importance with ultrasonography, biophysical profile. Doppler of surviving fetus and maternal monitoring with coagulation profile. Our patient was continuously monitored by serial ultrasounds with Doppler study and coagulation profile throughout the pregnancy once the fetal demise of one twin was diagnosed and delivered vaginally at term with no maternal and fetal complications.

In Jain D, Purohit RC has reported three out of five pregnancies could be extended to term and had no maternal and fetal complications.5 In Dahiya et al have reported two cases of fetus papyraceous delivered at term with no complications to the surviving fetus.6

Preterm labour, infection from a retained foetus, extreme puerperal haemorrhage, consumptive coagulopathy, and obstruction by a low-lying foetus papyraceous causing dystocia leading to caesarean delivery are all examples of maternal complications. To avoid serious complications, it's important to get a diagnosis as soon as possible. It's important to reassure the patient that in the vast majority of cases, a normal outcome is anticipated. Consumptive coagulopathy in the mother as a result of a late foetal death is an unusual complication. The release of tissue thromboplastin from the foetal circulation into the mechanical circulation has been proposed as a mechanism to explain coagulopathy associated with IUFD.7,8 The maternal coagulation mechanism is believed to be stimulated by thromboplastin, resulting in intravascular consumption of clotting factors and platelets. Fibrinogen is broken down into fibrin degradation products (FDPs) and fibrin-fribin dimers as the activation of the fibrinolytic pathways increases (D-dimers). There are three types of foetal death complications depending on the gestational period, vanishing twin syndrome in the first trimester, foetus papyraceus in the second trimester, and the macerated twin in the third trimester. The majority of pregnancies end in death during the second trimester.9 The length of time between foetal death and delivery determines the degree of compression; the larger the foetus, the more difficult it is to become a foetus papyraceous.10 Twin-twin transfusion syndrome, membranous or velamentous cord insertion, true cord knot, cord stricture, placental insufficiency, and congenital defects are some of the causes of intrauterine death of one fetus.11,12

Close monitoring is of critical importance. The coagulation profile should be tested every 2 weeks, and ultrasound, biophysical profile, and Doppler should closely track the surviving twin's well-being. Before deciding to continue the pregnancy, any abnormalities in the surviving twin should be ruled out.13,14 Prompt diagnosis of foetus papyraceous is therefore very necessary for the prevention of further complications and the successful outcome of the survival of the foetus. It is really necessary to assure the parents. An unusual recorded complication is maternal consumptive coagulopathy due to the foetal death of a single twin.15,16

CONCLUSION:

All twin pregnancies with one fetal demise should be managed in tertiary care centres with good neonatal support. A management plan should be individualized, For successful pregnancy outcomes careful fetal and maternal monitoring is required. For the detection of multiple gestations, routine ultrasound testing with better training and the use of modern ultrasound machines with good resolution is necessary. This will enable early pregnancy to be diagnosed with papyraceous foetuses and could avoid potential obstetric complications and decrease the risk of mortality and morbidity for the surviving foetus.

ACKNOWLEDGEMENT

The authors acknowledge the immense help received from the scholars whose articles are cited and included in references of 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-Nil

Financial support-Nil

References:

  1. Daw EG. Fetus vanescens, fetus compressus and fetus papyraceus.   J Obstet Gynecol. 1992;12(6):375-6.

  2. Usharani N, Suyajna D, Joshi D, Veena. Fetus papyraceous: A rare case report and review of the literature. Int J Sci Study. 2015;3:184.

  3. Rahman H, Pathak R, Dubey S. Fetus papyraceous in uniovular twin; death of one twin in the early third trimester and successful outcome of other twins at term: a rare case report. Gen Med(Los Angel)2013;1:118.

  4. Sandhya G. Reshika G, Fetus Papyraceous in Monochorionic  Diamniotic Twins. J Obstet Gynaecol India. 2019Apr;69(Suppl 1):4043.

  5. Jain D, Purohit RC. Review of twin pregnancies with single fetal death: management, maternal and fetal outcome. J Obstet Gynecol India. 2014;64(3):180-183. doi: 10.1007/s13224-013-0500-5.

  6. Dahiya P, Bains R. Conservative management of fetus papyraceous: a report of two cases. Oman Med J. 2014;29(2):132-134.

  7. Finley BE. Acute coagulopathy in pregnancy. Med Clin North Am. 1989; 73: 723-43.

  8.  Weiner AE, Reid DE, Roby CC, Diamond LK. Coagulation defects with intrauterine death from Rh are sensitization. Am J Obstet Gynecol 1950:60: 1015-22.

  9. Daw E. Fetus papyraceus—11 cases. Postgrad Med J. 1983;59(695):598-600.

  10. Benirschke K. Intrauterine death of a twin: Mechanisms, implications for surviving twin, and placental pathology. Semin Diagn Pathol 1993;10(3):222-31.

  11. Akbar M, Ikram M, Talib W, Saeed R, Saeed M. Fetus papyraceous: the demise of one twin in the second trimester with the successful outcome of the second twin at term. Professional Med J. 2005;12:351-3.

  12. Benirschke K. Intrauterine death of a twin: Mechanisms, implications for surviving twin, and placental pathology. Semin Diagn Pathol 1993;10(3):222-31.

  13. Akbar M, Ikram M, Talib W, Saeed R, Saeed M. Fetus papyraceous: the demise of one twin in the second trimester with the successful outcome of the second twin at term. Professional Med J. 2005;12:351-3.

  14. Hagay ZJ, Mazor M, Leiberman JR, Biale Y. Management and outcome of multiple pregnancies complicated by the antenatal death of one fetus. J Reprod Med 1986; 31(8): 717- 720.

  15. Ong SS, Zamora J, Khan KS, Kilby MD. The prognosis for the co-twin following single-twin death: A systematic review. BJOG 2006;113(9):992-8.

  16. Novak CM, Patel SV, Baschat AA, Hickey KW, Petersen SM. Maternal coagulopathy after umbilical cord occlusion for twin reversed arterial perfusion sequence. Obstet Gynecol. 2013 Aug;122(2 Pt 2):498-500.

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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.

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‘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.


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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
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A Study by Ajai KG & Athira KN entitled "Patients’ Gratification Towards Service Delivery Among Government Hospitals with Particular Orientation Towards Primary Health Centres" is awarded Best Article for Vol 14 issue 04
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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