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

Pages: 161-166

Date of Publication: 12-Sep-2021


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A Panorama of the Applications of Midazolam in Dentistry and Recent Advances

Author: Jason ASD, Manisha, Samuel VA

Category: Healthcare

Abstract:The prevalence of dental fear is ubiquitous and so is the need; to remove fear and anxiety. Depression of the individual's consciousness during the treatment aids tremendously in a positive patient outcome. It also contributes to a better overall oral health of the community. All the sedative agents of old have either caused more harm than good or failed in their effectiveness. With the introduction of midazolam in1975 sedation has not only become safe but also highly effective. Midazolam acts by enhancing the activity of the GABA receptors in the central nervous system. Alongside the sedative effect, the drug shows anxiolytic, muscle relaxant, anticonvulsant, hypnotic and amnesic properties. Literature supports the use of midazolam as an emergency drug for seizures, for conscious sedation and as a part of the pre-anaesthetic medication. Midazolam has been used extensively to achieve positive behaviour in children undergoing dental therapy. Certain side effects have been reported with the use of this drug. With modern delivery systems such as Mucosal Atomization Device (MAD), the rapidity of onset of the drug is enhanced along with a reduction of the dose. This review article stands as a testimony to the use of midazolam in dentistry.

Keywords: Dental Fear, Anxiety, Midazolam, Sedation Dentistry, Conscious Sedation, Mucosal Atomization Device

Full Text:

INTRODUCTION

Fear is an unpleasant feeling often caused due to the awareness of danger or hurt.1The most pragmatic way to define fear is as the neurophysiological processes that prepare an organism to perform innate or learned responses to cope with danger.2,3Dental fear has been a significant contributor to the evasion of dental health care.4,5,6  

Anxiety precedes fear, wherein anxiety occurs before the presence of a stimulus that, more often than not, is threatening.7,8Anxiety alters reality which leads to patients experiencing a change in the quality of pain perceived by them and instils an everlasting pain-tinted dental experience.9 the dentist has to identify the aspects of the dental setting which would likely aggravate the anxiety, the need for the current appointment and the previous dental experiences of the patient.7,10,11The components of pharmacological anxiolysis include sedation and general anaesthesia.12Factors to be considered are the risks of the pharmacological management versus benefit, selection of the appropriate drug, the level of anxiety, dentist’s expertise, presence of equipment and emergency care.13

Sedation is defined as the use of a drug or combination of drugs to depress the central nervous system, thus reducing patients’ awareness of their surroundings.14Conscious sedation has been employed as a means to remove fear and anxiety from dental care and it is considered of paramount importance. Anxiolysis is a drug-induced state during which patients respond normally to verbal commands.15,16It is mandatory to note that the use of conscious sedation should be taken bearing the patient’s thorough medical and dental history. Barbiturates were a few of the earliest sedative agents used for conscious sedation. With the introduction of benzodiazepines (Midazolam), conscious sedation included anxiolysis along with profound amnesia. They are considered the gold standard in sedation and are regarded as very safe drugs.17

The dentist must alleviate the anxiety and fear as it can cause exhaustion post-treatment and a ripple in the normal facets of one’s daily activities including personal, social interactions and sleep deprivation.18,19Midazolam as a sedative has made a significant contribution towards conscious sedation. A plethora of studies backs midazolam in terms of efficiency, ease of administration and safety. This article provides a meticulously prepared agglomerate of the scientific literature with regards to the use of midazolam for conscious sedation in dental practice.

HISTORY

The need for the removal of fear and pain from the dental office has existed as long as the existence of the art of dentistry. In the 15th century ether was used as the first anaesthetic agent alongside, a distillate of sulphuric acid and diethyl ether called ‘sweet oil of vitriol’ which was widely used in dentistry.20The 17th century saw the discovery of nitrous oxide by Joseph Priestley. Humphrey Davy commented on the uses of nitrous oxide in surgeries and its potency in alleviating pain.21The first benzodiazepines were created by Hoffmann-La Roche and Leo Sternbach in 1955.  Diazepam (Valium) was discovered a little later but grew very famous. Molecular changes were made to meet the demands and also counteract any undesirable quality.22Midazolam was created in 1975 by Walser and Fryer.23

CHEMICAL STRUCTURE

Midazolam is a water soluble, crystalline yellow to white salt.24The IUPAC name for midazolam hydrochloride is 8-chloro-6-(2-fluorophenyl)-1-methyl-4H-imidazo[1,5-a][1,4]benzodiazepine hydrochloride and the molecular formula is C18H13ClFN3 • HCl.25 In low pHthe salt is hydrophilic and has an open diazepine ring which closes shut at high pHto form the physiologically active lipophilic product as in Figure 1.It has a molecular weight of 325.8 g/mol.24

MECHANISM OF ACTION

Midazolam is a short-acting benzodiazepine with pharmacological uses such as anxiolytic, amnestic, muscle relaxant and sedative uses.26The mechanism of action of midazolam as a sedative is based on its effect on the GABA (gamma-aminobutyric acid) receptors. It works by enhancing the affinity of the GABA to the GABA receptor.21GABA is a major inhibitory neurotransmitter present in the central nervous system.27Benzodiazepines do not have a direct agonistic activity on GABA rather it has a boosting effect on the action of GABA.26The GABA receptors are classified into GABAa and GABA receptors. GABAa receptors have subtypes α1 and α2.  Of these α1 subtype mediates sedation, anti-convulsant and amnesia activity while the α2 subtype mediates anxiolysis and muscle relaxation. They do not act on GABA receptors.

Midazolam has both hydrophilic and lipophilic properties depending on the pH of the solution. When midazolam is absorbed it has to bio transform through both the microsomal oxidation and glucuronide conjugation. First, it gets hydroxylated with the help of cytochrome CYP3A4, CYP3A5.28Through the hydroxylation process two pharmacologically active agents namely, α-hydroxymidazolam and 4-hydroxymidazolam are formed. They undergo rapid glucuronide conjugations to form pharmacologically inactive compounds.29Midazolam gets bounded to the plasma protein and is well distributed.30

 PHARMACOKINETICS

Absorption

Midazolam is available in its salt form which is hydrophilic and maintains its hydrophilicity at a low pH. The oral midazolam tablet often stays hydrophilic due to the low pH in the stomach. With the change in pH in the gastrointestinal tract to the physiological pH, the ring structure of midazolam closes forming the lipophilic form.31Midazolam is absorbed through the gastrointestinal tract following oral administration, with peak effect 30-90 minutes after administration. Owing to the first pass metabolism only 40-50% of the administered dose reaches circulation.32Midazolam has shown rapid onset and increased bioavailability of 90% through the intramuscular route.33The intranasal route of administration has shown superiority in the onset duration and ease of use when compared with the oral route.34It is important to consider the painless quality of the intranasal route compared to the intramuscular and the intravenous routes.35

Distribution

Midazolam distribution is higher among obese people as it gets distributed to the adipose tissue. The volume of distribution has been found to be 1-2.5 l/kg.36The distribution is greater in women compared to men.37Midazolam has a good affinity to plasma proteins and is mostly bound to them only about 4% of the given dosage is available as free faction.38

Elimination

Metabolites of midazolam in the form of α-hydroxymidazolam and glucuronide conjugate are excreted by the kidney through urine. Almost all of the midazolam gets conjugated, less than 0.5% gets excreted unchanged. The plasma clearance seemed to increase in patients in supine position owing to the 40-60% increase in the hepatic blood flow.24

PHARMACODYNAMICS

The action of midazolam in the body is chiefly based on its highly sedative potency. Besides its sedative nature, it has antiepileptic properties, acts as a muscle relaxant and causes anterograde amnesia. Once the effect wears off, the patient’s cognitive and psychomotor skills are retained.37Minimal cardiovascular changes are evoked by this drug. Midazolam could decrease vascular resistance.39Midazolam causes an increase in the frequency of respiratory rate with a decrease in tidal volume.40It leaves the cortisol and renin responses unaltered during surgical stress. It preserves the blood flow to the brain and myocardium while reducing flow to the liver and kidneys.41

SIDE EFFECTS

Midazolam like any other drug is a slave to the side effects it manifests. The side effects are cardiac arrest, heart rate variations, a fall in blood pressure, convulsions, anaphylaxis, thrombosis, laryngospasm, bronchospasm, respiratory depression, gastrointestinal changes, xerostomia, hiccups, increased appetite, jaundice, drowsiness, confusion, dysarthria, urinary retention or incontinence, blood disorders, muscle weakness, visual disturbances including diplopia, salivation changes, skin reactions along with any skin changes in the intravenous route injection site. When given through the intranasal route, midazolam is known to produce a burning sensation, irritation to the nasal mucosa and lacrimation.24,25,42 When taken orally there is a delay in onset and there is no IV access for a reversal agent in case of overdose.43

DRUG INTERACTION

Drug interactions between midazolam and other drugs are chiefly governed by the cytochrome P450 oxidase system in the liver where midazolam gets metabolized. Drugs such as cimetidine, ranitidine, omeprazole, macrolides and oral contraceptives inhibit the metabolism of midazolam causing reduced clearance and increased half-life.36,44,45 Rifampin is a cytochrome P450 enzyme inducer that increases the clearance of midazolam.46

DISCUSSION

Midazolam has shown anxiolytic, sedative, muscle relaxant, anticonvulsant, hypnotic and amnesic properties which can be exploited in the dental setting.26,47, 48, 49  

Midazolam as an emergency drug in the dental office

Seizures are commonly encountered in the dental office with a worldwide prevalence of 0.5-0.9% The management of epilepsy is achieved through the depression of the central nervous system which could be achieved with benzodiazepines.50Midazolam has been included in the additional emergency drugs for the management of dental emergencies.51,52The muscle relaxant property of midazolam has been exploited in the rapid sequence intubation for establishing a patent airway in the emergency department in dosage of 0.1mg/kg.53,54Besides these the property of amnesia, anxiolysis and sedation play their role in making midazolam a must-possess emergency drug.27,55

Midazolam as a pre-anaesthetic agent in the pediatric population

Children in the initial stage of anaesthesia could experience unpleasantness, have anxiety and suffer from separation from parents leading to hypersalivation, breath-holding and laryngospasm.56Besides these, there could be traumatic experiences deeply rooted in the child’s mind from the induction room.57, 58

Midazolam is chosen as a pre-anaesthetic medication as it is predictable and has good patient acceptance. It is consistent and has few side effects which are the ideal characteristics of a premedicament.59Various drug dosages have been tried by various authors when using midazolam as a pre-anaesthetic agent.60 The most effective dosage and safest dose for children has been identified as 0.75mg/kg considering the age and weight of the child.61

Midazolam in conscious sedation

Conscious sedation in dentistry plays a major role in achieving a positive psychological effect on the patient while also preserving the consciousness and the responsiveness to verbal commands.7Midazolam is one of the most commonly used benzodiazepine drugs.62 In conscious sedation, the consciousness of the patient remains uncompromised as compared to general anaesthesia and deep sedation; hence it provides a wide margin of safety.15

A few reported disadvantages of nitrous oxide inhalation include expensive equipment, patients should breathe through their nose and interference of nasal mask with maxillary injection techniques.63 Chronic exposure to nitrous oxide showed devastating effects on the health of the dental personnel. It could decrease the fertility of female doctors and assistants and cause a 1.7 fold increase in liver disease among men. Midazolam for conscious sedation is available in various routes such as oral, intravenous and intranasal.64 Oral midazolam is the go-to technique among the pediatric population. A 0.5 mg/kg dosage is given 20 minutes before the procedure which causes significant anxiolysis and results in a more positive environment.65 Besides, midazolam causes anterograde amnesia changing the postoperative perspective of the patient towards dental treatment.66

Studies indicate intravenous midazolam given at 0.06mg/kg dosage produced adequate anxiolysis. The onset was significantly faster.  5 minutes post-administration the effects of sedation started to manifest. The children administered IV midazolam showed lesser movement in-between treatments, cried less and mostly fell asleep during the entire procedure.67 The intranasal route has the benefits such as a large surface area of the nasal mucosa and the drug escapes the first-pass metabolism. Though various anatomic, physiologic and drug characteristics play a major role in the absorption one of the most important criteria is that the drug needs to be lipophilic for absorption to occur through the mucosa.68 Literature claims the intranasal route to be effective in terms of ease of use and reduced duration of onset with a dosage of 0.3-0.5mg/kg.69-73

The intranasal use of midazolam has been enhanced with the introduction of MAD® (Mucosal Atomization Device, Wolfe Tory Medical Inc., Salt Lake City, UT, USA) Figure 2. The MAD® atomizes the drug into particles of 30-100 microns. Particles this small are readily absorbed through the nasal mucosa. The soft plug gives a neat seal, reducing the run-off. The procedure is painless and less cumbersome compared to the other injection techniques.74The use of this spray has proven to be more efficient in terms of acceptability and the induction of sedation compared to intranasal drops and the oral route.75,76 The use of such a device is explicit in the emergency setting and to attain anxiolysis before diagnostic scans chiefly due to the ease of administration and quick onset.74,77       

CONCLUSION

Of the many challenges that confront the dentist, the obliteration of fear from the dental setting proves fit to test the mettle of the dentist.  Midazolam has made sedation easy for patients and dentists alike. Midazolam is very safe for use in the pediatric population, where the need to remove fear is even more important to develop a positive attitude in children, which would drastically improve their overall oral health. With the introduction of newer technologies, the figments of painless, fearless dentistry have come closer to reality.

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.

SOURCE OF FUNDING

Not applicable as there is no source of funding

CONFLICT OF INTEREST

The authors declare no conflict of interest.

AUTHOR’S CONTRIBUTION

Samuel VA conceptualized the work. Data collection was carried out by Jason ASDand Manisha. The article was drafted by Jason ASD with support from Manisha and Samuel VA. Critical revision of the article was done by Manisha and Samuel VA. The final approval of the version of the article to be published was done by Samuel VA.

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



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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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