International Journal of Current Research and Review
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IJCRR - 14(1), January, 2022

Pages: 22-28

Date of Publication: 03-Jan-2022


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Laboratory Findings in Treatment & Prognostication of COVID-19

Author: Anuradha Sekaran, Swapna S, Shruthi Dulala, Maddipati Veda Ganga Ritesh, Jagadeesh Kumar V, Nitin Jagtap, Naveen Chandra Reddy, Sandeep Lakhtakia, Duvvur Nageshwar Reddy

Category: Healthcare

Abstract:Introduction: Majority of COVID-19 patients present with mild disease. 20% of patients progress to severe disease and have high mortality, because of hyperinflammation, cytokine storm development, viral mutation and lack of specific targeted medication. Critical analysis of laboratory parameters and potential biomarkers aids in assessing the evolution of disease, rapid identification of severe cases, identification of possible impending cytokine storm and guide appropriate medical management. Aim: The aim of the current study is to identify the significance of laboratory parameters that assist in disease categorization, so as to initiate early medical management. Materials and Methods: Between April 1 to April 15 2021, we retrospectively and prospectively included 200 patients admitted with COVID-19 infection (COVID-19 RTPCR positive and CORADS >3). Clinical assessment including history and associated comorbidities were noted at admission. Correlation of laboratory parameters was performed with disease category along with duration of hospitalization and clinical outcome. Results: Out of 200 COVID-19 patients, there were 145 males (72.5%). Severe disease patients had significantly higher neutrophil percentage, ESR, lower absolute lymphocyte count, elevated serum Ferritin and LDH. Non-survivors had low oxygen saturation, high absolute neutrophil count, Neutrophil to lymphocyte ratio (NLR), ferritin, D-dimer, IL-6 and low platelets at admission. Conclusion: Laboratory parameters are rapid, simple, cost-effective and aid in early diagnosis in assessing the severity of disease by indicating changes in immune and clotting system. Dynamic measurements help in timely institution of treatment strategies.

Keywords: Biomarkers, COVID-19, CORADS, Fibrinolysis, Hypoxia, Pandemic

Full Text:

INTRODUCTION

COVID-19 infection due to SARS-CoV-2 is a fifth documented pandemic, declared as global health emergency by WHO.1

Due to sudden drastic increase in numbers of COVID-19 patients worldwide, treatment in intensive care units has become a challenge, and seriously affected the health resources all over the globe. SARS-CoV-2 in minor population of elderly patients and with preexisting clinical comorbidities such as cardiovascular diseases, diabetes, respiratory disease and other conditions show critical disease progression to severe stage involving lung and other organs and few of these patients require ventilation, plasma and ECMO therapy.  Early identification of severe forms is essential for triaging of patients and control progression of the disease. 2

Currently majority of COVID-19 patients have mild self-limiting disease due to vaccination and mild herd immunity. 20% of COVID-19 are complicated and develop bacterial superinfections, organ dysfunction and progress to severe acute respiratory distress syndrome. 3

Cytokines are released by immune system cells and have a role in intercellular signaling. COVID-19 has an aggressive dysregulated inflammatory response of pro- inflammatory cytokines leading to hyperinflammation known as cytokine storm which causes tissue damage resulting in multiorgan failure including heart failure, septic shock, DIC, thromboembolism and death. Common laboratory parameters and potential biomarkers aid in assessing the disease evolution, effective and rapid identification of severe cases and for therapeutic management and particularly for home isolation patients.4

MATERIALS & METHODS:

STUDY DESIGN:

A prospective and retrospective study was conducted over a period of 15 days (between April 1 to April 15). A total 200 COVID-19 patients have been included in our study who were admitted in AIG hospital. All the symptomatic patients with RTPCR positive, CORADS >3 were included. Clinical history with associated comorbidities, laboratory parameters at different points of time (day 0, 3, 5, 10), treatment and outcome were analyzed. Correlation of laboratory parameters was done with disease categorization along with duration of hospitalization and treatment provided. Patient details were kept confidential.

INCLUSION AND EXCLUSION CRITERIA:

All patients with confirmed COVID-19 positive by RTPCR from nasal and throat swab and HRCT Chest findings CORADS 3 or more along with clinical symptoms were included. Associated co-morbidities documented include - Hypertension, Diabetes mellitus, Respiratory illness, cardiovascular disease, immunosuppression, patients on chemotherapy.

COVID-19 positive without any clinical symptoms or having CORADS< 3, those under home quarantine were excluded. Any readmitted patients after discharge were also excluded.

Ethical clearance was obtained from the Hospital ethical committee.

DATA COLLECTION:

Throat and nasal swabs for molecular identification of SARS-CoV-2 using nucleic acid amplification tests. Reverse transcriptase quantitative polymerase chain reaction (RTPCR) were obtained from COVID-19 patients using standard techniques as per ICMR recommendations.

Investigations included - complete blood picture (CBP), Erythrocyte sedimentation rate (ESR). Coagulation profile which includes Prothrombin time (PT)/ Activated partial thromboplastin time (APTT) / D-dimer, Liver function tests (LFT), Renal function tests (RFT). Inflammatory markers included serum Ferritin, Interleukin-6 (IL-6), Lactate dehydrogenase (LDH), Troponin and C reactive protein (CRP). Fasting blood glucose was not included in the analysis. All investigations were done at hospital using standard procedures on fully-automated analyzers.

An analysis of presenting symptoms, CT Chest, laboratory parameters over the days of admission (repeated based on clinical condition), treatment and outcome were noted (from electronic medical records).

For patients with mild disease, investigations were done once in 5 days. For patients with moderate or severe disease and those with clinical deterioration, the laboratory parameters were done more frequently (usually once in 2 to 3 days).

DEFINITION OF CLINICAL SEVERITY OF COVID-19:

According to clinical management protocol of COVID-19 published by the Government of India, Ministry of Health and Family Welfare, the infection has been classified into 4 categories based on clinical manifestations - mild, moderate, severe category and severe with sepsis. In this study, patients were categorized into three - mild, moderate and severe disease. Mild disease patients have symptoms such as fever, cough, sore throat, nasal congestion, malaise, headache with no breathlessness or Hypoxia (normal oxygen saturation) and no imaging symptoms of pneumonia. Moderate diseases are patients with fever and or hypoxia, dyspnea, cough, including SpO2 < 94% (range 90 -94%) on room air, respiratory rate > 24 per minute (pneumonia with no signs of severe disease). Severe diseases are patients with clinical signs of pneumonia plus anyone of the following: respiratory rate >30 breaths/min, severe respiratory distress, or SpO2<90% on room air.6

RESULTS:

The data of 200 patients was analyzed. Mean age was 55.8 years (IQR 43-47 years) in mild disease, 57.1 years (IQR 52-67years) in moderate disease and 57.2 years (IQR 45-68 years) in severe disease. 145 males were infected (72.5%). 158 (79%) subjects had mild COVID 19 infection, 19 (9.5%) had moderate infection, and 23 (11.5%) had severe infection. The most common symptoms were fever, cough, sore throat (59.5%) followed by shortness of breath (33.5%), and anosmia (6 %).

There was a significantly lower neutrophil percentage in patients with mild disease 70.11(14.21) compared to moderate 79.58(7.19; p 0.008) and severe 79.22 (19.43; 0.005). Absolute lymphocyte count was higher in mild disease compared to moderate and severe disease (p 0.011). ESR was significantly higher in severe disease compared to mild disease (67.11 (15.46) Vs 43.38 (27.86); p 0.047). Also, at admission, serum ferritin and serum LDH were significantly higher in severe diseases compared to mild and moderate diseases (p 0.004 for ferritin, 0.0001 for LDH). Other laboratory parameters CRP, IL-6, Bilirubin, ALT, AST, albumin, D-dimer, prothrombin and activated partial thromboplastin time were not significantly different in three categories of disease at presentation (Table 1).

Patients who succumbed to the illness during hospital stay had low oxygen saturation at admission (85.88 (11.5) vs 95.67 (4.58); p 0.03); higher absolute neutrophil count (p 0.03); higher NLR (p value 0.02); lower platelets (p 0.011) compared to survivors (Table 2).

Patients with higher ferritin (p 0.046), IL-6 (p 0.001), creatinine (p 0.04), BUN (p value 0.004), LDH (p value 0.001), INR (p value 0.027) died during hospital stay. 

At day 3, patients with higher WBC, ANC, LDH, D-dimer and ferritin died during hospital stay (p value < 0.05). At day 5, patients with Higher TLC, ANC, NLR and low haemoglobin died (p value < 0.05).

Median hospital stay was 8 days (range 1-49) days. Favipiravir was prescribed to 26 (13%). Remedesivir was prescribed to 71 (35.5%). Steroids, heparin and tocilizumab were used in 79 (39.5%), 24 (12.0%) and 4 (2.0%) patients respectively. and plasma therapy was given in one patient. 

Mortality rate was 8.5% (17/200). Mortality rate in mild disease at admission 3.8% (6/158), in moderate disease 15.79% (3/19) and in severe disease is 34.8% (8/23). There was no difference in mortality in male and female patients (7.59% vs 10.91%, p 0.570).

DISCUSSION:

The intent of this paper is to identify the relation between the COVID-19 disease severity and its outcome by clinical and laboratory parameters in local population. This would benefit in early recognition of more aggressive diseases, triaging accordingly to predict disease severity, and early institution of treatment, including newer options to reduce mortality. The severity of disease with the comorbid conditions may change with the viral mutation, status of vaccination and probable some amount of herd immunity but these factors were not analyzed.

DIAGNOSTIC VALUE OF CT CHEST:

Patients with COVID-19 may have normal CT chest findings, if imaging is done in early-stage after onset of symptoms. CT findings peak around 9-13 days after onset. 5th to 7th day is recommended in order to not significantly delay treatment and in clinically moderate to severe disease. The hallmark CT findings for suspected COVID-19 patients are bilateral and peripheral lung disease with ground glass appearance, consolidation, total lung involvement and are seen more frequently as the duration of disease increases.

DIAGNOSTIC AND PROGNOSTIC VALUE OF HEMATOLOGICAL PARAMETERS:

In the early stages of viral infection, there is a reduction in the circulating leukocytes, including neutrophils, and platelet count due to either bone marrow suppression or peripheral destruction. This phenomenon may increase the susceptibility to secondary bacterial infection.8 However, severe COVID-19 is marked by leukocytosis. 6Retrospective analysis from one study shows patients with leukocytosis were significantly older, probably associated with chronic disease, develop severe illness and may require ventilation. Zhou et al. reported that leukocyte counts were higher among non-survivors when compared to recovered patients7.Data from our study shows leukocyte count increases as the severity increases and is higher in non-survivors when compared to recover. Monocytes are increased and eosinophils are reduced during infection. Eosinophil increases in the recovery phase.

Absolute lymphocyte count is an important parameter to discriminate between severe and non-severe disease. Pronounced lymphocyte depletion is a predictor of imminent death and a key marker of increased severity. 7 Persistence of low lymphocyte count throughout the disease have been associated with critical illness and death.8 The possible reason for lymphopenia include direct effect of virus on lymphocyte, disordered inflammatory cytokines leading to lymphocyte apoptosis and inhibition of lymphocytes by metabolic molecules. Yang et al. reported lymphopenia in 80% of critically ill adult COVID 19 patients.8 In our study too, the lymphocyte percentage is lower in severe disease when compared to mild disease.

Neutrophil to lymphocyte ratio is a significant prognostic biomarker of outcome in critically ill patients which integrates 2 subtypes of WBC. The ratio is calculated from the values generated by automatic blood cell coulter by dividing absolute number of neutrophils with an absolute number of lymphocytes.9 Normal NLR value is 1-3. High NLR predicts bacteremia and suggests severe disease. This information at admission will help in prognostication and instituting aggressive management strategies. De Jager et al. reported that NLR predicts bacteremia and is better than conventional inflammatory markers like C?reactive protein, WBC count, and neutrophil count. A recent analysis shows the probability of severe illness in patients with NLR ≥ 3.13 and age ≥ 50 years old was 50% (compared to a modest 9.1% inpatients aged≥ 50years and NLR < 3.13). Severe COVID-19 disease had higher NLR values (standard mean difference (SMD): 2.80, 95% CI: 2.12 - 3.48, P < 0.00001) when compared to patients with non-severe disease. In the subgroup analysis, non-survivors have higher NLR values when compared to survivors (SMD: 3.72, 95% CI: 0.53 - 6.90, P = 0.02).10 Our analysis also shows NLR is higher in severe disease and is nonsurvivors when compared to moderate and mild disease and survivors.

Platelet count is useful for diagnosis and prognostication. Thrombocytopenia occurs due to invasion of bone marrow by virus infecting progenitor cells and activation of thrombocytes by virus triggered immune complexes along with increased consumption by lung damage due to excessive thrombosis. A significant decrease in platelet count is indicator of worsening of illness.11 Our study shows no significant difference between three categories.

 ESR is a non-specific inflammatory marker and indicates the changes of plasma protein type. In our analysis, ESR is higher in severe cases when compared to mild cases. This may be due to more inflammation in severe group. Older patients had higher ESR which may be explained by ESR level which increases with age. 12

DIAGNOSTIC VALUE OF COAGULATION MARKERS:

Dynamic changes of peripheral blood coagulation function are D-dimer, PT, APTT. Severe COVID-19 has elevated D-dimer, FDP levels and longer PT. D-dimer correlates with clinical classification of patients at first and last test. D-dimer is product of fibrinolytic degradation which predicts the severity and prognosis of the disease. Elevated levels help in the diagnosis of thrombotic diseases and is an indication for therapeutic anticoagulation rather than prophylaxis with >800ng/ml in normal individual and >1000-1200ng/ml in 60-70 years of age. 13

Potential risk factors during hospitalization are DIC, infection, dehydration, mechanical ventilation and use of central venous catheter.14 Terpos et al. reported hypercoagulability is common and patients with elevated PT, APTT, FDP and D-dimer are associated with life-threatening DIC which needs continuous vigilance and prompt intervention. 15 Our study shows no significant difference in D-dimer, PT, and APTT between mild, moderate and severe cases. This may be due to small number of patients in our study.

INFLAMMATORY BIOMARKERS:

Dysregulation of cytokines and chemokines leads to pathological activation of innate and adaptive immunity that causes ‘cytokine storm’ syndrome (CSS). IL-6 is a cytokine that controls the immune response, cell proliferation and differentiation and is associated with pleiotropic functions such as acute-phase response. Increased levels of IL-6 (cut off- 80pg/L) in COVID-19 patients are associated with inflammation and extensive lung damage. IL-6 acts as a therapeutic target and using IL-6 inhibitors (Tocilizumab) can arrest the cytokine storm and cytokine storm-associated organ damage.16 Our study shows that the level of IL-6 was low in mild cases when compared with the moderate and severe cases, and also high in non-survivors. WBC in collected blood samples on storage continue to release interleukins leading to erroneous high values. Repeat testing may be sent to same lab for comparison. 16

CRP is an acute-phase reactant and a sensitive marker of inflammation, infection, tissue damage and production is stimulated by cytokines. The significant elevation is seen in early stages of infection, especially the severe grade reflecting lung lesions. Elevation of CRP often may precede CT findings. CRP value correlates with level of inflammation and acts as early prognosticator for severe cases. 12 In our study, there was no statistically significant difference between severe and mild cases However, mean level of CRP was higher in the severe group.

Procalcitonin is a glycoprotein and its synthesis is increased due to cytokines. Higher procalcitonin (PCT) concentrations (usually ≥0.05 ng/ml) can distinguish between severe and non-severe disease due to Covid-19, suggesting its prognostic significance. However, a recent meta-analysis reported a marginal benefit (by 0.2 ng/ml). 17 Among critically ill COVID-19 patients, PCT and CRP elevation may be associated not only with the inflammatory response but also with the higher frequency of bacterial super-infections (up to 50% rate among non-survivors).18 In our study, procalcitonin was not included in the analysis.

Ferritin is an acute-phase reactant elevated in inflammatory conditions and is a direct indicator of cellular damage. Ferritin synthesis is controlled by cytokines. Extreme higher values leads to increased expression of pro and anti-inflammatory cytokines, a hallmark of hyperferritinemia syndrome (macrophage activation syndrome). Values over 800ng/ml is directly related to organ damage and is an indication for steroid initiation with clinical correlation values over 2000ng/ml portend poor prognosis in hospitalized COVID-19 patients.19Henry et al. reported ferritin as a surrogate marker of immune dysregulation and prognosis and shows a direct correlation between serum ferritin and poor survival.7 Zhou et al. reported that both ferritin and IL-6 concentrations showed higher values in non-survivors in comparison to discharged patients, and increased as the patient deteriorates. 20 Our study shows an increase of IL-6 in non-survivors when compared to survivors, and increase in moderate and severe cases when compared to mild cases.

ACE2 is a receptor that mediates virus entry into host cell and its expression is increased in patients with diabetes mellitus which enhances susceptibility to COVID-19. We have not analyzed variations of blood glucose in current study. Increased ALT, AST, Total bilirubin and decreased albumin in COVID-19 patients might be due to viral cytopathic effects, drug-induced or systemic inflammatory response. 21

Mortality rate among admitted patients with COVID-19 was 8.5% in our study, higher in severe disease 34.8% (8/23). The mortality rate is more due to selection bias as more sick patients got admitted. The categorization into mild, moderate & severe changed over time with more proper definition of disease. As observed in other parts of country in initial phase of pandemic, lack of patient awareness in approaching hospital for early treatment could also be the reason. There was no difference in mortality in male and female.

LIMITATIONS OF STUDY:

This was a single-centre study with small number of study subjects and thus might have a selection bias. This study finding need to be corroborated with a large population

CONCLUSION:

Laboratory parameters have diagnostic and prognostic value. Dynamic measurements of laboratory parameters correlate with disease severity and will be predictors for the clinical evaluation of COVID-19 patients for better monitoring and therapeutic interventions.

ACKNOWLEDGMENT:  Authors would like to thank technical and hospital staff for providing material for publication.

DECLARATIONS:

Source of funding: Granules India Grant

Conflicts of interest: None declared

Ethical approval: Approval letter is attached.

AUTHOR’S CONTRIBUTION STATEMENT:

1. Anuradha Sekaran - Conception of study, Data analysis, interpretation and critical revision

 2. Swapna S - Data analysis and Review of manuscript

3.  Shruthi Dulala – Data collection, Analysis

4. Maddipati Veda Ganga Ritesh – Data collection, Analysis

5. Jagadeesh Kumar V – Review of manuscript

6.  Nitin Jagtap - Statistical analysis and manuscript review

7. Naveen Chandra Reddy - Clinical data analysis

8. Sandeep Lakhtakia - Review of manuscript

9. Duvvur Nageshwar Reddy - Review of manuscript

References:

1. Liu YC, Kuo RL, Shih SR. COVID-19: The first documented coronavirus pandemic in history. Biomed j.2020. Aug 1; 43(4):328-33.

2. Velavan TP, Meyer CG. Mild versus severe COVID-19: laboratory markers. J Infect Dis Med .2020 Jun 1;95:304-7.

3. Directorate General of Health Services (EMR Division), Ministry of Health & Family Welfare, Government of India. March 31, 2020. 

4. Chen Q, Yu B, Yang Y, Huang J, Liang Y, Zhou J, et al. Immunological and inflammatory profiles during acute and convalescent phases of severe/critically ill COVID-19 patients. Int Immunopharmacol .2021 Aug 1;97:107685

5. Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N et al. Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology .2020 Feb 20:200463.

6. Zhao K, Li R, Wu X, Zhao Y, Wang T, Zheng Z et al. Clinical features in 52 patients with COVID-19 who have increased leukocyte count: a retrospective analysis. Eur J Clin Microbiol Infect Dis .2020 Dec;39(12):2279-87.

7. Skevaki C, Fragkou PC, Cheng C, Xie M, Renz H. Laboratory characteristics of patients infected with the novel SARS-CoV-2 virus. J Infect .2020 Aug 1;81(2):205-12.

8. Tan L, Wang Q, Zhang D, Ding J, Huang Q, Tang YQ, et al. Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Signal Transduct Target Ther .2020 Mar 27;5(1):1-3.

9. Yan X, Li F, Wang X, Yan J, Zhu F, Tang S et al. Neutrophil to lymphocyte ratio as prognostic and predictive factor in patients with coronavirus disease 2019: a retrospective cross-sectional study. J Med Virol .2020 Nov; 92(11):2573-81.

10. Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C, et al. Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. J Transl Med. 2020 May 20;18(1):206.

11. Soraya GV, Ulhaq ZS. Crucial laboratory parameters in COVID-19 diagnosis and prognosis: an updated meta-analysis. Medicina clinica .2020 Aug 28; 155(4):143-51.

12. Zeng F, Huang Y, Guo Y, Yin M, Chen X, Xiao L, et al. Association of inflammatory markers with the severity of COVID-19: a meta-analysis. Int J Infect Dis .2020 Jul 1;96:467-74.

13. He X, Yao F, Chen J, Wang Y, Fang X, Lin X, et al. The poor prognosis and influencing factors of high D-dimer levels for COVID-19 patients. Sci Rep. 2021 Jan 19; 11(1):1-7.

14. Li Q, Cao Y, Chen L, Wu D, Yu J, Wang H, et al. Hematological features of persons with COVID-19. Leukemia. 2020 Aug; 34(8):2163-72.

15. Ponti G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarkers associated with COVID-19 disease progression. Crit Rev Clin Lab Sci .2020 Aug 17; 57(6):389-99.

16. Vatansever HS, Becer E. Relationship between IL-6 and COVID-19: to be considered during treatment. Future Virol .2020 Dec; 15(12):817-22.

17. Zhang J, Wang X, Jia X, Li J, Hu K, Chen G, et al. Risk factors for disease severity, unimprovement, and mortality in COVID-19 patients in Wuhan, China. Clin Microbiol Infect .2020 Jun 1;26(6):767-72.

18. Henry BM, De Oliveira MH, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med 2020.Jul 1;58(7):1021-8.

19. Banchini F, Cattaneo GM, Capelli P. Serum ferritin levels in inflammation: a retrospective comparative analysis between COVID-19 and emergency surgical non-COVID-19 patients. World J Emerg Surg .2021 Dec;16(1):1-7.

20. Gómez-Pastora J, Weigand M, Kim J, Wu X, Strayer J, Palmer AF, et al. Hyperferritinemic in critically ill COVID-19 patients–is ferritin the product of inflammation or a pathogenic mediator Clin Chim Acta .2020 Oct;509: 249–251.

21. Chen J, Wu C, Wang X, Yu J, Sun Z. The impact of COVID-19 on blood glucose: a systematic review and meta-analysis. Front Endocrinol .2020;11: 574541.

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

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A Study by Monica K. entitled "Risk Predictors for Lymphoma Development in Sjogren Syndrome - A Systematic Review" is awarded Best Article for Vol 14 issue 13
A Study by Mokhtar M Sh et al. entitled "Prevalence of Hospital Mortality of Critically Ill Elderly Patients" is awarded Best Article for Vol 14 issue 12
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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
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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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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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