International Journal of Current Research and Review
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IJCRR - 14(13), July, 2022

Pages: 30-35

Date of Publication: 05-Jul-2022


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Inflammatory Markers as Predictors of Severity and Mortality in Coronavirus Disease: A Cross-sectional Study

Author: Saima Jatoi, Muhammad Adnan Bawany, Sunil Dat Maheshwari, Muhammad Akbar Memon, Sheeza Saleem Qureshi, Hasham Masood Qureshi

Category: Healthcare

Abstract:Introduction: COVID-19 is a pandemic that demands swift, in-depth, and well-grounded research work. WHO (World Health Organization) has declared around 1 million deaths and confirmed about 35 million cases worldwide. Aim: To predict the role of three inflammatory markers (serum ferritin, C-reactive protein and lactate dehydrogenase) in severity and mortality in patients with corona virus disease patients admitted in the hospital. Methodology: Patients with traceable SARS-CoV-2 by polymerase chain reaction (PCR) were inducted into this study by simple random sampling. Patients with potential radiological scans but without positive SARS were not included in this study. The nasopharyngeal sample technique was used to check the presence of the virus. This viral load's severity was checked via World Health Organization recommendations. All the information including the sociodemographic data, severity of disease and laboratory values of three inflammatory markers gathered on a semi-structured proforma designed for the study. Study Design: A Cross-Sectional study. Place and Duration: Isra University Hospital from 1st June 2021 to 31st December 2021. Results: 240 patients were included in the study; aged between 20 and 60 years. The values of the three inflammatory markers were found raised in the group of patients being studied (more frequently within the moderate and severe disease groups). C - reactive protein was raised in 122 patients, ferritin was raised in 83 patients and Lactate dehydrogenase was raised in 184 patients Conclusion: Measuring the values of CRP, LDH, and Ferritin at admission can be a reliable predictor of severity and mortality in SARs-CoV-2. Out of the three, ferritin is the best indicator and should be considered essential.

Keywords: Coronavirus disease, Mortality, Ferritin, CRP, Lactate dehydrogenase, Inflammatory

Full Text:

Introduction

COVID-19 is a pandemic that demands swift, in-depth, and well-grounded research work. The in-hospital presentation shows off an entire spectrum of symptoms in the affected population; from asymptomatic patients to patients with complete respiratory failure. The World Health Organization has declared around 1 million deaths and confirmed about a 35 million cases worldwide.1 According to the Pakistani Government, in Pakistan COVID-19 mortality rate has been recorded at 2.06%.2 Inflammatory markers are important in the assessment of this viral disease as inflammation plays an important role in its pathogenesis.

When white blood cells in the body get activated as a result of viral infiltration, they release a large number of inflammatory chemokines and cytokines which in turn leads to the permeation of monocytes and neutrophils inside the lungs. As a result of which, the endothelium and the alveolar cells are damaged. This state of bodily conditions is termed acute respiratory distress syndrome or tissue hypoxia.3 C-reactive protein gets elevated in a COVID-19 infection and triggers a protective response in the body. This response allows it to bind itself with phosphocholine present on the surface of affected cells, which in turn activates the classical complement pathway and ejects the virus as well as the damaged cells from the host.4 

Cytokine storms are the foremost reason for mortality in cases of severe disease. Interleukin-6 (one of the two inflammatory contributors) is the main protagonist. Unfortunately, in most Pakistani setups it cannot be routinely measured.5 C-reactive protein can instead be used as a substitute for reliable interleukin-6 testing, to measure these cytokine release storms.6 Inflammation is the main cause of death among patients as it can cause worsening of the respiratory function to the point where complete shut-down can occur in less than four days.7 In order to avoid this unfortunate situation, proper post-hospital care and monitoring can be instituted which can let the physicians keep track of the disease and introduce efficient and effective interventions in severe to critical patients.

Many studies have been done in order to check the effectiveness of various inflammatory markers for COVID-19. Most of these markers that rank high in terms of reliability and effectiveness are not easily available and are also economically unfeasible. The three markers that were chosen for this study, serum ferritin, C-reactive protein, and lactate dehydrogenase are accessible at almost all laboratory settings. If certainty can be achieved in terms of the results of these three markers then this could mean that customized care is possible and can be given to individual patients to a great standard.

COVID-19 is a disease that is relatively in its early period when it comes to the level of research done and meaningful/applicable medical literature gathered. Despite having accumulated a praise-worthy level of theoretical knowledge in terms of the disease itself, professional practitioners are unfortunately still lacking solid local data which could give concreteness to the inter-relationship of inflammatory markers and mortality. This piece of work is dedicated to establishing the reliability of the three inflammatory markers (namely serum ferritin. C-reactive protein and lactate dehydrogenase at hospital admission of infected COVID-19 patients for mortality, and to establish a definitive basis for best cutoff values for each marker. 

Methodology

This is a cross-sectional study and was conducted at Isra University Hospital from 1st June 2021 to 31st December 2021. The protocol for this study work was approved and allowed by the Ethics Review Committee of the said hospital. During the time period mentioned above the patients that had a confirmed case of the infection were considered valuable for study by simple random sampling. Consent was not taken from the patients as it was not considered a prerequisite for a study that was to publish the data anonymously in terms of the individual patient/participant. The diagnosis was made based on a positive polymerase chain reaction (PCR). Patients with potentially indicative radiological scans but without positive SARS test results (on more than one occasion) were specifically not included in the study.

During the initial hit, the hospital data showed the mortality rate to be below 10%. A very recent study conducted in Pakistan showed the maximum AUC (Area under Curve) to be 0.875 for all three inflammatory markers.8 Keeping all the above in mind the following study group was considered.

As per the institution’s protocol, a nasopharyngeal swab method for polymerase chain reaction (PCR) was used to ascertain the presence of the contagious viral infection in all patients prior to their admission to the hospital. The results were recorded qualitatively; either present or absent. Blood samples for the quantitative measurement of C-reactive protein, Ferritin, and LDH were taken within the first 30 minutes’ post-admission and were sent to Isra University Hospital laboratory. After the patients were discharged or post mortality the records for the total duration of in-hospital stay were also collected from the medical archives for the purpose of this study paper. Hospital’s lab information management software network was used in case of missing reports. After collecting and compiling all the hospital data against each individual patient, the disease severity for each case was marked using the World Health Organization assessment charts.9 As the number of patients falling within the critical disease category was meager, this category was merged with the severe disease category.  

System IBM SPSS Statistics 20.0 Version was used for data analysis (IBM Corp, Armonk, NY). Data were expressed in the following two ways, Qualitative data: in terms of percentages and numbers/numeral figures and Quantitative data: in terms of mean±standard deviation.

Interquartile range and median were used for variables that were continuous (interpolated) with the non-parametric distribution. Shapiro-Wilk test was used to check the normality of the data collected. All three categories of patients in terms of severity (keeping in mind that the fourth category ‘critical disease’ was made a part of the third ‘severe disease’ category) were tested using the Kruskal-Wallis method for the purpose of drawing comparisons between the interquartile and median ranges for the three inflammatory markers.

Using the two outcome-based groups as a basis, levels of C-reactive protein, serum LDH, and serum ferritin were compared via independent-samples by Mann-Whitney U-test. Another indispensable test namely the Chi-square/ Fisher’s exact test was used to compare the proportionality of patients (of separate groups) with high ranges of inflammatory markers against each other. After all these tests were applied, the ROC (receiver operating characteristic) curve analysis was done to measure both the specificity and the sensitivity of CRP, LDH, and Ferritin as predictors of mortality. This curve was also used to determine their cut-off values in order to ascertain and justify the most appropriate times for intervention. IBM SPSS Statistics (the system previously referred to) automatically generated the AUC (area under the curve) values for each marker, hence helping with the study. This parameter throws light on how significantly efficient the statistical model is at differentiating. For instance, if the differentiation between the number of people dying in-hospital or getting discharged is good, then the model would show a raised value for AUC. In order to calculate the probability of the patients getting discharged, the study used the Kaplan Meier methodology. p <0.05 was the value taken as significant for all the comparisons.

Results:

During the time interval considered for this study paper, about 450 infected patients were admitted. Out of the above, 9% died (about 39 admitted patients). 98 patients out of the total 450, had incomplete data sets (due to various reasons). 70 patients had probable COVID-19 and 3 patients were left without proper medical clearance. All of these mentioned above were not included in the data evaluation phase. Clinical fit-for-evaluation characteristics of the rest of the patient group are included in the study displayed in Table II. The mean age was 40±15 and 87.13% were males. Mild cases of COVID-19 disease successfully fought against the odds of mortality and are 160 (66.39%) in number with total death reported in 20 (8.29%) patients due to severe disease. Table III show the exact values of three inflammatory markers that were calculated (after blood testing) for the population under study.  Serum ferritin is highly sensitive with sensitivity of 95.45% and C reactive protein is highly specific with specificity of 88.89% among all three inflammatory markers (see Table IV).

The values for these inflammatory markers were found to be above the higher limits (limit considered normal) in the greater proportion of the affected that had disease ranging from moderate to severe to critical to those who died. The results of the Kaplan Meier analysis for affected patient survival at the above-mentioned thresholds are displayed in Table IV.

Patient’s CRP, ferritin and LDH improved in those who were discharged, while it increased significantly in those who were died (As shown in Table 5)

Discussion

All the results compiled above in various formats clearly show that patients that have contracted COVID-19 in moderate to severe levels have a higher level of inflammation in their bodies versus patients that have contracted the disease in a milder form. These results are in accordance with the majority of the other current studies’ conclusions. It is a well-established fact by now that cytokine storms are a tell-tale sign (pathophysiological model) of the severe form of the considered disease 10. One thing to notice though is that even this study marks inflammatory markers as high in serious cases of COVID-19, it does not differentiate between the levels of markers when it comes to moderate and severe cases. This last statement sits in contrast to what is available in the medical literature regarding COVID-19; which is that the higher the criticalness of a disease, the higher the inflammation, hence the higher the levels of inflammatory markers.11 A reason for this could be that if we place data against a continuous spectrum, it could place higher levels of disease against higher levels of inflammatory markers as both would move progressively towards the upper sections of the spectrum. Nonetheless, according to the current practice of physicians worldwide, patients towards this higher spectrum (moderate to severe level) are advised to stay in the hospital while milder disease-inflicted patients are recommended to continue treatment at home.12 Another thing to note here is that this study showed no variance between the levels of C-reactive protein in severe cases and in moderate ones 13.

If the inflammatory markers are considered individually, we can see that serum ferritin is the only contender that shows the least level of quantitative interference when it comes to patients falling within the moderate to severe disease range. Yet, the study results also show that serum ferritin is also the only contender when it comes to predicting mortality from the beginning as it has the greatest odds ratio and well the highest AUC (area under the curve). Hence, when the patients showed a high level of ferritin in their bloodstream, it could be concluded that mortality will be high.

Why is the level of ferritin so high in COVID-19? The answer is believed to be either the production of high levels of proinflammatory cytokines (tumor necrosis factor-α and interleukin-6) in the body or the increased release from damaged cells in the bloodstream.14 The case for serum ferritin as a dependable predictor for mortality is fought differently by different studies. (Feld et al.). Serum ferritin is a poor predictor at admission (AUC - 0.677).15 (Harold et al.) Serum ferritin is a relatively reliable predictor (compared to above) with AUC at 0.750 16. The cut-off will be set at 1285 ng/ml; time for the introduction of mechanical ventilation.17 Elevated levels of ferritin were directly proportional to the likelihood of death in New York. (This result is consistent with the current study conclusions.)

The study at hand concludes that if the value of C-reactive protein (CRP) increases seven-folds, then the case for mortality prediction is solid. In order to avoid various complications that can occur before and can lead to death, a number of cut-off values are set for CRP. The results of different studies include the following conclusive discussions: Huang et al. If CRP ≥10mg/L, the risk of death increases threefold in patients.18 Liu et al. If CRP > 41.8 mg/L, acute complications are expected.19 Luo et al. CRP >41.4mg/L is 95% sensitive as a predictor as well as 77.6% specific when it comes to death in hospitalized patients.20

COVID-19 is not the only viral infection to have raised levels of LDH. Other viral diseases such as H5N1 and MERS-CoV also result in increasing LDH levels.21 If the level of LDH rises by two, then it becomes a very surefire marker of death in the hospital cohort. If LDH levels ≥1200 U/L then according to an American study, one is eight times more susceptible to death than one with levels less than 1200 U/L.

A local study (in Pakistan) done by Asghar et al. took under the microscope 360 indoor patients afflicted by COVID-19.8 This study was done for the purpose of measuring a large number of parameters. Fortunately, this set of parameters also included the three inflammatory markers. All three markers showed lower values when compared to the results of the study at hand. Surprisingly, they deduced serum ferritin as the weakest mortality predictor. Despite this interesting inference, we would still encourage the use of ferritin as the first priority.

The distribution of males and females per each class of severity was unequal in this study despite as per the fact that males overall greatly outnumbered the females 22. This is not surprising as the data from Global Health 50/50 Research Initiative also shows a percentage as high as 74% of the affected population in Pakistan to be only males.23 This is not the case with European countries. Their datasets show the number of male and female confirmed case affected to be approximately equal in number.24 This discrepancy could be because of the conservativeness of our society which renders the females to be less outgoing and hence contracting less disease.

One thing to note, which makes this dataset consequential, is that the blood sampling for all patients was done strictly within the first 30 minutes post-admission. This was because of the hospital protocol. Consequently, in order to avoid partiality, patients who could not be assessed within this time period upon admission were entirely excluded from the study population. For this study, the authors studied the inflammatory markers only in the beginning. It would be fascinating to know how these markers fluctuate throughout the stay of the patient; how hospitalization affects the results. Even though some inflammatory markers are already established as reliable, such as interleukin-6 and procalcitonin, the authors could not test them due to a number of reasons, most of which were of a financial nature. This was a period of intense workload for the participants performing the analysis. For this reason, no standardized textbook format was used to document the data. The negative impact of this was that the authors could not include within this research the study of the factors that adversely affect the levels of the three inflammatory markers, specifically CRP. One such example is the patients with cirrhosis. Their CRP levels are naturally lower than the rest. Another example consists of those patients that are on medications like statins.25 They also have a decreased level of CRP in their blood.

Conclusion

Serum C-reactive protein, LDH, and Ferritin if measured at the time of admission can prove to be reliable predictors of severity and mortality in COVID-19 disease. Out of the three, ferritin is highly sensitive and should be considered essential.

FUNDING SOURCE

None.

CONFLICT OF INTEREST

None.

PERMISSION

Permission was taken from the ethical review committee of the institute

References:

1. WHO Coronavirus Disease (COVID-19) Dashboard. World Health Organization. https://covid19.who.int/. (accessed on 6/10/2020)

2. COVID-19 Health Advisory Platform by Ministry of National Health Services Regulations & Coordination. Government of Pakistan. https://covid.gov.pk/stats/ Pakistan (accessed on 6/10/2020)

3. Lingeswaran M, Goyal T, Ghosh R, Suri S, Mitra P, Misra S, et al. Inflammation, immunity and immunogenetics in COVID-19: A narrative review. Indian J Clin Biochem 2020; 35(3):260-73. doi: 10.1007/s12291-020-00897-3.

4. Ali N. Elevated level of C-reactive protein may be an early marker to predict risk for severity of COVID-19. J Med Virol 2020; doi10.1002/jmv.26097

5. Chen X, Zhao B, Qu Y, Chen Y, Xiong J, Feng Y, et al. Detectable serum SARS-CoV-2 viral load (RNAaemia) is closely correlated with drastically elevated interleukin 6 (IL-6) level in critically ill COVID-19 patients. Clin Infect Dis 2020; 10.1093/ cid/ciaa449.

6. Lee DW, Gardner R, Porter DL, Louis CU, Ahmed N, Jensen M, et al. Current concepts in the diagnosis and management of cytokine release syndrome. Blood 2014; 124(2):188-95. doi: 10.1182/blood-2014-05-552729.

7. Vultaggio A, Vivarelli E, Virgili G, Lucenteforte E, Bartoloni A, Nozzoli C, et al. prompt predicting of early clinical deterioration of moderate-to-severe COVID-19 patients: Usefulness of a combined score using IL-6 in a preliminary study. J Allergy Clin Immunol Pract 2020; 8(8):2575-81. doi: 10.1016/j. jaip.2020.06.013.

8. Asghar M, Kazmi SJH, Khan NA, Akram M, Hassan M, Rasheed U, et al. Poor prognostic biochemical markers predicting fatalities caused by COVID-19: A retrospective observational study from a developing country. Cureus 2020; 12(8):e9575. doi: 10.7759/cureus.9575.

9. Clinical management of COVID- 19: interim guidance, 27 May. World Health Organisation. https://apps.who.int/iris/ handle/10665/332196. (Accessed on 12/7/2020).

10. Arshad AR, “Inflammatory markers in COVID-19 pneumonia”, Harvard Dataverse, V1, 2020, https://doi.org/ 10.7910/DVN/ JGUOUM.

11. Zeng Z, Yu H, Chen H, Qi W, Chen L, Chen G, et al. Longitudinal changes of inflammatory parameters and their correlation with disease severity and outcomes in patients with COVID-19 from Wuhan, China. Crit Care 2020; 24(1):525. doi: 10.1186/ s13054-020-03255-0.

12. Gandhi RT, Lynch JB, Del Rio C. Mild or moderate Covid-19. N Engl J Med 2020; Doi. 10.1056/NEJMcp 2009249.

13. Miatech JL, Yaslik CP, Tarleton HE, West D, Kellum W, McKnight M, et al. Retrospective analysis of inflammatory markers and patient characteristics in hospitalized Covid-19 patients: an early experience in Louisiana. Cureus 2020; 12(9):e10257. doi: 10.7759/ cureus.10257.

14. Lin Z, Long F, Yang Y, Chen X, Xu L, Yang M. Serum ferritin as an independent risk factor for severity in COVID-19 patients. J Infect 2020; 81(4):647-79. doi: 10.1016/j.jinf.2020.06.053

15. Feld J, Tremblay D, Thibaud S, Kessler A, Naymagon L. Ferritin levels in patients with COVID-19: A poor predictor of mortality and hemophagocytic lymphohistiocytosis. Int J Lab Hematol 2020; 10.1111/ijlh.13309.

16. Gayam V, Chobufo MD, Merghani MA, Lamichanne S, Garlapati PR, Adler MK. Clinical characteristics and predictors of mortality in African-Americans with COVID-19 from an inner-city community teaching hospital in New York. J Med Virol 2020; doi. 10.1002/jmv.26306.

17. Herold T, Jurinovic V, Arnreich C, Lipworth BJ, Hellmuth JC, von Bergwelt-Baildon M, et al. Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19. J Allergy Clin Immunol 2020; 146(1):128-36. e124. doi: 10.1016/j. jaci.2020.05.008.

18. Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. Creactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: A meta-analysis. Ther Adv Respir Dis 2020; 14:1753466620937175.

19. Liu F, Li L, Xu M, Wu J, Luo D, Zhu Y, et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol 2020; 127:104370. doi: 10.1016/j. jcv.2020.104370.

20. Luo X, Zhou W, Yan X, Guo T, Wang B, Xia H, et al. Prognostic value of C-reactive protein in patients with COVID-19. Clin Infect Dis 2020; ciaa641. doi: 10.1093/ cid/ciaa641.

21. Shi J, Li Y, Zhou X, Zhang Q, Ye X, Wu Z, et al. Lactate dehydrogenase and susceptibility to deterioration of mild COVID-19 patients: A multicenter nested case-control study. BMC Med 2020; 18(1):168. doi: 10.1186/s12916- 020-01633-7.

22. Ayanian S, Reyes J, Lynn L, Teufel K. The association between biomarkers and clinical outcomes in novel coronavirus pneumonia in a US cohort. Biomark Med 2020; 14(12): 1091-7. Doi. 10.2217/bmm-2020-0309.

23. The COVID-19 sex-disaggregated data tracker. Global Health 5050. https://globalhealth5050.org/the-sex-gender-and-covid19-project/the-data-tracker/? explore=country&country=Pakist an#search. (accessed on 6/10/2020)

24. Gebhard C, Regitz-Zagrosek V, Neuhauser HK, Morgan R, Klein SL. Impact of sex and gender on COVID-19 outcomes in Europe. Biol Sex Differ 2020; 11(1):29. doi: 10.1186/ s13293- 020-00304-9.

25. Asher J, Houston M. Statins and C-reactive protein levels. J Clin Hypertens (Greenwich) 2007; 9(8):622-8. doi.org/ 10.1111/j.1524-6175.2007.06639.x

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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.

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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.


Best Article Award

A study by Dorothy Ebere Adimora et al. entitled \"Remediation for Effects of Domestic Violence on Psychological well-being, Depression and Suicide among Women During COVID-19 Pandemic: A Cross-cultural Study of Nigeria and Spain\" is awarded Best Article of Vol 14 issue 23
A study by Muhas C. et al. entitled \"Study on Knowledge & Awareness About Pharmacovigilance Among Pharmacists in South India\" is awarded Best article for Vol 14 issue 22
A study by Saurabh Suvidha entitled \"A Case of Mucoid Degeneration of Uterine Fibroid with Hydrosalphinx and Ovarian Cyst\" is awarded Best article of Vol 14 issue 21
A study by Alice Alice entitled \"Strengthening of Human Milk Banking across South Asian Countries: A Next Step Forward\" is awarded Best article of Vol 14 issue 20
A study by Sathyanarayanan AR et al. entitled \"The on-task Attention of Individuals with Autism Spectrum Disorder-An Eye Tracker Study Using Auticare\" is awarded Best article of Vol 14 issue 19
A study by Gupta P. et al. entitled \"A Short Review on \"A Novel Approach in Fast Dissolving Film & their Evaluation Studies\" is awarded Best Article of Vol 14 issue 18.
A study by Shafaque M. et al. entitled \"A Case-Control Study Performed in Karachi on Inflammatory Markers by Ciprofloxacin and CoAmoxicillin in Patients with Chronic Suppurative Otitis Media\" is awarded Best Article of Vol 14 issue 17
A study by Ali Nawaz et al. entitled \"A Comparative Study of Tubeless versus Standard Percutaneous Nephrolithotomy (PCNL) \? A Randomized Controlled Study\" is awarded Best Article for Vol 14 issue 16.
A study by Singh R. et al. entitled \"A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)\" is awarded Best Article for Vol 14 issue 15
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
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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
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
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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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