International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 07 Issue 10, May, 2015

Pages: 39-42

Date of Publication: 30-Nov--0001


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VISUAL OUTCOME AND COMPLICATIONS OF NEODYNIUM : YTTRIUM ALUMINIUM GARNET LASER POSTERIOR CAPSULOTOMY IN PSEUDOPHAKIC PATIENTS USING SPIRAL METHOD OF CAPSULOTOMY

Author: Garima Agrawal

Category: General Sciences

Abstract:Aim: To determine the visual outcome and complications of Neodynium : Yttrium Aluminium Garnet laser posterior capsulotomy in pseudophakic patients with visually significant posterior capsular opacification using the spiral method of capsulotomy. Material and Methods: Neodynium : Yttrium Aluminium Garnet laser posterior capsulotomy was done in a spiral fashion in 50 eyes of 50 patients with visually significant posterior capsular opacification. The visual outcome and complications were documented 1week, 4 weeks and 12 weeks after the procedure. Observations: 94% patients had good visual recovery (best corrected visual acuity >/=6/12) 12 weeks post laser. The complicationsobserved were intraocular lens pitting in 6 eyes but was not significant to reduce vision. Intraocular pressure spike greater than 5 mm Hg was seen in 3 eyes 1 hour post laser but was controlled with anti -glaucoma medication. Cystoid macular edema was seen in 2 eyes, 8 and 10 weeks after laser. Conclusion Neodynium : Yttrium Aluminium Garnet laser posterior capsulotomy with the spiral method is effective in cutting the posterior capsule with good visual results and low rate of complications in our Institute.

Keywords: Neodynium: Yttrium Aluminium Garnet posterior capsulotomy, Visual outcome, Complications

Full Text:

INTRODUCTION

In the age where the femtosecond laser is being used for anterior capsulotomy in cataract surgery, we revisit the cold cutting laser i.e. Neodynium : Yttrium Aluminium Garnetlaser. Posterior capsular opacification is the most common delayed complication following cataract surgery.1 Neodynium: Yttrium Aluminium Garnet laser posterior capsulotomy is the standard treatment of posterior capsular opacification.2,3 The ND YAG laser offers a safe ,non invasive method of cutting the posterior capsule with good visual outcomes. Complications as rise in intra ocular pressure, cystoid macular edema and retinal detachment have been reported after the procedure.4,5A number of ways have been used to minimize energy delivery into the eye and minimize complications of the procedure. These include accurate focussing, cutting across tension lines along with a number of ways for cutting the posterior capsule including cross technique, can opener, inverted U, circular and spiral.6,7The present study aims at determining the visual outcome and complications of Neodynium : Yttrium Aluminium Garnet laser posterior capsulotomy in our Institute using spiral method of capsulotomy.

AIM

To determine the visual outcome and complications of Neodynium : Yttrium Aluminium Garnet laser posterior capsulotomy in pseudophakic patients with visually significant posterior capsular opacification using the spiral method of capsulotomy 

MATERIAL AND METHODS

Fifty pseudophakic eyes of fifty cases (28males) and (22 Females) with visually significant posterior capsular opacification were enrolled . The study was carried out at our regional Institute of Ophthalmology from April 2014 to September 2014.The study is a prospective observational study. Ethical approval was obtained from the institutional review board. Informed consent was obtained from each enrolled subject for the procedure. The mean age (+/-SD) was 59.14+/-9.18 years(range 35-77 years). These cases had different types of PCO Elschnig pearls, mixed type and thick fibrotic membrane type.(Table I). All patients with corneal opacities, corneal edema, active intraocular inflammation, cystoid macular edema, retinal detachment, high myopia, lattice degeneration and history of retinal detachment in the fellow eye and other ocular comorbidities were excluded from the study. The meantime from cataract surgery was 22.42+/-16.32 months (range: 6–68). All patients were examined before Neodynium: Yttrium Aluminium Garnet laser capsulotomy and 1week, 4weeks, and 12 weeks after Nd: YAG laser capsulotomy. All patients underwent a complete ocular examination on all visits, including bestcorrected visual acuity, refraction, slit-lamp, intraocular pressure measurement, and posterior segment examination. Intraocular pressure was measured one hour after the laser. Tropicamide 1% and phenylephrine 2.5% were administered for pupillary dilatation prior to procedure. The capsulotomy size was kept slightly larger than the size of the mesopic pupil.The VISULAS II plus Q switched Neodynium: Yttrium Aluminium Garnet laser (Carl Zeiss Germany)was used. The capsulotomy was done in a spiral fashion. After capsulotomy, prednisolone acetate 1% four times daily and timolol maleate 0.5% eye drops twice daily for 15 days were prescribed. The chi square test was used for statistical analysis. p<0.05 was taken as significant

Observations and Results

Table I shows the Background demographics. The mean age was 59.14(+/-9.18) years. Majority (62% ) patients had the mixed type of opacification (including pearls and fibrosis).28 were male and 22 patients were female. Table II shows the procedure parameters. The mean (+/-standard deviation ) total laser energy used was 17.46+/-6.23mJ.Table III shows the visual outcome.96 % patients had >/= 6/12 best corrected visual acuity one week post laser and 94%patients 3 months post laser. The p value is 0 i.e. <0.05 and hence the post laser visual acuity change is significant. One patient showed long term decrease of visual acuity of one line due to regression to posterior capsular opacification .The good visual results reflect the effectiveness of the procedure as well as good patient selection as we excluded patients with other ocular co morbidities. Table IV shows the complications of the procedure. Pitting over the intraocular lens was seen in 6(12%) patients, cystoid macular edema in 2(4%) patients and an intraocular pressure spike greater than 5 mm Hg in 3(6%) patients. Cystoid macular edema was the cause of poor visual recovery in two patients(BCVA <6/36).It was diagnosed on fundus examination and posterior segment optical coherence tomography and treatment started with topical nepafenac 0.1% four times a day and a posterior subtenon injection of 20mg Triamcinolone acetonide at our centre. Three patients had an IOP spike greater than 5mm Hg 1 hour,1 day post laser. The IOP was controlled and returned to baseline at I week with anti- glaucoma medication

DISCUSSION

Neodynium: Yttrium Aluminium Garnet laser is the standard treatment for posterior capsular opacification with good visual results. Jung KM et al have reported that the mean post procedural best corrected visual acuity was found to be 0.22±0.26 and procedural outcome showed 96 % (74 eyes out of the 77 eyes) enhancement in patients’ visual acuity.7In our study 94% patients had improvement in visual acuity 3 months post laser. We report high percentage of good visual results as all patients with other ocular co morbidities which may cause diminution of vision were excluded from the study. The procedure is not without its complications. Reported complications include damage to the intraocular lenses . 8,9We report pitting of the intraocular lens in 12 % of patients but it was not significant enough to cause diminution of vision. Increase in intraocular pressure, cystoid macular edema and disruption of the anterior vitreous face are also documented.4,10,11,12Three patients had a spike of intraocular pressure >5 mm Hg 1 hour,1 day post laser which was successfully treated with anti- glaucoma medication. Cystoid macular edema was seen in two of our patients 8weeks and 10 weeks after laser. Increased incidence of retinal detachment has been reported after the procedure.4,13,14,15,16,17 ,18In our study retinal detachment was not observed. A good patient selection and exclusion of high risk patients may account for low incidence of retinal detachment. We conclude that the spiral method of capsulotomy could be performed relatively safely with good visual recovery with low rate of complications using accurate focusing, proper technique and good patient selection.

Randomized controlled trials to compare two /several techniques of opening the posterior capsule are warranted to know the superiority of one method over the other.

CONCLUSION

Neodynium : Yttrium Aluminium Garnet laser posterior capsulotomy with the spiral method is effective in cutting the posterior capsule with good visual results and low rate of complications in our Institute. Good patient selection, accurate focusing and proper technique are cornerstones to maximize procedure results.

ACKNOWLEDGEMENT

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.

 

References:

1. Aslam TM, Devlin H, Dhillon B. Use of Nd:YAG laser capsulotomy. Surv Ophthalmol 2003;48(6):594-612.

2. Aron Rosa D, Aron JJ, Griesemann M, Thyzel R. Use of neodymium yag laser to open the posterior capsule after lens implant surgery: a preliminary report. Am Intraoc Implant Soc Journal 1980;6(4):352-354.

3. Frankhauser F, Roussel P, Steffen J. Clinical studies on the efficiency of high power laser radiation upon some structures of the anterior segment of the eye. First experiences of the treatment of some pathological conditions of the anterior segment of the human eye by means of a Q-switched laser system .Int Ophthalmol 1981;3(3):129-139.

4. Steinert RF, Puliafito CA, Kumar SR, Dudak SD, Patel S. Cystoid macular edema, retinal detachment, and glaucoma after Nd:YAG laser posterior capsulotomy. Am J Ophthalmol1991;112(4):373-380.

5. Channel MM, Beckman H. Intraocular pressure changes after neodymium-YAG laser posterior capsulotomy. Arch ophthalmol 1984;102(7):1024-1026.

6. M Vella,S Wickhermansinghe, N Gupta, P Andreou, A Sinha.YAG laser capsulotomy, an unusual complication. Eye2009;18:193-194.

7. Jung KM, Jae HA, Jim HY.A new technique for Nd YAG laser posterior capsulotomy. Int J Ophthalmol 2014;7(2):345- 349.

8. Newland TJ, McDermott ML, Eliott D, Hazlett LD, Apple DJ, Lambert RJ, Barrett RP. Experimental neodymium:YAG laser damage to acrylic, poly(methyl methacrylate), and silicone intraocular lens materials. J Cataract Refract Surg 1999;25(1):72–76.

9. Trinavarat A, Atchaneeyasakul L, Udompunturak S. Neodymium:YAG laser damage threshold of foldable intraocular lenses. J Cataract Refract Surg 2001;27(5):775– 780.

10. Ge J, Wand M, Chiang R, Paranhos A, Shields MB. Longterm effect of Nd:YAG laser posterior capsulotomy on intraocular pressure. Arch Ophthalmol 2000;118(10):1334– 1337.

11. Krauss JM, Puliafito CA, Miglior S, Steinert RF, Cheng HM. Vitreous changes after neodymium-YAG laser photodisruption. Arch Ophthalmol 1986;104(4):592–597.

12. Bath PE, Fankhauser F. Long-term results of Nd: YAG laser posterior capsulotomy with the Swiss laser. J Cataract Refract Surg 1986;12(2):150–153.

13. Dardenne MU, Gerten GJ, Kokkas K, Kermani O. Retrospective study of retinal detachment following neodymium: YAG laser posterior capsulotomy. J Cataract Refract Surg 1989;15(6):676–680.

14. Javitt JC, Tielsch JM, Canner JK, Kolb MM, Sommer A, Steinberg EP. National outcomes of cataract extraction. Increased risk of retinal complications associated with Nd:YAG laser capsulotomy. The Cataract Patient Outcomes Research Team. Ophthalmology 1992;99(10):1487–1498.

15. Powell SK, Olson RJ. Incidence of retinal detachment after cataract surgery and neodymium:YAG laser capsulotomy. J Cataract Refract Surg 1995;21(2):132–135.

16. Shah GR, Gills JP, Durham DG, Ausmus WH. Three thousand YAG lasers in posterior capsulotomies: an analysis of complications and comparison to polishing and surgical discission. Ophthalmic Surg 1986;17(8):473–477.

17. Nielsen NE, Naeser K. Epidemiology of retinal detachment following extracapsular cataract extraction: a follow-up study with an analysis of risk factors. J Cataract Refract Surg 1993;19(6):675–680.

18. Hayashi K, Nakao F, Hayashi H. Influence of size of neodymium:yttrium-aluminium-garnet laser posterior capsulotomy on visual function. Eye 2010;24(1):101–106.

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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

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 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 situs slot and 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 et al. situs slot "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 situs slot 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 situs slot et al 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
Late to bed everyday? You may die early, get depression situs slot
Egg a day tied to lower risk of heart disease situs slot
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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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