International Journal of Current Research and Review
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IJCRR - Vol 07 Issue 10, May, 2015

Pages: 43-48

Date of Publication: 30-Nov--0001


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IS CAROTID ATHEROSCLEROSIS AN INDICATOR OF GENERALIZED ATHEROSCLEROSIS: AN AUTOPSY STUDY

Author: Lokesh Haswani, Harendra Kumar M.L., Kiran J.

Category: General Sciences

Abstract:Background: Atherosclerosis is one of the major causes of morbidity and mortality worldwide. Autopsy study is a gold standard for atherosclerosis. None of the study done on autopsy to prove the carotid atherosclerosis has the generalized nature. Objective: To examine the association between carotid atherosclerosis with coronary, aorta and renal arteries in non cardiac patients using histological analysis. Methods: We histologically examined 91 patients died of non cardiac cause. Atherosclerotic lesion in carotid, coronary, aorta and renal arteries were noted and graded according to modified AHA classification of atherosclerosis using morphological descriptions (2000).
Results:
Mean of carotid atherosclerosis was 11.5\?0.71, in coronary it was 37.33\?7.57, in aorta the mean we found was 27\?9. The mean of renal artery atherosclerosis was 2.75\?0.71. The association of carotid atherosclerosis with coronary, aorta and renal arteries was statistically significant (p < 0.05).
Conclusion:
In present study we conclude that if carotid atherosclerosis is present, patient will be having coronary, aortic atherosclerosis but patient might have renal atherosclerosis. If carotid atherosclerosis is absent it doesn't mean that patient won't be having atherosclerosis in any other vessels.

Keywords: Atherosclerosis, Autopsy, Carotid artery

Full Text:

INTRODUCTION

Atherosclerosis is a major cause of morbidity and mortality worldwide and it account for one third of all deaths from heart disease.[1] The most serious outcome of atherosclerosis are stroke, myocardial infarction and death. [2] Autopsy is a tool of real value rather than an exercise of tradition, when done selectively and efficiently. [2] Autopsy series are often quoted as an unbiased information source. [3] As study of atherosclerosis in the living population is difficult in many ways including its cost-effectiveness, autopsy studies have been regarded as one good way of dealing with the problem. [4] Given the limited ability of current clinical imaging methods to visualize the vessel wall, as opposed to the lumen, we are highly dependent on autopsy material for describing various different stages of atherosclerosis. [5] Atherosclerosis is a generalized vascular disease. [6] Although there is asymmetry in involvement of various arteries in atherosclerosis but the disease usually proceeds in parallel in various organ system in our body. [3] Once the disease apparent in one territory, there is increased risk of adverse events in the vascular territories including those supplying the brain, kidneys, mesentery, and limbs. [8] Atherosclerosis has the distinctive topographical distribution in the intimal surface of each artery of various organs.[7] Hypothesis which explain the difference in atherosclerotic lesions in every organ are hemodynamic stresses related to arterial geometry; anatomic, cellular or biochemical variation in arterial wall, particularly in the endothelium, smooth muscle cell mutations leading to monoclonal proliferation and infectious agent. [7] Atherosclerosis affects the Indian population at a younger age than in any other ethnic groups with more severe and extensive angiographic involvement. [8] By imaging technique only few superficial vessels like carotid can be studied for the atherosclerosis. [9] Sever al radiological studies show that carotid intima media thickness can be regarded as an indicator of generalized atherosclerosis which can predict the future cardiovascular and cerebrovascular events. [9, 10] Radiological studies had shown that there is close association of carotid atherosclerosis with aortic and coronary artery atherosclerosis. [9] Several studies done angiographically had shown that renal artery atherosclerosis usually exits as one manifestation of generalized atherosclerosis. [11] So it is very important to see whether the extent of disease correlates in different arterial beds same as in carotid artery or not. [12] Till now none of the radiological or autopsy study had correlated carotid atherosclerosis with coronary aorta and renal atherosclerosis. So here the study had been conducted, to see whether the carotid atherosclerosis can be correlated with the atherosclerosis of other major vessels using gold standard technique of histomorphological analysis on the autopsy specimens. So that carotid atherosclerosis can be used as a screening tool to predict the future cardiovascular, cerebrovascular and kidney disease. This is to help to start early intervention for these diseases and thus decreases the disease burden.

MATERIAL AND METHODS

Patient selection

The study was descriptive, cross sectional done on the autopsy cases in which patient died without morphological evidence of atherosclerotic catastrophe, during the period of January 2011 to August 2013.

Histological preparation: Specimen of heart and the whole length of aorta along with carotids, upto the bifurcation of common carotid artery and the renal arteries was removed and fixed in 10% formalin. The heart was dissected by inflow outflow technique, along the direction of flow of blood and aorta along the posterior surface. The three major coronary arteries were identified and cut transversely at 0.5 cm intervals until their entry into the musculature. Bits from the suspicious or definite atherosclerotic lesions were taken. All arteries were processed by routine tissue processing and stain with hematoxylin and eosin stain.

Pathological Assessment and Morphological Analysis: The microscopic grading of atherosclerosis was done according to the modified American Heart Association Classification(AHA) of atherosclerosis using morphological descriptions (2000) which is better than the earlier AHA classification with regard to the description of intermediate lesions which was prone for future development of complicated atherosclerosis.[5] The atherosclerotic lesions were divided into non-atheromatous lesions (Intimal thickening and Intimal Xanthoma) and progressive atheromatous lesions like [Pathological intimal thickening (PIT), Thick Fibrous cap atheroma (FCA) and Thin fibrous cap atheroma (TFCA), Calcified nodule (CN) and Fibrocalcific plaque (FCP)]. (Figure-2,3,4)

Statistical Analysis: Statistical analysis was done using chi square test using SPSS software.

RESULTS

In the present study, the ages ranged from 7 to 72 years and mean age were 39.23±14.24 years. Number of males and female were 67(74%) and 24 (26%) respectively. The most common cause of death was road traffic Accidents 42(46.1%), followed by poisoning 21(23.1%), then hanging and burns 5(5.5%) each. For comparing the atherosclerosis between the arteries, we have divided our results into two broad category i.e Non atherosclerotic lesion (NAL) and progressive atherosclerotic lesion (PAL) which was given in the classification because most NAL has potential to regress.[7] In present study, the atherosclerosis(which has PAL) in carotid was 12.6%. In case of coronaries atherosclerosis in LAD is about 51% followed by RCA 35% and last LCA was 37%. Atherosclerosis was 40% in ascending aorta, 20% in thoracic aorta and 30% in the abdominal aorta Atherosclerosis in renal arteries was only 3 %.The number and percent of PAL in all arteries was given in the (Table-1) When comparing the association of significance of atherosclerosis in carotid with coronaries, aorta and renal arteries, the P value was < 0.05, which was statistically significant.

DISCUSSION

Atherosclerosis is generalized systemic disease, affected by multiple risk factors such as age, gender, race, smoking, personality, hyperlipidemia etc. Atherosclerosis usually proceeds in parallel in various organ systems but there is asymmetry in involvement of various arteries by this disease. [3] The reason may be that the magnitude of the effect of each risk factor varies among the arterial beds for example- smoking selective augments abdominal aorta and thoracic more commonly affect the younger age group. [7] Many earlier studies had mention that carotid intima media thickness can be regarded as an indicator of generalized atherosclerosis. [9, 10] So it is very important to see whether the extent of disease cor-relates in different arterial beds same as in carotid artery or not. [12]

Association between carotid and coronary atherosclerosis: In the present, study mean of carotid atherosclerosis was 11.5±0.71 (12.6%) and mean of coronary atherosclerosis was 37.33±7.57 (41%). Nazarat et al had reported 50% and 85% of carotid and coronary atherosclerosis respectively. [14] Most Indian studies has shown steep rise in coronary atherosclerosis after second decade of life. [13] Advanced lesion in the coronary artery start appearing as early as in third decade. [15] In present study the none of the patient less than 34 years had carotid atherosclerosis. Prati et al. also reported none of the carotid atherosclerosis in less than 30 years. [16] Both above studies show that carotid atherosclerosis may start appearing after fourth decade compare to coronary which show steep rise after second decade. It was observed in our study that the coronary arteries were invariably involved showing atherosclerosis when carotid artery was affected and the percentage distribution of both arteries being involved when carotid artery showed atherosclerotic changes was 100%. The association between two arteries was statically significant.

Association between carotid and aortic atherosclerosis: The mean of aortic atherosclerosis was 27±9(29.9%) which was higher compared to the carotid atherosclerosis which was observed in this study. Earliest age of aortic atherosclerosis was observed is 20 year, whereas earliest age of carotid atherosclerosis was observed at 40 years. Siraj Ahmed et al had observed earliest aortic atherosclerosis in the second decade. [17] When carotid had atherosclerotic lesion 100% of patient had aortic involvement and most frequently associated with the ascending and abdominal aorta. Kallikazaros et al had found74.3% of incidence of carotid plaque in the subgroup with aortic plaque.[18] and also found that absence of carotid plaque may not reflect the absence of aortic plaque. [18] The association between the two arteries were statically significant.

Association between carotid and renal artery atherosclerosis: The mean of renal artery atherosclerosis was 2.75 ± 0.71(2.7%) which was much lower compared to the carotid atherosclerosis observed in our study. Only 25% of cases of carotid atherosclerosis had renal atherosclerosis. The difference may be due to the prevalence of renal artery atherosclerosis was much lower than the carotid atherosclerosis. Kuroda et al had reported 22.8% patient with carotid atherosclerosis had renal atherosclerosis. [11] Aggarwal et al reported advanced lesion like fibrous plaque was rarely observed before fifth decade. [19] When atherosclerosis presents in renal artery all (100%) the cases also had carotid atherosclerosis. It had been seen that 45%-100% of patient with renal atherosclerosis had co-morbid carotid artery atherosclerosis. [11] Studies had shown that severe carotid atherosclerosis associated with renal atherosclerosis and also the chronic kidney disease. [20] The wide difference in atherosclerotic lesions between the present study and other studies might be due to the fact that they have used the earlier AHA classification which considered even grade I and II lesions as atherosclerosis. In the present study since we have used the modified AHA classification of atherosclerosis, the earliest lesions like intimal thickening and intimal xanthoma were not considered as atherosclerotic lesions, partly explaining the difference in the prevelance of atherosclerosis. From above discussion we conclude that if carotid atherosclerosis is present, patient will be having coronary, aortic atherosclerosis but patient might have renal atherosclerosis. If carotid atherosclerosis is absent it doesn’t mean that patient won’t be having atherosclerosis in any other vessels.

CONCLUSION

From above study we conclude that carotid atherosclerosis is the indicator of generalized atherosclerosis. Assessing the carotid atherosclerosis using non-invasive technique can be used as screening tool for cardiovascular, cereberovascular and kidney disease due to renal artery atherosclerosis. The use anti-atherogenic preventive measures may be implemented as soon as carotid atherosclerosis is detected. So as to prevent premature death caused by cardiovascular, cereberovascular and kidney disease, burdening the national economy.

ACKNOWLEDGEMENT

The authors would like to thank Mr Ravishankar for statistical analysis and lab technicians from Histopathology division for processing the samples for this study. Authors acknowledge the immense help received from scholars whose article are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publisher of all those articles, journals and books from where the literature for the article has been reviewed and discussed.

 

References:

1. Shah PK. Screening asymptomatic subjects for subclinical atherosclerosis: can we, does it matter, and should we? J Am Coll Cardiol. 2010;56:98–105.

2. Fausto N. Atherosclerosis in young people. Am J Pathol 1998;153:4.

3. Zoccali C, Mallamaci F, Finocchiaro P. Atherosclerotic renal artery stenosis: epidemiology, cardiovascular outcomes, and clinical prediction rules. J Am Soc Nephrol2002; 13: S179–83.

4. Naher S, Naushaba H, Muktadir G, Rahman MA, Khatun S, Begum M. Percentage area of intimal surface of the abdominal aorta affected by atherosclerosis: A postmortem study. J Med Sci Res 2007; 9 (1):26-30.

5. Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM. Lessons From Sudden Coronary Death: A Comprehensive Morphological Classification Scheme for Atherosclerotic Lesions. Arterioscler Thromb Vasc Biol 2000;20:1262- 1275.

6. Prince MR. Is there replacement for percentage stenosis in characterizing occlusive vascular disease? Radiology. 2007;245(3):617-8

7. McGill HC Jr, McManhan CA, Herderick EE, Tracy RE, Malcom GT, Zieske AW, et al. Effects of coronary heart disease risk factors on atherosclerosis of selected regions of the aorta and right coronary artery. PDAY Research Group. Pathobiological Determinants of Atherosclerosis in Youth. Arterioscler Thromb Vasc Biol. 2000;20:836–45.

8. Faxon DP, Creager MA, Smith SC, Jr, et al. Atherosclerotic Vascular Disease Conference: Executive summary: Atherosclerotic Vascular Disease Conference proceeding for healthcare professionals from a special writing group of the American Heart Association. Circulation. 2004;109:2595– 2604.

9. Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation. 1997;5(5):1432–1437.

10. Mattace-Raso F, van Popele NM, Schalekamp MA, van der Cammen TJ. Intima-media thickness of the common carotid arteries is related to coronary atherosclerosis and left ventricular hypertrophy in older adults. Angiology. 2002;53(5):569–74

11. Kuroda S, Nishida N, Uzu T, Takeji M, Nishimura M, Fujii T et al. Prevalence of renal artery stenosis in autopsy patients with stroke. Stroke. 2000;31:61–65

12. Finn AV, Kolodgie FD, Virmani R. Correlation between carotid intimal/medial thickness and atherosclerosis: a point of view from pathology. Arterioscler Thromb Vasc Biol. 2010;30:177–181

13. Singh H, Oberoi SS, Gorea RK, Bal MS. Atherosclerosis in coronaries in Malwa region of Punjab. J Indian Acad Forencis Med. 2005;27(4):236-239

14. Nezarat N, Sadeghi M, Rabiel K, Afshar Moghadam N , Satareh M, Ezadinezhad M, et al The effect of body fat distribution on coronary and carotid atherosclerosis: an autopsy study. J Res Med Sci. 2012;17(Spec 1):S125-S130.

15. Keche AS, Tirpude BH, Bobade HJ. Progressive atherosclerosis in central India – A modern epidemic. Al Ameen J Med Sci. 2013;6(4):342-349.

16. Prati P, Vanuzzo D, Casaroli M, Di Chiara A, De Biasi F, Feruglio GA, Touboul PJ. Prevalence and determinants of carotid atherosclerosis in a general population. Stroke. 1992;23:1705–1711.

17. Ahmed S, Prabhu MH, begum A. Atherosclerosis of aortaan autopsy study. J Biomed Pharm Res. 2013;2(5):52-58.

18. Kallikazaros IE, Tsioufis CP, Stefanadis CI, Pitsavos CE, Toutouzas PK. Closed relation between carotid and ascending aortic atherosclerosis in cardiac patients. Circulation.2 000;102:III263–268

19. Aggarwal A, Kapoor K, Singh B. Prevalence and severity of atherosclerosis in renal artery in Northwest Indian population: an autopsy study. Surg Rad Anat. 2009;31(5):349- 346.

20. Iwakiri T, Sato Y, Matsuura Y, Hatakeyama K, Marutsuka K, Yasashit A, et al. Association between renal vasculature changes and generalized atherosclerosis: An autopsy survey. J Atheroscler Thromb. 2014;21(2):99-107

Abbreviations:

LAD - Left anterior descending artery

RCA – Right coronary artery

LCA – Left circumflex coronary artery

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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.

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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 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 
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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
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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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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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