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: 51-54

Date of Publication: 30-Nov--0001


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HYSTERECTOMY: A CLINICOPATHOLOGICAL CORRRELATION

Author: V. Arunadevi

Category: General Sciences

Abstract:Objectives: To correlate indications of hysterectomy with the histopathological findings, in order to determine the percentage of preoperative diagnosis that was confirmed on histopathology and to determine the frequency of unexpected pathologies. Methods: A retrospective study of 200 patients who had elective hysterectomy performed for various indications during the study period from January 2014 to December 2014 was conducted. Settings: Karpaga Vinayaga Institute of Medical Sciences and Research Institute. Results: 97.5% of hysterectomies were done for benign indications. The most common pathology identified was Leiomyoma in 32% of cases. Hysterectomies done for UV prolapse showed atrophic endometrium in 62.7% of cases. Other less frequent pathologies identified included endometrial hyperplasia, disordered proliferative phase and endometrial polyps. Conclusion: Histopathological analysis correlated well with preoperative clinical diagnosis for hysterectomy. Benign pathologies were more common than their malignant counterparts. The commonest indication and histological finding in our setting was leiomyoma. The clinical and pathological correlation is 91.8% in case of leiomyoma. Histological diagnosis is considered the definitive method of evaluating tumours.

Keywords: Leiomyoma, Adenomyosis, Hysterectomy

Full Text:

INTRODUCTION

Hysterectomy is the most commonly performed gynecological surgical procedure. It is estimated that over 500,000 hysterectomies are performed each year. The vast majority of these procedures are still performed via an abdominal approach (64%) with vaginal (22%) and laparoscopic (14%) approaches being less common (Jacoby etal1 ., 2009). The Society of Pelvic Reconstructive Surgeons issued guidance on choosing hysterectomy route in 1999. Since then vaginal hysterectomy has again gained favor2,3. The advantages of laparoscopic hysterectomy are shortterm hospital stay and recovery time. A systematic review and meta-analysis reports the average length of hospital stay to be 2 days less (95% CI 1.9-2.2) when compared to abdominal hysterectomy4 . However, a systematic review based on 5RCTs and 4 large case series reported laparoscopic hysterectomy to be more expensive and time-consuming than abdominal or vaginal hysterectomy5 . Laparoscopic techniques are not without risks and are associated with more complications than open operations, notable amongst which are bladder and ureteric injuries5 . Whether to remove the cervix remains unclear in both open and laparoscopic hysterectomy procedures5 . The disadvantages of a subtotal hysterectomy are possible in on-going menstrual bleeding and requirement of continued cervical surveillance (eg. smears)5 . Fibroids are the most common indication (39%) cited for performance of hysterectomy (Whiteman et al6 ., 2008). The purpose of this study is to correlate various indications of hysterectomy with the histopathological examination.

METHODS

The retrospective study analysis of 200 hysterectomy cases over a period of one year from January 2014 to December 2014 was reviewed in Department of OBG. Patient’s age, type of hysterectomy ,indication of surgery as well as true pathological diagnosis were reviewed , analyzed and correlated.

This study was approved by ethical committee.

RESULTS AND ANALYSIS

200 hysterectomies were studied. Hysterectomies were distributed over a wide age ranging from 20 years to 80 years. Of this 46% of cases were encountered in 40-49 years, which is the most common age group 22.5% of women were in age group of 30-39 years and 16.5% were 50-59 years. The relationship between age and number of hysterectomies is illustrated in Table 1.

The most common type of hysterectomies was Total Abdominal Hysterectomy with Bilateral Salphingo Ophorectomy (TAH with BSO) and Vaginal Hysterectomy (VH) , followed by Total Abdominal Hysterectomy (TAH). The most common age group for TAH with BSO was 40-49 years and Vaginal hysterectomy was 60-69 years, as shown in Table 2.

The various indications for hysterectomy are depicted in Table 3. 97.5% were benign and2.5% were for malignant indications. Leiomyoma was the most common preoperative clinical diagnosis found in 61 (30.5%) cases, followed by UV prolapse diagnosed in 59 (29.5%) cases. Other benign clinical indications included DUB (20.5%), Adenomyosis (4%), CIN (5.5%), Benign ovarian tumours (5%). 5 hysterectomies were performed for malignant indications which included CA endometrium, CA cervix and CA ovary

Leiomyoma was the commonest pathology found in 32% of cases as illustrated inTable 4. Hysterectomies for UV prolapse showed atrophic endometrium in 62.7% of cases. Other less frequent pathologies identified included endometrial hyperplasia, disordered proliferative phase and endometrial polyps. 7 cases of Benign serous cystadenomas, 2 cases of ovarian endometriosis and 1 case of hydrosalphix was found. 2 cases of endometrial adenocarcinoma, 2 cases of squamous cell carcinoma of cervix and 1 case of malignant mixed germ cell tumour of ovary was identified.

The final pathologic diagnosis confirmed the clinical indication in 91.8% in cases of leiomyomas, 75% in case of adenomyosis. The 41 cases diagnosed clinically as DUB were pathologically proven as follows: 9 adenomyosis, 8 as fibroid, 8 had endometrial hyperplasia and 2 showed endometrial polyps.

DISCUSSION

Hysterectomy still remains the widely used treatment modality even in developed countries. The complications of hysterectomy are often underestimated. Minor pyrexial morbidity was found in 47% of women after abdominal hysterectomy in the Pinion study with 5% requiring a blood transfusion7 .Common complications after hysterectomy include hemorrahage (2.4%), genitourinary disorders (eg. urinary retention, renal or ureteral injury) (1.9%), urinary tract infection (1.6%) and infection other than that in the urinary tract (1.6%)8 In a retrospective study including over 62,000 hysterectomies, the total incidence of ureteral injury after all hysterectomies was 1.0 of 1000 procedures and only 0.4 of 1000 procedures after total abdominal procedures (Harkki – Siren etal9 ., 1998). It has been shown that hysterectomy increase risk for subsequent stress urinary Incontinence (SUI). The true incidence of SUI caused by hysterectomy remains controversial (Roovers et at.,10 2000) Adhesion after an abdominal operation is very common, infact, 94% of patients develop intra-abdominal adhesions following a laparotomy 11,12. Al-Sunaidi and Tulandi13, studying small bowel obstruction (SBO) after hysterectomy for benign conditions, reported that TAHrelated adhesions accounted for 98% of SBO. The pooled rate for surgical site Infections (SSIs) after abdominal hysterectomy is reported at 1.7% by the National Health care Safety Network but ranged from 1% to 11% (olsen et at., 14 2009). The incidence of vault prolapse after vaginal hysterectomy for prolapse is approximately 12% but only 2% when the indication was other than prolapse15. Larger uteri are associated with a higher complication rate, primarily due to blood loss. When comparing uterine weights of less than 500 g, 500-999g, and greater than 1000g, risk of experiencing blood loss over 500ml, blood transfusion, major organ injury, and hospital readmission all increased as weight of the uterus increased (Unger et al., 16 2002). In 4% of women who die of cancer of the ovary, cervix and uterus hysterectomy should be seen as a life saving as well as life enhancing procedure.17 Hysterectomy has a high patient satisfaction rate because it is curative, usually performed when medical or minimal access management has failed, and repeated procedures or prolonged follow up is not needed. 18, 19-21

CONCLUSION

While confirming the preoperative diagnosis by histopathological examination, high confirmation rates were found for leiomyomas, malignancy and adenomyosis. Out of 41 cases , clinically diagnosed as DUB, histopathological examination revealed leiomyoma in 8 cases, adenomyosis in 9 cases, endometrial polyp in 2 cases.

ABBREVIATIONS

RCT – Randomised Controlled Trial

TAH with BSO- Total Abdominal Hysterectomy with Bilateral Salphingo Ophorectomy

VH - Vaginal Hysterectomy

CIN - Cervical Intraepithelial Neoplasia

DUB – Dysfunctional Uterine Bleeding

SUI - Stress Urinary Incontinence

SBO - Small Bowel Obstruction

SSI - Surgical Site Infection

ACKNOWLEDGEMENT

Author acknowledges the enormous help received from the scholars whose articles have been cited and incorporated in references. Author is also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this articles has been reviewed and discussed.

References:

1. Jocoby VL, Autry A, Jacobson G, et al Nation wide use of laparoscopic hysterectomy compared with abdominal and vaginal approaches. Obstet Gynecol 2009: 114: 1041- 1048.

2. Babalola EO, Bharucha AE, Schleck CD, et al. Decreasing utilization of hysterectomy, a population based study in Olmsted country, Minnesota, 1965-2002. Am J obstetric Gynecol 2007; 196; 214, e1-7

.3. National Guideline Clearing house (NGC). Guideline synthesis; guidelines for determining the route of hysterectomy for benign conditions.

4. Laparoscopic techniques for hysterectomy. National Institute for Health and Clinical Excellence, November 2007.

5. Luesley DM. Obstetrics and Gynaecology. An Evidence – Based Text for MRCOG 2nd ed. Hodder Arnold, 09/2010; 571-2.

6. Whiteman MK ,Hillis SD, Jamieson D, et al. Inpatient hysterectomy surveillance in the united states, 2000-2004. Am J Obstet Gynecol 2008; 31-37.

7. Pinion SB, Parkin DE, Abramovich DR et al. Randomised trial of hysterectomy, endometrial laser ablation and transcervical resection for dysfunctional uterine bleeding .BMJ 1994; 309; 979-983.

8. Spilsbury K, Hammond I, Bulsara M, Semmens JB. Morbidity outcomes of 78, 577 hysterectomies for benign reasons over 23 years. BJOG 2008; 115; 1473-83.

9. Harkki – siren P, sjoberg J, Tiitinen A. Urinary tract injuries after hysterectomy. Obstet Gynecol 1998; 92, 113-118.

10. Roovers JP, van der Vaart CH, van der Bom JG, Heintz AP.Urinary incontinence after hysterectomy. Lancet 2000;356:2012-2013.

11. Tulandi T, Al-Shahrani A, Adhesion prevention in gynecologic surgery . Curr Opin Obstet Gynecol 2005;17:395-398.

12. Ellis H, Moran BJ, Thompson JN et al. Adhesion-related hospital readmissions after abdominal and pelvic surgery; a retrospective cohort study. Lancet 1999;353;1476-1480.

13. Al-Sunaidi M, Tulandi T. Adhesion-related bowel obstruction after hysterectomy for benign conditions. Obstet Gynecol 2006;108:1162-1166.

14. Olsen MA, Higham-Kessler J, Yokoe DS, et al.Developing a risk stratification model for surgical site infection after abdominal hysterectomy. Infect Control Hosp Epidemiol 2009;30;1077-1083.

15. Marchionni M, Bracco GL, Checcuci V et al. The true incidence of vaginal vault prolapse: thirteen years experience, J Reprod Med 1999;44;679-684.

16. Unger JB, Paul R, Caldito G. Hysterectomy for the massive leiomyomatous uterus. Obstet Gynecol 2002;100:1271- 1275.

17. Studd J Hysterectomy A life saving as well as life enhancing operation. Menopause Int 2009; 15:2-3.

18. Lethaby A, Hickey M, Garry R, Penninx J. Endometrial resection / ablation techniques for having menstrual bleeding. Cochrane Database syst Rev 2009;CD001501.

19. A randomized trial of endometrial ablation versus hysterectomy for the treatment of dysfunctional uterine bleeding: outcome at four years. Aberdeen Endometrial Ablation Trials Group. Br J Obstet Gynaecol 1999;106:360-6.

20. Reich H, Ribeiro SC, Vidalia A. Hysterectomy as treatment for dysfunctional uterine bleeding. Baillieres Best Pract Res clin obstet Gynaecol 1999;13:257-67.

21. Ballard L, Lyon DS, Jones JL. Inpatients with menometrorrhagia : etiologies, treatments and outcomes. South Med J 2000;93:571-4.

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Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

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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.

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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