Article|International Journal of Current Research and Review

Search Articles

Track manuscript

Full Html

IJCRR - 6(6), March, 2014

Pages: 14-19

Print Article Download XML Download PDF

ISOLATED MEDIASTINAL LYMPHADENOPATHY - ETIOLOGICAL ANALYSIS

Author: Mandal A., Pan K., Maity P. K., Panchadhyayee S., Sarkar G., Chakraborty S., Choudhury R., Chakrabarti S.

Category: Healthcare

Abstract:Background: The etiology of isolated mediastinal lymphadenopathy (without lung involvement or peripheral lymph node enlargement) is difficult to approach. Though various methods are available for histopathological confirmation, few literatures are there regarding the etiological diagnosis of isolated mediastinal lymphadenopathy. Aims and objective: This study was taken up with the aim to investigate the pattern of involvement of isolated mediastinal lymphadenopathy and to analyze the etiology among the adult patients presenting to a tertiary care institution in Eastern India. Materials and methods: A total of 50 patients were subjected to our study. Non-invasive investigation such as x-ray, CT scan, mantoux test etc. were done and these investigations established only a indirect evidence of etiological diagnosis. For definitive diagnosis, fine needle aspiration biopsy cytology ( FNABC) or biopsy from peripheral lymph node( if any) or various invasive investigations such as CT guided biopsy from mediastinal lymph node, bronchoscopy with transbronchial biopsy, mediastinoscopy or endobronchial ultrasound-guided transbronchial needle aspiration were done wherever feasible. Results: Overall tubercular lymphadenopathy was the most common (45 among 50 patients; 90%) followed by sarcoidosis (3 among 50 patients; 6%), lymphoma (1 among 50 patients; 2%) and carcinoma of lung ( 1 among 50 patients; 2%). Conclusion: So tuberculosis is the leading cause of isolated mediastinal lymphadenopathy.

Keywords: Mediastinal lymphadenopathy.

Full Text:

INTRODUCTION

Common causes of mediastinal lymphadenopathy include tuberculosis, sarcoidosis, lymphoma, metastatic lymph node, fungal infections, etc. In 1959, Lyons and coworkers1 reported lymphoma as a group was the most common (26%) followed by sacoidosis (20%), nonlymphomatous neoplasm including metastatic disease (16%), histoplamosis ( 7%) and Tuberculosis. Tubercular mediastinal lymphadenopathy is common in pediatric age group. However, isolated tubercular mediastinal lymphadenopathy without a parenchymal lung lesion in adults is unusual. The reason why different individuals respond differently to infection with mycobacterium tuberculosis had been reviewed by Crofton J et all2 . The prevalence of the tubercular mediastinal lymphadenopathy is encountered as high as 49% in children below the age of 3 years3 and the prevalence decreases with age4 . The prevalence of tubercular mediastinal lymphadenopathy has been reported to be from 4% to 67% in adults5-10 . Sarcoidosis has been reported from all over the world. It is prevalent in western countries. In India, the first proven case of sarcoidosis was described by Ghose andChakraborty in1956. In reported study, Gupta (1985) observed an incidence of 150 per100,000 among the hospital population in south Calcutta, while Chakraborty in Delhi found the incidence to be 61.2 per 100,000 population11 . In carcinoma lung, a mass lesion with or without collapse of lung is the most common finding , the chest skiagram is normal only in rare occasion. Though the finding of mediastinal widening in carcinoma of lung was 16.7% seen in a large Indian series of 1009 patients12 . In Hodgkin, s lymphoma, most patients present with palpable lymphadenopathy in the neck, supraclavicular area and axilla. More than half of the patients will have mediastinal adenopathy at diagnosis, and this is sometimes the initial manifestation13 . The aim of the study was to investigate the pattern of involvement of the isolated mediastinal lymphadenopathy and to analyze its etiological diagnosis in adult patients attending this tertiary care institution.

STUDY DESIGN AND

METHODS This is a prospective study carried out over a period of two years (January 2010 –January 2012) at the Institute Of Post Graduate Medical Education And Research, Kolkata. Those patients having mediastinal lymphnode enlargement demonstrated by chest x-ray without presence of other organ involvement like lung, liver, bone, spleen other than cervical lymphnode were included in this study. Besides routine investigations including complete haemogram, liver function tests, mantoux tests, chest x-ray, the following investigations were done accordingly – 1) Contrast enhanced computed tomography (CECT) of chest 2) Fine needle aspiration biopsy cytology (FNABC) and/or cervical lymph node biopsy . 3) Mediastonoscopy guided biopsy from mediastinal lymphnode 4) CT guided FNABC from mediastinal lymph node and bronchoscopy were done 5) Sputum for AFB (3 times) 6) HIV serology was done by ELISA with consent

RESULTS

A total of 50 patients with isolated mediastinal lymphadenopathy diagnosed by chest X Ray were subjected to this study. Age at presentation ranged from 14-62 years. In this study population, 37 out of 50 patients were male. CECT scan was done in all 50 cases, It is evident that most common site of lymphadenopathy in tubercular group was right paratracheal nodes. Peripheral rim enhancement with low attenuation at the centre of the node was the most frequent pattern in tubercular group. Homogenous enhancement, inhomogenous enhancement and calcification of the involved lymphnodes were also seen in the same group. In sarcoidosis, both hilar and right paratracheal lymphnode involvement were seen. More than one site was involved in all cases. The distribution of lymphadenopathy and the pattern of nodal involvement have been depicted in table-1 and table-2 respectively. CECTscan revealed—lung infiltration in 16 cases, consolidation in 4 cases, retro-peritoneal lymphadenopathy in 4 cases, hypodense lesion in spleen in 2cases and in liver in 1 case in tubercular group. In sarcoidosis, lung involvement including peribronchial thickening and subpleural reticulo-nodular changes were seen in all 3 cases. Retro-peritoneal lymphadenopathy was seen in lymphoma. In carcinoma lung, lung involvement was seen. For confirmation of the diagnosis, peripheral lymph node biopsy from cervical region was done in 21 cases, CT guided mediastinal lymphRESULTS A total of 50 patients with isolated mediastinal lymphadenopathy diagnosed by chest X Ray were subjected to this study. Age at presentation ranged from 14-62 years. In this study population, 37 out of 50 patients were male. CECT scan was done in all 50 cases, It is evident that most common site of lymphadenopathy in tubercular group was right paratracheal nodes. Peripheral rim enhancement with low attenuation at the centre of the node was the most frequent pattern in tubercular group. Homogenous enhancement, inhomogenous enhancement and calcification of the involved lymphnodes were also seen in the same group. In sarcoidosis, both hilar and right paratracheal lymphnode involvement were seen. More than one site was involved in all cases. The distribution of lymphadenopathy and the pattern of nodal involvement have been depicted in table-1 and table-2 respectively. CECTscan revealed—lung infiltration in 16 cases, consolidation in 4 cases, retro-peritoneal lymphadenopathy in 4 cases, hypodense lesion in spleen in 2cases and in liver in 1 case in tubercular group. In sarcoidosis, lung involvement including peribronchial thickening and subpleural reticulo-nodular changes were seen in all 3 cases. Retro-peritoneal lymphadenopathy was seen in lymphoma. In carcinoma lung, lung involvement was seen. For confirmation of the diagnosis, peripheral lymph node biopsy from cervical region was done in 21 cases, CT guided mediastinal lymph node biopsy was done in 2 cases, bronchoscopy was done in 9 cases (bronchoalveolar lavage and transbronchial lung biopy were done), mediastinoscopy with mediastinal lymphnode biopsy was done in 2 cases, cold abscess aspiration in cervical region was done in 1 case. Diagnosis was made in 30 cases by isolation of organism( acid fast bacilli) or by presence of caseating granuloma as tubercular lymphadenopathy. Diagnosis of sarcoidosis was made by bronchoscopy (broncho-alveolar lavage and trasbronchial lung biopsy was done) in 3 cases. 1 case of carcinoma lung and 1 case of lymphoma were diagnosed by cervical lymph node biopsy. Investigation procedure required for diagnosis is shown in table-3. In the remaining 15 cases, the Mantoux reaction, presence of necrosis in mediastinal lymphnodes on CT scan finding and response to anti-tubercular treatment were the only evidence of tuberculosis and included in tubercular group. Tuberculin test - it is observed that 36 patients were positive in tubercular mediastinal lymphadenopathy group. So, among randomly taken 50 cases, tubercular lymph-adenopathy was the most common finding (45 cases) followed by sarcoidosis (3 cases), lymphoma (1 case) and carcinoma of lung (1 case).

DISCUSSION

We are prompted to undertake this study on account of several number of patients having isolated mediastinal lymphadenopathy are found in our outpatient department(O.P.D). Most of the patients had isolated mediastinal lymphadenopathy without any significant pulmonary parenchymal lesion, at least on plain x-ray of chest. CECT of chest is the standard investigation in patients with mediastinal lymphadenopathy. Radiologically, right paratracheal lymphnodes were most commonly involved in tubercular mediastinal lymphadenopathy5 . In our study, it is observed that in tubercular group, right paratracheal nodes was the most common site (89%) of involvement followed by subcarinal (66%) , pretracheal (55%) and hilar nodes in decreasing order of frequency. In tubercular mediastinal lymphadenopathy, peripheral rim enhancement with relative low attenuation at centre was the commonest pattern of nodal involvement 14-16 . In our study, it is observed that peripheral rim enhancement was the commonest pattern 53% followed by inhomogenous enhancement 24%. Homogenous enhancement was seen in 22% and nodal calcification was seen in 08%. Distribution of lymphadenopathy in tubercular group has been depicted in table-4.Pattern of nodal involvement in tubercular group of patients is shown in table-5.Determining the presence peripheral rim enhancement with relative low attenuation at centre of lymphnodes and location of lymphnodes in young adults with appropriate clinical setting is very helpful in differentiating tuberculosis from other causes of mediastinal lymphadenopathy. In sarcoidoisis, low density in mediastinal nodes is unusual. Lymphadenopathy in sarcoidosis is usually bilateral and hilar. Calcification is also described in sarcoid glands16. The associated reticulonodular pattern of lung parenchymal disease if present, may be a additional help. In our study, bilateral hilar lymphadenopathy was seen in all 3cases. Calcification of lymph nodes and reticulonodular pattern of lung involvement were seen in all 3 cases. In lymphoma group, the typical CT appearance of a nodal mass in a patient with Hodgkin , s disease is usually that of homogenous soft-tissue mass with sharply defined and often lobulated borders. Occasionally the centre of the nodal mass contains an area of decreased attenuation due to necrosis.17 In patient with metastatic lymphnode from lung cancer, the primary lung lesion is usually visible on CT scan. Visible low density within the metastatic nodes are not unusual15 . The granuloma in sarcoidosis may sometimes caseate, where in tuberculosis there may be absence of caseation. In view of above, diagnosis of tubercular mediastinal lymphadenopathy in present series of patients can only be considered to be a provisional one, except in those few in whom the AFB could be demonstrated. In area of high endemicity of tuberculosis, response to antituberculosis treatment may also consider to be diagnostic criteria for tubercular mediastinal lymphadenopathy. This is specially important, as methods for obtaining tissue diagnosis are sparingly available in developing countries where the disease is prevalent. CT scan is useful tool for diagnosis of mediastinal lymphadenopathy. The morphology of lymphnode on CT scan may help in diagnosing etiology, however, it is not specific. All efforts should be made to attend a cytological, microbiological, and histological diagnosis18. Invasive diagnostic tests including mediastinoscopy19 , bronchoscopy20,21 and endobronchial ultrasound- guided transbronchial needle aspiration22 should be undertaken for definitive diagnosis of mediastinal lymphadenopathy where facilities are available. CONCLUSION To conclude, though various differentials are there, tuberculosis is the leading cause of isolated mediastinal lymphadenopathy in our country. CECT of chest is the initial standard investigation to assass the pattern and characteristics of involved lymph nodes. Right paratracheal nodes was the most common site and peripheral rim enhancement with relative low attenuation at centre was the commonest pattern of nodal involvement in tubercular group.

References:

REFERENCES

1. Lyons HA, Calvy GL, Sammons BP. The diagnosis and classification of mediastinal mass. A study of 782 cases. Ann Intern Med 1959;51: 897-932.

2. Crofton J, Douglas A. Respiratory disease. The incidence of scrofula (tubercular lymphadenitis) in mediaeval Europe. Second edition. Oxford. Blackwell Scientific Publications,1975;chapter 11.

3. Lamont AC, Cremina BJ, Pelteret RM: Radiological patterns of pulmonary tuberculosis in pediatric age group. Pediatr radiol 1986;16:2-7.

4. Leung AN, Muller NL, Pindia PR, Fitz Gerald JM. Primary tuberculosis in childhood: Radiographic manifestation. Radiology 1992;182:87-91.

5. Amorosa JK, Smith PR, Cohen JR, Ramsy C, Leons HA. Tuberculous mediastinal lymphadenitis in adults. Radiology 1978;126:365-368.

6. Miller WT, MacGregor RR. Tuberculosis: frequency of unusual radiographic findings. AJR 1978; 130:867-875.

7. Stead WW,Kerby GR, Schlueter DP, Jodahl CW. The clinical spectrum of primary tuberculosis in adults. Confusion with reinfection in the pathogenesis of chronic tuberculosis. Ann Intern Med 1968;68:731-45.

8. Muller NL. Pulmonary tuberculosis. In : Sperber M, (ed): Radiographic diagnosis of chest disease. Springer- verlag, New York 1990;188-199.

9. Krysl J, Korzeniewska-Kosela M, Muller NL, Fitz Gerald JM. Radiologic feature of pulmonary tuberculosis: an assessment of 188 cases. Can Assoc Radiol J. 1994;45:101-108.

10. Moon WK, Im J, Yeon KM, Han ML. Mediastinal tuberculous lymphadenitis: CT finding of active and inactive disease. AJR 1998, 170:715-718.

11. Gupta SK. Pande JN. Sarcoidosis. In : Pande JN.(ed).Respiratory Medicine In The Tropics. Oxford University Press :1998, p.366.

12. Jindal. S.k. Pulmonary neoplasm. In: Pande JN. (ed). Respiratory Medicine In The Tropics. Oxford University Press: 1998, p.443.

13. Longo .DL. Malignancies of lymphoid cells. In : Longo, Fauci, Kapser, Hauser, Jameson,Loscalzo (eds): Harrisons Principles Of Internal Medicine: 18th ed. Mc Graw Hill Medical.2012. p.934.

14. Pombo F, Rodriguez E,Mato J, Perez-Fontan J, Rivera E, Valuena L. Patterns of contrast enhancement of tuberculous lymph nodes demonstrated by computed tomography. Clin Radiol 1992;46:13-17.

15. Im JG, Song KS, Kang HS, Park JH, Yeon KM, Han ML. Mediastinal tubercular lymphadenitis: CT manifestation. Radiology 1987;164: 115-119.

16. Gulati M, Suri S, Kaur G, Jindal SK, Behera D. CT manifestations of tuberculous madiastinal lymphadenopathy. Indian J Chest Dis Allied Sci. 1994jan-mar;36(1) : 3-7

17. Graham R Cherryman, Bruno Morgan. The lymphatic system. In :Sutton D.(ed). Textbook of Radiology And Imaging. Elsevier Churchill livingstone.2012, p.527.

18. Tiwari M, Aryal G, Shrestha R, Rauniyar SK, Shrestha HG. Histopathologic diagnosis of lymph node biopsies. Nepal Med Coll J. 2007 Dec;9(4): 259-61.

19. Nalladaru ZM, Wessels A. The role of mediastinoscopy for diagnosis of isolated mediastinal lymphadenopathy. Indian J Surg. 2011 Aug; 73(4): 284-6.

20. Straddling P (ed). In : diagnostic bronchoscopy a teaching manual. Churchill Linvinstone 6 th edition,1991,p.72.

21. Trisolini R, Anevalvis S, Tinelli C, Orlandi P, Patelli M. CT pattern of lymphadenopathy in unteated patients undergoing bronchoscopy for suspected sarcoidosis. Respire Med. 2013 jun; 107(6):897-903.

22. Navani N, Lawrence DR, Kolveker S, Hayward M, McAsey D, Kocjan G, Falzon M, Capitanio A,Shaw P, Morris S, Omar RZ, Janes SM; REMEDY Trial Investigators. Endobronchial ultrasound- guided transbronchial needle aspiration prevents mediastinoscopies in the diagnosis of isolated mediastinal lymphadenopathy : a prospective trial. Am J Respir Crit Care Med. 2012 Aug 1; 186(3): 255-60.

Announcements

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

COPE guidelines for Reviewers

SCOPUS indexing: 2014, 2019 to 2021

Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award:

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

Women Researcher Award:

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

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Best Article Award

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

A Study by Vidya S. Bhat et al. entitled "Effect of an Indigenous Cleanser on the Microbial Biofilm on Acrylic Denture Base - A Pilot Study" is awarded Best Article for Vol 14 issue 11

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

A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15

A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14

A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13

A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12

A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11

A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10

A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09

A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08

A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07

A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness

A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health

A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06

A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia

A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05

A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04

A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03

A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02

A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01

A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24

A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23

A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22

A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21

A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20

A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19

A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18

A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17

A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16

A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15

A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020

A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"

A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13

A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for Vol 12 issue 12

A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for Vol 12 issue 11

A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for Vol 12 issue 10

A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for Vol 12 issue 09

A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for Vol 12 issue 08

A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for Vol 12 issue 07

A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20

A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR

A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13

A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR

A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR.

A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award

A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award

RSS feed

IJCRR

ISOLATED MEDIASTINAL LYMPHADENOPATHY - ETIOLOGICAL ANALYSIS

RSS feed

ABOUT US

Useful links

Useful links

Contact