International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 06 Issue 06, March, 2014

Pages: 80-83

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SEVERE HYPOMAGNESEMIA, HYPOKALEMIA AND HYPOCALCEMIA ASSOCIATED WITH PULMONARY TUBERCULOSIS

Author: Baskaran S., Gopi Manigandan, Arumugam Aashish

Category: Healthcare

Abstract:We report a case of severe hypomagnesemia, hypokalemia and hypocalcemia in a 55-year-old lady who defaulted her treatment twice for pulmonary tuberculosis and presented with tetany to the emergency room. Hypocalcemia and hypokalemia persisted despite adequate correction and improved only after the correction of hypomagnesemia. The biochemical abnormalities were further complicated by streptomycin therapy necessitating to modify the anti-tuberculous regimen. The association of hypomagnesemia with tuberculosis is reported earlier and this association is attributed to renal magnesium wasting following aminoglycoside containing anti tuberculous regimen. However, hypomagnesemia contributing to hypocalcemia and hypokalemia, occurring as a primary abnormality in patients with tuberculosis is reported rarely. Here we report a case of active pulmonary tuberculosis who presented with such rare manifestations. This report emphasizes the need to maintain a high index of clinical suspicion of hypomagnesemia in patients with tuberculosis and in those receiving aminoglycoside as a part of their anti tuberculous therapy (ATT).

Keywords: hypomagnesemia, hypokalemia, hypocalcemia, pulmonary tuberculosis

Full Text:

INTRODUCTION

Magnesium is the second most abundant intracellular cation after potassium and plays a significant role in neuromuscular function. Though magnesium depletion may contribute to increased morbidity and mortality in hospitalized patients, it is most under diagnosed electrolyte abnormality in current medical practice.(1) Magnesium deficiency is strongly associated with other electrolyte deficiencies especially potassium and calcium, although phosphate and sodium deficiencies are also described.(2) We report a case of active pulmonary tuberculosis presented to us with clinical manifestations of hypomagnesemia and associated biochemical abnormalities.

CASE REPORT

A 55-year-old south Indian lady presented to the emergency room with numbness and paresthesia involving the extremities over the past two days and episodes of carpopedal spasm over the past twelve hours. She had no history of recent episodes of loose stools and vomiting. She reported occasional cough, poor appetite and undocumented weight loss over the past two years. Earlier, she was diagnosed to have pulmonary tuberculosis elsewhere and had defaulted her treatment twice within a period of two years. She had no history of diuretic or aminoglycoside use in the past. She had no other significant past, personal or family history. On examination, she was moderately built and poorly nourished. She was pale with pulse rate 96/min, BP 110/70mmHg and respiratory rate 18/min. Chevostek’s and Trousseau’s signs were present. Systemic examination revealed bronchial breath sound over the right axillary region. Initial laboratory evaluation showed Haemoglobin 8.6g/dl, total leukocyte count 12900/cu.mm, differential leukocyte count N90%, L8%, E2%, platelet count 3.05 lakhs/cu.mm, erythrocyte sedimentation rate 96mm/hr, urea 31mg/dl, creatinine 1mg/dl, sodium 130meq/L, potassium 2meq/L. Arterial blood gas showed metabolic alkalosis (pH-7.65, HCO3-40meq/L, PCO2- 41mmHg). Serum calcium was reported as 6.2mg/dl (NV : 8.7 – 10.2mg/dl). Her LFT including serum albumin was within normal limits. ECG showed QTc prolongation (Fig.1) and chest X-ray revealed a thin walled cavity over the right midzone and a small pleural effusion on the left. (fig.2) which was exudative but sterile on aspiration. Correction of hypokalemia and hypocalcemia initiated with intravenous infusion of KCl and calcium gluconate at recommended doses. However serial electrolytes and biochemical tests revealed persisting hypokalemia and hypocalcemia despite adequate correction. Magnesium level was reported as low at 1mg/dl (NV:1.5-2.3 mg/dl). Patient was administered magnesium 8gm (64mEq) infusion for 24 hours followed by 4gm (32mEq) infusion for next five days with simultaneous potassium and calcium replacement with necessary precautions and frequent monitoring of the serum magnesium, potassium and calcium levels. Electrolyte abnormalities, calcium level and metabolic alkalosis gradually improved with reduction of patient’s symptoms. Her further investigations revealed urinary spot magnesium as 0.9mg/dl(NV:0.9-1.9mg/dl), urinary spot potassium 15meq/L, urinary spot creatinine 67mg/dl(NV:25-400mg/dl), serum osmolality-278.1 mOsmol/kg serum water (NV:275-295 mOsmol/kg serum water), urine osmolality-328.5 mOsmol/kg water(NV:500-800 mOsmol/kg serum water), 24 hrs urinary calcium 0.27g (NV:0.15-0.35g/d), 25 – hydroxyl - vitamin D 38.8 ng/ml (NV:30-100 ng / ml), PTH 16.41 pg / ml (NV:15-65 pg / ml). She was found to be positive for sputum AFB, microcytic hypochromic picture on peripheral smear, low serum ferritin and no evidence of GI blood loss on stool examination and endoscopy. She was started on antituberculous treatment as per the WHO guidelines with isoniazid, rifampicin, pyrazinamide, ethambutol and Streptomycin. After five days of ATT, she again developed symptoms of tetany with carpopedal spasm and was found to have severe hypomagnesemia (0.8mg/dl), hypokalemia (3.2meq/L) and hypocalcemia (6.3mg/dl). Repeated urinary spot magnesium and creatinine showed 5.6mg/dl and 72mg/dl respectively. Streptomycin was discontinued. She was restarted on intravenous magnesium and calcium gluconate with continuing oral potassium. Patient improved symptomatically and biochemically and was discharged on modified ATT regimen including isoniazid, rifampicin, pyrazinamide, ethambutol and ofloxacin, oral magnesium, calcium and Iron supplements. One week later, she was reviewed in the OPD and was found to be doing better symptomatically. Her repeated values showed serum magnesium 1.4mg/dl, potassium 3.8meq/l and calcium 8.2mg/dl. Oral potassium was discontinued and was continued with ATT, magnesium and calcium supplementation. She was counselled for regular follow up.

DISCUSSION

Hypomagnesemia, though infrequently looked for, is present in up to 12 % of hospitalised patients.(3) Hypomagnesemia may present clinically as fatigue, cramps, nausea, irritability, tetany, seizures, lethal cardiac arrhythmias and sudden death.(2) Symptomatic magnesium depletion is often associated with multiple biochemical abnormalities such as hypokalemia, hypocalcemia and metabolic alkalosis.(4) Few studies(5,6, 7, 8) have documented the association of hypomagnesemia in patients with tuberculosis and is multifactorial in origin such as malnutrition, malabsorption, and therapy induced renal loss. Hypomagnesemia occurring as a complication of anti tuberculous therapy is reported by few authors (7, 8, 9), however, hypomagnesemia occurring as a primary complication of pulmonary tuberculosis is reported rarely. The above patient harbouring active pulmonary tuberculosis presented to us with symptoms of tetany secondary to hypomagnesemia and hypocalcemia. Hypomagnesemia contributed to Hypokalemia due to increased distal renal potassium secretion (10) as indicated by increased transtubular potassium gradient at 6.34. Hypocalcemia associated with hypomagnesemia is due to inappropriately low PTH level and PTH resistance (11, 12) which is consistent with the observations in our patient. Further, persistent hypocalcemia and hypokalemia despite adequate correction and had improved only after the correction of hypomagnesemia suggest that hypomagnesemia is the primary electrolyte abnormality contributing to other biochemical abnormalities in our patient. Hypomagnesemia in our patient prior to initiating antituberculous therapy in the absence of urinary magnesium wasting (fractional excretion of magnesium, FEMg<3%) is probably due to nutritional deficiency or malabsorption and is also supported by coexistence of iron deficiency anaemia. However magnesium depletion of nutritional origin seldom occurs in the absence of alcoholism and parenteral feeding, as nearly all foods contain significant amount of magnesium and renal adaptation to conserve magnesium is very efficient.(13) This suggests that magnesium depletion in this case may be due to malabsorption of magnesium however the underlying mechanism of magnesium malabsorption in tuberculosis is not clear. Recurrence of severe hypomagnesemia following streptomycin therapy in our patient was secondary to renal magnesium wasting as evidenced by increase in FEMg (value 13.89 %, NV: <3%). Increased urinary loss of magnesium and hypomagnesemia following aminoglycoside therapy is reported with the use of capreomycin (9) and gentamycin (14). In our patient Streptomycin also caused similar effect on magnesium homeostasis, necessitating to modify the antituberculous regimen.

CONCLUSION

We conclude that it is important to maintain a high index of suspicion of magnesium deficiency and its associated biochemical abnormalities in patients with tuberculosis. Streptomycin which is used as a first line anti tuberculous drug in patient with previously treated tuberculosis may further cause severe hypomagnesemia. Hence we recommend that streptomycin may be avoided in tuberculosis patients with pre existing hypomagnesemia and in patients receiving streptomycin, high index of clinical suspicion to be maintained to look for early signs and symptoms of hypomagnesemia.

References:

REFERENCES

1. Limaye CS, Londhey VA, Nadkar MY, Borges NE. Hypomagnesemia in critically ill medical patients. Journal of associations of physicians of India 2011; 59:19-22.

2. Wong ET, Rude RK, Singer FR. A high prevalence of hypomagnesemia in hospitalized patients. Am J clin pathol 1983; 79: 348-352.

3. Ahsan SK. Metabolism of magnesium in health and disease. J Ind Med Assoc 1997; 95(9):507-10.

4. Zalman S.Agus. Hypomagnesemia. J AM Soc Nephrol 1999; 10:1616-1622.

5. Biswajit das, Prassanna Chandra, K.V Thimmaraju. A Comparitive study of serum magnesium in pulmonary tuberculosis and bronchial asthma. International Journal of Pharma and Bio Sciences 2011; 2(3): B 23-29.

6. Jain MK Khanuo sk, Chandre RD, Jain GC, Bisarya BN. Serum magnesium in pulmonary tuberculosis. IND.J.Tuber 1976; 23:177-181. 

7. Shin S Furin J, Alcantra F et al. Hypokalemia among patients receiving treatment for multi drug resistant tuberculosis. Chest 2004; 125:974-80.

8. Aquinas M, Citron k. Rifampicin, ethambutol and capreomycin in pulmonary tuberculosis, previously treated with both first and second line drugs: the results of two years chemotherapy. Tubercle 1972; 53:153-65.

9. Vanasin B, Colmer M, Davis P. Hypocalcemia hypomagnesemia and hypokalemia during chemotherapy of pulmonary tuberculosis. Chest 1972; 61:496-99.

10. Chou-Long Huang, Elizabeth Kuo. Mechanism of hypokalemia in magnesium deficiency. J AM SOC Nephrol 2007; 18 (10):2649-2652.

11. Chase LR, Slatopolsky E. Secretion and metabolic efficiency of parathyroid hormone in patients with severe hypomagnesemia. J Clin Endocrinal Metab 1974; 38: 363-371.

12. Rude RK, Oldhan SB, Singer FR. Functional hypoparathyroidism and parathyroid hormone end organ resistance in human magnesium deficiency. Clin Endocrinol 1976 5:209-224.

13. Martin R.Pollak, Alan.S.L.Yu, Eric N.Taylor. Disorders of Calcium Magnesium and Phosphate imbalance. In: Barry M.Brenner. Brenner and Rector’s The Kidney. 8th(ed). vol 1; Philadelphia: Saunders, 2007:596-601

14. Avinash K Shetty, N Lymn Rogurs, Elizabeth E Mannick, Diego H. Aviles. Syndrome of hypokalemic metabolic alkalosis and hypomagnesemia associated with gentamicin therapy: case reports. CLIN PAEDIATR 2009; 39:529-533.

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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.


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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


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