International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - vol 06 issue 03, February, 2014

Pages: 16-21

Date of Publication: 30-Nov--0001


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HIGH LEVEL AMINOGLYCOSIDE RESISTANT ENTEROCOCCUS SPECIES : A STUDY

Author: Niharika Lall, Silpi Basak

Category: Healthcare

Abstract:Background and Objectives: The emergence of Enterococcus species as a causative agent of Health care Associated Infections, poses therapeutic challenge to clinicians. Enterococci are well equipped with intrinsic resistance to multiple antibiotics. Acquired resistance to commonly used antibiotics such as Penicillin, Aminoglycoside and Vancomycin have made the situation even worse. Detection of High Level Aminoglycoside Resistance (HLAR) in Enterococcus species can predict the loss of synergy between cell wall active antimicrobial agents and Aminoglycosides. Hence, the present study was undertaken to detect the incidence of High level Aminoglycoside Resistant (HLAR) Enterococcus species isolated in a rural hospital and to study their antibiotic susceptibility profile. . Method: HLAR in Enterococcus species was detected by disk diffusion test using High level Streptomycin (HLS - 300 \?g) disk and High level Gentamicin (HLG - 120 \?g) disk and Agar dilution method as per CLSI guidelines. High Level Gentamicin Resistance (HLGR) was also confirmed by HiMedia Ezy MIC Strip. Antibiotic sensitivity test was done by Kirby Bauer Disc diffusion method as per CLSI guidelines. Result: Out of total 190 Enterococcus species isolated from different clinical samples, High Level Aminoglycoside Resistance was detected in 115 (60.5%) Enterococcus strains. Amongst 115 HLAR Enterococcus strains, 59 (51.4%) were E. faecalis and 56 (48.6%) were E. faecium. Conclusion: We hereby conclude that Enterococcus strains, isolated from different clinical specimens must be screened routinely for HLAR (High Level Aminoglycoside Resistance) by all Clinical Microbiology Laboratories to improve the therapeutic outcome.

Keywords: Enterococci, High Level Aminoglycoside Resistant (HLAR), Multi-drug resistant.

Full Text:

INTRODUCTION

Enterococci are Gram positive bacteria that normally inhabit the gastrointestinal tract of many animals including humans. However, when they colonize the sites where they are not normally found, they can become pathogens1 . Enterococci are now the second most common cause of nosocomial urinary tract and wound infections and third most common cause of nosocomial bacteremias2 . Serious enterococcal infections (e.g., bacteremia and endocarditis) require treatment with a bactericidal combination of antibiotics that should include penicillin group of drugs (e.g., Ampicillin or Penicillin G) to which the Enterococcus isolate is susceptible and an Aminoglycoside (e.g., Gentamicin or Streptomycin) to which the Enterococcus isolate does not exhibit high-level resistance3 . High-level Aminoglycoside resistance (HLAR) among Enterococci is increasingly being reported worldwide. The presence of HLAR is predictive of the loss of synergy between a cell-wall-active agent (e.g. Penicillin, Ampicillin or Vancomycin) and an Aminoglycoside, which makes the treatment of serious enterococcal infections difficult4 . Hence, the present study was undertaken to detect the incidence of High-level aminoglycoside resistant (HLAR) Enterococcus species isolated from different clinical samples and their antibiotic susceptibility profile. 

MATERIAL AND METHODS

A total number of 190 Enterococci were isolated from various specimens like urine, blood, pus and wound swab, body fluids, etc from July 2011 to August 2013. The specimens were collected from patients attending Indoor and Outdoor Patients Department of our Hospital and sent to Department of Microbiology. Our hospital is a tertiary care hospital in a rural set up. All Enterococcus species were identified by conventional methods2 . The speciation of Enterococcus species was done by scheme proposed by Facklam and Collins5 . Antibiotic susceptibility test was done for all 190 strains by Kirby- Bauer disk diffusion method, according to CLSI guidelines6 . Antibiotics like Ampicillin(10µg), Linezolid (15µg),Vancomycin (30µg), Erythromycin (15µg), Tetracycline (30µg), Quinupristin-dalfopristin (15µg) were used. Additionally, for urine samples only, Nitrofurantoin disc (300µg) was used. HLAR (High Level Aminoglycoside Resistance) was detected by disk diffusion test using High level Streptomycin (HLS - 300 µg) disk and High level Gentamicin (HLG - 120 µg) disk and Agar dilution method as per CLSI guidelines6 . As per CLSI guidelines, for detection of High Level Gentamicin Resistance by Agar dilution method, Gentamicin concentration was taken as 500 µg/ml. 10 µL of 0.5 Mc Farland suspension of test strain was spotted onto BHI (Brain Heart Infusion) agar surface containing Genatamicin 500 µg/ml6 . High Level Gentamicin Resistance (HLGR) was also confirmed by putting the Himedia Ezy MIC strip. A lawn culture of the test strain (turbidity adjusted to 0.5 Mc Farland) was done on Mueller Hinton (MH) agar plate and Himedia Ezy MIC strip was put and MIC (Minimum Inhibitory Concentration) was detected after incubation at 370C for 18 hours. MIC range of the strip was from 0.064-1024 µg/ml. E.faecalis ATCC 29212 was used as quality control for all the tests.

RESULTS

Out of 190 Enterococcus strains isolated, High level aminoglycoside resistance (HLAR) was detected in 115(60.5%) strains. HLAR strains were detected by disc diffusion test, agar dilution method and HLGR by Gentamicin Ezy MIC strip (photo1,2 and 3). Amongst 115 HLAR strains, 59 (51.4%) strains were E.faecalis and 56 (48.6%) were E.faecium (fig1). Only High level Gentamicin resistance (HLGR), only High level Streptomycin resistance (HLSR) and both HLGR and HLSR producing E.faecalis strains were detected as 23(38.9%), 7 (11.9%) and 29 (49.2%) respectively out of total 59 HLAR positive E.faecalis strains (fig 2). Similarly, out of total 56 HLAR producing E.faecium strains, 34(60.7%) produced only High level Gentamicin resistance (HLGR), 5(8.9%) produced only High level Streptomycin resistance (HLSR) and 17 (30.4%) produced both High level Gentamicin resistance (HLGR) and High level Streptomycin resistance (HLSR) (fig 3). Out of 93 HLAR Enterococcus strains isolated from urine samples, 49 (52.7%) were E.faecalis and 44 (47.3%) were E.faecium. 11(68.8%) HLAR strains were isolated from total 16 pus and wound swab samples. Out of 11 HLAR strains, E. faecalis and E. faecium were 7 and 4 strains respectively. Out of total 25 blood samples, 9(36%) strains produced HLAR and E. faecium strains were shown to exhibit more HLAR than E. faecalis. Amongst 9 HLAR Enterococcus strains, only 3(33.3%) strains were E. faecalis whereas 6(66.7%) were E. faecium. Only 2 HLAR strains were detected from other specimens, which were identified to be E. faecium (fig 4). Maximum 36 (31.3%) HLAR strains were isolated from Surgery ward followed by Pediatrics (22), Medicine (16) and Gynaecology ward (10) (fig 5). Out of 36 HLAR strains isolated from Surgery ward, 23 (63.9%) were E. faecalis and rest 13 were E. faecium. Only 7 (6.1%) HLAR strains were isolated from different ICUs (MICU-3, NICU-3 and PICU-1). No HLAR strain was isolated from OT ICU . Out of 115 HLAR strains, 90 Enterococcus strains were MDR (Multi-drug Resistant). MDR Enterococcus strains were detected on the basis of resistance (acquired) to Erythromycin, Tetracyline and High level aminoglycosides. All (100%) HLAR Enteococcus strains were sensitive to Vancomycin and Linezolid. Out of 115 HLAR strains, only 7 (6.1%) and 23 (20%) were sensitive to Quinupristin-dalfopristin and Ampicillin respectively. Nitrofurantoin sensitivity was tested for 93 HLAR Enterococcus strains isolated from urine sample only and 85(91.4%) HLAR strains were sensitive to Nitrofurantoin.

DISCUSSION

A common regime for treatment of serious enterococcal infections is the combination of cellwall inhibitors, such as penicillin, ampicillin or vancomycin; with aminoglycosides, such as streptomycin or gentamicin. The addition of cellwall inhibitor agent helps in the penetration of the aminoglycoside into the bacterial cytoplasm, making the intrinsically resistant organism aminoglycoside sensitive. The presence of HLAR in Enterococci makes the synergism of cell-wall inhibitor and aminoglycoside ineffective7 . In our study, 60.5% HLAR producing Enterococcus strains were isolated. Our study correlated well with Deshpande et al who had reported 58.8% HLAR producing Enterococcus strains8 . Mendiratta et al in 2008 reported 46% HLAR producing Enterococcus strains9 , whereas Vinod kumar et al in 2008 reported 65.6 % HLAR producing Enterococcus strains10. The study conducted by Mendiratta et al also reported that 69.6 % of their HLAR strains were E.faecalis and 30.4 % were E. faecium9 , whereas in the present study 51.4 % strains were E. faecalis and 48.6 % were E. faecium. As per χ 2 test, when only HLGR producing E. faecalis (23) and only HLGR producing E. faecium (34) are considered, we conclude, that isolation of only HLGR producing E.faecium is significantly higher than only HLGR producing E. faecalis11. In our study, out of 115 HLAR strains, 90 (78.3%) were MDR which is quite higher than reported by Deshpande et al (57%) in 20088 . MDR is defined as acquired nonsusceptibility to at least one agent in three or more antimicrobial categories12. Nitrofurantoin sensitivity was tested for 93 HLAR Enterococcus strains and it showed good activity (total 91.4% sensitivity) against both E.faecalis and E.faecium. Probably, the resistance could not be acquired by Enterococcal strains as Nitrofurantoin is not used commonly nowadays. HLAR (High level aminoglycoside resistance) i.e., Streptomycin MICs >2000 µg/ml or Gentamicin MICs > 500 µg/ml is an acquired resistance2 . HLAR occurs due to the presence of AME ( Aminoglycoside modifying enzymes). The most frequently encountered enzyme include dual function 2?phosphotransferase and 6?acetyl transferase conferring HLR to all available Aminoglycoside (Kanamycin, Gentamicin, Amikacin, Netilmicin, Tobramycin) except streptomycin13. Hence, gentamicin resistance is a good predictor of resistance to other aminoglycosides except streptomycin14 . 6?adenyl transferase is another AME which is responsible for HLR to streptomycin but does not inactivate other useful aminoglycosides13 .

CONCLUSION

We hereby conclude, that as High level Aminoglycoside resistant (HLAR) Enterococcus species can predict the loss of synergy between cell-wall active antimicrobial agents and Aminoglycosides, all Enterococcus strains must be screened routinely for HLAR by all Clinical Microbiology Laboratories to get an effective therapeutic outcome. Administration of Penicillin –Aminoglycoside combination without knowing HLAR status of the causative Enterococcus species can be fatal in life threatening Enterococcal infections. 

ACKNOWLEDGEMENT

Authors are thankful to DMIMS (DU) for the help rendered, while conducting the study. Authors also acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

References:

REFERENCES

1. Tendulkar PM, Baghdayan AS, Shankar N. Pathogenic Enterococci: New developments in the 21st Century. Cell Mol Life Sci. 2003;60: 2622-2636.

 

2. Washington Winn, Jr., Stephen Allen, William Janda et al.Koneman’s Color Atlas and Textbook of Diagnostic Microbiology. 6th ed. Philadelphia: Lippincott Williams And Wilkins; 2006. Chapter 13, Gram –Positive Cocci Part II: Streptococci, Enterococci, and the “Streptococcus-Like” Bacteria; p.672-764.

3. Herman, D. J., and Gerding DN. Screening and treatment of infections caused by resistant enterococci. Antimicrob. Agents Chemother. 1991; 35: 215–219.

4. Papaparaskevas J, Vatapoulos A, Tassios PT, Avlami A, Legakis NJ and Kalapothaki V. Diversity among high-level aminoglycosideresistant enterococci. Journal of Antimicrobial Chemotherapy 2000;45: 277-283.

5. Facklam RR, Collins MD. Identification of Enterococcus species isolated from human infections by conventional test scheme. J Clin Microbiol. 1989;24: 731-734.

6. Clinical and Laboratory Standards Institute (2012) Performance standards for antimicrobial susceptibility testing: 22th informational supplement. CLSI document M100-S22. Clinical Laboratory Standards Institute, 940 West Valley Road, Suite 1400, Wayne, Pennsylvania 19087-1898 USA.

7. Adhikari L. High-level Aminoglycoside Resistance and Reduced Susceptibility to Vancomycin in Nosocomial Enterococci. J Glob Infect Dis. 2010; 2(3): 231–235.

8. Deshpande VR, Karmarkar MG, Mehta PR. Prevalence of multidrug-resistant enterococci in a tertiary care hospital in Mumbai, India. J Infect Dev Ctries. 2013;7 (2): 155-158.

9. Mendiratta DK, Kaur H, Deotale V, Thamke DC, Narang R, Narang P. Status of High level aminoglycoside resistant Enterococcus faecium and Enterococcus faecalis in a rural hospital of Central India. Indian Journal of Medical Microbiology. 2008; 26 (4): 369-71.

10. Vinodkumar C. S, Srinivasa H., Basavarajappa K. G., Geethalakshmi S., Bandekar N. Isolation of bacteriophages to multi-drug resistant Enterococci obtained from diabetic foot: A novel antimicrobial agent waiting in the shelf? Indian Journal of Pathology and Microbiology. 2011; 54 ( 1 ):90-95.

11. Park K. Park’s Textbook of Preventive and Social Medicine. 22nd ed. Jabalpur: Banarsidas Bhanot; 2013. Chapter 19, Health information and basic medical statistics: p.782-796.

12. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, Vatopoulos A, Weber JT, Monnet DL. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012; 18(3):268-81.

13. Marothi YA, Agnihotri H, Dubey D. Enterococcal resistance:an overview. Indian Journal of Medical Microbiology. 2005; 23(4):214-219.

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Awards, Research and Publication incentive Schemes by IJCRR

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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
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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
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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
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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
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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
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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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