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: 46-52

Date of Publication: 30-Nov--0001


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RISK FACTORS FOR STROKE : A CASE CONTROL STUDY

Author: Vijaya Sorganvi, M. S. Kulkarni, Deepak Kadeli, Suhasini Atharga

Category: Healthcare

Abstract:Background: Stroke is global health problem and is a leading cause of disability. It is one of the leading causes of mortality and morbidity worldwide. In rapid increase in burden of stroke in coming years and limited availability of stroke care in India, it would be better to study stroke prevention strategies. The current hospital based case-control study was undertaken with aim, to identify the risk factors for stroke. Material and Method: Study was carried out in BLDEU?s Shri B M Patil Medical College, Hospital & Research Centre. A prospective case-control, age and sex matched study was designed to find the risk factors. Cases: The study consisted of 100 hospitalized computed demography (CT) scan proved cases of stroke. Controls: The controls were selected from patients who attended the study hospital for conditions other than stroke (confirmed with CT scan). For each case of stroke, one control was selected. The controls were matched to cases in respect to age (\? 5 years), sex. One hundred controls were selected in the same manner. Results: Bivariate analysis included odds ratio and its 95% confidence intervals were indentified, hypertension (0R=3.807), diabetes (0R=3.473), hypercholesteremia (OR=3.768), obesity (0R=2.471), smoking (0R=2.42), family history of stroke (OR=2.359), and transient ischemic attack (OR=2.006) as a risk factors for stroke. Conclusion: This is a study that quantifies the contribution of different factors to the overall risk of stroke. Finding that, hypertension, hypercholesterolemia, diabetes are the biggest risk factors for all type of strokes is important because like many other factors, these are modifiable risks, that can be treated by appropriate medication and life style changes.

Keywords: Stroke, Risk factors, case-control study, odds ratio, 95% confidence interval.

Full Text:

INTRODUCTION

It has been suggested that no single medical measure could makes as much as contribution to the quality of life in old age as prevention of cerebro-vascular disease. An understanding of the etiological factors that contribute to the onset of stroke is required in order to assess the potential for stroke prevention (1). Stroke is global health problem and is a leading cause of disability. It is one of leading causes of mortality and morbidity worldwide. Approximately 20 million people each year will suffer from stroke (2). And of these 5 million will not survive. Developing countries accounts for 85% of global deaths from stroke (3). Stroke is also a leading cause of impairment with 20% of survivors requiring institutional care after 3 months and 15% - 30% being permanently disabled (4). It is a life changing event that affects not only the person who may be disabled, but their family and caregivers. India with more than 1 billion inhabitants is undergoing remarkable economic and demographic changes in recent years, resulting in a transition from poverty - related infections and nutritional deficiency diseases towards lifestyle related cardiovascular and cerebro-vascular diseases(5,6). Despite rapid economic boom, a large segment of the Indian population still lives in poverty. Given the anticipated increase in burden of stroke incoming years. The prevalence of stroke in India varies in different regions of country and the estimated prevalence rates increases from 0.3/1000 in <45 years age group to 12-20/1000 in the 75-84 years age group. (7) Approximately 12% of all strokes occur in a population < 40 years of age. (8) It is generally acknowledged that stroke is a multifactorial condition. A number of risk factors have been shown to be associated with stroke namely age, sex, hypertension, serum cholesterol, alcohol intake, smoking diabetes mellitus obesity, physical inactivity, family history of transient ischemic attack and dietary factors. However, their relative contribution in the outcome of stroke varies from study to study and from population to population (9- 20). In rapid increase in burden of stroke in coming years and limited availability of stroke care in India, it would be better to study on population based stroke prevention strategies, because preventive methods will reduce the incidence of stroke. So in view of the increasing incidence, high health care costs and the potential for prevention of stroke a current study was undertaken to identify the important risk factors contributing to the outcome of stroke.

METHODS

The present study was carried out at BLDEU?s Shri B M Patil Medical College, Hospital & Research Centre, Bijapur India. The study was designed as age ( and sex matched case control study.

CASES

The study consisted of 100 hospitalized computed demography (CT) scan proved cases of stroke. The recruitment of cases in the study was performed prospectively and only incident cases (first ever in the lifetime) were included. Hence we did not include cases who had a past history of any type of stroke.

CONTROLS

The controls were selected from patients who attended the study hospital for conditions other than stroke (confirmed with CT scan). For each case of stroke, one control was selected. The controls were matched to cases in respect to age (± 5 years), sex. One hundred controls were selected in the same manner.

SAMPLE SIZE

A pilot study, using the method described below, was performed to determine the sample size and for assessing the feasibility of the study. Six risk factors for stroke were determined in 30 randomly selected stroke cases admitted in medicine wards and equal number of age and gender matched controls admitted to diseases other than stroke in the same medicine wards. The odds ratio of six risk factors were estimated. An average odds ratio 3.0 and prevalence of hypertension in general population 10%,(21) allowable error of 5% and with 90% the power of study, sample size calculated was 93 (Lwanga SK and Lemeshow S)22. Hence a total of 100 cases and equal number of controls were finally included in the study.

RISK FACTORS

Eight risk factors namely hypertension, diabetes mellitus, cigarette smoking, serum cholesterol, smoking, alcohol consumption, waist to hip ratio, family history of stroke and transient ischemic attack were identified. Subject were considered to have hypertension if they had systolic blood pressure ≥140 mmhg or diastolic blood pressure ≥90 mm hg. Diabetes mellitus was diagnosed. If a subject had fasting blood glucose level was ≥120 mm/dl. On admission we have considered only those who currently smoked cigarettes, which was defined as smoking more than 10 cigarettes per day for more than 6 months. We defined alcohol consumption as a person who has consumed alcohol atleast once a day for a minimum period of 6 months. Transient ischemic attack defined as abrupt onset of focal neurological deficit lasting less than 24 hours. Subjects were considered to have obesity only when waist hip ratio was ≥0,9 cm in males and ≥0.8 cm in females. And if participants had serum cholesterol ≥220mg/dl, were considered as hypercholesterolemia. Statistical Analysis Bivariate analysis on matched pairs was carried out. Odds ratio, their 95% confidence interval (CI), Chi square test was calculated for all the risk factors. The continuous type of data namely Age, systolic and diastolic blood pressure, fasting blood sugar level, waist to hip ratio and serum cholesterol level were presented with mean ± SD and were compared by using unpaired „ test and Mann Whitney „U? test..

RESULTS

Table 1 and Table 2 show the distribution of cases and controls according to age and gender. Among cases 85% were ≥ 50 years of age group and among controls 83% were ≥ 50 years of age. The mean age of cases were 62.88 years and that of controls were 61.39 years. Statistically there was no significant difference found between cases and controls. Among cases and controls 59% of subjects were males and 41% were females. As sex was one of the matching variable, the number of males and females in controls is identical. Male and female ratio in the study was 1:1.7 as shown in (Table 2). The potential risk factors for stroke were investigated as shown in Table 3. Both systolic blood pressure. (155.88 mmHg vs127.73 mmHg) and diastolic blood pressure (90.67 mmHg vs 80.35 mHg) were higher among cases than among controls. Stroke victims had higher fasting blood sugar level (137.15 mg/dl vs 109.19 mg/dl) and serum cholesterol levels (242.17 mg/dl vs 191.51 mg/dl) and higher waist hip ratio i.e. more abdominal obesity (1.030 cm vs 0.996 cm) than control group. The difference between cases and controls across all risk factors was found to be statistically significant. We performed a univariate analysis to identify the association between risk factors and stroke. Table 4 Described comparison of cases and controls according to exposure to risk factors and results of univariate analysis. Hypertension: In the current study among cases of stroke 62%, among controls 30%, had hypertension and the difference was found statistically significant (X2 =20.612, P<0.0001). Hypertension was found to be significantly associated with stroke. (OR = 3.807, 95% C.I. 2.114 -6.856). When we analysed about systolic and diastolic blood pressure separately, among cases 84% patients had SBP≥ 140 mmHg compared to 37% among controls, OR=3.866, 95% C.I 2.206 to 6.773, P<0.0001) and 76% had DBP≥ 90 compared to 35% among controls (OR= 5.881, 95% C.I. 3.176 to 10.890, P<0.001) SBP and DBP were found to be significantly associated with stroke. Thus hypertension, whether systolic or diastolic has emerged as a significant risk factor for stroke in the present study.

DIABETES MELLITUS

The stroke cases had significantly higher proportion of diabetes mellitus (38%) than controls (15%) (X2 = 13.587, P ≤ 0.0002). The risk of stroke associated with diabetes mellitus was also high and significant (OR= 3.473, 95% C.I 1.757-6.866). Smoking: Out of 100 cases of strokes 49% were smokers compared to 30% of controls. This difference was statistically significant (X2 = 7.553, P 220 mg/dl as against only 34% among controls. It was found that, Hypercholesterolemia level is significantly associated with stroke. (X2 = 20.480, P<0.0001); also the risk of stroke associated with hypercholesterolemia was three times higher (OR= 3.768, 95% C.I. 2.099 to 6.766).

DISCUSSION

The current case-control study of risk factors for stroke identified eight risk factors. Univariate analysis demonstrated that hypertension is the most important risk factor for stroke (62%, OR=3.807) followed by hypercholesterolemia level (66%, OR = 3.768), Diabetes mellitus (38%; OR = 3.474), obesity (84% OR 2.471), Family history of stroke (31% OR = 2.2.359), smoking (49%, OR= 2.242), Transient Ischemic Attack (32%, OR 2.006). Similar findings were found in many studies. A recent study conducted in Gujarat, it was found that, modifiable risk factors such as hypertension (40%), smoking (28%), and hyperlipidemia (17%) are the commonest cause of stroke among elderly (23%) (23) Prasad et al study titled as “Stroke in young: An Indian prospective” found that smoking, increased BMI, diabetes and hypertension are significantly associated with strokes among young people (7) . Recent study on hospital based multicentre prospective stroke registry in India with 5301 acute stroke patients from 100 hospitals found that, patients with stroke had high rates of risk factors including high alcohol consumption, tobacco consumption, diabetes, hypertension and dyslipidemia (24) . Recent data from the study as Inter heart and Inter stroke studies conducted in 22 countries included India by Ponnell et al identified major risk factors for stroke that contribute to 90% of stroke in these countries. He showed that the top risk factors for stroke are – Hypertension (34.6%), smoking (18.9%), waist hip ratio (26.5%) Diet (18.8%), Regular Physical activity (28.5%), Diabetes (8%), Alcohol intake (5%), psychosocial stress (4.6%) depression (5.2%), cardiac causes (6.7%) (25).

CONCLUSION

This is a study that quantifies the contribution of different factors to the overall risk of stroke. It was found that, hypertension, hypercholesterolemia, diabetes are the biggest risk factors for all type of strokes and are important. Like many other factors, these are modifiable risks. That can be treated by appropriate medication and life style changes. This is very important to low-income settings as screening programmes, relatively little training, resources and interventions are expensive: weight reduction reducing alcohol intake, cessation of cigarette smoking and exercise these simple methods and life style alterations have a greater potential for stroke prevention.

References:

REFERENCES

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2. Dalal P, Bhattacharjee M Vairale J, Bhat P. UN millennium development goals: can we halt the stroke epidemic in India ? Ann Indian. Acad Neurol 2007: 10: 130-6.

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4. Adams R et al. Update of the AHA/ASA recommendations for the prevention of stroke in patients with stroke and transient ischemic attacks stroke 2008; 39: 1647-52

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7. Prasad Kameshwar, Singhat Kapil K. Stroke in young: An Indian Prospective 2010;58(3):343-350

8. Anand K, Chowdhury D, Singh KB, Pandav CS Kapoor SK. Estimation of mortality and morbidity due to stroke in India. Neuroepidemiology. 2001; 20: 208-211.

9. Jamrozik K, Broadhurst RJ, The role of lifestyles factors in the etiology of stroke: A population based case control study in peth, western Australia stroke 1991; 25:51-59.

10. Shaper AG, Phillips AN, Docock SJ. Risk factor for stroke in middle aged British Men. British Medical Journal 1991; 302: 1111- 1115

11. Shinton R, Sagar G, Lifelong exercises and stroke BMJ 1993 307: 231-234

12. Gill JS, Shipley MJ, Tsementiziassa, Hornby Rs, Gill SK, Hitchcock EA, Beevers DG, Alcohol consumption – A risk factor for haemorrhagic and non haemorrhagic stroke. Am J Med. 1991; 90 489-497.

13. Trusen T, Lindenstrom E, Baysen G Comparison of probability of stroke between the Copenhagen city heart study and the Framingham study. Stroke 1994; 25: 802- 807.

14. Nagaraja D Gurmurthy SG. Taly AB, Subbakrishna K Sridhararama Rao BS. Risk factors for stroke: relative risk in young and elderly. Neural India 1998: 46: 183-184.

15. Dalal PM, strokes in young and elderly. Risk factors and strategies for stroke prevention. Ass. Physic Ind 1997; 47: 125- 131.

16. Bansal BC, Prakash C, Arya RK. Serum lipids platelets and fibrinolytic activity in cerebrovascular diseases. Stroke 1978; 9: 137-139.

17. Chopra JS, Praphakar S. Clinical features and risk factors in stroke in young. Acta Neurologia scandanavia 1979; 60: 2899 – 3000.

18. Srinivasan K. Ischaemic cerebrovascular disease in young: Two common causes in India stroke 1984; 15: 733-735.

19. World Health Organization. WHO collaborative study of cardiovascular disease and steroid hormone contraception: Ischemic stroke and combined oral contraceptives: results of an international multicentre, case control study. Lancet 1996; 348: 498-504.

20. World Health Organization. WHO collaborative study of cardiovascular disease and steroid hormone contraception: Hemorrhage stroke, overall stroke risk and combined oral contraceptives: results of an international, multicentre, case-control study. Lancet 1996; 348: 504-510.

21. Mohan V, Deepa M, Farooq S., Datta M, Deepa R Prevalence Awareness and Control of hypertension in Chennai. The Chennai Urban- Roral epidemiology study (CURES 62). Journal Assoc. Physicians India 2007; 55:326-32.

22. Lwanga SK, Lemeshows. Determination of sample size WHO publication WHO Geneva 1999: 8-11

23. R.P. Eapan, J H Prekh, N.T.Patel A study of clinical profile and Risk factors of cerebrovascular stroke Gujarat Medical Journal 2009, Vol.64 No. 2

24. D.Xavier, M.O. Donnel, P Pais Sigamani R Joshi, R Gupta, et al. Interstroke study: Method and Preliminary results of large stroke registry from India 2012.

25. O „ Donnell. MJ Xavier D, Liu L, Zhang H, Chinsl, Rao Melacini P et al. Inter stroke investigators, Risk factors for ischemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case control study. Lancet 2010 July 2010; 376 (9735): 112-23.

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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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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.

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


Best Article Award

A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by situs slot and Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh et al. situs slot "Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
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 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
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A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
Late to bed everyday? You may die early, get depression situs slot
Egg a day tied to lower risk of heart disease situs slot
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A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


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


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