Article|International Journal of Current Research and Review

Search Articles

Track manuscript

Full Html

IJCRR - 5(11), June, 2013

Pages: 87-93

Date of Publication: 18-Jun-2013

Print Article Download XML Download PDF

INCREASING PREVALENCE OF EXTENDED SPECTRUM BETA LACTAMASES (ESBLS) PRODUCING E.COLI AND KLEBSIELLA SPP IN OUTPATIENT DEPARTMENTS (OPDS) PATIENTS IN URINARY TRACT INFECTIONS (UTIS) IN TERTIARY CARE HOSPITAL

Author: Gopal Kashyap, Sweta Gupta, Ved Prakash Mamoria, Pushpa Durlabhji, Dinesh Jain

Category: Healthcare

Abstract:Background: Extended-spectrum \?-lactamases (ESBLs) are plasmid-mediated group of fast growing enzymes synthesized by the Gram negative bacteria that are causing medicinal crisis. At present, ESBLs has been increasing as a serious pathogen having the property multidrug resistance. So, The present study was undertaken to find out the prevalence of ESBLs positive E. coli and Klebsiella in urinary isolates obtained from various In-patient Departments (IPDs) , Outpatient Departments (OPDs) and Intensive Care units (ICUs). Methods: Processing of 251 non- repetitive urine samples received during a period of about one year for detection of ESBLs positive Escherichia coli and Klebsiella spp. was done. All suspected isolates of ESBLs producers were confirmed by the Double Disc potentiating discs test, Double disc synergy test and E-Test. Results: Out of Two fifty one urinary isolates of Escherichia coli and Klebsiella spp. 93 (37.1%) were confirmed as ESBLs producers and 158(62.9%) were non ESBL producers by all the three tests of confirmation. 61 out of 93 (65.6%) were from OPDs and in all IPDs maximum ESBLs producing urinary isolates were obtained from Medicine wards 12/93 (12.9%). Conclusion: Results indicate that now ESBL producers are increasing in community. So, routine ESBL detection should be made mandatory not only in indoor patient but also in outdoor also. Appropriate use of third generation cephalosporins must be encouraged to reduce the risk of multidrug resistant bacteria and to make an antibiotic policy.

Keywords: Extended-spectrum ?-lactamases, Gram negative bacteria, E. coli

Full Text:

INTRODUCTION
Urinary tract infection (UTI) is one of the most common infectious disease ranking next to Respiratory tract infection [1] and is an important cause of morbidity and mortality. UTI is also the most common hospital acquired infection approx. 35% of total infection.[2] Bacteria are the major causative organism of UTI and E.coli is the most prevalent-causative bacteria of UTI in community as well as hospital acquired UTIs. [3,4] followed by Klebsiella, Staphylococcus, Proteus & Pseudomonas. These bacteria along with other members of Enterobacteriacae are found to produce an arsenal of enzymes known as extended spectrum β- lactamases. UTI can usually be treated with a short course of antibacterial therapy.[4] β-lactamases are enzymes which open β-lactam ring (4 carbon atom ring) of penicillin/cephamycins (i.e cefoxitin & cefotetan). β-lactam antibiotics have 4 atom ring known as β-lactam ring. β-lactamases break the β lactam ring open and therefore deactivate the antibacterial activity of drugs. Gradually with time the property of inactivating the antibiotics spread to other groups of bacteria in Enterobacteriacae and also larger group of antibiotics were inactivated. This property was first documented in 1983 in Germany in K. Pneumoniae [5] & spread quickly to Europe and US and was later known as Extended spectrum β-lactamases.[6,7] New threat was proposed by Amp C β- lactamases as they confer resistance to cephamycins (7-2 methoxy cephalosporin) and not affected by commercially available β lactamases inhibitors with loss of outer membrane porins provide resistance to carbapenems [8] ESBLs become clinically important because they destroy cephalosporins given as first line antibiotics in hospital. This may lead to inappropriate treatment and increased mortality. ESBLs producers are multi-resistant to nonlactam antibiotics such as quinolones, tetracyclines, amino glycosides and trimethoprim/cotrimoxazole, narrowing treatment options due to plasmid mediated transfer of resistance and provides therapeutic challenges. [9] Detection of ESBL production by urinary isolates is therefore very important to ensure appropriate antibiotic treatment. As the prevalence of ESBLs differs significantly both geographically and with different risk factors in patients, knowledge of these variations can help in appropriate and timely antibiotic therapy as well as avoidance of preventable antibiotic use. With reports of high prevalence of ESBL producers and lack of information in India, the present study was carried out to find out the distribution of ESBL producing bacteria isolate from urine in different units of a tertiary care hospital in Jaipur and in community acquired UTIs presenting to this hospital.

MATERIAL AND METHOD
The present study was carried out in the Department of Microbiology, Mahatma Gandhi Medical College and Hospital, Jaipur (Rajasthan).The test group selected was the population of patients from various Out Patient Departments, different wards, and Intensive care units in the hospital regardless of their age, sex, occupation, religion and ethnicity. A Proforma was filled accordingly. Sample collection Processing of 251 non- repetitive urine samples received during a period of about one year for detection of ESBLs positive Escherichia coli and Klebsiella spp. was done. Sample was collected with Universal precautions by prescribed sterile technique. Samples were transported to the laboratory as soon as possible maintaining optimum transportation conditions. Routine microscopy of all urine samples was done and samples with more than /equal to 5 white blood cells /HPF were selected. Sample culture All culture Medias were obtained from Hi media Laboratories Mumbai, India. Primary inoculation was done on the Blood agar, MacConkey agar which was incubated 18-24 hrs at 370C aerobically. Escherichia coli and Klebsiella spp. from samples were finally identified by standard techniques based on Colony morphology, Gram’s staining, Hanging drop for motility and Biochemical tests as per CLSI guidelines. Antimicrobial susceptibility test using modified Kirby-Bauer disk diffusion method was done of all isolates of Escherichia coli and Klebsiella spp. All the strains identified were tested for ESBLs production as per CLSI guidelines. Following criteria were used in isolates of Escherichia coli and Klebsiella spp. for selection of ESBLs producers: Screening Isolates of Escherichia coli and Klebsiella spp. were examined for their susceptibility to 3rd generation cephalosporins Cefotaxime and Ceftazidime antimicrobial discs.

In our isolates of Escherichia coli and Klebsiella spp. the diameter of zone of inhibition was measured for Cefotaxime (30µg) & Ceftazidime (30µg) antimicrobial discs. Diameter of ≤ 22mm for Ceftazidime and/or ≤ 27mm for Cefotaxime was considered as ESBLs suspects as per NCCLS guidelines. [10] All suspected isolates of ESBLs producers of Escherichia coli and Klebsiella were confirmed by the Double Disc potentiating discs test, double disc synergy test and few suspected isolates were also be confirmed by E-Test. Quality control with Standard strains for Escherichia coli ATCC 25922 and Klebsiella spp. 700603 was also done.

RESULTS
The present study was under taken to detect the prevalence and antimicrobial susceptibility of ESBLs positive Escherichia coli and Klebsiella spp. in urinary isolates obtained in Department of Microbiology, Mahatma Gandhi Medical College, and Jaipur. The samples were obtained from OPDs, IPDs and ICUs of various Department from Mahatma Gandhi Hospital,Jaipur. 251(Two fifty one) urinary isolates of Escherichia coli and Klebsiella spp. were processed for ESBL detection. In primary screening of 251 isolates 97 were found to be resistance to Cefotaxime and/or Ceftazidime antibiotic discs. Those 97 suspects of ESBL producing Escherichia coli and Klebsiella spp.in urinary samples were further tested for confirmation by Double Disc Synergy test and Double Disc Potentiation test .Out of 97 suspects of ESBL producing Escherichia coli and Klebsiella spp.in urinary samples 75 (77.32%) were confirmed by Double Disc Synergy test and 90 (92.78%) were confirmed by Double Disc Potentiation test.25 suspected ESBL producing urinary isolates were tested with E-Test. All except four isolates were tested positive by E-Test. 4(four) isolates were not confirmed positive by any of the three tests hence they were considered non ESBLs producers. Out of 251(Two fifty one) urinary isolates of Escherichia coli and Klebsiella spp. 93 (37.1%) were confirmed as ESBLs producers and 158(62.9%) were non ESBL producers by all the three tests of confirmation. Out of 93 confirmed ESBLs producers Escherichia coli (89/93) (95.7%) was the predominating organism.52/93 i.e. 56% of ESBLs producing isolates were obtained from female patients. Maximum ESBLs producing isolates were from patients of 20-40 yrs age group followed by 10-20 yrs age group. Maximum ESBLs producing urinary isolates i.e. 61/93 (65.6%) were from Outpatient Departments of various clinical disciplines. Of all In-patient Departments maximum ESBLs producing urinary isolates were obtained from Medicine wards 12/93 (12.9%).

DISCUSSION
ESBLs are an example of the increasing number and diversity of the enzymes that inactivate β- lactam antibiotics. Multi drug resistance and ESBLs enzymes producing E.coli & Klebsiella spp. are major threat to treat urinary tract infections. A dramatic increase in the frequency of ESBL producing E.coli & Klebsiella spp. has been observed in last decade. Frequent and inappropriate use of antibiotics in human led to increasing resistance rate making the treatment of urinary tract infections more complex. ESBLs has become a major problem worldwide as is confers resistance to the third generation broad spectrum cephalosporins. Although CLSI guidelines exist for detection of E.coli & Klebsiella spp., no such recommendation exists for other ESBLs producing organisms. Failure of empirical therapy, which is usually, initiated with third generation cephalosporins due to resistance of ESBL producing E.coli & Klebsiella spp. lead to increase in mortality rate in Hospital settings.

Emphasized must be laid on developing rapid screening method for ESBL detection by clinical laboratories so as to report ESBLs producing organisms in appropriate time. Combination of Antibiotics with their clavulanate salt confirms ESBLs production. Clinical microbiologist play an important role in devising ways and means of rapidly identifying these ESBLs producing organisms and help institutions to initiate appropriate therapy. Detection become more important by the fact that resistance to one of the 3GC cephalosporins means therapeutic resistance to all cephalosporins up to 3GC even when in vitro sensitivity may be detected otherwise. In this study observed that female have a higher probability (56%) of predisposition to UTIs. These findings were in accordance with the study by Fennell et al (2008) from Ireland and it was 65.5%.Another study by Babypadmini S et al (2004) from India where they found 56.62 %.[11,12] Therefore our study correlate with various other studies which shows higher percentage of isolates were from female patients. [11,12,13] Most of the patients in our study were from the age group 20-40yrs (43 %), which shows that UTI is more common in middle age group person in our population compare to Tada Dharmistha G et al 2012 study in which most of the patients were from the age group 10-20 yrs (30%).[13] The prevalence of ESBLs production in India varies from 5-60%in urinary isolates. In present study the prevalence of ESBLs production was 37% which correlates with MS Kumar et al and S Jalalpour. [17,18] The prevalence of ESBLs producers organisms are on the rising trend as seen in various studies since 2002 to 2012. The prevalence of ESBLs producing E.Coli is 35.45% which correlates with Babypadmini S et al & Shila Jalalpour. Prevalence of Klebsiella spp. is 1.59% which correlates with Joseph Gangoue et al. [12,18] Our study showed that most of the ESBLs producing isolates were from the Out Patient Departments (Community Acquired).Various studies show that prevalence of Community Acquired UTIs is increasing in recent times. In the beginning ESBLs were in a good number identified to be a hospital based crisis but it is now becoming more common along with community acquired isolates, especially Esch. coli (Shila Jalalpour(2011) Iran[18] Parul Agarwal et al 2008 Pune [22]. In the present study Esch.coli and Klebsiella spp. were found 35.45% and 1.59% respectively. This was due to illogical and ample use of third generation cephalosporins in both the hospital and community and is alleged to be the main cause of mutations in these enzymes that lead to the appearance of the ESBLs. [23] Initially ESBL producers were restricted to hospital –acquired infections only, but they have now also been isolated from outpatient departments. Major outbreaks involving ESBL producing strains have also been reported from all over the world.

CONCLUSION
Considering various findings of the present study, it can be concluded that Extended Spectrum beta lactamases are gradually increasing in community in India. ESBL producing organisms have become clinically important in last two decades because of increasing trend in prevalence leading to increase in antimicrobial resistance. Increase antimicrobial resistance result in increase morbidity, mortality and cost of health care. In order to prevent and control the emergence of antimicrobial resistance in ESBL producing organisms it is of utmost importance to limit the misuse and overuse of antibiotics especially broad spectrum antibiotics. ESBL producing strains were previously common in Inpatient Departments few years back but nowadays they are commonly isolated in Outpatient Departments therefore early detection is of clinical importance for effective management of patients. To conclude, early and sensitive methods to detect ESBL producing strains should be practiced so that appropriate antibiotics may be given to treat the patients and further decrease the spread of ESBL producing microorganisms. It is also utmost important to formulate appropriate hospital antibiotic policies and taking adequate precautionary measures to decrease the spread of ESBL producing microorganisms.

ACKNOWLEDGEMENT
Authors acknowledge the great help received from the scholars whose articles 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. Authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.

References:

1. Nachimuthu R ,Chethpalayam SS,Balasubramanium V,Ravichandran Palamappam K,Kannan VR.,2008.Urinary tract Infection and Antimicrobial susceptibility patternof Extended Spectrum Beta Lactamase producing Clinical isolates,Adv in Biol Research.,2(5-6):78- 82.

2. Bailey and Scott?s Diagnostic Microbiology.12th Edition .

3. Walter E. Stamm, Urinary Tract Infection,Pyelonephritis,and Prostatitis. Harrison’s Principle of Internal Medicine.17th Edition(Vol 2):1820-1827

4. Paterson, D.L., W.C. Ko, Von Gottberg, et al., 2001.Outcome of cephalosporin for serious infection due to apparently susceptible organisms producing extended spectrum Beta-lactamases: implications for the clinical microbiology laboratory, J.Clin Microbiol.,39:2206-2212.

5. Knothe H, Shah P,Kremery V et al.(1983).Transferable resistance to cefotaxime,Cefoxitin,Cefamandole and Cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens.Infection II(6):315-317

6. Quinn JR,Miyashiro D,Sahm D et al.Novel plasmid-mediated beta-lactamase (TEM10) conferring selective resistance to ceftazidime and aztreonam in clinical isolates of Klebsiella pneumoniae.Antimicrob Agents Chemother 1989;33:1451-6.

7. Jacoby GA ,Medeiros AA,O Brien TF, et al. Broad spectrum transferable beta lactamases.N Eng J Med 1988;319:723-4

8. Phillipon A,Arlet B,Jacoby GA.2002.Plasmid-Determined AmpC-Type β-Lactamases.Antimicrob Agents Chemother.,2002;46:1-11.

9. Matsumoto, Y., and M. Inoue. 1999. Characterization of SFO-1, a plasmidmediated inducible class A beta-lactamase from Enterobacter cloacae. Antimicrob. Agents Chemother. 43:307-31.

10. Rosenthal VD, Maki DK, Jamulitrat S, et al. International Nosocomial Infection Control Consortium report ,data summaryfor2003-2008,issued June 2009.Am J Infect Contr2010;38:95-106.

11. Jerome Fennell, Akke Vellinga et al (2012) “Increasing prevalence of ESBL production among Irish clinical Enterobacteriaceae from 2004 to 2008: an observational study”; BMC Infectious Diseases 2012, 12:116

12. Babypadmini S, Appalaraju B. Extendedspectrum β-lactamases in the urinary isolates of Escherichia coli and Klebsiella pneumoniae – prevalence and susceptibility pattern in a tertiary care hospital. Indian J Med Microbiol 2004; 22(3): 172-74.

13. Tada Dharmishtha G, Gandhi Paragi J, Patel Kiran N.A study on antibiotic related resistance in UTI patients: a comparison between community acquired and hospital acquired E. Coli. National Journal of Community Medicine. Vol 3 Issue 2 AprilJune 2012 Page 255.

14. Subha A, Ananthan S. Extended-spectrum β-lactamase (ESBL) mediated resistance to the third generation cephalosporins among Klebsiella pneumoniae in Chennai. Indian J Med Microbiol 2002; 20:92-95

15. Joseph Gangoue P, Branka bedenic et al . Extended spectrum β-lactamases producingEnterobacteriaceae in Yaunde,Cameroon.J Clin Microbio,july 2005,3273-77.

16. Ananthan S, Subha A. Cefoxitin resistance mediated by loss of porin in clinical strains of Klebsiella pneumoniae and Escherichia coli. Indian J Med Microbio, (2005) 23(1):20-23

17. MS Kumar, V Lakshmi, R. Rajagopalan. Occurrence of Extended –spectrum β- lactamases among Enterobacteriaceae ssp. Isolated at a tertiary care institute. Indian J Med Microbio, (2006) 24(3): 208-211

18. Shila Jalalpour (2011) “ Survey frequency of extended spectrum beta-lactamases (ESBLs) in Escherichia coli and Klebsiella pneumonia strains isolated from urinary tract infection in Iran”; African Journal of Microbiology Research vol 5(22) pp. 3711- 3715, 16, December 2011.

19. Husam S. Khanfar, Khalid M. Bindayna, Abiola C. Senok, and Giuseppe A. Botta. Extended spectrum beta-lactamases (ESBL) in Escherichia coli and Klebsiella pneumoniae: trends in the hospital and community settings. J Infect Dev Ctries 2009; 3(4):295-299.

20. S. Meier, R Weber et al “Extendedspectrum β-lactamase-producing gramnegtive pathogens in community acquired urinary tract infections: an increasing challenge for antimicrobial therapy”; Infection(2011) 39:333-340.

21. Shakti Rath, Debasmita Dubey , Mahesh C. Sahu,et al.Surveillance of multidrug resistant Escherichia coli in a hospital in India.

22. Agrawal P, Ghosh A N, Kumar S, Basu B, Kapila K. Prevalence of extended-spectrum β-lactamases among Escherichia coli and Klebsiella pneumoniae isolates in a tertiary care hospital. Indian J Pathol Microbiol 2008;51:139-42

23. Chaudhary, U, Aggarwal, R.Extended spectrum beta lactamases(ESBL)- An emerging threat to clinical theraputics, Indian Journal of Medical Microbiology,2004;.22(2): 75-80.

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