International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 4(10), May, 2012

Pages: 39-42

Date of Publication: 25-May-2012


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DETECTION OF INDUCIBLE CLINDAMYCIN RESISTANCE IN CLINICAL ISOLATES OF STAPHYLOCOCCUS AUREUS FROM A TERTIARY CARE HOSPITAL IN BIJAPUR, KARNATAKA STATE OF INDIA

Author: Lakshmi S. Kakhandki, B V Peerapur, Prashant Parandekar

Category: General Sciences

Abstract:The present study aimed at in-vitro detection of macrolide resistant phenotypes of methicillin resistant Staphylococcus aureus and interpretation of susceptibility tests to guide therapy. The study included 100 strains of Staphylococcus aureus out of which 67 strains were methicillin sensitive Staphyloccus aureus (MSSA) and 33 strains were methicillin resistant Staphyloccus aureus (MRSA). Overall 20 (20%) strains of Staphylococcus aureus exhibited inducible resistance to clindmycin by double disc diffusion test . Of these 20 strains, 15(75%) were methicillin resistant, while 5 (25%) were methicillin sensitive.

Keywords: Methicillin Resistant Staphyloccus aureus (MRSA), Inducible Clindamycin Resistance, Double Disc Diffusion test.

Full Text:

INTRODUCTION
Clindamycin is considered as an useful alternative drug in penicillin allergic patients and in the treatment of skin and soft tissue infections caused by Staphylococcus aureus. It has excellent tissue penetration (except for central nervous system), accumulates in abscesses, no dosage adjustments are required in presence of renal diseases.1 Good oral absorption of clindamycin makes it an attractive option for use in outpatients or as follow-up treatment after intravenous therapy (deescalation).2 Methicillin resistant Staphylococcus aureus (MRSA) are increasingly being reported as multidrug resistant with high resistance to macrolides (erythromycin, clarithromycin) and lincosamides (clindamycin, lincomycin) leaving very few therapeutic options.3 Newer antibiotics like vancomycin, linezolid, quinupristin, dalfopristin have been advocated in the management of such isolates , but the recent reports of resistance to these agents raise real concerns over how long this uniform susceptibilities will hold good.3-5 Interestingly,all vancomycin intermediate Staphylococcus aureus (VISA) and vancomycin resistant Staphylococcus aureus (VRSA) isolates reported so far from United States have been sensitive to trimethoprim – sulfamethaxazole and tetracycline raising the probability that the older agents may have some efficiency in the treatment of MRSA infection.3

For years, macrolides have been used as an alternative to the use of penicillins and cephalosporins in the treatment of infections caused gram positive bacteria, but the worldwide development of macrolide resistance has now limited the use of these antibiotics.6 Lincosamides (clindamycin) are generally not recommended in erythromycin resistant Staphylococcus aureus as they share a similar mode of action and have common resistance mechanisms. However, recent studies on treatment of erythromycin resistant S,aureus using clindamycin show the possible role of clindamycin in some of erythromycin resistant isolates, as there are multiplicity of resistance mechanisms and diversity of phenotypic expression.7-10 Staphylococcus aureus can be resistant to erythromycin through either erm gene or msrA genes. Strains with erm mediated erythromycin resistance may possess inducible clindamycin resistance but may appear susceptible to clindamycin by disc diffusion.1 So if this inducible clindamycin resistance can be reliably detected on a routine basis in clinically significant isolates, clindamycin can be safely and effectively used in patients with true clindamycin sensitivity.2 So the present study is aimed at in-vitro detection of clindamycin susceptibility in macrolide resistant phenotypes of S. aureus.

MATERIAL AND METHODS
A total of 100 Staphylococcus aureus isolates were studied which were collected from pus, blood, wound swabs and sputum between April 2011-June 2011. The isolates were identified as Staphylococcus aureus by gram stain, slide and tube coagulase test, mannitol fermentation test, phosphatase test, deoxyribonuclease test. Methicillin resistance was tested on mueller - hinton agar with 4% sodium chloride using cefoxitin disc by kirby-bauer disc diffusion method. Plates were incubated 370 C for 24 hrs. A zone size of 18mm or more was considered sensitive as per CSLI guidelines.11

Erythromycin and clindamycin double disc susceptibility testing
Inducible clindamycin resistance was detected by double disc diffusion test using 15µg erythromycin disc placed 20mm from the centre of 2µg clindamycin disc. Inhibition of circular zone around the clindamycin disc was considered positive for inducible resistance (Flattening of the zone towards erythromycin disc).12

RESULTS
Out of 100 strains of Staphylococcus aureus, 67 were methicillin sensitive Staphylococcus aureus (MSSA) and 33 strains were methicillin resistant Staphylococcus aureus (MRSA). Overall 20 strains of Staphylococcus aureus (20%) exhibited inducible resistance to clindamycin. Of these 20 strains 15(75%) were methicillin resistant while 5(25%) were methicillin sensitive.

DISCUSSION
Resistance to macrolide, lincosamide, streptograminB (MLSB) antibiotics most commonly results from acquisition of erythromycin resistant methylase genes (erm genes) which encode enzymes that methylate the 23S rRNA. The overlapping binding sites of macrolide, lincosamide, streptograminB in 23S rRNA account for cross-resistance to the three classes of drugs. Expression of MLSB resistance can be constitutive or inducible. In inducible resistance, the bacteria produce inactive mRNA that is unable to encode methylases. The mRNA becomes active only in the presence of a macrolide inducer. By contrast, in constitutive expression, active methylated mRNA is produced even in the absence of an inducer.6 The strains harbouring an inducible erm gene are resistant to the inducer but remain susceptible to the non-inducer macrolide and lincosamide, but the use of such non-inducer antibiotic such as clindamycin, can lead to selection of constitutive mutants at frequencies of 10-7 cfu.9,1o Besides methylation of the target site, active efflux of macrolides is encoded by plasmid borne msr (A) gene which has specificity for 14 and 15 membered macrolides (erythromycin, azithromycin, clarithromycin) and type B streptogramin. Clindamycin is neither an inducer nor a substrate for the pump, and thus the strains are fully susceptible to this antimicrobial.6 In our study 20% of the strains exhibited resistance to clindamycin, while it was 24% in the study done by R Goyal et al.13 So our observation suggest that, susceptibility testing of Staphylococcus aureus should include the disc diffusion induction test, which will facilitate the identification of isolates exihibiting inducible or constitutive resistance to MLSB phenotypes. Patients with infections caused by such isolates can probably be treated with clindamycin without expectation of resistance developing during therapy.

References:

1. Fiebelkorn KR, Crawford SA, McElmeel ML, Jorgensen JH. Practical disc diffusion method for detection of inducible clindamycin resistance in Staphylococcus aureus and coagulase negative Staphylococci. J Clin Microbiol 2003; 41: 4740-4.

2. MR Angel, V Balaji, JAJ Prakash, KN Brahmadathan, MS Mathews. Prevalance Of Inducible Clindamycin Resistance In Gram Positive Organisms In A Tertiary Care Centre. IJMM 2008; 26(3): 262-64.

3. Srinivasan A, Dick JD, Perl TM. Vancomycin resistance in Staphylococci. Clin Microbiol Rev 2002; 15(3): 430-438.

4. Johnson AP, Woodford N. Glycopeptide resistant Staphylococcus aureus. J Antimicrobial Chemotherapy 2002; 50: 621- 623.

5. Eliopoulos G M. Quinupristin - dalfopristin and linezolid : Evidence and opinion. Clin Infect Dis 2003; 36: 473-481.

6. Leclercq R. Mechanisms of resistance to macrolides and lincosamides: Nature of resistance elements and their clinical implications. Clin Infect Dis 2002; 34 : 482- 492.

7. Panagea S, Perry JD, Gould FK. Should clindamycin be used as treatment of patients with infections caused by erythromycin resistant Staphylococci? J Antimicrobial Chemotherapy 1999; 44: 581-582.

8. Gopal Rao G. Should clindamycin be used in treatment of patients with infections caused by erythromycin resistant Staphylococci ? J Antimicrobial Chemotherapy 2000; 45: 715.

9. Drinkovie D, Fuller ER, Shore KP, Holland DJ, Rod Ellis Pegler. Clindamycin treatment of Staphylococcus aureus expressing inducible clindamycin resistance. J Antimicrobial Chemotherapy 2001; 48: 315- 16.

10. Watanakunakorn C. Clindamycin therapy of Staphylococcus aureus endocarditis. Clinical relapse and level of resistance to clindamycin, lincomycin and erythromycin. Am J Med 1976; 60: 419-25.

11. Clinical and laboratory Standards Institute (CLSI). Performance Standard for Antimicrobial disk susceptibility tests. Approved Standard M2-A72, 11th ed. Wayne, PA; 2007.

12. Seppala H, Nissinen A, Quan Yu, Huovinen P. Three different phenotypes of erythromycin resistant Streptococcus pyogenes in Finland. J Antimicrobial Chemotherapy 1993; 32: 885-891.

13. R Goyal, NP Singh, V Manchanda, M Mathur. Detection of Clindamycin Susceptibility in Macrolide Resistant Phenotypes of Staphylococcus aureus. IJMM, 2004; 22(4):251-254.

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

Women Researcher Award:

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

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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


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