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IJCRR - 7(15), August, 2015

Pages: 68-73

Date of Publication: 11-Aug-2015


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PROFILE OF PATIENTS OF VENOUS THROMBOSIS IN MEDICAL WARDSAN OBSERVATIONAL STUDY

Author: Cheena Garg, Arjun Agarwal, Dhruva Chaudhry

Category: Healthcare

Abstract:Introduction: Venous thrombosis is not an uncommon entity in medicine wards. Clinically, in majority of patients of venous thrombosis one or the other risk factor can be identified. Radiological investigations like-Duplex sonography, Coronary Transhepatic Pulmonary Angiography(CTPA) and Magnetic Resonance Imaging (MRI) venography have revolutionized the diagnosis of these disorders. There is an urgent need and scope to identify factors contributing to thrombophilia. Method: A prospective observational study over a period of 7 months including all the patients admitted in one unit of medicine. Results: Overall prevalence of venous thrombosis was 4.18% (26 out of 622 patients). The mean age of patients was 40.7 \? 16.2 years. Patients were divided into two groups. Group 1 (19 patients) consisting of patients with venous thrombosis (11 patients) and pulmonary thromboembolism (8 patients). Whereas group 2 (7 patients) had patients with cortical venous thrombosis (CVT). CVT and Deep Vein Thrombosis (DVT) were predominantly seen in females while pulmonary embolism was common in males. While in Group 1, Dyspnoea and pedal oedema were the commonest features. In group 2, headache followed by focal neurological deficit was common. All the cases were confirmed by necessary radiological investigations. All patients received enoxaparin. Thrombololysis was additionally given to 5 patients of group 1.11 (42%) patients had one or more risk factors. Overall mortality was 26%.
Conclusion:
Significant number of patients of venous thrombosis had one or the other risk factors. In this highly selective group wherever the tests were done, they demonstrated presence of thrombophilic state. It reinforces the belief that thrombophilias are prevalent in our population.

Keywords: Venous thrombosis, Pulmonary embolism, Cortical vein thrombosis, Thrombophilias

Full Text:

INTRODUCTION

Venous thrombosis is the formation of a clot or thrombus inside the veins, obstructing the flow of blood through the circulatory system caused as a consequence of Virchow’s triad. Venous thrombosis of the extremities is the commonest, followed by lungs (Pulmonary Thromboembolism) and brain. Venous Thromboembolic (VTE) disease is a common and potentially life threatening complication that incorporates signs and symptoms of 2 interrelated but distinct clinical conditions, Deep venous thrombosis(DVT) and Pulmonary embolism(PE). Signs and symptoms of VTE are non-specific like- swelling and pain in limbs, breathlessness, chest pain, cough and hemoptysis. Thus, making diagnosis difficult. Several risk factors have been advocated includingmalignancy, major orthopaedic surgery, spinal cord trauma, advanced age, obesity, immobilization, previous history of thrombosis, Ischaemic Heart Disease, smoking, atrial fibrillation, inherited causes- FactorV Leiden, hyperhomocysteinemia, deficiencies of Antithrombin III, Protein C and S.1,2 Cortical venous thrombosis(CVT), is also a challenging condition because of its myriad presentation. It is not so rare, but an alarming disease usually beginning with severe headache and may lead to seizures, neurological deficits and even death. It has been reported to cause 10-20% young strokes in India.3,4 A multitude of risk factors have been associated with CVT, including- all the prothrombotic states mentioned earlier, pregnancy, puerperium, infection and some other causes still remaining unknown(20-25%).5.

MATERIALS AND METHODS

Ours was a prospective observational clinical study carried out over a period of seven months in a medicine unit. Inclusion criteria-All confirmed cases of venous thrombosis in the medicine unit were eligible for the study. Venous thrombosis was defined to include- Deep Vein thrombosis of legs, Cortical vein thrombosis, Venothromboembolic diseases, Axillary vein thrombosis, Mesentric vein thrombosis.

RESULTS

Out of total 622 patients admitted in the hospital unit, 26 (4.18%) suffered from venous thrombosis. For the study, they were further divided into two groups: Group I – Patients having venous thromboembolic (VTE) disease (19 patients) (73.1%) including deep venous thrombosis (DVT, 11 patients i.e. 58% ) and pulmonary thromboembolism (PTE, 8 patients i.e. 42% ). Group II – patients with cortical venous thrombosis (CVT) (7 Patients i.e. 26.9%). There was a variable distribution of age with a very wide range from 20-75 years with mean age of 40.7±16.2 years. Nearly 3/4th of the patients were in the range of 20-50 years (73.1%). In group I 14 patients and in group II 6 patients were in the said range, respectively. There was almost equal no. of males and females in group I. However, there were more females (7 out of 11) in the DVT subgroup and more males (6 out of 8) in the PTE subgroup. In group II all the patients were females except one. In group I, the mean age of presentation was 43.42±16.1 years. Majority of patients had breathlessness and swelling feet. While others had distended abdomen, ascites, chest pain, cough and pain in legs. There was only 1 patient with hemoptysis. Majority of patients had pallor on general physical examination (12 patients) (63.15%), followed by pedal edema, facial puffiness and cyanosis. 4 patients (21.05%) had raised Jugular Venous Pressure. Clubbing was present in only 1 patient who had carcinoma lung. All patients were hemodynamically stable, however most patients were tachypnoeic.3 patients (15.78%) had systolic murmurs (one had ejection systolic murmer in Pulmonary area, other in both Pulmonary area and Tricuspid area and third one had Pan Systolic Murmer in Mitral area and Tricuspid area). 6 patients (31.57%) had basal crepts, 4 patients (21.05%) had reduced air entry and 2 had (10.52%) spasm on inspiration. Collaterals on abdomen with flow below upwards were seen in 2 patients (10.52%) of IVC thrombus. One of them had Budd chiari syndrome and other one had ovarian carcinoma. Around 60% of the patients had one or the other clinical risk factor for VTE. (Table 1)

In group II, the mean age of presentation was 33.29±15.12 years. Majority of patients presented with headache followed by weakness of limbs and abnormal mentation. All patients were hemodynamically stable. There was no tachypnea.4 patients (57.14%) had abnormal higher mental function. Almost all patients had plantar silent or extensor. Hemiparesis incidently all left sided was observed in 3 patients. 2 had (28.57%) signs of meningeal irritation. Fundus examination showed papilloedema in one patient.

Risk factors were found clinically in all except one. (Table 2)

Baseline routine investigations were carried out in all the patients in both the groups and were insignificant statistically. Specific investigations in group I were as follows: (Table 3a, 3b)

Laboratory evaluation of risk factor was done wherever possible to further investigate the cause of venous thrombosis.(Table 5)

The following treatment was given to the patients: Thrombolysis- 5 patients of VTE were thrombolysed, which included 4 patients of PTE and 1 of DVT. 4 patients were given Urokinase 1 patient had been previously thrombolysed with streptokinase was then thrombolysed with Tissue plasminogen activator (tPA Alteplase). Anticoagulant therapy20 (76.92%) patients were treated with low molecular weight heparin and 6 (23.07%) received heparin. All patients were given coumarin derivatives after thrombolysis and heparin or Low molecular weight Heparin therapy. Antiplatelet therapy-Clopidogrel was given in 8 patients (30.76%). Out of 26 patients, 19 (73.1%) patients were discharged after treatment while 7 (26.9%) patients expired

DISCUSSION

Thromboembolic events in India are still an under reported entity .In our study, the prevalence of venous thrombosis was 4.18% in the population studied (out of which 3.05% patients were diagnosed as VTE and 1.13% patients as CVT). According to a study, a prevelance rate of 10-20% of DVT has been reported amongst the medical patients. 6 The overall incidence of venous thromboembolism was reported as 1.83 per thousand per year (1.69 to 1.98) in the western population. 7 Whereas pulmonary embolism has an average annual incidence of 1 case per 1000 in the western population.8 Studies in India are too meagre in this respect and prevelance of VTE in our population is not known. Epidemiological data though is available on CVT from India, its exact incidence is debatable. During the last 40 years, there have been clinical series from India suggesting higher incidence of CVT in the subcontinent than the western world.9.10 In group I which included VTE patients ,the mean age of presentation was 43.42±16.1 years against 39±12.1 years in a study of pulmonary embolism patients from north India.11 Many other studies also reported increased risk of VTE in patients >40 years age.12,13,14 Thus, our study supports the fact that VTE is more common around 40 years. The same study of PE from north India showed that 17 males and 7 female patients were affected i.e. males were twice more predisposed to develop PTE than females. In our study also, nearly 3/4th patients of PTE (6 out of 8 patients of PE) were males However, DVT was commoner in females( 7 out of 11) as compared to males (4 out of 11)in the present study. Breathlessness and swelling foot were the commonest complaints in contrast to the previously mentioned study11, which demonstrated dyspnoea and cough as the main presenting symptoms. This could probably be because the above referred study was done purely on patients of PE while our study included both PE and DVT, thus, more patients with swelling foot. In the present study majority (57.8%) of the patients had at least one risk factor known to predispose to VTE. However, they showed scattered distribution among the local population with no difference from literature. The risk factors observed were IHD, previous history of VTE, underlying renal glomerular disease , carcinoma ,intake of Oral Contraceptives and immobilization. Hypercoagulability in cancer patients may indicate an aggressive change in the tumor and is associated with tumor progression.15 VTE incidence is around 40-100 cases per 1000 person-years in lung carcinoma patients.16 Gastrointestinal and gynaecological malignancies have also been found to be associated with hypercoagulation more frequently.17 Interestingly, 3 patients who had venous thrombosis associated with malignancy, one patient each had lung, ovarian and esophageal carcinoma. Many studies published in the last decade, reported that the incidence of venous thromboembolism (VTE) was higher in women who used oral contraceptives (OCs).18, in more so with third generation , as was seen in one of our subjects. In group II , the mean age of presentation was 33.29±15.12 years which was similar to a previous study from India on CVT (had mean age as 33.27 years).19 It had 41% female patients whereas in our study nearly all patients (85.7%) were females. All the patients had some or the other risk factor predisposing to CVT. Most of the females were in their pospartal periods. Puerperium has a strong relationship with CVT probably due to increased levels of clotting factors during pregnancy and hormonal changes. 10It is further complicated by local customs of not hydrating the mother adequately. Therefore, it was not a surprise to observe young females mostly in their postpartal periods with CVT. On laboratory tests, positive APLA and hypertriglyceridemia were revealed in a patient each. Several researches all over the world indicate that APLA20,21,22 hypertriglyceridemia 23,24 are proven prothrombotic states .In patient of CSOM with mastoiditis, direct extension of infection to the ipsilateral transverse sinus is supposed to be the cause of venous thrombosis. Headache was the commonest presenting symptom in 71.42% of the cases. It was primarily due to raised intracranial tension secondary to impaired drainage of CSF and venous sinuses. Headache has been constantly found to be the commonest complaint 2,19,10 However, the incidence of seizures was lower(28.57%) in our study than Pillai et al (42%)19.This was due to more common involvement of Superior Saggital sinus in their study, while most of our patients had transverse sinus involvement(6 out of 7). Hemiparesis was also a common presentation in our study owing to the same reason.MRI venography due to ready availability was the main modality for diagnosis of CVT in our institution. MR venography not only seems to offer an important advantage as a non-invasive tool in diagnostic procedures but also seems useful as a follow-up instrument for documentation of thrombus regression, recanalisation and venous collateralisation.25 In group I, echocardiography showed PAH in 60% patients and dilated right ventricle and atrium in 80% patients, primarily suspected to have VTE as compared to 83.3% and 62.5% , respectively in the PGIMER study.11 .73.68% patients had evidence of DVT on Duplex ultrasonography in the present study. Lower limb DVT was more common as with many other studies .The sensitivity and specificity of duplex for proximal vein thrombosis is 98%. Further, it helps to differentiate venous thrombosis from hematoma, Baker’s cyst, abscess, other causes of leg pain and edema.6 7 out of 8patients of PTE were confirmed on CT pulmonary angiography. The use of spiral CT pulmonary angiography(CTPA) is a major advancement in the diagnosis of PE with sensitivity and specificity greater than 90%.26. Therefore, the present study confirms the utility of CTPA in the diagnosis of PE. In our hospital thrombolysis was carried out in 5 patients, of which 3 had right ventricular dysfunction and one had IVC thrombus. Thrombolysis is being used more commonly now a days, not only for treating massive PE with shock but also in patients with echocardiographic evidence of right ventricular dysfunction.27,28,29 Such therapy has been shown to preserve the pulmonary microcirculation after pulmonary embolism and to decrease the incidence of the post-thrombotic syndrome following deep venous thrombosis27 Certain specific investigations like-factor V leiden, APLA,ATIII levels, Protein C and S levels, etc. were carried out in some cases .These tests though promising, but due to their non-availability in the hospital and for economic considerations were not carried out in every case on presentation. Moreover, majority of the investigations like- Protein C and S are more relevant when done after 6 months of anticoagulation therapy as their levels may be initially falsely low due to consumption of clotting factors.

CONCLUSION

Our study has demonstrated that venous thrombosis is not an uncommon entity in medicine wards. It affects predominantly when people are economically most productive. Clinically, in majority of patients of venous thrombosis have one or the other risk factor can be identified. Radiological investigations like-Duplex sonography, CTPA and MRI venography have revolutionized the diagnosis of these disorders. They should be used at first instance wherever clinical probability is high. There is an urgent need and scope to identify factors contributing to thrombophilia.

ACKNOWLEDGEMENT

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

References:

1. Clagett GP, Anderson FA, Jr, Heit J, et al. Prevention of venous thromboembolism. Chest 1995;108 (Suppl 1):31234.

2. Bick RL, Haas S. Thromboprophylaxis and thrombosis in medical, surgical, trauma, and obstetric/gynecologic patients. Hematol Oncol Clin North Am 2003;17:21758.

3. Srinivasan K. Ischemic cerebrovasular disease in the young: Two common causes in India. Stroke 1984;15;733-5.

4. Nagaraja D, Sarma GR. Treatment of cerebral sinus/venous thrombosis. Neurol India 2002;50;2:114-6.

5. Deschiens M. Coagulation studies, factor V leiden, and anticadiolipin antibodies in 40 cases of cerebral venous thrombosis. Stroke 1996;27;1724-30.

6. Parakh R, Somaya A, Todi SK, Iyengar SK. Consensus Development Recommendations for the Role of LMWHs in Prophylaxis of Venous Thromboembolism : An Indian Perspective. SUPPLEMENT OF JAPI _ JANUARY 2007 _ VOL. 55.

7. Incidence of venous thromboembolism: a community-based study in Western France. Thromb Haemost. 2000 May ;83 (5):657-60 10823257.

8. Wells PS, Rodger M. Diagnosis of pulmonary embolism: when is imaging needed? Clin Chest Med2003:24:13-28.

9. Padmavati S, Gupta S, Singh B.A clinical study of 44 cases of hemiplegia in adult women. Neurol India 1957;5:59-65.

10. Srinivasan K.Cerebral venous and arterial thrombosis in pregnancy and puerperium:a study of 135 patients. Angiology 1983;34:731-46.

11. Agarwal R, Gulati M, Mittal BR, Jindal SK.Clinical profile, diagnosis and management of patients with symptomatic PE, PGIMER Chandigarh. Original article. Indian J Chest Dis Allied Sci 2006;48:111-114.

12. Nicolaides AN, Irving D. Clinical factors and the risk of deep venous thrombosis. In: Nicolaides A, editor. Thromboembolism Etiology. Advances in Prevention and Management. Baltimore, MD: University Park Press; 1975: 193–204.

13. Gillum RF. Pulmonary embolism and thrombophlebitis in the United States, 1970–1985. Am Heart J. 1987; 114: 1262–1264

14. Gjores JE. The incidence of venous thrombosis and its sequelae in certain districts in Sweden. Acta Chir Scand. 1993; 111 (Suppl 206): 16–24.

15. Ten Cate-Hoek AJ, Prins MH. Low molecular weight heparins in cancer Management and prevention of venous thromboembolism in patients with malignancies. [Epub ahead of print] Thromb Res. 2007 Nov 7.

16. Margot Tesselaar, ET, Susanne Osanto, Department of Clinical Oncology, Leiden University Medical Center, The Netherlands .Current Opinion in Pulmonary Medicine. 13(5):362-367, September 2007.

17. TAHRI A, El Hattaoui M,Charei N, El Belghiti M, Mahmal L, Tahiri F, Bouras N. Journal of Clinical Oncology, 2007 ASCO Annual Meeting Proceedings Part I. Vol 25, No. 18S (June 20 Supplement), 2007: 19672.

18. Farmer RD, Lawrenson RA, Thompson CR, Kennedy JG, Hambleton IR. Population-based study of risk of venous thromboembolism associated with various oral contraceptives. Department of Public Health and Primary Care, Charing Cross and Westminster Medical School, University of London, Chelesa, UK.Lancet,1997 Jan 11;349(9045):83-88.

19. Pillai Lalitha V, Ambike Dhananjay P, Nirhale Satish, Husainy S M K, Pataskar Satish. Cerebral venous thrombosis: An experience with anticoagulation with low molecular weight heparin. Critical Care Department, Lokmanya Hospital, Chinchwad, Pune, India. IJCCM 2005;9:14-18.

20. Petri, M. Epidemiology of the antiphospholipid antibody syndrome. J Autoimmun. 2000; 15: 145–151.

21. Schved JF, Dupuy-Fons C, Biron C, et al. A prospective epidemiological study on the occurrence of antiphospholipid antibody: the Montpellier Antiphospholipid (MAP) Study. Haemostasis. 1994; 24: 175–182.

22. Bick RL. Hypercoagulability and thrombosis. Med Clin North Am. 1994; 78: 635–665.

23. Carine J.M. Doggen; Nicholas L. Smith; Rozenn N. Lemaitre; Susan R. Heckbert; Frits R. Rosendaal; Bruce M. Psaty. Serum Lipid Levels and the Risk of Venous Thrombosis. Arteriosclerosis, Thrombosis, and Vascular Biology:Volume24(10)October 2004pp 1970-1975.

24. Larsen LF; Bladbjerg EM; Jespersen J; Marckmann P. Effects of dietary fat quality and quantity on postprandial activation of blood coagulation factor VII. Arterioscler Thromb Vasc Biol (United States) Nov 1997, 17 (11) p2904-9.

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28. South path S.A. thrombolytic therapy for venous thrombosis and pulmonary embolism. Baillieres clin hematol 1998. 11(3): 663-73.

29. Fattahi O.H. Thrombolytic Therapy for Deep Vein Thrombosis and Pulmonary Embolism. Shiraz E-Medical Journal. October 2001, Vol. 2, No. 4.

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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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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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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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