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2021 | May-August | Volume 6 | Issue 2

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Chakrapani Mittal, Aviral Gupta, Shrikant Choudhary, Mukesh Sarna, Aakriti Vij

Role of Hematological Indices in COVID-19 Patient's Prognosis

[Year:2021] [Month:May-August] [Volume:6] [Number:2] [Pages:3] [Pages No:39 - 41]

Keywords: Coronavirus disease 2019, Hematological indices, Neutrophil:lymphocyte ratio, Platelet:lymphocyte ratio

   DOI: 10.5005/jp-journals-10057-0155  |  Open Access |  How to cite  | 


Aim and background: In this study, the role of hematological indices in coronavirus disease 2019 (COVID-19) patients’ prognosis who have visited our hospital has been evaluated. Materials and methods: Clinical profile, disease severity, disease outcome, blood parameters [hemoglobin, white blood cell counts, neutrophil counts, lymphocyte counts, neutrophil:lymphocyte ratio (NLR), lymphocyte:monocyte ratio, platelet counts, eosinophil count, and platelet:lymphocyte ratio (PLR)] were evaluated in patients with confirmed COVID-19 infection. Results: High values of leukocytes, neutrophils, and low value of platelets, eosinophil counts indicated poor prognosis in COVID-19 patients. High NLR, PLR, and low lymphocyte:monocyte ratio also indicated a bad prognosis. Conclusion: Monocyte count, lymphocyte count, eosinophil count, NLR, lymphocyte monocyte ratio, and PLR values can be used in the prognosis of COVID-19 patients.



Aakriti Vij, Shrikant Choudhary, Chakrapani Mittal, Aviral Gupta, Kishore Moolrajani

Diabetes Mellitus as a Bad Prognostic Marker in COVID-19 Patients and Its Relationship with Inflammatory Markers (CRP, D-dimer, LDH, and Ferritin)

[Year:2021] [Month:May-August] [Volume:6] [Number:2] [Pages:4] [Pages No:42 - 45]

Keywords: Coronavirus disease 2019, Diabetes mellitus, Outcome

   DOI: 10.5005/jp-journals-10057-0156  |  Open Access |  How to cite  | 


Background: Coronavirus disease 2019 (COVID-19) is a newly recognized illness that is spreading rapidly around the world, causing many disabilities and deaths. Some diseases, for instance, diabetes, are continuously suggested as a risk factor, which contribute to the severity and mortality of COVID-19. However, to date, there are no comprehensive studies done that are aimed at explaining the exact relationship between diabetes mellitus and COVID-19. Thus, this study aims to evaluate the relationship between diabetes and COVID-19 and its relationship with inflammatory markers. Materials and methods: This single-center retrospective observational study was conducted on 187 patients diagnosed with COVID-19. The data were collected on admission or during hospitalization by the attending physicians and was documented in the form of electronic medical records. The need for informed consent from patients was waived due to the time constraints during the COVID-19 emergency. Results: Of the 187 hospitalized patients with COVID-19, 50 patients had diabetes. The median age was 59 years and 35 (70.00%) were male. Common symptoms among all patients included fever (57.21%) and cough (48.13%). Patients with diabetes had a non-significantly higher LDH, ferritin, CRP, and D-dimer when compared with those without diabetes. Coronavirus disease 2019 patients with diabetes were significantly more likely to develop severe disease or suffer mortality, indicating a poorer prognosis among COVID-19 patients. Conclusion: We concluded that diabetes mellitus is associated with greater disease severity and poor outcome (mortality) in COVID-19, and a higher but statistically non-significant inflammatory burden.



Effect of Oral Gabapentin and Pregabalin in the Management of Neuropathic Pain in Palliative Care Patients: An Institution-based Comparative Study

[Year:2021] [Month:May-August] [Volume:6] [Number:2] [Pages:2] [Pages No:46 - 47]

Keywords: Cancer, Gabapentin, Palliative care, Pregabalin

   DOI: 10.5005/jp-journals-10057-0151  |  Open Access |  How to cite  | 


Background: Gabapentin and pregabalin are antiepileptic drugs used in the treatment of neuropathic pain. They are used as adjuvants with analgesics in the management of pain. Aims and objectives: We aimed to compare gabapentin and pregabalin's role in neuropathic pain in cancer patients. Materials and methods: This prospective, comparative study included 100 patients having neuropathic pain, undergoing cancer treatment in Mahatma Gandhi Hospital. Results: The mean age of patients was 38.2 ± 8.2 in the gabapentin group and 37.4 ± 7.4 in the pregabalin group. Headache was the most common among the gabapentin group, followed equally by placebo and pregabalin groups. Nausea was equally reported by the gabapentin and placebo groups. Dizziness was seen equally among the placebo and pregabalin groups followed by the gabapentin group. Conclusion: The study concluded that pregabalin is a better medication for the management of neuropathic pain as compared to gabapentin.



Sarvesh Maheshwari, Brijesh Kumar Sharma, Mahesh Chandra Misra

Learning Curve in Laparoscopic Inguinal Hernia Repair

[Year:2021] [Month:May-August] [Volume:6] [Number:2] [Pages:5] [Pages No:48 - 52]

Keywords: Laparoendoscopic, Learning curve, totally extraperitoneal/transabdominal preperitoneal repair

   DOI: 10.5005/jp-journals-10057-0146  |  Open Access |  How to cite  | 


Background: There are two standardized techniques for the laparoendoscopic repair of inguinal hernia, i.e., transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP); however, both are associated with a steep learning curve. The objective of the present study was to define the learning curve of a laparoendoscopic inguinal hernia repair for both TEP repair and TAPP repair. Material and methods: In this prospective study, 85 patients with inguinal hernia posted for laparoendoscopic inguinal hernia repair using either TEP or TAPP were included to assess the learning curve. The learning curve was assessed for junior surgeon (otherwise experienced laparoscopic surgeon not performing laparoendoscopic groin hernia repair) under the direct supervision of senior surgeon (regularly performing laparoendoscopic groin hernia repair). The study period was between January 2018 and June 2019. A comparison was done based on patient demographics, details of operative procedure [TEP or TAPP, operative time, intraoperative difficulty, peritoneal laceration (TEP), vascular injury, conversion from TEP to TAPP, and/or open hernia repair] postoperative hospital stay, intraoperative complications, conversion rate, hospital stay in days, and postoperative complications. Results: Out of 85, 50 patients were operated by the senior surgeon (TAPP was done in 38 cases and TEP was done in 12) and 35 by the junior surgeon (TAPP was done in 14 cases and TEP in 20 and 1 case, i.e., 1.2% was converted from laparoscopic to open). There were 103 groin hernias in 85 patients in the study. Indirect, direct, and combined hernias were present in 39, 28, and 36, respectively. In our study, there was less prevalence of direct hernia, i.e., 32.8% out of which 38 and 62% were operated by the senior and junior surgeons, respectively, whereas 45.6% were indirect hernia out of which 40 and 60% were operated by the senior and junior surgeons, that shows its high prevalence. 17.6%, i.e., 15 cases were found to be bilateral hernia out of which 73.33% were operated by the senior surgeon while 82.4%, i.e., 70 cases were unilateral hernia out of which 60% were operated by the junior surgeon, statistically not significant (p = 0.44). The patients operated by the senior surgeon had higher mean age, i.e., 53 ± 17.43 years as compared to the junior surgeon, i.e., 46 ± 14.22 years (p value = 0.043) with statistically significant. Mean operating time by the senior surgeon was 49 ± 4.63 minutes, and 62 ± 4.20 minutes for the junior surgeon with a p value of 0.0005, statistically highly significant. 25.33% of patients had intraoperative complications and 24.13% of patients had a peritoneal injury. The surgeries done by the junior surgeon had 30% of peritoneal injury while it was 21.05% for the senior surgeon in the TEP procedure, statistically not significant (p = 0.56). Twenty percent of patients had postoperative complications out of which urinary retention was maximum, i.e., in 8 (9.4%) statistically insignificant with p = 0.71. Conclusion: The junior surgeon in the present study was highly experienced and accomplished in laparoscopic surgery with over 15 years of experience but not performing laparoendoscopic groin hernia repair; that seems to be the reason for a fewer number of procedures (8 for TAPP and 9 for TEP) required to overcome the learning curve. Therefore, surgeons with excellent laparoscopic skills need a shorter learning curve as compared to the beginner in laparoscopic surgery, when it comes to laparoendoscopic groin hernia repair.



Tapan Kapoor, Guman Singh, Anushree Loyal, Dharam Pal Singh

Breast Cancer Tumor Biology Characteristics and Its Correlation in a Tertiary Care Center

[Year:2021] [Month:May-August] [Volume:6] [Number:2] [Pages:3] [Pages No:53 - 55]

Keywords: Breast cancer, Cancer, Histopathology

   DOI: 10.5005/jp-journals-10057-0143  |  Open Access |  How to cite  | 


Aims/Objectives: The study aims to evaluate and correlate the relationship between hormone receptor status—estrogen, progesterone receptor (ER and PR), and Herceptin receptor (Her-2/neu) with tumor characteristics in breast cancer patients. Materials and methods: The current study included 101 breast cancer patients of various age-groups from the period 2016–2020. The tumors were evaluated for hormone expression, size, histologic grade, lymphovascular invasion, and axillary node status. The excised breast tissue specimen was evaluated for hormone status by immunohistochemistry (IHC) testing on paraffin blocks and was further analyzed using the fluorescence in situ hybridization (FISH) technique as per requirement. Stratification based on hormone receptor status was done in four categories—ER+PR+Her-2neu−, ER−PR−Her-2neu+, ER+PR+Her-2neu+, and ER−PR−Her-2neu−. Results: In this study, 37.6% of tumors were ER+PR+Her-2neu−, 13.8% ER−PR−Her-2neu+, 13.8% ER+PR+Her-2neu+, and 34.6% ER−PR−Her-2neu−. Among high-grade tumors, more than half (52%) patients were hormone receptor-negative, whereas among low-grade tumors 55% of patients were hormone receptor-positive. Sixteen percent of patients presented with a younger age-group (<35 years) and in these patients, nearly 38% were Her-2/neu positive and most of the Her-2/neu receptor-positive patients (80%) had lymphovascular space invasion. Primary tumor size at time of presentation was <2 cm (T1) in only 11% of cases and 2–5 cm (T2) in 72% of cases. Lymph node positivity did not correlate with hormone receptor status. Conclusion: The incidence of Her2-neu positive breast cancer patients was higher in the Indian population as compared to the Western world. The current study depicts the distinct shift in terms of tumor stage and biology, higher rate of Her-2/neu-positivity, younger age at diagnosis, larger tumor size, advanced tumor grade, and more positive lymph node involvement in contrast to the Western population.



Brij Mohan Gupta

A Hospital-based Prospective Study of Hypomagnesemia in Type 2 Diabetes Mellitus Patients

[Year:2021] [Month:May-August] [Volume:6] [Number:2] [Pages:4] [Pages No:56 - 59]

Keywords: Diabetes complications, Diabetes mellitus, Hypomagnesemia, Neuromuscular weakness, Poor control

   DOI: 10.5005/jp-journals-10057-0148  |  Open Access |  How to cite  | 


Background: Magnesium is the second most abundant intracellular cation in the body and recently there has been an emerging interest in its major role played in various physiological and disease states of the body. Its deficiency is being correlated with pathogenesis, glycemic control, and various complications occurring in patients of diabetes mellitus (DM) in many studies. Aim and objective: To estimate serum magnesium levels in diabetic patients and correlating it with pathogenesis, duration of diabetes, poor glycemic control, and various complications in our tertiary care hospital patients. Materials and methods: This is a case-control, prospective study comprising 120 diabetic patients diagnosed as per recommended criteria of ADA and were evaluated at NIMS Medical College, Jaipur, Rajasthan. Keeping serum magnesium value threshold of 1.6 mg/dL, all patients were divided into two groups; hypomagnesemic(s) and normomagnesemic(s). Twenty-five healthy age-matched controls were also enrolled and compared. Results: We observed 120 patients (52.5% males and 47.5% females), with age ranges between 36 years and 78 years; however, 60% of patients were in the range of 40–65 years. Mean serum values in hypomagnesemic, normomagnesemic, and healthy controls were detected in the range 1.54 ± 0.43, 1.81 ± 0.56, and 2.12 ± 0.67, respectively. 60.8% of diabetic patients had one or more diabetic complications; more in hypomagnesemic (83.3%) compared with normomagnesemic (51.9%). Microvascular complications were the most common. A single case of neuromuscular weakness was also detected. Conclusion: Hypomagnesemia is common in patients of type 2 DM (T2DM) and has a negative correlation with its incidence, duration of disease, poor glycemic control, and various complications of DM. The therapeutic potential of serum magnesium is worth exploring via large clinical trials. Since replenishment of serum magnesium is a simple clinical entity, thus, it will be prudent to measure serum magnesium in each diabetic patient and replenish it accordingly.



Parth H Mehta, Naveen Bansal, Gurinder Singh, Sangeeta Sunda, Amit Choudhary, Alisha Chuchra

Evaluation of Beta, Yen, and W Angle in Assessment of Anteroposterior Jaw Relationship in North Indian Population: A Cephalometric Study

[Year:2021] [Month:May-August] [Volume:6] [Number:2] [Pages:4] [Pages No:60 - 63]

Keywords: Beta angle, Lateral cephalogram, W angle, Yen angle

   DOI: 10.5005/jp-journals-10057-0153  |  Open Access |  How to cite  | 


Aim and objective: To establish the mean value, standard deviation, and to determine statistically significant differences of Beta, Yen, and W angle for skeletal class I, skeletal class II, and skeletal class III malocclusion in North India population. Materials and methods: The study will be carried on 90 pretreatment lateral cephalograms randomly taken from records of the Department of Orthodontics and Dentofacial Orthopedics, Genesis Institute of Dental Sciences and Research, Ferozepur. All the cephalograms will be traced using a sharp 0.5 mm pencil on 0.003-inch acetate tracing paper using an X-ray viewer. Mean values of measurements such as ANB angle and Wits appraisal will be calculated and will be divided into 3 groups of 30 samples each. Then, Beta, Yen, and W angle will be measured for all three groups. The data will then be summarized and standard statistical methods will be applied. Results: Beta angle had a value of 31.23 ± 3.2.99° for skeletal class I group, 25.33 ± 2.64° for skeletal class II group, 40.03 ± 3 0.05° for skeletal class III group, YEN angle had a value of 122.57 ± 6.53 for skeletal class I group, 115.20 ± 2.49 for skeletal class II group, and 132.60 ± 3.56 for skeletal class III group, and W angle had a value of 54.90 ± 2.39 for skeletal class I group, 51.17 ± 3.21 for skeletal class II group, and 59.40 ± 1.95 for skeletal class III group. Conclusion: A significant difference was present between the mean value of Beta, Yen, and W angle for class I, class II, and class III malocclusion. Clinical significance: Beta, Yen, and W angle are new parameters to diagnose the skeletal relationship of both the arches and are important clinically in diagnosis and treatment planning of the patient for orthodontic treatment.



Vaishnavi Gupta, Nikita Arora, Yash Jain, Sushil Mokashi, Chiranjibi Panda

Assessment on Adoption Behavior of First-time Mothers on the Usage of Chatbots for Breastfeeding Consultation

[Year:2021] [Month:May-August] [Volume:6] [Number:2] [Pages:5] [Pages No:64 - 68]

Keywords: Artificial intelligence in Healthcare, Chatbots, Postpartum depression

   DOI: 10.5005/jp-journals-10057-0161  |  Open Access |  How to cite  | 


In today's world, there is more reliance on technologically advanced systems and artificial intelligence (AI) to shoulder the work-related commitments of individuals, corporate giants, government, or businesses. Artificial intelligence refers to the human-like intelligence exhibited by a computer, robot, or other machines ( Many high-tech advancements in the field of healthcare are all due to improvements and evolutions in AI. Moreover, an AI-powered chatbot swiftly responds to all the queries; reducing the lag time and other hindrances. They have become real-time healthcare assistants, bringing about revolutions in the healthcare industry. The future belongs to AI-enabled technologies and henceforth, leading to an increased importance of the introduction of this kind of technology in the public health sector also. An important constituent in the public health sector is a maternal issue like breastfeeding. There are several challenges, doubts, hesitations, and skepticism that new mothers face while breastfeeding their kids. Along with facing postpartum depression, several new or first-time mothers have limited knowledge about breastfeeding. This paper focuses on the usage of AI-enabled chatbots that educates first-time mothers regarding anxiety, stress, postpartum depression, and lactation patterns. The paper gives an insight into the adoption behavior of new mothers using chatbots related to breastfeeding counseling. The authors have gone thru 85 peer-reviewed papers published between the years 2002 and 2020 and found this research to be one of its kinds in this sphere. The study includes the population of new mothers from the city of Amritsar and Jaipur, India, and gives solutions with respect to problems and doubts pertaining to breastfeeding the newborn.



Neha Bagri, Ritu Misra

A Rare Case Report of Out of the Ordinary Canal of Nuck Hernia Encompassing Pelvic Structures, Showing up as a Labial Mass

[Year:2021] [Month:May-August] [Volume:6] [Number:2] [Pages:3] [Pages No:69 - 71]

Keywords: Canal of Nuck, Hernia, Inguinal canal, Ovary, Uterus

   DOI: 10.5005/jp-journals-10057-0147  |  Open Access |  How to cite  | 


Aim and objective: We report a rare case of the canal of Nuck hernia containing part of the uterus and both ovaries as its contents. The aim is to build up the awareness of this condition by reviewing the ultrasound and MRI imaging findings and identification of prolapsed ovary with correct knowledge of the entity and focused analysis. Background: The patent canal of Nuck is one of the rare developmental entities in females. Hernia of the canal of Nuck is an extension of the peritoneal fold through the inguinal canal up to the labia majora. Defective obliteration of this peritoneal fold leads to herniation of abdominal content into the inguinal canal. Case description: An exceptionally rare case of a 5-month-old female child who presented to us with a palpable, non-tender, left labial mass. Ultrasound and MRI were performed showing the contents of herniating sac as uterine fundus and bilateral ovaries along with minimal free fluid. The infant was managed conservatively and kept under follow-up. Conclusion: Incidence of both ovary and uterus as contents of hernia is very rare. Furthermore, early and correct identification of the herniated ovary prevents an uncalled-for surgery. Clinical significance: It is very important to be familiar with this entity, especially in cases of ovarian hernia due to the risk of associated complications like incarceration and torsion.



Nripesh Sadasukhi

A Rare Case of Stuck Guidewire with Foley Catheter in Urethra due to Knotting

[Year:2021] [Month:May-August] [Volume:6] [Number:2] [Pages:3] [Pages No:72 - 74]

Keywords: Foley catheter, Guidewire, Knotting, Urethra

   DOI: 10.5005/jp-journals-10057-0159  |  Open Access |  How to cite  | 


Guidewires play a significant role in many medical specialties.1 They were initially developed for vascular procedures,2 but are also nowadays an essential tool in endourology. The knotting of the guidewire is a very rare complication and only a few cases have been reported until now. We report a case of spontaneous intraurethral knotting of guidewire on the Foley catheter during per urethral catheterization that led to retained Foley catheter with the guidewire. The balloon was punctured percutaneously with a needle under ultrasound guidance but due to knotting guidewire and Foley catheter, both are stuck in the urethra. A guidewire knot was found proximal to the balloon. The urethroscopy shows the knotting of the guidewire with a Foley catheter. Open urethrotomy done and both guidewire and Foley catheter removed.



Renuka P Chinchalkar, Shantanu Jain, Shavan K Yadav, Priyanka S Lekhwani, Nikita Gupta

Natal Teeth in Association with Sublingual Ulceration: A Case Report

[Year:2021] [Month:May-August] [Volume:6] [Number:2] [Pages:3] [Pages No:75 - 77]

Keywords: Natal teeth, Riga–Fede disease, Sublingual ulceration

   DOI: 10.5005/jp-journals-10057-0150  |  Open Access |  How to cite  | 


Natal teeth are a rare sight in a newborn child's oral cavity. The presence of teeth natal teeth can cause a series of damage to the child including difficulty in feeding, ulceration on the tongue. A 31-day-old baby reported to the Department of Pediatric and Preventive Dentistry with a chief complaint of ulceration on the tongue and difficulty in breastfeeding. On further examination, a diagnosis of natal teeth was narrowed down. Due to the presence of mobility of the present teeth and ulceration on the tongue, the teeth were extracted.


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