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   Table of Contents - Current issue
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July-September 2020
Volume 7 | Issue 3
Page Nos. 151-234

Online since Monday, January 25, 2021

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ORIGINAL ARTICLES  

Frequency of micronuclei in tobacco habitués and Non-Habitués with oral lichen planus Highly accessed article p. 151

DOI:10.4103/cjhr.cjhr_109_1910.4103/cjhr.cjhr_109_19  
Background: Tobacco in any form is genotoxic to the oral epithelium and manifests as tobacco-associated mucosal lesions, some of which are OPMDs with a propensity for progression into OSCC (2-17%). The aberrations in the count and morphology of micronuclei in exfoliative cytological preparations have been demonstrated in all forms of oral tobacco usage and OLP independently. The more extensive these aberrations, the greater the possibility of undergoing malignant change. This study focused on assessing the extent of micronuclear damage in tobacco-habitués with OLP, thus placing them in a higher risk group as compared to non- habitués with OLP. Aim and Objectives: To evaluate the frequency of micronucleated exfoliative cells in oral lichen planus and to evaluate the effect of tobacco on the frequency of micronuclei in these patients. Material and Methods: Patients were divided into 3 groups: OLP with habit, OLP without habit and healthy controls. Exfoliated cells were obtained from the lesion, smeared on slides, stained by Papanicolaou's method and 1000 cells per slide evaluated for micronuclei according to the Tolbert et al criteria. Statistical Analysis: A statistically significant result was obtained using ANOVA and Bonferroni tests. Result: The genetic damage and increased potential for malignant transformation in OLP is compounded in tobacco habitués evidenced by the increase in the number of micronuclei. Conclusion: The Micronucleus Index was observed to be three-fold greater in tobacco habitués with OLP as compared to non-habitués with OLP.
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Clinico-bacteriological profile and outcome of children with pneumonia under 5 years of age Highly accessed article p. 156

DOI:10.4103/cjhr.cjhr_20_20  
Context: India has the highest mortality due to pneumonia in the world. Despite advances in management, it still continues to be major cause of under 5 mortality in children with pneumonia. Aims: The aim of this study was to assess the clinico-bacteriological profile and outcome associated with pneumonia in Uttarakhand, India. Settings and Design: This was a prospective hospital-based observational study. Materials and Methods: Two hundred and sixteen children 1 month to 5 years of age, fulfilling the WHO criteria of pneumonia over a period of 18 months, were studied. Clinical profile, blood culture, and outcome were evaluated as per predesigned pro forma. Statistical Analysis: Data were analyzed using the Chi-square test. Results: Most of the patients were infants (65.28%, n = 141) and males (58.8%, n = 127). Cough (98.15%, n = 212), fever (91.67%, n = 198), difficulty in breathing (76.39%, n = 165), and crepitations (97.22%, n = 210) were the most common clinical pictures. Blood culture positivity was 21.3% (n = 46), more in infants (24.8%, n = 35) as compared to 1–5 years of age. Staphylococcus aureus (39.13%, n = 18) was the most common organism, followed by Gram-negative bacilli (26.09%, n = 12). Lack of exclusive breastfeeding (33.3%, n = 72), incomplete immunization (54.2%, n = 117), exposure to smoke (6.02%, n = 13), and malnutrition (26.39%, n = 57) were significantly associated with severe pneumonia (P < 0.05). Bronchopneumonia seen as fluffy infiltrates was seen in 72.2% (n = 156). Bubble Continuous Positive Airway Pressure (CPAP) was provided in 26% (n = 52), ventilation 14% (n = 28), and change of antibiotics was done in 29.5% (n = 59). Mortality was 8.8% (n = 18). Conclusions: This study highlights increasing incidence of S. aureus as a causative organism, especially in infants. We recommend updating antibiotic guidelines and liberal use of CPAP for better outcome. Infancy, lack of exclusive breastfeeding, incomplete immunization, malnutrition, anemia, and exposure to smoke are key domains that should be addressed for decreasing severity of pneumonia and its better outcome.
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Acceptability of babies conceived through assisted reproductive technology among married women in University of Benin Teaching Hospital, Benin City, Nigeria Highly accessed article p. 162

DOI:10.4103/cjhr.cjhr_110_19  
Context: Infertility is a condition whereby a married woman is unable to get pregnant despite having frequent, unprotected sex for at least a year. This has been an area of medicine in which health care practitioners had limited means to help their patients. The landscape of this field changed dramatically with the announcement of birth through the use of Assisted Reproductive Technology (ART) by Louise Brown in 1978. This has given hope to millions of couples suffering from infertility; but it has also introduced countless social challenges like acceptability issues, which is a multi-faceted construct that reflects the extent to which people delivering or receiving intervention consider it to be appropriate. Acceptability of babies conceived through ART in developing countries is a major challenge to the effective use of ART among married women in the area. Aims: This study examined the acceptability of babies conceived through ART among women attending tertiary health facility. Setting and Design: A cross-sectional study was conducted on women who attended the University of Benin Teaching Hospital. Materials and Methods: The study was carried out among 348 women through a stratified probability sample technique, and a self-structured questionnaire with open-ended and Likert scale questions used as instrument was administered. Statistical Analysis Used: Data collected were analyzed using descriptive statistics, means, standard deviation and Linear regression at 0.05 level of significance, through Statistical Package for Social Sciences software. Results: Acceptability of babies conceived through ART had a mean of 3.23 (1.025). The result also revealed through linear regression of the relationship between acceptability of babies conceived through ART and religion, level of education, and cultural background to be 0.333, >0.001, and >0.001, respectively. Conclusion: The acceptability of babies conceived through ART among the participants is very low. Therefore, government should do more on fertility public enlightenment, all training schools should include it in their curriculum, and royal fathers should be sensitized to keep everybody abreast with the right knowledge about ART babies.
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Candidemia – Changing trends from Candida albicans to non-albicans Candida from a tertiary care center in western UP, India p. 167

DOI:10.4103/cjhr.cjhr_12_20  
Introduction: Candidemia is a major cause of morbidity and mortality in hospitalized patients, especially pediatric population, justifying the importance of adequate antifungal therapy. Immunocompromised patients, preterm neonates, elderly patients and patients admitted to intensive care units are at higher risk of invasive candidiasis infections. A shift has been observed in the relative frequency of non-albicans Candida (NAC) and Candida albicans in blood stream infections. Studies on the prevalence of infections and antifungal susceptibility testing can help with deciding on clinical strategies to manage this problem. Aims and Objectives: The following study was performed to find the prevalence of various Candida species causing candidemia and their resistant pattern in Aligarh region of western Uttar Pradesh. Materials and Methods: Two thousand and eighty-four samples for blood culture were received in the microbiology laboratory over a period of 5 months. Seventy-one positive samples for Candida were identified and tested for antifungal susceptibility testing by Vitek-2 (21) and conventional methods (50). Results: 3.41% of the blood culture were positive for Candida species. Candida tropicalis (35.21%) was the most common species isolated followed by Candida glabrata (21.13%), C. albicans (14.08%), Candida krusei (9.86%), Candida pelliculosa (9.86%), Candida parapsilosis (4.23%), Candida guilliermondii (4.23%), and Candida utilis (1.41%). Maximum percentage of isolates were from neonates (47.89%) followed by infants (25.35%). Resistance to fluconazole and amphotericin B was seen in 11.27% and 1.41% of isolates. Conclusion: NAC species outnumbering C. albicans even as single most common species in candidemia patient isolates is alarming. Fluconazole is generally used as empirical therapy. NAC being more resistant and some being intrinsically resistant (C. krusei) to fluconazole strengthens the need of antifungal susceptibility testing on priority basis.
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Morphometric analysis of the acromion process of the scapula p. 173
Ananya Priya, Anjali Jain
DOI:10.4103/cjhr.cjhr_127_19  
Context: This study was done to analyze the morphometric parameters of the acromion process of human scapulae. The knowledge of morphometry of acromion process is vital for orthopedic surgeons while performing surgeries like acromioplasty for the treatment of subacromial impingement syndrome and repair of rotator cuff tears. Aims: The aim was to study the morphometry of the acromion process of the scapula. Settings and Design: The study was conducted on 105 adult dry human scapulae of unknown age and sex. All damaged human scapulae were excluded from the present study. Subjects and Methods: Length, breadth, thickness of acromion process, coraco-acromial distance, and acromioglenoid distance were measured in millimeter using digital Vernier caliper. Statistical Analysis Used: Data were tabulated. Mean and standard deviation for each parameter were calculated using SPSS version 16.0. Results: The mean acromial length was 41.65 ± 7.57 mm, acromial width was 24.50 ± 2.91 mm, acromial thickness was 7.62 ± 1.34 mm, coracoacromial distance was 33.35 ± 6.12 mm, and acromioglenoid distance was 29.41 ± 4.65 mm. Conclusions: The data obtained in the current study can add to the knowledge that can aid in surgical procedures around the shoulder joint.
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Knowledge and attitude of emergency management of avulsed teeth among a sample of Indian parents in Vadodara, Gujarat p. 177

DOI:10.4103/cjhr.cjhr_48_19  
Background: Traumatic injuries are commonly seen in children and adolescents, affecting their teeth and supporting structures. The most severe form of traumatic injury is tooth avulsion which leads to major psychological and esthetic problems in children. The prognosis of avulsed teeth significantly depends on prompt and efficient action at the site of the accident, thus requiring that parents or caretakers be knowledgeable about the correct management of this situation. Aim: The objective of the present study was to assess the level of knowledge of parents and caretakers regarding the emergency management for tooth avulsion by the help of a questionnaire. Materials and Methods: The study included 1000 parents of children, aged between 6 years and 12 years, who were asked to fill the modified Ralph and Gregory questionnaire for avulsed teeth. Data were analyzed using SPSS software version 20.00, and descriptive statistics were used to compare the results. Results: Nearly 68.8% of the parents believed in self-replantation, but only 42% would attempt self-replantation themselves. Only 15.4% of the parents felt that replantation should be done immediately. Water and salt solution were the most accepted cleaning medium for avulsed teeth by majority of the parents (77.4%). Almost 92% of the parents were interested in saving the tooth and 2.5% of the parents had encountered previous dental avulsion injuries in children. Conclusion: The study shows a significant lack in knowledge among parents with regard to management of tooth avulsion. There is a definitive need to hold educational campaigns imparting knowledge regarding emergency management of tooth avulsion for parents.
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A study of aerobic and anaerobic bacterial profile along with In vitro antibiotic susceptibility pattern in cases of puerperal, postabortion sepsis in a Tertiary Care Hospital p. 182

DOI:10.4103/cjhr.cjhr_152_18  
Background: Puerperal pyrexia and sepsis are still among the leading causes of preventable maternal morbidity and mortality both in developing and developed countries. The study was aimed to determine the causative organisms, risk factors, and antibiotic susceptibility of the isolates of puerperal sepsis. Materials and Methods: A total of 52 clinically suspected cases of puerperal sepsis were included in this study. Collected blood and endocervical samples were inoculated in appropriate culture media and incubated both aerobic and anaerobically. The isolated organisms were identified by standard biochemical tests. Antimicrobial sensitivity testing was performed by as per the CLSI guidelines. Results and Observation: In the present study, among 52 patients, majority of women (61.53%) were between 20 and 25 years and uniparous (55.76%). The present study showed predominance of Gram-negative bacilli (82.69%) with 17.30% isolates being Gram-positive cocci. Klebsiella pneumoniae (28.84%) was the most frequent isolate pathogen followed by Escherichia coli (19.23%). Bacteremia was present in 27.03% of cases. Most of the organisms were resistant to commonly used antibiotics such as amoxicillin, ciprofloxacin, levofloxacin, and amikacin. Conclusion: In the prospect of changing the spectrum of pathogens of puerperal sepsis and their antibiotic susceptibility patterns from time to time, positive blood culture and the antibiotic susceptibility testing of the isolates are the best guides in choosing the appropriate antimicrobial therapy in the treatment of puerperal sepsis.
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The comparative study of antenatal magnetic resonance imaging and ultrasound in the evaluation of fetal central nervous system abnormalities p. 188

DOI:10.4103/cjhr.cjhr_52_20  
Background: The role of fetal magnetic resonance imaging (MRI) was studied in antenatal anomalies detected by ultrasound. Materials and Methods: The study was conducted in the Department of Radiodiagnosis and Imaging, Government Medical College, Srinagar, over a period of 12 months including all pregnant women with suspected fetal anomalies on ultrasonography (US). Results: In 9/23 cases (39.1%), the US findings and MRI findings were similar. MRI changed the diagnosis in 11/23 cases (47.8%). MRI provided additional information than US in 2/23 cases (8.69%), and there was 1/23 (4.3%) cases in which US provided additional information to that provided by MRI in terms of intrauterine growth restriction. Conclusions: US and MRI are complementary to each other in reaching a diagnosis in the fetal central nervous system abnormalities, and MRI is a major problem-solving modality where the US findings are inconclusive. The major role for fetal MRI was found in confirmation of inconclusive sonographic findings and the evaluation of sonographically occult diagnoses.
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Evaluation of burn sepsis with reference to platelet count as a prognostic indicator p. 193

DOI:10.4103/cjhr.cjhr_57_19  
Background: Burn is the oldest form of injury to inflict humankind, and infection is a major challenge in the management of burn patients and is a leading cause of morbidity and mortality. The onset of standard clinical indicators of sepsis is known to be delayed and is preceded by fall in platelet count. Thus, the declining platelet count in burn patients is useful prognostic indicator Aim: The following study is undertaken to examine the value of platelet count in predicting the development of sepsis and outcome. Settings and Designs: This was a retrospective study. Materials and Methods: The present study was conducted with eighty-four patients of burn. Routine investigation was done for all the patients. Total platelet count was calculated manually in 84 cases of burn patients. Results: A consistent correlation was noticed between the total platelet count, the presence of burn wound sepsis, and the final outcome. The Platelet count decreased initially in all cases of burn wound sepsis and later on got normal in those who survived while got more decreased in non survivors. Conclusion: Thus the declining platelet count in burn patients is useful prognostic indicator.
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Assessments of the level of adherence to antiretroviral therapy and the health status of people living with HIV in Calabar, Nigeria p. 197

DOI:10.4103/cjhr.cjhr_84_19  
Background: Medication adherence describes a patient's behavior of accurately following drug regimens; nonadherence describes a patient's inability to accurately follow drug regimens. Several factors such as psychosocial, educational, health-related, and environmental-related factors could contribute in determining the level of adherence to antiretroviral drug. This was a study to assess the level of adherence antiretroviral combination therapy and the health status of people living with HIV in Calabar, Nigeria. Materials and Methods: Questionnaires were administered to 350 HIV persons who attended antiretroviral treatment (ART) clinic to obtain their sociodemographic data, knowledge of ART, service received, and drug history. Stool samples were collected and examined using direct microscopy, formol–ether concentration technique, and modified Ziehl–Neelsen technique for enteric parasites, whereas blood samples were collected for HIV status examination using serial HIV testing algorithm, hemoglobin levels using cyanmethemoglobin method, and counting of CD4 using Partec CyFlow counter. Results: The results showed that 79.43% (278/350) of the participants adhered to antiretroviral drugs, with most of them (47.84%, 133/278) having CD4 counts between 201 and 400 cell/μl. Stigma was the major reason for nonadherence to treatment. Those who adhered to therapy had a lower infection rate and an elevated mean hemoglobin level than those who did not adhere. Conclusion: There was also an elevated hemoglobin level, lower enteric parasite infections, and an improved CD4 count among the adherents than those who did not adhere.
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Parental knowledge and attitude toward pit and fissure sealants and fluoride therapy in children: A questionnaire study p. 202

DOI:10.4103/cjhr.cjhr_121_19  
Background: To increase the utilization of preventive dental care in the children, it is essential to improve the knowledge and attitude of parents about such cares. Prevention at primary level is of great value in Pediatric dentistry. Aim: The aim of the study was to evaluate the knowledge and attitude of parents toward fissure sealant and professional fluoride therapy. Methods and Material: In the present study, parents of children aged 7-12 years (n=80) were selected. A validated and reliable questionnaire was designed including demographic section, questions about parent's knowledge and attitude about fissure sealant and professional fluoride therapy. Data were analyzed by Chi-square test. Results: Majority of the parents had low level of knowledge about fissure sealant and fluoride therapy (68.8%). There was significant higher knowledge and attitude in academically educated parents (30%). Parents from urban area showed positive attitude (27.5%). Conclusion: In the present study, majority of the parents had low level of knowledge regarding preventive care. Knowledge acquired through dentists, mass media consultations and school dental program might be effective in improving the knowledge and attitude of parents.
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To investigate the effect of age and body mass index on blood pressure in menopausal and premenopausal women p. 206

DOI:10.4103/cjhr.cjhr_88_19  
Objectives: The objective of the study is to examine the effect of age and body mass index (BMI) on blood pressure (BP) in menopausal and premenopausal women. Methods: Five hundred and thirty women between the age groups of 35 and 60 years were taken. The association between BMI and BP was measured using simple linear regression. Student's t-test was used for intragroup comparison. Results: Systolic BP (P = 0.008) and diastolic BP (P = 0.004) were slightly but significantly higher in menopausal women as compared to premenopausal women. Obesity was found to be more in menopausal women than premenopausal women (P < 0.01). Conclusion: It can be concluded that higher BMI and age lead to higher BP in menopausal women.
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Assessment of birth satisfaction among the women attending the immunization clinics in South Delhi: A cross-sectional study p. 212

DOI:10.4103/cjhr.cjhr_142_18  
Background: A woman's satisfaction with childbirth services can have a significant impact on her mental health and ability to bond with her neonate. Indian women's satisfaction with childbirth services has been explored qualitatively, or by using nonstandard local questionnaires, but quantitative data gathered with standardized questionnaires are extremely limited Objective: The aim of this study is to assess the birth satisfaction level among women of South Delhi with institutional normal vaginal delivery and to determine the factors associated with it. Materials and Methods: A cross-sectional study was conducted among the 102 mothers attending the immunization clinics of a primary care and a tertiary care center in South Delhi during March 2018–April 2018. A prevalidated, semi-structured, Hindi version 36-item Scale, with 10 domains, Scale for Measuring Maternal Satisfaction in normal birth was used. Statistical Analysis: Pearson Chi-square, Mann–Whitney test, and Fisher's exact test were applied as tests of significance. Results: The median age in completed years of the respondents was 24 years (interquartile range = 5). Majority, 58 (61.1%), of the participants, were more satisfied. Bribes were asked from 61.1% of the mothers. Demanding bribes, perceived competence of healthcare providers by the mothers, and the motivation given by others were significantly associated with the individual domains of birth satisfaction such as postpartum care satisfaction and overall support received. No significant association between the sociodemographic, birth time events and overall birth satisfaction levels was obtained. Conclusion: About 38.9% less satisfied mothers and the domain-specific associated factors give the scope for the areas to be worked on to improve the quality of maternal and patient-centric services. Hospitals should publicly declare and implement zero tolerance for bribes in the care of mothers.
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A cross-sectional study on the preponderance of stress and depression among medical students and their association with various recent factors p. 219

DOI:10.4103/cjhr.cjhr_80_19  
Background: Stress and depression among medical students are the prevalent and global concern these days. Stress is a critical risk factor for depression as it can contribute to depression through various pathways. Stress is multifactorial in causation which can be associated or attributable to depression. Aims: The aim of this study is to evaluate and elicit the levels of stress and depression in association with various recent factors, accounting and resulting to stress and depression. Subjects and Methods: This is a cross-sectional study conducted among medical students of a well-recognized medical college. Analysis sheets consisting of Beck's Depression Inventory (BDI), Perceived Stress Scale (PSS), and other criteria comprising demographic details such as gender, age, year of studying and some associated factors which include appetite, gastrointestinal (GI) problem, sleep, social feelings, body mass index (BMI), and hair fall adding to stress and depression were made to fill by 288 medical students of a medical college. Results: Majority of the study participants have moderate-or-high levels of stress but no depression. Nearly 46.5% of the study participants have normal values of BMI, and 42.7% are over the levels of their normal BMI. Nearly 59.7% of the total students have hair fall, 76.7% have normal sleep-wake cycle, 77.4% have normal social feelings, 75.6% have normal appetite, and 84.7% do not have any GI problems. When the relation between stress and these study variables was observed, the association between BMI and hair fall was found to be significant. Conclusions: First-year students feel more stressed that could be due to their recent entry into the course. Female students are more prone to these stressors and depressors. Juniors are more stressed when compared to senior students.
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A community-based study on modifiable risk factors of hypertension among Adults of rural Bengal, India p. 223

DOI:10.4103/cjhr.cjhr_101_19  
Background: Chronic noncommunicable diseases such as hypertension (HTN) are emerging as a major health problem in India with increasing prevalence significantly in both urban and rural population. This is largely due to preventable and modifiable risk factors such as physical inactivity, unhealthy diet, obesity, tobacco, and inappropriate use of alcohol. Objectives: This study aimed to find the prevalence and risk factors of HTN and its association with HTN among the study population, if any. Materials and Methods: A community-based study was conducted among 651 adults (age 20 years and above) in rural communities of Singur, West Bengal. Blood pressure measurement and information regarding sociodemography, behavioral risk factors, and family history of HTN were collected using a predesigned pretested schedule. Data were presented in appropriate tables, and the significance of association was analyzed with P < 0.05 as statistically significant; all statistical analysis was done in SPSS version 19.0. Results: The overall prevalence of HTN was 26.1% (male: 21.8% and female: 29.9%). The prevalence increased with increase in age group. Muslim religion, less education, tobacco usage, obesity, and sedentary lifestyles were found to be significantly associated with HTN. The association between different modifiable risk factors with HTN was found statistically significant (P < 0.05). Conclusion: The prevalence of HTN in the rural population was found to be on the higher side compared to previous reports from India. The modifiable risk factors of HTN in rural communities were found to be increased indicating implementation of strong public health measures to combat HTN and its consequences.
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Factors associated with extubation failure in the intensive care unit patients after spontaneous breathing trial p. 230

DOI:10.4103/cjhr.cjhr_39_19  
Introduction: Extubation failure is associated with high mortality and poor outcome of patients. Aims: This study was conducted to assess the factors associated with extubation failure in the intensive care unit (ICU) patients planned for extubation. Settings and Design: It was a prospective observation study conducted in all patients aged >18 years admitted in the ICU of a tertiary care hospital. Subjects and Methods: It was done on 108 patients who were planned for extubation. Patients were assessed by an intensivist clinically and decided whether a patient can be extubated on clinical grounds. Spontaneous breathing trial (SBT) was done for 2 h by T-piece in patients who met clinical and objective criteria. Arterial blood gas (ABG) was done in all patients who successfully completed SBT. Patients with successful SBT and acceptable ABG were extubated. Patients were observed for 48 h for extubation failure, and the reason for reintubation was recorded. Statistical Analysis Used: Independent Student's t-test and Chi-square test were used for data analysis. Results: Of 108 patients who passed the SBT, 96 (88.88%) patients had acceptable ABG and were extubated. 85 (88%) underwent successful extubation and 11 (12%) underwent unsuccessful extubation. Duration of mechanical ventilation (MV) and chronic obstructive airway disease was a risk factor associated with extubation failure. Conclusion: Duration of MV of >2 days and chronic obstructive pulmonary disease were identified as independent risk factors for extubation failure.
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