Different treatment options are available for subclavian stenosis (SS). Carotid to subclavian bypass surgery (CSBS) is an increasingly used effective treatment strategy when stenting is impossible. However, in Nepal, little is known about SS and its management. A 58-year-old man with a history of aortic valve replacement surgery complained of progressive left arm weakness for the past 6 months associated with pain on exertion and blood pressure discrepancies in both arms. A computed tomographic scan confirmed near-complete subclavian artery stenosis and a Doppler ultrasound showed decreased blood flow and systolic velocity. CSBS was selected as stenting was not feasible. Post-CSBS, all hemodynamic parameters returned to normal, lasting even after 2 years. CSBS appears to be a viable, safe, and promising treatment for symptomatic SS. However, additional studies need to be conducted to analyze the benefits of CSBS relative to other interventions.
Objective: To explore the effect of ADOPT (Attitude, Definition, Open mind, Planning, Try it out) nursing intervention mode on the living habit compliance, self-monitoring compliance and quality of life of kidney transplant patients in 1-3 years after surgery.
Methods: From December 2020 to August 2021, 48 patients in 1-3 years after kidney transplantation who met the inclusion and exclusion criteria and were regularly followed up in the Kidney Transplantation Clinic of the Department of Urology Surgery in Baogang Hospital were selected as the research subjects, and 48 kidney transplant patients were divided into the intervention group and the control group by simple random sampling. The control group was given routine nursing care in the Kidney Transplantation Clinic of the Department of Urology Surgery, and the intervention group was given nursing care measures formulated on the basis of ADOPT nursing intervention mode. The compliance and quality of life of the two groups were compared with the Kidney Transplant Patient Compliance Scale and the Kidney Transplant Patient Quality of Life Related Rating Scale in 1-3 years after surgery.
Results: After 2 months and 4 months of intervention, the scores of living habit compliance and self-monitoring compliance in the intervention group were significantly higher than those in the control group (p <.001), and the scores of quality of life in the intervention group and the total score of quality of life were better than those in the control group, and the difference was statistically significant (p <.001).
Conclusions: The implementation of the ADOPT nursing intervention mode for kidney transplant patients in 1-3 years after surgery can improve their compliance level and enhance the quality of life, which is worthy of reference.
Objective: To explore the application effect of improved Beck oral score in oral care of burn patients with mechanical ventilation, to provide practical basis for oral care of such patients.
Methods: A total of 42 patients with tracheotomy and mechanical ventilation in the Department of Burn Surgery of Baogang Hospital in Inner Mongolia from January 2021 to December 2022 were selected as the study objects, and the patients were randomly divided into observation group and control group, with 21 cases in each group. The control group was given routine oral care, and the observation group was given oral care according to improved Beck oral score. The following were compared between the two groups: Age, total burn area, third-degree burn area, acute physiological and chronic health assessment scores, as well as improved Beck oral scores; the incidence of oral odor, plaque index, mouth ulcer and ventilator-associated pneumonia (VAP) after 7 days; the detection of microorganism in oral secretions.
Results: After 7 days, the oral condition of patients in observation group was effectively improved, and the oral comfort level was significantly improved. The incidence of oral odor (2.57±1.59), dental plaque index (2.62±1.47), oral ulcer evaluation (2.24±1.09), VAP incidence (9.52%) and improved Beck oral score (8.09±1.92) in observation group were all lower than those in control group, which was (3.95±1.82), (3.57±1.21), (3.14±1.24), (38.09%), and (9.90±2.21) respectively. The difference was statistically significant (p <.05). The oral normal florain observation group (71.43%) was higher than that in control group (28.57%), and the difference was statistically significant (p <.05). The oral gram-positive bacteria (19.05%) and Gram-negative bacteria (23.81%) in observation group were lower than those in control group, which was 52.38% and 57.14% respectively, and the difference was statistically significant (p <.05).
Conclusions: The application of the improved Beck oral assessment method in dynamic oral care can effectively reduce the content of oral pathogens, lower the incidence of pulmonary infection, and improve the quality of life of patients.
Aim: To provide suggestions for clinical diagnosis, treatment and eugenics through the retrospective analysis of a case of neonatal machete syndrome.
Methods: The clinical data of a newborn with machete syndrome admitted to the pediatrics department of Baogang Hospital of Inner Mongolia were analyzed, and suggestions of eugenics were provided based on the literatures.
Results: The child, male, natural conception, G2P2, gestational age 38+4 weeks, was born by cesarean section (at am 09:24 on November 13th, 2021). He was hospitalized in our department for 9 days and given NCPAP positive pressure ventilation to give oxygen and anti-infection symptomatic treatment. The dyspnea of the child was not significantly alleviated, and the heart murmurs became increasingly obvious. The child was transferred to the neonatology Department of the Seventh Medical Center of the PLA General Hospital for further treatment on 9 days afterbirth. After admission, piperacillin and tazobactam were treated with anti-infection, high-frequency oscillation mode of invasive ventilator, limited fluid volume and other symptomatic treatments. Fiberbronchoscopy showed atelectasis of right lung and tracheomalacia of left lung. Echocardiography showed partial anomalous pulmonary venous drainage, atrial septal defect (secondary foramina), inferior vena cava dilatation, pulmonary hypertension, initial coronary artery dilatation, and patent ductus arteriosus. CT 3D imaging of pulmonary veins showed: Congenital heart disease: partial anomalous pulmonary venous drainage (subcardial),consideration of “machete syndrome,” atrial septal defect, consideration of pulmonary hypertension, right pulmonary artery stenosis, right lower lung receiving abdominal aorta blood supply, right lung tissue dysplasia, and widening of inferior vena cava pulmonary veins. Therefore, the comprehensive diagnosis was “machete syndrome.” Considering the high surgical risk of the child, conservative symptomatic treatment was recommended, and the family requested discharge after 22 days of treatment. The patient died at home at 3 months follow-up after discharge.
Conclusions: Machete syndrome is a rare congenital property of abnormal partial or complete pulmonary venous drainage from the right or left lung to the inferior vena cava. With an incidence of approximately 2 in 100,000 live births, the syndrome is commonly associated with right lung dysplasia, pulmonary sequestration, persistent left superior vena cava, and right tilt of the heart. In this case, the child had these syndromes afterbirth, since the primary hospital did not recognize the disease, the child was clearly diagnosed in the higher hospital. Children with machete syndrome can be treated with surgery in the early neonatal period, but the indication of surgical treatment is still controversial, and the need for surgery is evaluated according to the severity of the patient’s symptoms and pulmonary circulation blood flow.