Accuracy of point­of­care ultrasonography in the diagnosis of necrotizing fasciitis: A case report.

Necrotizing fasciitis is a serious infectious condition that may compromise the patient's life. In the present case study, a 42-year-old male patient was reported. The condition manifested as the presence of subjective fever, general malaise, myalgia, non-productive cough, dysphagia and neck pain ~1 week prior to hospital admission. Vascular dissection was considered as the initial diagnostic suspicion, and thus, angiotomography of neck vessels was performed, ruling out aortic and neck vessel dissection. Radiology indicated negativity for aortic syndrome and cervical vascular disease, but the presence of cervical-mediastinal edema, lamellar fluid between muscular and fatty planes and posterior pulmonary atelectasis, absence of pleural fluid or consolidations, and tonsillar hypertrophy without abscesses. Due to the rapid evolution of the condition, the presence of dyspnea with the need for supplemental oxygen, and the disproportion between the intensity of the pain described by the patient and the external findings observed, the presence of necrotizing fasciitis was considered. Point-of-care ultrasonography was performed, indicating a cobblestone pattern of the subcutaneous cellular tissue, with diffuse thickening of the anterior cervical fascia and increased echogenicity with soft tissue edema posterior to the fascia. Magnetic resonance imaging confirmed the inflammatory findings in the fascia and other cervical soft tissues, without exhibiting any signs of necrosis, but with the presence of abscesses in the visceral and carotid space.

Automated landmark identification on cone-beam computed tomography: Accuracy and reliability.

OBJECTIVES: To evaluate the accuracy and reliability of a fully automated landmark identification (ALI) system as a tool for automatic landmark location compared with human judges. MATERIALS AND METHODS: A total of 100 cone-beam computed tomography (CBCT) images were collected. After the calibration procedure, two human judges identified 53 landmarks in the x, y, and z coordinate planes on CBCTs using Checkpoint Software (Stratovan Corporation, Davis, Calif). The ground truth was created by averaging landmark coordinates identified by two human judges for each landmark. To evaluate the accuracy of ALI, the mean absolute error (mm) at the x, y, and z coordinates and mean error distance (mm) between the human landmark identification and the ALI were determined, and a successful detection rate was calculated. RESULTS: Overall, the ALI system was as successful at landmarking as the human judges. The ALI's mean absolute error for all coordinates was 1.57 mm on average. Across all three coordinate planes, 94% of the landmarks had a mean absolute error of less than 3 mm. The mean error distance for all 53 landmarks was 3.19 ± 2.6 mm. When applied to 53 landmarks on 100 CBCTs, the ALI system showed a 75% success rate in detecting landmarks within a 4-mm error distance range. CONCLUSIONS: Overall, ALI showed clinically acceptable mean error distances except for a few landmarks. The ALI was more precise than humans when identifying landmarks on the same image at different times. This study demonstrates the promise of ALI in aiding orthodontists with landmark identifications on CBCTs.

Dehospitalisation at a general hospital in Minas Gerais: challenges and prospects. / A desospitalização em um hospital público geral de Minas Gerais: desafios e possibilidades.

OBJECTIVE: To analyse the dehospitalisation process at a general public hospital in Minas Gerais, Brazil, from the perspective of managers, health workers, users and their families. METHODS: This is a qualitative, exploratory, descriptive study based on the principles of methodological and theoretical dialectics. The participants were 24 hospital health workers and 15 companions of users going through the process of dehospitalisation. Data were collected from April to June 2015 using semi-structured interviews and a field journal records and subsequently subjected to content analysis. RESULTS: Analysis of the empirical material led to the construction of the following categories: Dehospitalisation: viewpoint of the institution and Family organisation for the dehospitalisation process. CONCLUSION: The study reveals a deficiency in the implementation, systematisation, internal reorganisation and continuity of care after dehospitalisation. Current dehospitalisation strategies do not favour comprehensiveness and continuity of home care.

A desospitalização em um hospital público geral de Minas Gerais: desafios e possibilidades / Desinstitucionalización en un hospital general público de Minas Gerais: retos y posibilidades / Dehospitalisation at a general hospital in Minas Gerais: challenges and prospects

Resumo OBJETIVO Analisar o processo de desospitalização em um hospital público geral de Minas Gerais na perspectiva dos diretores, dos profissionais de saúde e dos familiares. MÉTODO Estudo descritivo e exploratório, utilizando a abordagem qualitativa, com orientação teórico-metodológica da dialética. Participaram do estudo 24 profissionais de saúde e 15 familiares de usuários em processo de desospitalização. A coleta de dados ocorreu entre os meses de abril a junho em 2015, com entrevistas semiestruturadas e registros em diário de campo. Os dados foram submetidos à análise de conteúdo temática. RESULTADOS A análise do material empírico permitu a construção das categorias: Desospitalização: perspectiva da instituição e Organização da família para o processo de desospitalização. CONCLUSÃO Existem fragilidades no processo que envolve questões de implementação, sistematização, reorganização interna e continuidade após a desospitalização. Assim, as estratégias utilizadas para a desospitalização têm sido insuficientes para favorecer a integralidade e a continuidade do cuidado no domicílio.

Resumen OBJETIVO Analizar el proceso de desinstitucionalización de un hospital general público de Minas Gerais desde la perspectiva de los gestores, de los profesionales de la salud y de los familiares. MÉTODOS Estudio descriptivo y exploratorio de enfoque cualitativo con orientación teórico- metodológica de la dialéctica. Participaron 24 profesionales de la salud y 15 familiares de usuarios en proceso de desinstitucionalización. La recogida de datos se llevó a cabo entre abril y junio de 2015 con entrevistas semiestructuradas y registros en el diario de campo . Los datos recogidos fueron sometidos a análisis de contenido temático. RESULTADOS El análisis de los materiales empíricos permitu la construcción de categorías: la desinstitucionalización: Perspectiva institución y organización de la familia al proceso de desinstitucionalización. CONCLUSIÓN Se concluye que en el procesohay fragilidades que involucran cuestiones de implementación, sistematización, reorganización interna y continuidad después de la desinstitucionalización. Las estrategias empleadas para la desinstitucionalización no han sido suficientes para promover la integralidad y continuidad de los cuidados domiciliarios.

Abstract OBJECTIVE To analyse the dehospitalisation process at a general public hospital in Minas Gerais, Brazil, from the perspective of managers, health workers, users and their families. METHODS This is a qualitative, exploratory, descriptive study based on the principles of methodological and theoretical dialectics. The participants were 24 hospital health workers and 15 companions of users going through the process of dehospitalisation. Data were collected from April to June 2015 using semi-structured interviews and a field journal records and subsequently subjected to content analysis. RESULTS Analysis of the empirical material led to the construction of the following categories: Dehospitalisation: viewpoint of the institution and Family organisation for the dehospitalisation process. CONCLUSION The study reveals a deficiency in the implementation, systematisation, internal reorganisation and continuity of care after dehospitalisation. Current dehospitalisation strategies do not favour comprehensiveness and continuity of home care.

A desospitalização de um hospital público geral de Minas Gerais: início da atenção domiciliar / Process of de-hospitalization at a public hospital in the state of Minas Gerais: the beginnings of home care

O objetivo geral deste estudo foi analisar o processo de desospitalização em um hospital público geral de Minas Gerais - MG na perspectiva de diretores,profissionais de saúde, usuário e sua família. Trata-se de estudo descritivo exploratório,utilizando a abordagem qualitativa, com orientação teórica metodológica da dialética. Os participantes: dois diretores, 10 enfermeiros, dois assistentes sociais, oito médicos e dois coordenadores da linha de cuidado vinculados à assistência na clínica médica em hospital público de ensino de médio porte em Belo Horizonte - BH. Os diretores foram entrevistados para verificar a política e as estratégias que o hospital utiliza para a desospitalização e como é a relação deste com a Rede de Atenção à Saúde (RAS). Os enfermeiros, assistentes sociais e médicos são responsáveis pelo processo dedesospitalização e foram entrevistados para identificar como se aplicam os mecanismos de desospitalização existentes no hospital. Também foram participantes 15 familiares de usuários em processo de desospitalização com a indicação para a continuidade do cuidado no Serviço de Atenção Domiciliar (SAD)em BH. Esses familiares foram entrevistados para identificar os atravessamentose potencialidades no processo de desospitalização. O trabalho de campo iniciou-se em 2015 na clínica médica do hospital, que recebe usuários provenientes da clínica cirúrgica, neurológica e pronto-socorro. Os dados foram coletados pelo pesquisador por meio de entrevista com auxílio de um roteiro semiestruturado, audiogravada, permitindo a identificação das interpretações emitidas sobre adesospitalização e a expectativa do cuidado no domicílio. No diário de campo foram registradas as observações após o trabalho de campo. A análise dos dados foi sustentada pela análise de conteúdo temática na perspectiva...

The aim of the present study was to analyse the process of de-hospitalization at apublic general hospital in the state of Minas Gerais from the perspective of managers, health professionals, service users and their families. This is a descriptive exploratory qualitative study using a dialectical methodology. Study participants were two directors, ten nurses, two social workers, eight doctors and two health care coordinators working at the clinical care unit of a public medium sized teaching hospital in the city of Belo Horizonte. Interviews to directors aimedat identifying the hospital’s policies and strategies for de-hospitalization and their relationship with the Health Care System (RAS). Nurses, social workers and doctors are responsible for the process and the interviews carried out with them aimed at recognising how existing de-hospitalization procedures were applied. Fifteen relatives of users in the process of being de-hospitalized and referred to take part in a continuity of care programme through the Home Care Service (SAD) also participated in the study. The objective of the interviews with this group was to assess both the obstacles to the process of de-hospital...

Implante glúteo em posição intramuscular parcial: relato de caso / Gluteal implant in partial intramuscular position: case report

Introdução: O conceito de beleza feminina tem mudado ao longo dos anos, porém a formae o tamanho das mamas e nádegas permanecem como símbolos de máxima feminilidade. Aexposição corporal, especialmente da região glútea, tem proporcionado aumento da procurapela cirurgia de gluteoplastia de aumento com utilização de implantes de silicone. Objetivo:O propósito deste relato de caso é mostrar a importância do descolamento intramuscularde forma correta. Relato do caso: Paciente de sexo feminino, operada em outro serviço,submetida a gluteoplastia de aumento com uso de implante de silicone, evoluindo no pósoperatóriocom implante palpável e visível. Foi realizada capsulorrafia da loja intramuscularparcial, confecção de uma nova loja totalmente intramuscular, com utilização da técnica XYZe troca do implante de silicone. Conclusão: A técnica intramuscular XYZ proporciona resultadosseguros e naturais. Porém, é importante a realização do descolamento inteiramente nointerior do músculo glúteo máximo para evitar complicações do posicionamento do implanteno plano subcutâneo, como contratura capsular, assimetria, extrusões e próteses aparentes.

Introduction: The concept of female beauty has changed throught-out time, but the formand size of the breasts and gluteal region have remained constant as symbols of maximumfemininity. The body expositions, especially on the gluteal area have developed an increaseof seek for buttocks surgery with silicone implants. Objective: The purpose of this casereport is to demonstrate the importance to make the correct intramuscular undermining. Casereport: Female underwent gluteal augmentation with a silicon implant at another service,followed after the surgery with implant visible and palpable. We brought the anterior andposterior aspects of the partial intramuscular compartment, create a new intramuscularcompartment using the XYZ method and change the implant. Conclusion: The XYZ intramuscularmethod produces safe and natural results. However, is very important the correctintramuscular undermining to avoid the subcutaneous plane complications: capsular contracture,asymmetry, dislodgements and perceptible implant.