Case for diagnosis

Ostraceous psoriasis is a rare form of psoriasis, characterized by lesions with firmly adhered thick scales, in various colors, with surfaces resembling oysters shells. The protracted course of clinical presentation allied with peculiar lesions and histopathological examination permit the diagnosis. Lesions are usually resistant to topical medications, requiring systemic treatment. It is important that dermatologists are able to diagnose the unusual forms of psoriasis to avoid iatrogeny. We report the case of a patient with ostraceous psoriasis treated with methotrexate.

Ectopic cutaneous schistosomiasis - Case report

Schistosomiasis is best known in its visceral form but it can attack the skin, its ectopic cutaneous manifestation being rare and clinically difficult to diagnose. It is characterized by isolated or coalescent papules, erythematous, pruritic or asymptomatic, with zosteriform distribution, often located on the trunk. The authors report a case of a 28-year-old female patient with lesions on the abdomen, with positive stool results for Schistosoma and absence of active symptoms of visceral disease. The case reveals rare exuberant cutaneous manifestation and the importance of the diagnosis of this entity in patients from endemic regions.

Avaliação da trajetória, no SUS, de pacientes atendidos na clínica cirúrgica de um serviço de emergência a partir de seus diagnósticos histopatológicos / Evaluation of patient´s rout aided on surgical clinic of an emergency service on SUS after their histopathologic diagnostics

Assim como na maioria dos serviços de emergência do Brasil, a Unidade de Emergência Dr. Armando Lages, principal hospital com este perfil de Alagoas, tem seu potencial limitado pelas lacunas no planejamento e na execução da Atenção Básica. A rede básica de atenção à saúde deveria constituir a principal porta de entrada no sistema. Afirma-se que na Atenção Básica 80% dos problemas de saúde da população sejam resolvidos. O que se verifica, contudo, é o escamoteamento de suas atribuições e potencialidades. Define-se que a Saúde da Família (SF) deve constituir equipes de saúde formadas por médicos, enfermeiros, auxiliares de enfermagem e agentes comunitários, em trabalho interdisciplinar com a definição de um território de abrangência. O processo de referência e contra-referência é imprescindível para que haja uma continuidade das ações e compete ao serviço municipal definir, no âmbito municipal ou regional, os serviços disponíveis para os níveis de maior complexidade. A SF deverá, portanto, em condições especiais, indicar o encaminhamento para consultas especializadas, assim como para os serviços de diagnóstico e internações hospitalares. Na prática, porém, os serviços de atenção terciária acabam absorvendo a demanda proveniente de problemas na rede básica. É o caso da Unidade de Emergência Dr. Armando Lages, na qual, mensalmente, a taxa de ocupação dos leitos é de 109,34%, absorvendo pacientes que não encontram outra referência para solucionar seus problemas de saúde. Obedecendo às normas que regem a Pesquisa em Seres Humanos, foi desenvolvido um estudo descritivo retrospectivo e prospectivo, aplicando-se questionário de perguntas estruturadas a pacientes da clínica cirúrgica da Unidade de Emergência Dr. Armando Lages que tiveram diagnósticos histopatológicos das peças cirúrgicas efetuados no período de janeiro de 2004 a dezembro de 2006. A análise dos dados revelou que, na trajetória dos pacientes pelo Sistema Único de Saúde, princípios doutrinários e organizativos do SUS estão desordenados, confirmando a hipótese do estudo, de que o número evidente de diagnósticos histopatológicos de neoplasias malignas e doenças infecto-parasitárias sugere falhas no planejamento em saúde da rede de Atenção Primária á Saúde.

Like most of the emergency services in Brazil, Dr.Armando Lages Emergency Unit, the main kind of hospital on its profile has its potential limited due to planning and execution weaknesses in basic healthcare. The basic healthcare network should be the health system?s main point.. It is stated that in basic care, 80% of the population?s health problems should be resolved. However, in real situation we can see a retraction in its attributions and potential. The definition of the Family Health Program (Brazilian acronym - PSF) states that there must be composed by health teams formed by doctors, nurses, nursing assistants and communitarian representatives composing an interdisciplinary working environment. The team must work within a defined area of coverage. The reference and contra-reference process is indispensable to enable the continuity of activities and the municipal service must define the available services for the most complex levels on a municipal and regional basis. The Family Health Program must therefore, coordinate appointments with specialists, diagnosis services and hospital admissions. Actually, the practical routine, however, the tertiary care services end up absorbing the demand originating from the shortcomings in the basic network. This is the case at Dr. Armando Lages Emergency Unit, where monthly the bed occupation rate is 109.34%, as patients who could not find other means to solve their health problems are absorbed.Aretrospective and prospective descriptive study was developed following the rules which conduct research in Human Beings, by applying a questionnaire of structured questions to patients in the surgical clinic at the Dr. Armando Lages Emergency Unit who had hystopatological diagnosises of surgical or biopsy parts, carried out in the period between January 2004 to December 2006. The data analysis revealed that in the trajectory of patients in the National Health System (SUS), the doctrinaire and organizational principles of SUS are disorderly, confirming in the case under study, that the evident number of hystopatological diagnosises of malign neoplasias and infected-parasitic diseases suggest that there are shortcomings in the health planning of the primary care network.