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Introduction: Psoriasis is a common, chronic, and inflammatory skin disorder with a high personal, social and economic burden and important implications for healthcare systems. The aim of this study was to provide an epidemiological characterization of individuals with psoriasis in Portugal. Material and Methods: A large observational, cross-sectional, nationwide, population-based survey study developed by the Portuguese Psoriasis Group of the Portuguese Society of Dermatology and Venereology (GPP-SPDV). A structured questionnaire was designed and applied by experienced interviewers to a random, representative sample of Portuguese individuals with psoriasis and/or psoriatic arthritis. Patients were considered to have psoriasis if they replied positively to one of the following questions: “Does any physician have ever diagnosed you with psoriasis?” or “Do you have a skin disorder characterized by scaling, reddish skin lesions located in the elbows/knees/scalp?”. Results: A total of 6381 individuals were interviewed, of which 283 met the criteria for psoriasis, corresponding to a prevalence rate of 4.4% (95% CI 3.95 – 4.98). Out of the participants that met psoriasis criteria, 24% had suggestive signs/symptoms but did not have a clinical diagnosis established and were not being monitored by a physician. Although more than 70% of participants had active disease (scaling, erythema, or pruritus) and one third had joint symptoms, only 12% were on systemic treatment. Fifty percent of participants with psoriasis (n = 139) had relevant comorbidities (most frequently depression/anxiety and cardiometabolic diseases). Sixteen percent of participants with psoriasis (n = 46) reported that psoriasis interfered with their daily activities (median impact of 5 in a 0 – 10 scale) and 12% mentioned the disease had an impact in their sexual life (median impact of 5 in a 0 – 10 scale). Conclusion: The results of this study suggest that the prevalence rate of psoriasis is likely to be high in Portugal, and several gaps exist at different levels of healthcare delivery to these patients, from diagnosis to treatment. This study provides important data for the future planning of interventions targeting the improvement of psoriasis care in Portugal.

Keywords: Biological Agents; Biosimilar Pharmaceuticals; Portugal; Psoriasis/drug therapy.

We report on a female patient who presented failure to thrive, laryngotracheomalacia, conductive deafness and facial dysmorphisms. A skeletal survey revealed thickening of the cranial vault, linear striations in the diametaphyses of all long bones and fan-like striations of the iliac bones. CT scan of the temporal bone showed thickening of the cranial base, sclerotic mastoids, abnormal ossicular fixation and stenosis of the otic foramina. The radiological findings led to the diagnosis of Osteopathia Striata with Cranial Sclerosis. A mutation in WTX gene confirmed the clinical and radiological diagnosis of Osteopathia Striata with Cranial Sclerosis in this patient and allowed proper genetic counseling and providing prenatal diagnosis.

Orbital vascular lesions represent an important group of orbital pathology, because of their high prevalence, particularly in the pediatric population. They are also the most controversial group of lesions, due to the polemics in regard to their nature. Based on cases of their experience, the authors analyze the orbital vascular pathology, especially its clinical and imagiological characteristics, important to the diagnosis.

Parkinson's disease is a progressive degenerative disease of the central nervous system frequently becoming motor disabling. Deep brain stimulation is one more therapeutic option. The authors describe the different steps of this therapeutic procedure with detail on imaging protocol to the precise and exact targeting of subthalamic nucleus. MR and CT imaging on stereotactic conditions are the imaging support to the determination of the anatomic target allowing also the choose of trajectory for the surgical procedure. Neurophysiologic exploration and clinical evaluation during the surgery give us the functional target. Deep brain stimulation has been revealing as a safe and effective therapy on some cases of Parkinson's disease with a significant improvement on quality of life of those patients. The brain imaging is a fundamental tool on target determination.

The purpose of this study was to determine the safety and efficacy in the first sixteen patients operated by endoscopic third ventriculostomy for triventricular obstructive hydrocephalus in the Hospital of S. João-Porto.Operated from December 1998 to December 1999, there were one adult, one teenager and 14 children, with a average age of 18 months in the paediatric group. The three major causes for the changed CSF dynamics in this 16 patients were: three had aqueductal congenital stenosis; nine had aqueductal acquired obstruction (three with post-infectious occlusion, three with tumours, two with intraventricular cysts and one with a pineal arteriovenous malformation), and four with obstruction of the basal arachnoidal cisterns associated with myelomeningocele.The endoscopic third ventriculostomy (ETV) was concluded in 15 of the selected cases (it was not possible in a new-born with hydrocephalus after bacterial meningitis), and it was repeated in two patients. The success rate (clinical efficacy of the procedure) was 9/15 (60%), and the mean follow-up was 9.1 months (range from three to 15 months).ETV is a efficient method in the treatment of non-communicant hydrocephalus. The safety and low-time consuming of this technique, avoiding the shunt disease, makes it desirable specially in paediatrics patients, or even in the case of different cases of hydrocephalus were some obstructive factor could be identified. So, some patients with a previous shunt or with a diagnosis of myelomeningocele, can benefit with this procedure.

Poor outcome and rebleeding, after admission to hospital of patients with spontaneous subarachnoid hemorrhage (SAH) has been found to be predicted by loss of consciousness at ictus (LOCi). In this study, we assessed the clinical and neuro-radiological significance of the LOCi in non-traumatic SAH.The authors retrospectively studied 102 patients with SAH admitted to S. João Hospital between January 1, 1989 and December 31, 1992, who were divided into two groups with and without LOCi and compared according to clinical and imaging features.Loss of consciousness at ictus was statistically associated with an age over 52 years (odds ratio, 2.9; 95% confidence interval, 1.1-7.8); a Hunt and Hess Scale score > ou = 3 (4.4; 1.6-12.3); finding of subarachnoid blood on initial cranial CT scan (5.5; 1.4-26.3); existence of aneurysm (3.4; 1.3-8.9); a Glasgow Outcome Scale score > ou = 3 (4.69; 1.6-14.1). A poor clinical condition on admission (5.2;1.8-14.5) and existence of aneurysm (4.1; 1.6-10.6) were the only two findings shown to have an independent power of significant association with loss of consciousness at ictus, using logistic regression analysis, with LOCi as a dependent variable.In this study, LOCi has independent predictive power for a poor neurologic condition on admission and for the finding of aneurysm on angiogram. Loss of consciousness at ictus may be explained by the direct impact of the initial hemorrhage on the brain from a large tear in the aneurysmal wall, causing a quick rise in intracranial pressure (with LOCi) but a relatively short bleeding time.

Pulmonary embolism is a serious and difficult problem. Many approaches for the prevention of recurrent pulmonary embolism have been tried. Percutaneous placement of inferior vena cava filters is an easy, safe, available and well established procedure for the prevention of pulmonary embolism. The authors review the indications for use of IVC filters, and they review the main filters available in terms of ease of use, the physical characteristics, the technique of introduction, the efficacy and morbidity, and the potential complications associated with their use. Insertion of IVC filters by percutaneous approach was successfully performed in 6 patients with recurrent pulmonary embolism. Following the intervention procedure without complication there were no further pulmonary emboli.

Percutaneous sclerotherapy of varicocele was considered in 21 patients with left sided varicocele, 16 of whom had recurrences after left spermatic vein ligation in the past. Percutaneous sclerotherapy was possible in 17 patients (80.9%). There were no serious complications with venography or sclerotherapy, and the recurrence rate was 17.6%. Percutaneous sclerotherapy is therefore a simple, safe and effective treatment of testicular vein insufficiency.

Bureaucracy is characterised by rules, specific sphere of competence, hierarchy, specialized training, separation from means of production or administration and the recording in writing. The NHS is not a typical bureaucratic organization, but it has some of its characteristics. The alternative models (democratic, matrix-type structure) do not seem to respond to the need for change. It is suggested that the characteristics of an organization’s structure be treated as variables. Partial alternatives are discussed. The relationship between the goals, the users and the workers - workers and users’ participation in the planning and control of the NHS. Conflict as a motor for change. Controlling power - representatives of the community and of the workers. The person in the organization - involvement of all workers in management at different levels and the development of persons towards their full capacity. The case is made for the person-centered approach to management.

Uma importante característica do pensamento filosófico e a capacidade de constantemente estar duvidoso em relação ao que nos e rotineiro ou familiar. O educador não é um filósofo mas tem de desenvolver uma atitude critica e espirito reflexivo, não se satisfazendo com o simples eco das doutrinas definidas mesmo que o tenham sido por cientistas de renome. A nível individual é indispensável que os educadores de enfermagem reflictam sobre as suas próprias crenças em relação a si ou ao seu papel social. A nível institucional devem os docentes sentir-se com capacidade de modificar a sua prática, através da discussão entre pares, dos princípios essenciais da Pedagogia. A nível nacional, e necessário que os enfermeiros se sintam enquadrados na sociedade e que as discussões dos princípios da educação sejam alargados a outros sectores e mesmo aos órgãos de poder de decisão. Só duma acção conjunta e integrada poderá resultar uma definição de Filosofia da educação que prepare cidadãos autónomos e capazes de modificar constantemente a realidade em que se inserem.