ABSTRACT Polycystic liver disease, a hereditary pathology, usually manifests as autosomal dominant polycystic kidney disease. The many cysts in the liver cause massive hepatomegaly, majorly affecting the patient’s quality of life. In cases of refractory symptoms, liver transplantation is the only treatment choice. A 43-year-old woman was followed up as a hepatology outpatient in August 2020, with a progressive increase in abdominal volume, lower limb edema, and cachexia. The patient was diagnosed with polycystic renal and liver disease with massive hepatomegaly in March 2021, a combined kidney-liver transplant. Liver size represented 13% of the patient’s corporal composition, weighing 8.6kg. The patient was discharged on the 7th postoperative day with no complications. Only 10-20% of patients with polycystic liver disease have clinical manifestations, most of which result from hepatomegaly. An increase in liver volume deteriorates liver function until the condition becomes end-stage liver disease, as kidney function is already compromised; liver-kidney transplantation remains the only treatment choice. The case described drew significant attention to the massive hepatomegaly presented in the patient, with the liver representing over 10% of the patient’s body weight, approximately five to six times larger than a normal-sized liver.

Abstract Periodontal disease (gingivitis and periodontitis) is an inflammatory process caused by the activity of pathogenic bacteria and their products on the gingival sulcus, with the consequent activation of the immune response. Saliva and crevicular fluid contain a wide variety of enzymes and antimicrobial factors that are in contact with the supragingival and subgingival region, including β-defensins (hBDs). hHBDs are non-glycosylated, cysteine-rich cationic peptides produced by epithelial cells with antimicrobial and immunoregulatory effects, thus contributing to maintaining homeostasis in periodontal tissues. The changes in the microbiota and the immune response from a healthy periodontium to gingivitis and, finally, to periodontitis are complex. Their severity depends on a dynamic balance between bacteria associated with plaque, genetic and environmental factors. Recent advances have made it possible to understand the implication of hBDs in the detection, diagnosis, and therapy of periodontal disease and the relationship between periodontitis and other inflammatory conditions. This review aims to describe the effect of hBDs on the immune response and its use as a possible marker of the inflammatory activity of the periodontal disease.

Resumen La enfermedad periodontal (gingivitis y periodontitis) es un proceso inflamatorio ocasionado por la actividad de bacterias patógenas y sus productos sobre el surco gingival, con la consecuente activación de la respuesta inmunitaria. La saliva y el fluido crevicular contienen una gran variedad de enzimas y factores antimicrobianos que están en contacto con la región supragingival y subgingival; entre ellos, las β-defensinas (hBDs). Las hBDs son péptidos catiónicos no glicosilados ricos en cisteína, producidos por las células epiteliales; tienen efecto antimicrobiano e inmunorregulador; de esta forma, contribuyen al mantenimiento de la homeostasis en los tejidos periodontales. Los cambios en la microbiota y en la respuesta inmunitaria de un periodonto sano a gingivitis y, finalmente, a periodontitis, es compleja. Su severidad depende de un equilibrio dinámico entre las bacterias asociadas a la placa, factores genéticos y ambientales. Los avances recientes han permitido comprender la implicación de las hBDs en la detección, el diagnóstico y la terapéutica de la enfermedad periodontal, así como la relación que hay entre la periodontitis y otras enfermedades inflamatorias. El objetivo de esta revisión es describir el efecto de las hBDs en la respuesta inmunitaria y su utilización como marcadores de la actividad inflamatoria de la enfermedad periodontal.

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This qualitative study aims to describe the pregnant women's perceptions on the delivery process. 10 women joined in the educational workshop first edition. The pregnant ladies were participating in a pioneering program sponsored by the Human Resources Department at a university in Curitiba, Paraná. The workshops were held from September to October 2008 with the contribution of the university's professors and employees and it approached issues related to the pregnancy cycle. Database was collected via individual interviews at the participants'workplace and recorded by digital equipment. We used a semi structured interview guide for data collection. After the transcription, data was submitted to a thematic content analysis. Two themes have been identified: a) participation in the workshops made possible for the pregnant women to share and strengthen their personal experience; b) the educational workshop contributed to expand the women's perspective about the childbirth process. The results show that this learning modality allows the sharing of experiences and that it can contribute to the consolidation of the pregnant women's perceptions and to the strengthening of their decisions about childbirth. Apart from the results achieved it is worth highlighting the initiative of starting up the program. The workshop demonstrated the importance of widening an educational modality that involves pregnant women in their own working environment.

Estudio cualitativo realizado con el objetivo de describir la percepción y perspectivas de las mujeres embarazadas sobre el proceso de parto. Participaron diez embarazadas inscritas en la primera edición de talleres educativos de un programa pionero promovido por el departamento de recursos humanos de una institución de enseñanza superior de la capital del Estado de Paraná. Los talleres se llevaron a cabo entre septiembre y octubre de 2008 y contaron con la participación de profesores y empleados de la institución. Se trataron asuntos relativos al ciclo del embarazo. Para la recogida de datos se realizaron entrevistas individuales en el lugar de trabajo de las participantes, grabadas con equipo digital. Se utilizó un cuestionario pré estructurado como instrumento de recogida de datos y, después de su transcripción, se efectuó el análisis temático de contenido. Fueron identificadas dos categorías a) la participación en talleres educativos posibilitó compartir experiencias, fortaleciendo la vivencia del embarazo y b) el (re)significado de la experiencia en dichos talleres contribuyó a ampliar los horizontes y perspectivas sobre el proceso de parto. Los resultados muestran que este tipo de modalidad educativa, además de posibilitar el compartir saberes y experiencias entre los sujetos implicados, puede contribuir a fortalecer a las mujeres en sus perceptivas y decisiones sobre el parto. Además de los resultados obtenidos, la iniciativa de establecer el programa ha merecido mención. Los talleres han dado visibilidad y demostrado la importancia de ampliar este tipo de modalidad educativa, más allá de las instituciones de salud, que involucra embarazadas en su propio ambiente de trabajo.

Estudo qualitativo cujo objetivo foi descrever a percepção e as perspectivas de gestantes sobre o processo de parto. Participaram dez gestantes inscritas na primeira edição de oficinas educativas, inseridas em um programa pioneiro promovido pelo Departamento de Recursos Humanos de uma instituição de ensino superior, situada na capital do Paraná. As oficinas foram realizadas no período de setembro a outubro de 2008 e contaram com a participação de professores e funcionários da instituição, que abordaram temáticas relativas ao ciclo gravídico puerperal. A coleta de dados foi feita por meio de entrevistas individuais, no local de trabalho das participantes, e gravadas com equipamento digital. Utilizou-se um roteiro semiestruturado para coleta de dados. Após a transcrição, os dados foram submetidos à análise temática de conteúdo. Foram identificadas duas categorias temáticas: a) a participação em oficinas educativas possibilitou o compartilhar experiências, fortalecendo a vivência da gestação e b) a (re)significação de experiência em oficinas educativas contribuiu para a ampliação de horizontes e o descortinar de perspectivas sobre o processo de parto. Os resultados mostram que a modalidade educativa sob a forma de oficina possibilita o compartilhar de experiências e pode contribuir para o fortalecimento das mulheres nas suas perceptivas e decisões sobre o parto. Além dos resultados alcançados, a iniciativa de formação do programa mereceu destaque. As oficinas deram visibilidade e demonstraram a importância de ampliar, para além das instituições de saúde, a realização de um tipo de modalidade educativa que envolve gestantes em seu próprio ambiente de trabalho.

The constitution of Brazil directs that the country’s health system, the Unified Health System (Sistema Único de Saúde), be politically and administratively decentralized. Nevertheless, handing over competencies, responsibilities, and resources to subnational levels, especially to municipal governments, has been a slow process, lasting almost two decades. Advances have been brought about by the Unified Health System, which, from a analytical perspective, is a public and universal system. Despite that, the decentralization process needs to overcome norms that keep all levels of management dependent on Brazil’s federal Government. The subnational levels have consistently faced difficulties in performing their macromanagement functions with autonomy, especially when it comes to financing and to the establishment or organization of health care networks. Boldness and responsibility will be needed to prevent Brazil’s health decentralization process from leading to fragmentation. New political agreements between different levels of government, with a reassignment of responsibilities and the enhancement of a culture of technical cooperation, are fundamental requisites to making the Unified Health System have a health policy that is truly public and universal.

Os, caracteres morfo-anatômicos do sistema genital e glândula pediosa de Phyllocaulis soleiformis são redescritos após exame de 30 espécimes provenientes de Porto Alegre e arredores. Dados biométricos, média e intervalo de cada caráter são também incluídos. Após análise estatística, propõem-se índices de proporção dos característicos descritivos válidos para a espécie.

The morpho-anatomical characters of the genital system and pedal gland of Phyllocaulis soleiformis are redescribed after a study of 30 specimens from Porto Alegre and surroundings. Biometric data, average and interval of each character are also included. After the statistical analysis we propose proportion indexes of those descriptive characteristic as valid for this species.