Metabolic Fingerprinting Links Oncogenic PIK3CA with Enhanced Arachidonic Acid-Derived Eicosanoids.

Oncogenic transformation is associated with profound changes in cellular metabolism, but whether tracking these can improve disease stratification or influence therapy decision-making is largely unknown. Using the iKnife to sample the aerosol of cauterized specimens, we demonstrate a new mode of real-time diagnosis, coupling metabolic phenotype to mutant PIK3CA genotype. Oncogenic PIK3CA results in an increase in arachidonic acid and a concomitant overproduction of eicosanoids, acting to promote cell proliferation beyond a cell-autonomous manner. Mechanistically, mutant PIK3CA drives a multimodal signaling network involving mTORC2-PKCζ-mediated activation of the calcium-dependent phospholipase A2 (cPLA2). Notably, inhibiting cPLA2 synergizes with fatty acid-free diet to restore immunogenicity and selectively reduce mutant PIK3CA-induced tumorigenicity. Besides highlighting the potential for metabolic phenotyping in stratified medicine, this study reveals an important role for activated PI3K signaling in regulating arachidonic acid metabolism, uncovering a targetable metabolic vulnerability that largely depends on dietary fat restriction. VIDEO ABSTRACT.

Identifying the etiology and pathophysiology underlying stunting and environmental enteropathy: study protocol of the AFRIBIOTA project.

BACKGROUND: Globally one out of four children under 5 years is affected by linear growth delay (stunting). This syndrome has severe long-term sequelae including increased risk of illness and mortality and delayed psychomotor development. Stunting is a syndrome that is linked to poor nutrition and repeated infections. To date, the treatment of stunted children is challenging as the underlying etiology and pathophysiological mechanisms remain elusive. We hypothesize that pediatric environmental enteropathy (PEE), a chronic inflammation of the small intestine, plays a major role in the pathophysiology of stunting, failure of nutritional interventions and diminished response to oral vaccines, potentially via changes in the composition of the pro- and eukaryotic intestinal communities. The main objective of AFRIBIOTA is to describe the intestinal dysbiosis observed in the context of stunting and to link it to PEE. Secondary objectives include the identification of the broader socio-economic environment and biological and environmental risk factors for stunting and PEE as well as the testing of a set of easy-to-use candidate biomarkers for PEE. We also assess host outcomes including mucosal and systemic immunity and psychomotor development. This article describes the rationale and study protocol of the AFRIBIOTA project. METHODS: AFRIBIOTA is a case-control study for stunting recruiting children in Bangui, Central African Republic and in Antananarivo, Madagascar. In each country, 460 children aged 2-5 years with no overt signs of gastrointestinal disease are recruited (260 with no growth delay, 100 moderately stunted and 100 severely stunted). We compare the intestinal microbiota composition (gastric and small intestinal aspirates; feces), the mucosal and systemic immune status and the psychomotor development of children with stunting and/or PEE compared to non-stunted controls. We also perform anthropological and epidemiological investigations of the children's broader living conditions and assess risk factors using a standardized questionnaire. DISCUSSION: To date, the pathophysiology and risk factors of stunting and PEE have been insufficiently investigated. AFRIBIOTA will add new insights into the pathophysiology underlying stunting and PEE and in doing so will enable implementation of new biomarkers and design of evidence-based treatment strategies for these two syndromes.

Extracellular vesicles as a promising source of lipid biomarkers for breast cancer detection in blood plasma.

Extracellular vesicles (EVs), including exosomes and microvesicles, mediate intercellular communication in cancer, from development to metastasis. EV-based liquid biopsy is a promising strategy for cancer diagnosis as EVs can be found in cancer patients' body fluids. In this study, the lipid composition of breast cancer-derived EVs was studied as well as the potential of blood plasma EVs for the identification of lipid biomarkers for breast cancer detection. Initially, an untargeted lipidomic analysis was carried out for a panel of cancerous and non-cancerous mammary epithelial cells and their secreted EVs. We found that breast cancer-derived EVs are enriched in sphingolipids and glycerophospholipids compared to their parental cells. The initial in vitro study showed that EVs and their parental cells can be correctly classified (100% accuracy) between cancerous and non-cancerous, as well as into their respective breast cancer subtypes, based on their lipid composition. Subsequently, an untargeted lipidomic analysis was carried out for blood plasma EVs from women diagnosed with breast cancer (primary or progressive metastatic breast cancer) as well as healthy women. Correspondingly, when blood plasma EVs were analysed, breast cancer patients and healthy women were correctly classified with an overall accuracy of 93.1%, based on the EVs' lipid composition. Similarly, the analysis of patients with primary breast cancer and healthy women showed an overall accuracy of 95% for their correct classification. Furthermore, primary and metastatic breast cancers were correctly classified with an overall accuracy of 89.5%. This reveals that the blood plasma EVs' lipids may be a promising source of biomarkers for detection of breast cancer. Additionally, this study demonstrates the usefulness of untargeted lipidomics in the study of EV lipid composition and EV-associated biomarker discovery studies. This is a proof-of-concept study and a starting point for further analysis on the identification of EV-based biomarkers for breast cancer.

LXR activation by GW3965 alters fat tissue distribution and adipose tissue inflammation in ob/ob female mice.

To investigate the role of liver X receptor (LXR) in adipose tissue metabolism during obesity, ob/ob mice were treated for 5 weeks with the synthetic LXR agonist GW3965. MRI analysis revealed that pharmacological activation of LXR modified fat distribution by decreasing visceral (VS) fat and inversely increasing subcutaneous (SC) fat storage without affecting whole body fat content. This was concordant with opposite regulation by GW3965 of the lipolytic markers hormone-sensitive lipase (HSL) and adipose triglyceride lipase (ATGL) in the two fat depots; moreover, the expression of genes involved in lipogenesis was significantly induced in SC fat. Lipidomic analysis suggested that changes in lipid composition in response to GW3965 also varied between VS and SC fat. In both depots, the observed alteration in lipid composition indicated an overall change toward less lipotoxic lipids. Flow cytometry analysis showed decreased immune cell infiltration in adipose tissue of ob/ob mice in response to GW3965 treatment, which in VS fat mainly affected the macrophage population and in SC fat the lymphocyte population. In line with this, the expression and secretion of proinflammatory markers was decreased in both fat deposits with GW3965 treatment.

Detection and quantification of viable Ascaris sp. and other helminth eggs in sewage sludge.

Some epidemiologic studies conducted in developing countries demonstrated a high incidence of enteroparasites, Ascaris sp. being the most prevalent. Therefore, the use of sewage sludge in agriculture may pose risks to human health. In order to protect public health, a Brazilian regulation has established standards regarding its use in rural areas. The objective of this study was to quantify Ascaris sp. and other helminth eggs in sewage sludge from five wastewater treatment plants from a dense metropolitan region, and also to check compliance with the law. The analysis was carried according to USEPA 2003 . A rich parasitological fauna was found, with a prevalence of the eggs of Ascaris sp. (9.55%). The samples analyzed presented a large variety of helminth eggs, and Ascaris sp. proved to be the most prevalent which put in evidence that its application poses public health concerns.

Efficacy of vedolizumab as maintenance therapy in a patient with ulcerative colitis receiving haemodialysis in end-stage kidney failure: A case report.

This report describes vedolizumab's clinical efficacy and safety in a patient with severe ulcerative colitis on haemodialysis for an end-stage kidney failure. The patient was a 75-year-old man on long-standing chronic diffusive three times per week haemodialytic treatment due to vascular nephropathy. At the presentation, the patient had severe bloody diarrhoea treated with a steroid cycle with temporary benefits and then developed steroid dependence. Upon remission, the patient started vedolizumab (Entivyo®) as maintenance therapy. After 6 weeks of induction, patient started the maintenance therapy with an infusion every 8 weeks. After the sixth infusion, the interval was prolonged to 9 weeks because of the good and fast response. Vedolizumab treatment proceeded without adverse events. However, no changes in renal function were noted during the same period, no complications were reported, and the patient regularly continued haemodialysis. At the second induction infusion (week 2) and the second maintenance infusion (week 22), we measured vedolizumab serum level before and after haemodialysis, observing no significant changes. Our case is the first report about using vedolizumab in a patient under haemodialysis, showing that vedolizumab can be safe, well tolerated, and effective in patients undergoing haemodialysis. However, more extensive trials are needed to prove its use in these patients.

Targeted Desorption Electrospray Ionization Mass Spectrometry Imaging for Drug Distribution, Toxicity, and Tissue Classification Studies.

With increased use of mass spectrometry imaging (MSI) in support of pharmaceutical research and development, there are opportunities to develop analytical pipelines that incorporate exploratory high-performance analysis with higher capacity and faster targeted MSI. Therefore, to enable faster MSI data acquisition we present analyte-targeted desorption electrospray ionization-mass spectrometry imaging (DESI-MSI) utilizing a triple-quadrupole (TQ) mass analyzer. The evaluated platform configuration provided superior sensitivity compared to a conventional time-of-flight (TOF) mass analyzer and thus holds the potential to generate data applicable to pharmaceutical research and development. The platform was successfully operated with sampling rates up to 10 scans/s, comparing positively to the 1 scan/s commonly used on comparable DESI-TOF setups. The higher scan rate enabled investigation of the desorption/ionization processes of endogenous lipid species such as phosphatidylcholines and a co-administered cassette of four orally dosed drugs-erlotininb, moxifloxacin, olanzapine, and terfenadine. This was used to enable understanding of the impact of the desorption/ionization processes in order to optimize the operational parameters, resulting in improved compound coverage for olanzapine and the main olanzapine metabolite, hydroxy-olanzapine, in brain tissue sections compared to DESI-TOF analysis or matrix-assisted laser desorption/ionization (MALDI) platforms. The approach allowed reducing the amount of recorded information, thus reducing the size of datasets from up to 150 GB per experiment down to several hundred MB. The improved performance was demonstrated in case studies investigating the suitability of this approach for mapping drug distribution, spatially resolved profiling of drug-induced nephrotoxicity, and molecular-histological tissue classification of ovarian tumors specimens.

Progressive Multifocal Leukoencephalopathy Associated With Idiopathic CD8+ Lymphocytopenia.

Progressive multifocal leukoencephalopathy (PML) is a severe demyelinating disease of the central nervous system (CNS) caused by the polyoma John Cunningham (JC) virus. This virus is rarely pathogenic in immunocompetent individuals, being associated with profound cellular immunosuppression. We present a case of a 72-year-old woman with schizoaffective disorder who presented to the emergency department with dysarthria and right hemiataxia. The initial computer tomography was normal and the diagnosis of ischemic stroke was first assumed. However, during hospitalization there was a progressive worsening of symptoms with cerebellar ataxia, and the magnetic resonance revealed a lesion in the right middle cerebellar peduncle hypointense in T1 and hyperintense on T2/fluid attenuated inversion recovery (FLAIR) sequence, suggestive of PML. Although the first cerebrospinal fluid analysis was negative, the second one was positive for the JC virus. Furthermore, due to radiological and clinical progression, mirtazapine was started and the patient underwent a course of intravenous immunoglobulin, with no response. In parallel, causes of immunosuppression were investigated, which led to the diagnosis of idiopathic CD8+ lymphocytopenia. Due to rapid progression of symptoms and radiological worsening of lesions, pembrolizumab was administered. After the first administration of pembrolizumab there was a transitory clinical stabilization. However, shortly after the second administration of pembrolizumab, the patient developed stridor with bilateral vocal cord paralysis and subsequent symptom progression, which led to the death of the patient three months after the appearance of initial symptoms. In conclusion, we report a case of a PML in a patient with idiopathic CD8+ lymphocytopenia, enhancing the need for a high suspicion index for this entity as well as for occult and less frequent forms of immunosuppression. Although there have been various case reports of favourable outcomes with pembrolizumab for PML, more research is needed, particularly to identify patient factors that might be associated with better responses to this therapy.

Metamizole-Induced Type I Kounis Syndrome.

Kounis syndrome (KS) is defined as acute coronary syndrome (ACS) triggered by mast cell and platelet activation in the setting of allergic or anaphylactic insults. KS is a unique and complex cause of ACS and many cases may be missed due to its highly variable clinical manifestations. In this report, we present a case of KS type I triggered by metamizole in the absence of a previous history of allergy to this drug. Following the administration of metamizole, the patient developed generalized acute urticaria, chest pain and diaphoresis. Electrocardiography (ECG) showed ST-segment elevation suggestive of myocardial infarction complicated by ventricular tachycardia. No coronary disease was observed on coronary angiography. The cardiac manifestations of KS may be life-threatening, and so it is important to appropriately recognize and treat this condition. LEARNING POINTS: Kounis syndrome (KS) diagnosis requires a high index of suspicion and should be considered in patients who present with acute coronary syndrome (ACS) soon after the administration of a new medication or possible allergic stimulus.Treatment should be administered carefully, since some drugs used to treat the cardiac manifestations of KS can worsen the allergic reaction.The prognosis is generally good with appropriate treatment, but some complications may occur, such as malignant arrhythmia.

Enhanced triacylglycerol catabolism by carboxylesterase 1 promotes aggressive colorectal carcinoma.

The ability to adapt to low-nutrient microenvironments is essential for tumor cell survival and progression in solid cancers, such as colorectal carcinoma (CRC). Signaling by the NF-κB transcription factor pathway associates with advanced disease stages and shorter survival in patients with CRC. NF-κB has been shown to drive tumor-promoting inflammation, cancer cell survival, and intestinal epithelial cell (IEC) dedifferentiation in mouse models of CRC. However, whether NF-κB affects the metabolic adaptations that fuel aggressive disease in patients with CRC is unknown. Here, we identified carboxylesterase 1 (CES1) as an essential NF-κB-regulated lipase linking obesity-associated inflammation with fat metabolism and adaptation to energy stress in aggressive CRC. CES1 promoted CRC cell survival via cell-autonomous mechanisms that fuel fatty acid oxidation (FAO) and prevent the toxic build-up of triacylglycerols. We found that elevated CES1 expression correlated with worse outcomes in overweight patients with CRC. Accordingly, NF-κB drove CES1 expression in CRC consensus molecular subtype 4 (CMS4), which is associated with obesity, stemness, and inflammation. CES1 was also upregulated by gene amplifications of its transcriptional regulator HNF4A in CMS2 tumors, reinforcing its clinical relevance as a driver of CRC. This subtype-based distribution and unfavorable prognostic correlation distinguished CES1 from other intracellular triacylglycerol lipases and suggest CES1 could provide a route to treat aggressive CRC.

Heterogeneity of the jealousy phenomenon in the general population: an Italian study.

INTRODUCTION: Despite the general agreement that normal jealousy is heterogenous, little is known about this specific topic. METHODS: In the present study, we explored the possibility of distinguishing between four subtypes of "normal" jealousy (depressive, anxious, obsessive, and paranoid) amongst a cohort of 500 healthy university students by means of a specifically designed questionnaire, "Ouestionario della gelosia" (QUEGE). QUEGE is a self-report instrument of 30 items which explores the presence, frequency, and duration of feelings and behaviors related to jealousy. It was devised to investigate four hypothetical psychopathological profiles: depressive, paranoid, obsessive, and anxious. RESULTS: The factor analysis identified five rather than four clear-cut factors: self-esteem, paranoia, interpersonal Sensitivity, fear of being abandoned, and obsessionality. Women showed statistically significant lower levels of self-esteem and higher levels of obsessionality than men. Younger age (<25 years) was associated with lower self-esteem and higher levels of paranoia and obsessionality, while being single was associated with lower self-esteem and higher levels of obsessionality. CONCLUSION: The present study provides evidence of the reliability and validity of the QUEGE instrument, which seems to identify the presence of five psychopathological dimensions within the jealousy phenomenon in the general population.

Drug reaction with eosinophilia and systemic symptoms syndrome in a patient taking lamotrigine.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare adverse drug reaction characterised by skin eruption and multiple organ involvement. Diagnosing this entity is challenging due to the variability of clinical manifestations, late onset and relapse even after stopping the causative drug. It is potentially life-threatening; thus, it must be promptly recognised and the causative drug withdrawn. We describe a case of a 50-year-old man with an acute diffuse rash, fever and eosinophilia 4 weeks after having started lamotrigine. The suspected eliciting drug was suspended and systemic corticoid treatment was initiated (prednisolone 0.5 mg/kg/day). Symptoms relapsed under corticoid tapering with greater severity. The patient developed an exuberant rash associated with peripheral lymphadenopathies, marked eosinophilia and hepatic cytolysis. The diagnosis of DRESS syndrome to lamotrigine was made. Prednisolone dosage was increased to 1 mg/kg/day, and the subsequent taper was performed slowly over the course of 10 weeks. Full clinical remission was observed.

Quality of Life and Sexual Function in Women with Liver Cirrhosis in Colombia

Introduction: The female sex has been systematically identified as one of the predictors of poor quality of life in patients with cirrhosis. However, the relationship between quality of life and sexual function in women with cirrhosis has not been widely studied. Aim: To determine the relationship between quality of life and sexual function in women with cirrhosis. Materials and methods: A cross-sectional observational study. Female patients aged 18 to 69 years were included. The SF-36-V2 survey assessed health-related quality of life, and the IFSF-6 evaluated sexual function. Univariate and multivariate linear regression was used to identify the relationship between quality of life and sexual function. Statistical significance was set at a p-value < 0.05. Results: 36 patients were available for analysis. The average age was 61 years. In the SF36-V2 survey, the physical component summary mean was 58, and the mental component summary mean was 56. The IFSF-6 had an average of 10. Sexual dysfunction occurred in 80% of patients. The IFSF-6 score was positively related to health-related quality of life. Factors associated with the deterioration of sexual function were age and menopause. The Child-Pugh score and body mass index were the main determinants of health-related quality of life. Conclusions: Sexual function could be a determinant of quality of life in women with cirrhosis.

Introducción: El sexo femenino se ha identificado de forma sistemática como uno de los predictores de mala calidad de vida en pacientes con cirrosis. Sin embargo, la relación de la calidad de vida con la función sexual en mujeres con cirrosis no ha sido ampliamente estudiada. Objetivo: Determinar la relación entre la calidad de vida y la función sexual de mujeres con cirrosis. Métodos: Estudio observacional de tipo transversal. Se incluyó a pacientes femeninas de 18 a 69 años. Se utilizó la encuesta SF-36-V2 para evaluar la calidad de vida relacionada con la salud y la IFSF-6 para valorar la función sexual. Para identificar la relación entre calidad de vida y función sexual se utilizó una relación lineal uni- y multivariante. La significación estadística se fijó con un valor p < 0,05. Resultados: 36 pacientes estuvieron disponibles para el análisis. La media de edad fue de 61 años. En la encuesta SF36-V2, la media del resumen del componente físico fue de 58 y la media del resumen del componente mental fue de 56. El IFSF-6 tuvo una media de 10. La disfunción sexual se presentó en un 80% de las pacientes. El puntaje IFSF-6 se relacionó de forma positiva con la calidad de vida relacionada con la salud. Los factores relacionados con deterioro de la función sexual son la edad y la menopausia. La escala Child-Pugh y el índice de masa corporal se identificaron como los principales determinantes de la calidad de vida relacionada con la salud. Conclusiones: La función sexual podría ser un determinante de calidad de vida de las mujeres con cirrosis.

[Clinical practice for the diagnosis of cardiac arrhythmias in patients on renal replacement therapy: data from a Lombard survey]. / Pratica clinica per la diagnostica delle aritmie cardiache in pazienti in terapia renale sostitutiva: dati di una survey lombarda.

Among dialysis patients, 40% of deaths are due to cardiovascular causes, and 60% of cardiac deaths are due to an arrhythmia. The purpose of this survey, carried out with the organizational support of the Lombard Section of the Italian Society of Nephrology, is to evaluate the frequency and mode of use of non-invasive instruments for the diagnosis of cardiac arrhythmias in the dialysis centers of Lombardy. Information on the prevalence and type of cardiac devices at December 1, 2016 in this population was also required. Data from 18 centers were collected for a total of 3395 patients in replacement renal therapy, including 2907 (85.6%) in hemodialysis and 488 (14.4%) in peritoneal dialysis. All centers use the 12-lead ECG in case of evocative symptoms of an arrhythmic event and 2/3 perform the exam with programmed cadence (usually once a year). Twenty four-hour ECG Holter is not used as a routine diagnostic tool. The proportion of cardiac devices is relatively high, compared to literature data: n=259, equal to 7.6% of the population. Pace-Maker patients are 166 (4.9%), those with intracardiac defibrillator 52 (1.5%), those with resynchronization therapy 18 (0.5%) and those with resynchronization therapy and intracardiac defibrillator 23 (0.7%). The survey provides interesting information and can be an important starting point for trying to optimize clinical practice and collaboration between nephrologists and cardiologists in front of a major problem like that of arrhythmic disease in patients on renal replacement therapy.

Factors that influence the decision of military dependents to decline smallpox vaccination during an outbreak.

OBJECTIVE: To examine factors that influence the decision of military dependents to decline smallpox vaccination in the event of an outbreak. METHODS: A total of 373 military dependents, 18 to 65 years of age, were surveyed in December 2003, at Fort Hood, Texas, and Fort Sill, Oklahoma, concerning smallpox vaccine knowledge, adverse reactions, and willingness to receive the vaccine. RESULTS: A total of 89% of respondents were willing to receive the vaccine. Respondents were less willing if the vaccine was unsafe during pregnancy or caused blood clots and heart attacks. African American and Hispanic respondents were less willing to be vaccinated than were Caucasian respondents (p < 0.0079), as were respondents with lower vaccine knowledge scores (p < 0.0029). CONCLUSIONS: The majority of military dependents would want to receive the vaccine in the event of an outbreak. Vaccine safety in pregnancy and an unproven link to blood clots and heart attacks may influence vaccine refusal. African American respondents, Hispanic respondents, and respondents with lower vaccine knowledge scores were less willing to receive the vaccine.

Epithelial ovarian carcinoma diagnosis by desorption electrospray ionization mass spectrometry imaging.

Ovarian cancer is highly prevalent among European women, and is the leading cause of gynaecological cancer death. Current histopathological diagnoses of tumour severity are based on interpretation of, for example, immunohistochemical staining. Desorption electrospray mass spectrometry imaging (DESI-MSI) generates spatially resolved metabolic profiles of tissues and supports an objective investigation of tumour biology. In this study, various ovarian tissue types were analysed by DESI-MSI and co-registered with their corresponding haematoxylin and eosin (H&E) stained images. The mass spectral data reveal tissue type-dependent lipid profiles which are consistent across the n = 110 samples (n = 107 patients) used in this study. Multivariate statistical methods were used to classify samples and identify molecular features discriminating between tissue types. Three main groups of samples (epithelial ovarian carcinoma, borderline ovarian tumours, normal ovarian stroma) were compared as were the carcinoma histotypes (serous, endometrioid, clear cell). Classification rates >84% were achieved for all analyses, and variables differing statistically between groups were determined and putatively identified. The changes noted in various lipid types help to provide a context in terms of tumour biochemistry. The classification of unseen samples demonstrates the capability of DESI-MSI to characterise ovarian samples and to overcome existing limitations in classical histopathology.

[Cryptogenic organizing pneumonia -- case report]. / Pneumonia em organização critogénica -- caso clínico.

Cryptogenic organizing pneumonia (COP) is one of the new recognized histological patterns of idiopathic interstitial pneumonias, in witch no cause or association is identified. Idiopathic bronchiolitis obliterans-organizing pneumonia (BOOP) is a synonymous. This rare entity is characterized by involvement of alveoli and bronchioles, which are filled by intraluminal polyps of fibroblastic tissue (Masson bodies). The clinical presentation often mimics that of community-acquired pneumonia. Persistent non-productive cough, dyspnoea with exertion and weight loss are common features, and in one-half of the cases the onset is heralded by a flu-like syndrome. Definitive diagnosis depends on histological data, and video-assisted thoracoscopic (VAT) has become the established technique. Spontaneous recovery is rare; corticosteroid therapy provides cure in two thirds of cases. The authors present a case of a patient whose lung biopsy by VAT confirmed the diagnosis. She was treated with corticoids without recurrence in a two year follow-up.

The dialysis staff workload and the blood volume tracking system during the hemodialysis sessions of hypotension-prone patients.

PURPOSE: Intradialytic hypotension (IDH) represents a common hemodialysis (HD) complication. Blood volume tracking (BVT) is a tool regulating the relative blood volume changes and potentially reducing the occurrence of IDH. The aim of this study was to evaluate the ability of BVT to reduce the staff workload associated to IDH. METHODS: Ten hypotension-prone HD patients were treated each with 39 conventional HD (HD) sessions and then switched to 39 HD sessions with BVT (HD-BVT). The staff interventions related to IDH were monitored by a trained staff. RESULTS: Dialysis sessions complicated by IDH and staff interventions were affected by BVT (HD: 102 and 127 vs. HD-BVT: 57 and 59, respectively, for both p<0.001). The time consumed by staff in IDH management was decreased by HD-BVT (1416 vs. 578 min, p<0.001). CONCLUSIONS: The effectiveness of BVT to reduce the frequency of IDH leads to a reduction of the dialysis staff workload with fewer staff interventions, allowing for major work-time saving.

[Puppet theatre as teaching strategy: a report of the experience]. / Teatro de fantoche como estratégia de ensino: relato da vivência.

The Didactics Applied to Care discipline is developed in the fifth semester of the nursing graduation course. It develops several theoretical-practical contents, among them, the teaching strategy. Our objective is to report the experience with the use of puppet theater to promote the oral health of children in a day nursery in the São Paulo East Zone. With this report we make it clear that the theoretical contents developed by the Didactics Applied to Care Discipline are essential to the practice of Health Education. The discipline allows us to develop multiple activities in the role of educator and in health promotion.