Phenotypic and genetic diversity of the species Lactobacillus rhamnosus

The thesis explores the diversity of Lactobacillus rhamnosus, a species from which strains are studied for their anti-inflammatory, anti-allergic, and diarrhea preventing effects. The work combines observations on the behavior of the bacteria in a simplified laboratory setting (use of carbohydrates, immune modulation effects, anti-pathogenic effects) with genomic information obtained by sequencing, with the aim to pinpoint genes that could be relevant for bacterial survival and metabolic capacities. Phenotypic and genotypic profiling analyses congruently revealed that carbohydrate metabolism and transport is essential for this species’ adaptation to the environment. Genotype–phenotype correlation analysis enabled us to predict and then experimentally verify genes responsible for the utilization of L-Sorbose, L-Fucose α-D-Methyl Glycoside.</p

Lean Healthcare: Estudo de Caso na Farmácia Campo Maior

Atualmente, o setor da saúde a nível mundial tem registado grandes alterações, no que diz respeito a preocupação com o aumento dos custos registados, assim como com a qualidade dos serviços prestados aos seus clientes. De acordo com dados fornecidos pela Organização Mundial da Saúde, cerca de 10% do Produto Interno Bruto mundial diz respeito aos gastos com a saúde. Através da filosofia Lean é possível aumentar a qualidade e reduzir os custos, isto é, não existe trade-off entre qualidade e custo. O conceito Lean surgiu na indústria, tendo rapidamente se expandido para outros setores tal como serviços, por exemplo, área de saúde. Durante o trabalho será abordado o Lean na indústria, nos serviços, dando destaque para o Lean Healthcare e sobretudo para a Gestão de Materiais na Área de Saúde. Com este trabalho, pretende-se realizar um estudo de caso na Farmácia Campo Maior, de modo a estudar o estado atual do Lean, ou seja, identificar as atividades que agregam valor e as que não agregam valor durante o fluxo de materiais. Isto é, desde a criação de encomenda no software Sifarma 2000 até a entrega do produto final ao cliente, para tal recorreu-se ao Value Stream Mapping, que permite identificar com facilidade os desperdícios e as áreas que necessitam melhorias. O estudo permitiu perceber que se trata de uma farmácia que já adotou várias práticas Lean que proporcionam valor acrescentado aos clientes (gestão visual, 5S, ciclo Plan-Do-CheckAct, Just-in-Time). Por outro lado, analisando a farmácia identificaram-se práticas que poderão aumentar o valor, tais como drive-through e os cacifos Click & Collect.Currently, the health sector worldwide has been undergoing major changes, with regard to the concern with the increase in costs registered, as well as with the quality of services provided to its customers. According to data provided by the World Health Organization, about 10% of the world's Gross Domestic Product is spent on health care. Through Lean philosophy it is possible to increase quality and reduce costs, that is, there is no trade-off between quality and cost. The Lean concept emerged in industry, having quickly expanded to other sectors such as services, for example healthcare. During the work, Lean will be analized in the industry, services, giving emphasis to Lean Healthcare and especially to Materials Management in the Healthcare. With this work, it is intended to perform a case study in Pharmacy Campo Maior, in order to study the current state of "Lean", that is, to identify the activities that add value and those that do not add value during the flow of materials. That is, from the creation of the order in the Sifarma 2000 software until the delivery of the final product to the customer. To do this, Value Stream Mapping was used, which allows the easy identification of waste and areas that need improvement. The study showed that this is a pharmacy that has already adopted several Lean practices that provide added value to users (visual management, 5S, Plan-Do-Check-Act cycle, Justin-Time). On the other hand, by analyzing the pharmacy we identified practices that could increase value, such as drive-through and Click & Collect lockers

Клинико-параклиническая характеристика туберкулеза легких, ассоциированного с вирусом иммунодефицита человека

Clinical-paraclinical characteristics of pulmonary tuberculosis associated with human immunodeficiency virus. Materials and methods: The analysis of selected scientific publications from the HINARI, MEDLINE, EMBASE, etc. Results and conclusions: in recent years, in the world, tuberculosis associated with the human immunodeficiency virus is one of the most serious public health problems, contributing to the increase in cases of morbidity, incapacity for work and mortality. Usually, the disease develops in young people, with the asocial lifestyle, with compromised immunity, etc. The most common manifestation of tuberculosis in HIV-infected adults is pulmonary. Initially, the tuberculous process affects the upper lungs, where cavities, fibrosis, shrinkage and calcification of the lung can occur. When the immunodeficiency increases, the cough becomes rarer, the intrathoracic lymph nodes become lysed more frequently, and the process already affects the lower lung lobes. To prevent tuberculosis in this contingent of patients it is necessary to dispense them with the necessary examination twice a year, indicating timely antiretroviral therapy and chemoprophylaxisMateriale si metode: A fost efectuată analiza publicaţiilor ştiinţifice selectate din bazele de date HINARI, MEDLINE, EMBASE,etc. Rezultate si concluzii: În ultimii ani, în lume, tuberculoza asociată cu virusul imunodeficienţei umane constituie una din cele mai grave probleme de sănătate publică, care contribuie la mărirea cazurilor morbidităţii, a persoanelor inapte de muncă şi a mortalităţii. De obicei, boala se dezvoltă la persoane tinere, cu modul de viaţă asocial, cu imunitatea compromisă, etc. Cea mai frecventă manifestare a tuberculozei la adulţii infectaţi cu HIV e acea pulmonară. Iniţial procesul tuberculos afectează părţile superioare pulmonare, unde pot apărea: cavităţi, fibroze, micşorarea volumului şi calcificarea plămânului. Cănd imunodeficienţa creşte tusea devine mai rară, ganglionii limfatici intratoracici se lizează mai frecvent, iar procesul afectează deja lobii pulmonari inferiori. Pentru prevenirea tuberculozei la acest contingent de bolnavi e necesar dispensarizarea lor cu examinarea necesară de două ori pe an, indicând la timp terapia antiretrovirală şi chimioprofilaxiaМатериалы и методы: Проведен анализ избранных научных публикаций из баз данных HINARI, MEDLINE; EMBASE и др. Результаты и выводы. В последние годы в мире туберкулез, связанный с вирусом иммунодефицита человека, является одной из самых серьезных проблем общественного здравоохранения, способствуя увеличению случаев заболеваемости, нетрудоспособности и смертности. Обычно заболевание развивается у молодых людей, ведущих асоциальный образ жизни, с ослабленным иммунитетом и т. д. Наиболее частым проявлением туберкулеза у взрослых ВИЧ-инфицированных является легочное. Первоначально туберкулезный процесс поражает верхние отделы легких, где могут возникать каверны, фиброз, сморщивание и кальцинаты легкого. При нарастании иммунодефицита кашель становится реже, внутригрудные лимфатические узлы поражаются чаще, и процесс уже затрагивает нижние доли легких. Для профилактики туберкулеза у этого контингента больных необходимо дважды в год обследовать, назначая вовремя антиретровирусную терапию и химиопрофилактик

Характеристика спектра свободных aминокислот в крови при химио-устойчивом туберкулезе легких и возможности коррекции его нарушений

The study is prospective, controlled, monocentric, randomized, descriptive-interventional, which proves the superiority of the treatment of drug – resistant pulmonary tuberculosis patients with thematic methods supplemented by the administration of the hyperosmolar mixture of аmine acids - Aminol and the lymphotropic use of isoniazid solution, compared to the routine medication performed according to the DOTS plus schemes.Studiul e prospectiv, controlat, monocentric, randomizat și descriptiv-intervențional, care confirmă superioritatea tratamentului bolnavilor de tuberculoză pulmonară drogrezistentă cu metode tematice suplementat prin administrarea amestecului hiperosmolar de acizi aminici – Aminol și utilizarea limfotropă a soluției isoniazidă, în comparație cu medicația de rutină efectuată conform schemelor DOTS plus.Характеристика спектра свободных аминокислот в крови при химио-устойчивом туберкулезе легких и возможности коррекции его нарушений Исследование проспективное, контролируемое, моноцентрическое, рандомизированное, описательно-интервенционное, подтверждающее превосходство лечения больных химио-устойчивым легочным туберкулезом с помощью тематических методов, дополненных введением гиперосмолярной смеси аминокислот - Аминол и лимфотропным использованием раствора изониазида по сравнению с рутинными препаратами, выполняемыми в соответствии со схемами ДОТС плюс

The Variable Regions of Lactobacillus rhamnosus Genomes Reveal the Dynamic Evolution of Metabolic and Host-Adaptation Repertoires

Lactobacillus rhamnosus is a diverse Gram-positive species with strains isolated from different ecological niches. Here, we report the genome sequence analysis of 40 diverse strains of L. rhamnosus and their genomic comparison, with a focus on the variable genome. Genomic comparison of 40 L. rhamnosus strains discriminated the conserved genes ( core genome) and regions of plasticity involving frequent rearrangements and horizontal transfer ( variome). The L. rhamnosus core genome encompasses 2,164 genes, out of 4,711 genes in total ( the pan-genome). The accessory genome is dominated by genes encoding carbohydrate transport and metabolism, extracellular polysaccharides ( EPS) biosynthesis, bacteriocin production, pili production, the cas system, and the associated clustered regularly interspaced short palindromic repeat ( CRISPR) loci, and more than 100 transporter functions and mobile genetic elements like phages, plasmid genes, and transposons. A clade distribution based on amino acid differences between core ( shared) proteins matched with the clade distribution obtained from the presence-absence of variable genes. The phylogenetic and variome tree overlap indicated that frequent events of gene acquisition and loss dominated the evolutionary segregation of the strains within this species, which is paralleled by evolutionary diversification of core gene functions. The CRISPR-Cas system could have contributed to this evolutionary segregation. Lactobacillus rhamnosus strains contain the genetic and metabolic machinery with strain-specific gene functions required to adapt to a large range of environments. A remarkable congruency of the evolutionary relatedness of the strains' core and variome functions, possibly favoring interspecies genetic exchanges, underlines the importance of gene-acquisition and loss within the L. rhamnosus strain diversification.Peer reviewe

Dairy products, dietary calcium and the risk of inflammatory bowel disease: results from a European prospective cohort investigation

Background: Dairy products may be involved in the etiology of inflammatory bowel disease by modulating gut microbiota and immune responses, but data from epidemiological studies examining this relationship are limited. We investigated the association between prediagnostic intake of these foods and dietary calcium, and the subsequent development of Crohn's disease (CD) and ulcerative colitis (UC). Methods: In total, 401,326 participants were enrolled in the European Prospective Investigation into Cancer and Nutrition cohort. At recruitment, consumption of total and specific dairy products (milk, yogurt, and cheese) and dietary calcium was measured using validated food frequency questionnaires. Cases developing incident CD (n = 110) or UC (n = 244) during follow-up were matched with 4 controls. Conditional logistic regression analyses were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for total energy intake and smoking. Results: Compared with the lowest quartile, the ORs for the highest quartile of total dairy products and dietary calcium intake were 0.61 (95% CI, 0.32-1.19, p trend = 0.19) and 0.63 (95% CI, 0.28-1.42, p trend = 0.23) for CD, and 0.80 (95% CI, 0.50-1.30, p trend = 0.40) and 0.81 (95% CI, 0.49-1.34, p trend = 0.60) for UC, respectively. Compared with nonconsumers, individuals consuming milk had significantly reduced odds of CD (OR 0.30, 95% CI, 0.13-0.65) and nonsignificantly reduced odds of UC (OR 0.85, 95% CI, 0.49-1.47). Conclusions: Milk consumption may be associated with a decreased risk of developing CD, although a clear dose-response relationship was not established. Further studies are warranted to confirm this possible protective effect