Avaliação do efeito da microfauna do tanque de arejamento no efluente final

O presente trabalho, efetuado na Estação de Tratamento de Águas Residuais do Freixo (ETAR do Freixo), decorreu durante um período de nove meses, (entre Dezembro de 2012 e Agosto de 2013), e teve como principais objetivos: - a observação microscópica e respetiva identificação dos organismos presentes nas lamas ativadas dos reatores biológicos da ETAR (incidindo nos protozoários, metazoários e bactérias filamentosas); - estabelecer a relação entre os organismos identificados/quantidade respetiva e a sedimentabilidade das lamas ativadas e sua influência no processo de depuração; - avaliar a variação das espécies identificadas com as alterações processuais. Para o efeito, a metodologia utilizada foi: - a colheita diária de amostras em vários pontos da ETAR; - a determinação dos parâmetros operacionais e caracterização das amostras recolhidas, tendo sido efetuadas 6039 análises físico-químicas, incluindo ao afluente à ETAR, ao afluente e ao conteúdo dos dois reatores biológicos, à corrente de recirculação de lamas e ao efluente; - a visualização diária microscópica ótica sem contraste de fase dos microrganismos presentes nos reatores biológicos; - a visualização microscópica ótica com contraste de fase da microfauna presente nos reatores biológicos, sendo efetuadas 16 identificações e quantificações dos protozoários presentes nas lamas ativadas dos dois reatores e 10 identificações e quantificações das bactérias filamentosas presentes nos dois reatores biológicos. O início do estudo ocorreu num período em que se começou a verificar um aumento excessivo de espumas nos decantadores secundários, resultando numa fraca sedimentabilidade das lamas e numa menor qualidade do efluente final. Na tentativa de reduzir a excessiva ascensão do manto de lamas que se verificou, foram efectuadas alterações operacionais, consistindo: - na alteração da razão de recirculação da decantação secundária para os reatores biológicos; - na introdução de um composto altamente concentrado em matéria orgânica na corrente de recirculação de lamas; - na alteração da extração de lamas biológicas. Verificou-se que as alterações processuais efetuadas foram muito eficazes na diminuição do manto de lamas da decantação secundária, bem como muito eficazes na qualidade do efluente final. Durante os meses de Fevereiro a Agosto fez-se o acompanhamento diário de todas as condições de operação de modo a manter e validar o procedimento de operação, o qual se considerou muito eficaz em termos de obtenção de uma água tratada de excelente qualidade. Durante o estudo efetuado, verificou-se que a população microbiológica existente nos dois reatores biológicos se manteve praticamente inalterada durante todo o período, sendo os móveis de fundo e os sésseis os grupos dominantes. Esta dominância traduziu-se na elevada qualidade do efluente final que se observou a partir do mês de Fevereiro, tendo dificultado o estudo de novas condições de operação, mas facilitando a validação do procedimento adotado. No que se refere às bactérias filamentosas, verificou-se que são diversas as espécies presentes nos reatores biológicos e que existem em grande abundância, sendo que o Tipo 0092 é claramente dominante. O excessivo crescimento deste tipo de bactérias mostrou ser o maior problema a nível microbiológico no processo de tratamento da instalação, tornando-se crítico no período de inverno em que a temperatura e os picos de pluviosidade se mostraram condições favoráveis ao seu desenvolvimento. Para além da temperatura outros fatores mostraram-se responsáveis pelo seu crescimento tais como a razão Alimento/Microrganismo (A/M), a idade das lamas, a carga mássica afluente e o teor de oxigénio dissolvido nos reatores biológicos. Pode-se concluir que apesar de não se trabalhar com os valores teóricos dos parâmetros microbiológicos e operacionais considerados ideais, a ETAR do Freixo, possui um tratamento bastante eficaz na remoção da carga orgânica, na remoção de nutrientes e na remoção de sólidos suspensos totais, apesar da não existência de uma etapa de afinação final como a filtração.

Post-surgical wound infections involving Enterobacteriaceae with reduced susceptibility to ß-lactams in two Portuguese hospitals

The post-surgical period is often critical for infection acquisition. The combination of patient injury and environmental exposure through breached skin add risk to pre-existing conditions such as drug or depressed immunity. Several factors such as the period of hospital staying after surgery, base disease, age, immune system condition, hygiene policies, careless prophylactic drug administration and physical conditions of the healthcare centre may contribute to the acquisition of a nosocomial infection. A purulent wound can become complicated whenever antimicrobial therapy becomes compromised. In this pilot study, we analysed Enterobacteriaceae strains, the most significant gram-negative rods that may occur in post-surgical skin and soft tissue infections (SSTI) presenting reduced β-lactam susceptibility and those presenting extended-spectrum β-lactamases (ESBL). There is little information in our country regarding the relationship between β-lactam susceptibility, ESBL and development of resistant strains of microorganisms in SSTI. Our main results indicate Escherichia coli and Klebsiella spp. are among the most frequent enterobacteria (46% and 30% respectively) with ESBL production in 72% of Enterobacteriaceae isolates from SSTI. Moreover, coinfection occurred extensively, mainly with Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus (18% and 13%, respectively). These results suggest future research to explore if and how these associations are involved in the development of antibiotic resistance.

Candida glabrata susceptibility to antifungals and phagocytosis is modulated by acetate

Candida glabrata is considered a major opportunistic fungal pathogen of humans. The capacity of this yeast species to cause infections is dependent on the ability to grow within the human host environment and to assimilate the carbon sources available. Previous studies have suggested that C. albicans can encounter glucose-poor microenvironments during infection and that the ability to use alternative non-fermentable carbon sources, such as carboxylic acids, contributes to the virulence of this fungus. Transcriptional studies on C. glabrata cells identified a similar response, upon nutrient deprivation. In this work, we aimed at analyzing biofilm formation, antifungal drug resistance, and phagocytosis of C. glabrata cells grown in the presence of acetic acid as an alternative carbon source. C. glabrata planktonic cells grown in media containing acetic acid were more susceptible to fluconazole and were better phagocytosed and killed by macrophages than when compared to media lacking acetic acid. Growth in acetic acid also affected the ability of C. glabrata to form biofilms. The genes ADY2a, ADY2b, FPS1, FPS2, and ATO3, encoding putative carboxylate transporters, were upregulated in C. glabrata planktonic and biofilm cells in the presence of acetic acid. Phagocytosis assays with fps1 and ady2a mutant strains suggested a potential role of FPS1 and ADY2a in the phagocytosis process. These results highlight how acidic pH niches, associated with the presence of acetic acid, can impact in the treatment of C. glabrata infections, in particular in vaginal candidiasis.

Interface HL7 para observation patterns

Com a generalização das tecnologias de informação e comunicação na área da saúde, a monitorização remota de pacientes, a partir de dispositivos móveis, é uma realidade que contribui para uma melhor qualidade de vida dos pacientes. Mas, não são só os pacientes que ganham com a introdução destas tecnologias, também os profissionais de saúde e os hospitais retiram as suas vantagens. Os profissionais de saúde são munidos de uma ferramenta móvel de monitorização permanente de sinais vitais, aumentando desta forma a ligação médico-paciente. Relativamente aos hospitais, estes vêem os custos de manutenção reduzirem, em virtude da possibilidade dos pacientes puderem ser monitorizados a partir dos seus lares. Neste projecto pretende-se identificar mecanismos que possibilitem responder de forma eficaz à necessidade de partilha de informação, nomeadamente protocolos de comunicação, segurança e sistemas de integração. Foi projectado um protótipo, constituído por um middleware e uma aplicação cliente móvel, onde o middleware tem como missão garantir a interoperabilidade entre um servidor HL7 e a aplicação cliente, utilizada pelo profissional de saúde. A normalização da informação médica trocada entre o servidor HL7 e o middleware obedece à norma internacional HL7.

Evolution of Drug Resistance: Insight on TEM -Lactamases Structure and Activity and Beta-Lactam Antibiotics

Extended-spectrum β-lactamases (ESBLs) prevalence was studied in the north of Portugal, among 193 clinical isolates belonging to citizens in a district in the boundaries between this country and Spain from a total of 7529 clinical strains. In the present study we recovered some members of Enterobacteriaceae family, producing ESBL enzymes, including Escherichia coli (67.9%), Klebsiella pneumoniae (30.6%), Klebsiella oxytoca (0.5%), Enterobacter aerogenes (0.5%), and Citrobacter freundii (0.5%). β-lactamases genes blaTEM, blaSHV, and blaCTX-M were screened by polymerase chain reaction (PCR) and sequencing approaches. TEM enzymes were among the most prevalent types (40.9%) followed by CTX-M (37.3%) and SHV (23.3%). Among our sample of 193 ESBL-producing strains 99.0% were resistant to the fourth-generation cephalosporin cefepime. Of the 193 isolates 81.3% presented transferable plasmids harboring genes. Clonal studies were performed by PCR for the enterobacterial repetitive intragenic consensus (ERIC) sequences. This study reports a high diversity of genetic patterns. Ten clusters were found for E. coli isolates and five clusters for K. pneumoniae strains by means of ERIC analysis. In conclusion, in this country, the most prevalent type is still the TEM-type, but CTX-M is growing rapidly.

Nonlinear dynamics of the patient’s response to drug effect during general anesthesia

In today’s healthcare paradigm, optimal sedation during anesthesia plays an important role both in patient welfare and in the socio-economic context. For the closed-loop control of general anesthesia, two drugs have proven to have stable, rapid onset times: propofol and remifentanil. These drugs are related to their effect in the bispectral index, a measure of EEG signal. In this paper wavelet time–frequency analysis is used to extract useful information from the clinical signals, since they are time-varying and mark important changes in patient’s response to drug dose. Model based predictive control algorithms are employed to regulate the depth of sedation by manipulating these two drugs. The results of identification from real data and the simulation of the closed loop control performance suggest that the proposed approach can bring an improvement of 9% in overall robustness and may be suitable for clinical practice.

Evolution of Drug Resistance: Insight on TEM β-Lactamases Structure and Activity and β-Lactam Antibiotics

Since the discovery of the first penicillin bacterial resistance to β-lactam antibiotics has spread and evolved promoting new resistances to pathogens. The most common mechanism of resistance is the production of β-lactamases that have spread thorough nature and evolve to complex phenotypes like CMT type enzymes. New antibiotics have been introduced in clinical practice, and therefore it becomes necessary a concise summary about their molecular targets, specific use and other properties. β-lactamases are still a major medical concern and they have been extensively studied and described in the scientific literature. Several authors agree that Glu166 should be the general base and Ser70 should perform the nucleophilic attack to the carbon of the carbonyl group of the β-lactam ring. Nevertheless there still is controversy on their catalytic mechanism. TEMs evolve at incredible pace presenting more complex phenotypes due to their tolerance to mutations. These mutations lead to an increasing need of novel, stronger and more specific and stable antibiotics. The present review summarizes key structural, molecular and functional aspects of ESBL, IRT and CMT TEM β-lactamases properties and up to date diagrams of the TEM variants with defined phenotype. The activity and structural characteristics of several available TEMs in the NCBI-PDB are presented, as well as the relation of the various mutated residues and their specific properties and some previously proposed catalytic mechanisms.

The role of molecular imaging in modern drug development

Drug development represents a highly complex, inefficient and costly process. Over the past decade, the widespread use of nuclear imaging, owing to its functional and molecular nature, has proven to be a determinant in improving the efficiency in selecting the candidate drugs that should either be abandoned or moved forward into clinical trials. This helps not only with the development of safer and effective drugs but also with the shortening of time-to-market. The modern concept and future trends concerning molecular imaging will assumedly be hybrid or multimodality imaging, including combinations between high sensitivity and functional (molecular) modalities with high spatial resolution and morphological techniques.

Development of paper-based color test-strip for drug detection in aquatic environment: Application to oxytetracycline

The wide use of antibiotics in aquaculture has led to the emergence of resistant microbial species. It should be avoided/minimized by controlling the amount of drug employed in fish farming. For this purpose, the present work proposes test-strip papers aiming at the detection/semi-quantitative determination of organic drugs by visual comparison of color changes, in a similar analytical procedure to that of pH monitoring by universal pH paper. This is done by establishing suitable chemical changes upon cellulose, attributing the paper the ability to react with the organic drug and to produce a color change. Quantitative data is also enabled by taking a picture and applying a suitable mathematical treatment to the color coordinates given by the HSL system used by windows. As proof of concept, this approach was applied to oxytetracycline (OXY), one of the antibiotics frequently used in aquaculture. A bottom-up modification of paper was established, starting by the reaction of the glucose moieties on the paper with 3-triethoxysilylpropylamine (APTES). The so-formed amine layer allowed binding to a metal ion by coordination chemistry, while the metal ion reacted after with the drug to produce a colored compound. The most suitable metals to carry out such modification were selected by bulk studies, and the several stages of the paper modification were optimized to produce an intense color change against the concentration of the drug. The paper strips were applied to the analysis of spiked environmental water, allowing a quantitative determination for OXY concentrations as low as 30 ng/mL. In general, this work provided a simple, method to screen and discriminate tetracycline drugs, in aquaculture, being a promising tool for local, quick and cheap monitoring of drugs.

Nonlinear dynamics of the patient’s response to drug effect during general anesthesia

In today’s healthcare paradigm, optimal sedation during anesthesia plays an important role both in patient welfare and in the socio-economic context. For the closed-loop control of general anesthesia, two drugs have proven to have stable, rapid onset times: propofol and remifentanil. These drugs are related to their effect in the bispectral index, a measure of EEG signal. In this paper wavelet time–frequency analysis is used to extract useful information from the clinical signals, since they are time-varying and mark important changes in patient’s response to drug dose. Model based predictive control algorithms are employed to regulate the depth of sedation by manipulating these two drugs. The results of identification from real data and the simulation of the closed loop control performance suggest that the proposed approach can bring an improvement of 9% in overall robustness and may be suitable for clinical practice.

Physical therapy with drug treatment in bell palsy: a focused review

ABSTRACT: The physical therapy (PT) associated with standard drug treatment (SDT) in Bell palsy has never been investigated. Randomized controlled trials or quasirandomized controlled trials have compared facial PT (except treatments such as acupuncture and osteopathic) combined with SDT against a control group with SDT alone. Participants included those older than 15 yrs with a clinical diagnosis of Bell palsy, and the primary outcome measure was motor function recovery by the House-Brackmann scale. The methodologic quality of each study was also independently assessed by two reviewers using the PEDro scale. Four studies met the inclusion criteria. Three trials indicate that PT in association with SDT supports higher motor function recovery than SDT alone between 15 days and 1 yr of follow-up. On the other hand, one trial showed that electrical stimulation added to conventional PT with SDT did not influence treatment outcomes. The present review suggests that the current practice of Bell palsy treatment by PT associated with SDT seems to have a positive effect on grade and time recovery compared with SDT alone. However, there is very little quality evidence from randomized controlled trials, and such evidence is insufficient to decide whether combined treatment is beneficial in the management of Bell palsy.

Modelos Teóricos de Difusão Dérmica: abordagens matemáticas e computacionais para terapias transdérmicas da Obesidade

É de senso comum que os nutrientes são fundamentais à vida e que a subnutrição leva à acumulação de gorduras que pode chegar a casos de obesidade, tendo como consequência inúmeras complicações de saúde. Diferentes estruturas neuroanatómicas do cérebro têm um papel essencial no comportamento digestivo. A ação de várias moléculas de sinalização (hormonas, neurotransmissores e neuropéptidos) resulta na regulação da ingestão de alimentos, sendo que, por exemplo, algumas hormonas podem aumentar a sensação de saciedade podendo diminuir o apetite e a ingestão calórica. A descoberta de hormonas envolvidas no balanço energético proporcionou novas oportunidades para desenvolver meios para o tratamento da obesidade. A transferência de medicação antiobesidade por via tópica ou transdérmica é um desafio pois a pele funciona como uma barreira natural e protetora. Sendo uma barreira com uma grande área de superfície e de fácil acessibilidade, a pele tem potencial interesse na libertação de fármacos específicos a cada terapia. Vários métodos têm sido estudados de modo a permitir um aumento da permeabilidade de moléculas terapêuticas para o interior da pele e através da pele. As biotecnologias transdérmicas são um campo de interesse cada vez maior, devido as aplicações dérmicas e farmacêuticas que lhes estão subjacentes. Existem vários modelos computacionais e matemáticos em uso que permite uma visão mais abrangente de puros dados experimentais e até mesmo permite a extrapolação prática de novas metodologias de difusão dérmica. Contudo, eles compreendem uma complexa variedade de teorias e suposições que atribuem a sua utilização para situações específicas. Este trabalho, primeiramente analisa, de forma extensiva, as várias metodologias teóricas para o estudo da difusão dérmica e sistematiza as suas características, realizando depois a fase prévia duma nova abordagem computacional para o estudo da difusão dérmica, que determina características microscópicas de moléculas capazes de provocar a perda de peso, tais como a Leptina e/ou os seus agonistas.