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Resumo A ética é essencial para garantir uma prática médica responsável e comprometida com o bem-estar do paciente e da sociedade. Diante disso, a compreensão da autonomia do paciente e sua participação ativa nas decisões sobre tratamentos e procedimentos médicos são fundamentais. Realizou-se revisão sistemática da literatura, entre dezembro de 2018 e maio de 2023, com o objetivo de auxiliar o debate ético e a conduta profissional acerca do que deve ser ponderado em uma situação de conflito entre a decisão médica e a vontade do paciente e, assim, fornecer perspectivas sobre o gerenciamento dessa temática. Os 18 artigos selecionados abordam questões éticas relacionadas à relação médico-paciente, destacando a importância das diretivas antecipadas de vontade, comunicação honesta e respeito à autonomia do paciente. Assim, busca-se fornecer perspectivas e orientações para o gerenciamento de conflitos éticos na prática médica.

Abstract Ethics is essential to ensure responsible medical practice, committed to the well-being of patients and society. Hence, understanding patient autonomy and their active participation in decisions about treatments and medical procedures is paramount. A systematic literature review was conducted on articles published between December 2008 and May 2023 to assist in the ethical debate and professional conduct about what should be considered in a conflict between the medical decision and the patient's wishes, and thus provide perspectives on how to manage this issue. The 18 articles selected address ethical issues related to physician-patient relations, highlighting the importance of advance directives, honest communication and respect for patient autonomy. We aim to provide perspectives and guidelines for managing ethical conflicts in medical practice.

Resumen La ética es esencial para garantizar una práctica médica responsable y comprometida con el bienestar de los pacientes y la sociedad. Así, es fundamental comprender la autonomía del paciente y su participación activa en las decisiones sobre tratamientos y procedimientos médicos. Se realizó una revisión sistemática de la literatura entre diciembre de 2018 y mayo de 2023, con el objetivo de aportar al debate ético y la conducta profesional sobre lo que debe considerarse en una situación de conflicto entre la decisión médica y la voluntad del paciente, y así proporcionar perspectivas sobre la gestión de este tema. Los 18 artículos seleccionados abordan cuestiones éticas sobre la relación médico-paciente, destacando la importancia de las voluntades anticipadas, la comunicación honesta y el respeto a la autonomía del paciente. Así, se espera ofrecer perspectivas y directrices para gestionar los conflictos éticos en la práctica médica.

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The use of intestinal probiotic bacteria is very common in the food industry and has been the focus of the majority of research in this field. Yet in recent years, research on extraintestinal microorganisms has greatly increased due to their well-known potential as probiotics. Thus, we studied a strain of Lactobacillus fermentum (TCUESC01) extracted from fermenting cocoa. First, we examined the impact of pH on the growth of this strain and studied its survival under conditions similar to those of the human gastrointestinal tract. L. fermentum TCUESC01 demonstrated resistance to conditions mimicking the human stomach and intestines and grew well between pH 5 and pH 7. Next, we subjected L. fermentum TCUESC01 to storage at 4°C in a milk solution and found that it survived well for 28 days. Lastly, we measured the susceptibility of this strain to numerous antibiotics and its tendency to autoaggregate. L. fermentum TCUESC01 showed significant autoaggregation, as well as susceptibility to the majority of antibiotics tested. Overall, our findings support the potential use of this extraintestinal bacterium as a dietary probiotic.

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BACKGROUND: Biofilm production represents an important virulence and pathogenesis factor for Staphylococcus aureus. The formation of biofilms on medical devices is a major concern in hospital environments, as they can become a constant source of infection. Probiotic bacteria, such as Lactobacillus fermentum and L. plantarum, have been found to inhibit biofilm formation; however little is known about the underlying mechanism. In this study, we tested the activity of supernatants produced by L. fermentum TCUESC01 and L. plantarum TCUESC02, isolated during the fermentation of fine cocoa, against S. aureus CCMB262 biofilm production. We measured inhibition of biofilm formation in vitro and analyzed biofilm structure by confocal and electronic microscopy. Additionally, we quantified the expression of S. aureus genes icaA and icaR involved in the synthesis of the biofilm matrix by real-time PCR. RESULTS: Both Lactobacillus supernatants inhibited S. aureus growth. However, only L. fermentum TCUESC01 significantly reduced the thickness of the biofilm, from 14 µm to 2.83 µm (at 18 mg∙mL-1, 90 % of the minimum inhibitory concentration, MIC), 3.12 µm (at 14 mg∙mL-1, 70 % of the MIC), and 5.21 µm (at 10 mg∙mL-1, 50 % of the MIC). Additionally, L. fermentum TCUESC01 supernatant modulated the expression of icaA and icaR. CONCLUSIONS: L. fermentum TCUESC01 reduces the formation of S. aureus biofilm under subinhibitory conditions. Inhibition of biofilm production probably depends on modulation of the ica operon.

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