The human gut microbiome is influenced by numerous factors including commonly used drugs, but it has also been shown that the gut microbiome by itself influences drug responses and efficacy. We studied the relations between commonly used drugs and microbial changes considering factors like polypharmacy and multi-morbidity. We performed metagenomics sequencing of 1883 faecal samples from three cohorts: 1) a population-based cohort, 2) patients with inflammatory bowel diseases and 3) patients with irritable bowel syndrome. Differences between drug users and non-users were analysed per cohort, followed by a meta-analysis. 17 of 41 drugs were associated with changes in microbial features. For example, metformin users showed enrichment of Escherichia-coli -derived metabolic pathways and methanogenic pathways were increased in oral steroid users in patients with IBD. Due the importance of the gut microbiome in health and the widespread use of drugs, we here provide evidence for extensive changes in taxonomy, metabolic activity and resistome in relation to commonly used drugs. This research paves the way to further mechanistic studies for drug response and side effects and has implications on future microbiome studies, underlining the need for correcting for multiple drug use in both general population and in GI disease cohorts.

Due to the development of information communication technologies (ICT), the number of medical devices (MDs) with telemetric possibilities is rising, so the concept of homecare is gaining importance. Also, new generation medical devices are equipped with artificial intelligence that is able to perform real-time analysis of measurement result and provide diagnosis prediction. This is the Industry 4.0 happening now. However, there is still traditional approach in management of medical devices. As medical devices have been sophisticated, management systems should improve so they can encompass all the important aspects regarding safety of patients and quality of care. This chapter presents how the technology of Industry 4.0 can be used to improve medical device maintenance systems by application of artificial intelligence (AI). Clinical engineering and health technology management departments benefit from such systems in terms of increase of safety and quality of patient diagnosis and treatments, and cost optimization in medical device management.