OPTIMIZATION OF MEDIUM COMPONENTS FOR ANTIBACTERIAL METABOLITE PRODUCTION FROM MARINE STREPTOMYCES SP. PUA2 USING RESPONSE SURFACE METHODOLOGY

Objective: The present study is an attempt to optimize the fermentation conditions for the antibacterial compound production from a newly isolated marine Streptomyces strain PUA2 by adopting response surface methodology as the statistical tool. Methods: Prior to using the Response Surface Methodology, Plackett Burmann (PB) design was used to explore the effect of variables on the antibacterial compound production. In PB method, high and low values were assigned for the eight variables viz., glucose, glycerol, soybean meal, manganese chloride, calcium carbonate, peptone and pH. Calcium carbonate and peptone were used as dummy variables. Based on the results of combined effects glycerol, soybean meal, manganese chloride and pH were investigated by 24 full-factorial central composite design. Results: The results of PB method showed the significant effect of glycerol, soybean meal, manganese chloride and pH on the antibacterial compound production. The results of ANOVA and regression of second order model showed that the linear effects of glycerol and manganese chloride and cross products effects of manganese chloride and pH were more significant. All the critical variables having greatest effect on the production of antibacterial compound from marine Streptomyces species PUA2. Optimization of process parameters resulted in increase in antibacterial activity from 7 mm to 14 mm. Conclusion: The factors optimized in the present study were useful for the increased production of antibacterial metabolite from Streptomyces sp PUA2. The result confirms the feasibility of medium optimization to improve antibiotic production

Baseline adherence, socio-demographic, clinical, immunological, virological and anthropometric characteristics of 242 HIV positive patients on ART in Malaysia

Adherence to antiretroviral therapy (ART) prevents disease progression, and the emergence of resistant mutations. It also reduces morbidity, and the necessity for more frequent, complicated regimens which are also relatively more expensive. Minimum adherence levels of 95% are required for treatment success. Poor adherence to treatment remains a stumbling block to the success of treatment programs. This generates major concerns about possible resistance of the human immunodeficiency virus (HIV) to the currently available ARVs. This paper aims to describe baseline results from a cohort of 242 Malaysian patients receiving ART within the context of an intervention aimed to improve adherence and treatment outcomes among patients initiating ART. A single-blinded Randomized Controlled Clinical Trial was conducted between January and December, 2014 in Hospital Sungai Buloh. Data on socio-demographic factors, clinical symptoms and adherence behavior of respondents was collected using modified, pre-validated Adult AIDS Clinical Trials Group (AACTG) adherence questionnaires. Baseline CD4 count, viral load, weight, full blood count, blood pressure, Liver function and renal profile tests were also conducted and recorded. Data was analyzed using SPSS version 22 and R software. Patients consisted of 215 (89%) males and 27 (11%) females. 117 (48%) were Malays, 98 (40%) were Chinese, 22 (9%) were Indians while 5 (2%) were of other ethnic minorities. The mean age for the intervention group was 32.1 ± 8.7 years while the mean age for the control group was 34.7 ± 9.5 years. Mean baseline adherence was 80.1 ± 19.6 and 85.1 ± 15.8 for the intervention and control groups respectively. Overall mean baseline CD4 count of patients was 222.97 ± 143.7 cells/mm³ while overall mean viral load was 255237.85 ± 470618.9. Patients had a mean weight of 61.55 ± 11.0 kg and 61.47 ± 12.3 kg in the intervention and control groups, respectively. Males account for about 90% of those initiating ART in the HIV clinic, at a relatively low CD4 count, high viral load and sub-optimal medication adherence levels at baseline

Socio-demographic profile and predictors of outpatient clinic attendance among HIV-positive patients initiating antiretroviral therapy in Selangor, Malaysia

Background: Inconsistent literature evidence suggests that sociodemographic, economic, and system- and patient-related factors are associated with clinic attendance among the HIV-positive population receiving antiretroviral therapy (ART) around the world. We examined the factors that predict outpatient clinic attendance among a cohort of HIV-positive patients initiating ART in Selangor, Malaysia. Patients and Methods: This cross-sectional study analyzed secondary data on outpatient clinic attendance and sociodemographic, economic, psychosocial, and patient-related factors among 242 adult Malaysian patients initiating ART in Selangor, Malaysia. Study cohort was enrolled in a parent randomized controlled trial (RCT) in Hospital Sungai Buloh Malaysia between January and December 2014, during which peer counseling, medication, and clinic appointment reminders were provided to the intervention group through short message service (SMS) and telephone calls for 24 consecutive weeks. Data on outpatient clinic attendance were extracted from the hospital electronic medical records system, while other patient-level data were extracted from pre-validated Adult AIDS Clinical Trial Group (AACTG) adherence questionnaires in which primary data were collected. Outpatient clinic attendance was categorized into binary outcome - regular attendee and defaulter categories - based on the number of missed scheduled outpatient clinic appointments within a 6-month period. Multivariate regression models were fitted to examine predictors of outpatient clinic attendance using SPSS version 22 and R software. Results: A total of 224 (93%) patients who completed 6-month assessment were included in the model. Out of those, 42 (18.7%) defaulted scheduled clinic attendance at least once. Missed appointments were significantly more prevalent among females (n=10, 37.0%), rural residents (n=10, 38.5%), and bisexual respondents (n=8, 47.1%). Multivariate binary logistic regression analysis showed that Indian ethnicity (adjusted odds ratio [AOR] =0.235; 95% CI [0.063-0.869]; P=0.030) and heterosexual orientation (AOR =4.199; 95% CI [1.040-16.957]; P=0.044) were significant predictors of outpatient clinic attendance among HIV-positive patients receiving ART in Malaysia. Conclusion: Ethnicity and sexual orientation of Malaysian patients may play a significant role in their level of adherence to scheduled clinic appointments. These factors should be considered during collaborative adherence strategy planning at ART initiation

Socioeconomic predictors of adherence behavior among HIV-positive patients receiving antiretroviral therapy in Selangor, Malaysia

Medication adherence remains a critical link between the prescribed ART regimen and treatment outcome. Several factors may influence adherence behavior. This cross-sectional study aimed to highlight socioeconomic predictors of adherence behavior among a cohort of 242 adult Malaysian patients receiving antiretroviral therapy in Hospital Sungai Buloh, Malaysia, where they were enrolled in a parent study (single-blinded randomized controlled trial) between January and December 2014. Statistical analysis of secondary data on adherence behavior and sociodemographic characteristics of the patients revealed mean age of 33.4 years and ranged from 18 to 64 years; 88.8% were males. A total of 224 (93%) patients who completed 6 months' adherence assessment were included in the model. Of these, 135 (60.3%) achieved optimal adherence. Multivariate binary logistic regression analysis revealed that patient's income and ethnicity were significant predictors of adherence behavior. This may be valuable for targeted programmatic interventions to further enhance successful treatment outcomes among the target population

Predictors of adherence behaviour among HIV positive patients receiving Antiretroviral Therapy (ART) in Malaysia

Introduction: Success of antiretroviral treatment depends on a host of factors, the most important of which is the patient’s adherence behaviour. The objective of this study was to determine whether the introduction of mobile phone technology (SMS and telephone call reminders) can significantly improve adherence and treatment outcomes among HIV positive patients on ART. This paper highlights ‘context-specific’ predictors of adherence behaviour among a cohort of Malaysian patients receiving ART. Methods: A single-blinded RCT was carried out in Hospital Sungai Buloh between January and December 2014 among HIV positive patients on ART. Data on socio-demographic factors, clinical symptoms, and adherence behaviour, assessed using the modified and pre-validated Adult AIDS Clinic Trials Group adherence questionnaires were collected. CD4 count, viral load, weight, full blood count, blood pressure, liver function and renal profile tests were also conducted and recorded. Multivariate regression models were used to examine the relationship between study variables using SPSS version 21 and R software. Results: The overall mean age of 242 respondents was 33.4 (standard deviation (SD) 9.2, range 18-64) years. Majority (88.8%) were males. Overall, 47.9% of respondents were placed on ZDV/3TC/EFV regimen, 47.1% took TDF/FTC/EFV regimen at baseline (ART initiation) while other HAART regimens accounted for only 5% of the distribution altogether. Univariate logistic regression analysis showed that adherence behaviour was significantly associated with ethnicity, monthly income and employment status. After controlling for the effect of age and treatment group, multivariate multinomial logistic regression analysis showed that patient’s employment status (adjusted Odds Ratio 4.46; 95% CI: 3.22, 6.18) was a significant predictor of adherence behaviour among HIV positive patients receiving ART in Malaysia. Conclusion: The findings provide additional support to the growing body of evidence on the strong relationship between patient’s employment status and their adherence behaviour, particularly in concentrated epidemics and low-to-middle income economies

Informační podpora doktorského studia

Import 20/04/2006Prezenční výpůjčkaVŠB - Technická univerzita Ostrava. Fakulta strojní. Katedra (352) automatizační techniky a řízen

Adherence research in Malaysia

Adherence research in Malaysi

Summary table of 2-way repeated measures ANOVA showing main effect of group, time and group x time interaction for adherence, CD4 count, viral load and weight.

<p>Summary table of 2-way repeated measures ANOVA showing main effect of group, time and group x time interaction for adherence, CD4 count, viral load and weight.</p

Baseline socio-demographic characteristics of respondents.

<p>Baseline socio-demographic characteristics of respondents.</p