Prevalence, toxin gene profile, antibiotic resistance, and molecular characterization of Clostridium perfringens from diarrheic and non-diarrheic dogs in Korea

Clostridium perfringens causes diarrhea and other diseases in animals and humans. We investigated the prevalence, toxin gene profiles, and antibiotic resistance of C. perfringens isolated from diarrheic dogs (DD) and non-diarrheic dogs (ND) in two animal hospitals in Seoul, Korea. Fecal samples were collected from clinically DD (n = 49) and ND (n = 34). C. perfringens was isolated from 31 of 49 DD (63.3%) and 21 of 34 ND dogs (61.8%). All C. perfringens strains were positive for the α toxin gene, but not for the β, ε, or ι toxin genes; therefore, all strains were identified as type A C. perfringens. All isolates were cpe-negative, whereas the β2 toxin gene was identified in 83.9% and 61.9% of isolates from DD and ND, respectively. Most isolates were susceptible to ampicillin (94%), chloramphenicol (92%), metronidazole (100%), moxifloxacin (96%), and imipenem (100%). However, 25.0% and 21.2% of isolates were resistant to tetracycline and clindamycin, respectively. Molecular subtyping of the isolated strains was performed by using pulsed-field gel electrophoresis. Fifty-two isolates were classified into 48 pulsotypes based on more than 90% similarity of banding patterns. No notable differences were observed among the isolates from DD and ND.

Do we use antibiotics judiciously enough? a study in accident and emergency department of tertiary care hospital in pakistan

Objective: To determine whether antibiotics are necessary for all minor wounds presenting to the Accident and Emergency Department at a tertiary care Centre in Pakistan

Methods: One hundred and five patients presenting to the Accident and Emergency Department, Jinnah Postgraduate Medical Centre, Karachi, with open wounds were included in the study and divided into two: Groups A [study] and B [control], with Group-A receiving conservative therapy. Eighty-four patients were included in the final analysis as the rest were lost to follow up. Follow up was done after one week to see how many patients had developed infection

Results: The average age of patients was 27.3 +/-9.7 years with similar baseline characteristics. From these, 51% had superficial wounds; average number of wounds was 1.63 +/-0.99, with an average length of 2.7 +/-1.6 cm. A total of 10 out of 84 patients developed infection at 7-10 days after presentation to the A and E. From these, 3 patients receiving conservative treatment [A, 10%, OR=0.107], and seven patients receiving prophylactic antibiotics [B, 12.96%, OR=0.149] developed an infection. Calculated odds ratio for increased risk of infection in Group-A = 0.72

Conclusion: A conservative approach to antibiotic prescription for minor trauma may be appropriate despite absence of strict asepsis during emergency wound care

NSAIDs ameliorate cognitive and motor impairment in a model of parkinsonism induced by chlorpromazine

Parkinson's disease [PD] is a long-lasting neurodegenerative brain disease. It is characterized by a gradual decline in motor and non motor symptoms especially postural instability, tremors and memory impairment with localized loss of neurons mainly in the Substantia nigra. In the current research we evaluated the effects of Non-steroidal anti inflammatory drugs [NSAIDs] on motor coordination and memory in chlorpromazine [CPZ] induced Parkinson's experimental model. Intraperitoneal [i.p.] injection of CPZ [3 mg/kg] was given to all rats for 21 days to induce Parkinson like symptoms; ibuprofen [40mg/kg/day] and celecoxib [20mg/kg] were administered 30 minutes after CPZ injection. Behavioral parameters like Catalepsy, muscle strength [wire hanging test], locomotor activity [open field test] were observed. Moreover, its effect on memory was explored by the use of water maze and passive avoidance test. Our results showed CPZ significantly induced motor fluctuation and cognitive impairment in a period of 21 days. Celecoxib and ibuprofen significantly improved cataleptic scores [P<0.01], locomotion and muscular coordination in open field [P<0.01] and in wire hanging test [P<0.01]. Significant improvement in memory was observed with celecoxib [P<0.01] and ibuprofen [P<0.05] in water maze test as well as in passive avoidance test. Therefore, the present study showed neuroprotective and memory enhancing effect of ibuprofen and celecoxib against CPZ induced Parkinson's model

Otitis media with effusion: Accuracy of tympanometry in detecting fluid in the middle ears of children at myringotomies

Objective: [1] The diagnostic accuracy of tympanometry in detecting fluid in the middle ear space in children with otitis media with effusion by comparing its findings with those of myringotomies. [2] Identify the age group most commonly affected by OME

Methods: This prospective study was conducted at the Department of ENTand Head and Neck Surgery, Postgraduate Medical Institute Hayatabad Medical complex, Peshawar from July 1, 2012 to April 30, 2015. Patients with suspicion of OME underwent tympanometry and later myringotomies. Using Jerger's classification, Type B tympanogram with normal canal volume was considered as conclusive evidence of fluid in the middle ear space. Its findings were compared with those of the respective myringotomies. From the data collected, the accuracy, sensitivity, specificity, positive predictive value and negative predictive values were calculated

Results: A total 117 ears of 63 patients were operated. The age range was 3 to 12 years. The commonest age group [58.7%] affected by OME was 6-8 years. Type B tympanogram with flat curve and normal canal volume was obtained in 71.4% of the ears. Comparison with myringotomy findings showed TP 85, TN 13, FP 5 and FN 14. The diagnostic value of tympanometry was; Sensitivity 85.85%, Specificity 72.22%, PPV 94.44%, NPV 48.14% and Accuracy of 83.76%. P value calculated using chi square test showed that there was significant difference between tympanometry and myringotomy findings in OME [p < 0.05]

Conclusions: OME is common in age group 6-8 years. Tympanogram Type B with normal canal volume is fairly sensitive in diagnosing this condition. However for occurrence of false positive results, final decision regarding management should be made on clinical findings and other supportive audiological tests

Sarcasm of quality and efficiency: an evaluation of inpatient bed utilization in services hospital Lahore Pakistan

Objective: to determine inpatient bed utilization in the Pediatrics Ward of Services Hospital, Lahore as average daily census and Bed Occupancy Rate

Methods: a cross sectional study was conducted in the Pediatrics Medicine Ward of Services Hospital Lahore which is a tertiary care hospital attached with Services Institute of Medical Sciences Lahore, Pakistan. A 'midnight census' was conducted by 4th year MBBS, Medical Students for the children admitted from 6 to 12 May, 2015. The data for inpatient service utilization was analyzed for estimation of average daily census and bed occupancy rate

Results: the average daily census was 69 patients per day and the Bed Occupancy Rate was found to be 137.7%. This rate was higher than 100% that shows the over-utilization of beds leading to quality compromise for the provided services

Conclusion: high bed occupancy rate indicates a scarcity of beds in the Pediatric Ward which highlights a disparity between the supply and demands of pediatric medical services. A change in policy and increase in number of beds would help provision of quality health services to the children

Cytogenetic and molecular analyses of philadelphia chromosome variants in CML [chronic myeloid leukemia] patients from Sindh using karyotyping and RT-PCR

To determine the frequency of Philadelphia chromosome [Ph] and its variants in chronic myeloid leukemia [CML] cases at a tertiary care hospital of Sindh. The study was conducted at the Department of Pathology, Liaquat University of Medical and Health Sciences, Jamshoro and Isra University Hospital, Hyderabad during May-to-September 2014. Bone marrow and peripheral blood samples from a total of 145 diagnosed cases of CML were collected. Cytogenetic analyses were performed using karyotyping as per the International System for Human Cytogenetic Nomenclature guidelines. All karyotypic images were analyzed using the Cytovision software. In order to identify BCR-ABL transcripts, RT-PCR was performed. Statistical analysis of the data was done using SPSS-version-21.0. Of the 145 samples, a total of 133 [91.7%] were positive for the Ph [Ph+] while 12 [8.3%] were negative for the Ph [Ph-]. Of the 133 Ph+ samples, standard karyotypes were noted in 121 [91%], simple variants in 9 [6.7%] and complex variants in 3 [2.3%] of the samples. All the Ph+ samples [n=133] showed BCR-ABL positivity. Of the 12 Ph- samples, a total of 7 [58.3%] were BCR-ABL-positive and 5 [41.6%] were BCR-ABL-negative. Frequency of the Ph was found to be of 90.9% in CML patients using a highly sensitive technique, the RT-PCR. Cytogenetic abnormalities were at a lower frequency. Cytogenetic and molecular studies must be conducted for better management of CML cases. These findings could be very useful in guiding the appropriate therapeutic options for CML patients

Differential immune cell densities in ductal carcinoma In-Situ and invasive breast cancer: possible role of leukocytes in early stages of carcinogenesis

To investigate immune cell densities in pre-neoplastic [DCIS], cancer [IDC] and control breast tissues. A total of four preneoplastic, 104 cancer and 104 control samples were analyzed. Morphological classification and prognostic scoring along with quantification of immune cells/mm[2] was performed. Data were entered and analyzed using SPSS version 16. Correlation of immune cell densities with various tumour sub-types was investigated using paired t-test and ANOVA. A p-value of <0.05 was considered as significant. Our data show increased infiltration of lymphocytes [mean lymphocytes = 287.6 cells/mm[2]] as well as myelocytes [mean lymphocytes = 117.1 cells/mm[2]] in pre-neoplastic tissues. This infiltration was significantly high compared to cancer [p-value<0.001] as well as control tissues [p-value <0.001]. Moreover, we report increased infiltration of lymphocytes in cancer tissues compared to controls [p-value<0.001]. There was no difference in lymphocyte densities within various tumour sub-types [all p-values >0.05]. Leukocytes may play a role in early stages of breast carcinogenesis

Attenuation of methylphenidate-induced tolerance on cognition by buspirone co-administration

Methylphenidate as a psycho stimulant drug has been prescribed in neuropsychiatric disorders to increase cognition and attention therefore is a medication of choice for attention-deficit/hyperactivity disorder however long-term administration of central nervous system stimulant produces tolerance on cognitive behavior. Previously it has been shown that long-term psychostimulant administration increases somatodendritic5HT-[IA] receptors effectiveness. Repeated buspirone administration attenuates 5-HT[IA] soma to dendritic receptors effectiveness. This study was designed to determine that buspirone co-administration may reduce methylphenidate-induced tolerance on cognitive behavior. Cognitive effects were compared by using water maze and passive avoidance test weekly after long-term administration of methylphenidate, buspirone and their co-administration. Methylphenidate at a dose of 2.0mg/kg/day in rats initially improve memory but after long-term treatment produce tolerance on cognitive behavior this effect is more pronounce in case of spatial working memory of water maze test than passive avoidance learning memory. However oral buspirone co-administration at a dose of 10mg/kg/day prevents methylphenidate-induce tolerance on cognition. It is suggested that buspirone may oppose methylphenidate-induced cognitive tolerance by reducing the sensitivity of 5-HT1A soma to dendritic receptors. These findings may help to extend future therapeutics in ADHD

Tonsillectomy performed by ultrasonic harmonic scalpel is associated with lower postoperative pain as compared with conventional blunt dissection method

Aims: To compare the mean intensity of post-operative pain in Harmonic scalpel tonsillectomy and conventional blunt dissection method in pediatric age group

Patients and Methods: It was randomized control trial with non-probability, consecutive sampling done in the ENT Department, Shaikh Zayed Hospital, Lahore. The study was conducted. from 01-03-2012 to 31-08-2013

Results: In 81 out of 162 patients, tonsillectomy was performed by Harmonic scalpel and they were labeled as Group-A. While in remaining 81 patients, labeled as Group-B, tonsillectomy was performed by conventional blunt dissection method. The post operative pain was significantly less in Group-A on day 1, 2, 3 and 5 with P-value <0.001. While on day seven although the pain is less in Group-A but it is not statistically significant

Conclusions: Tonsillectomy performed by ultrasonic harmonic scalpel is associated with lower postoperative pain as compared with conventional blunt dissection method. Thus, we believe that the use of this new technique for tonsillectomy may result in additional benefit to the patients

Detection of xenotropic murine leukemia virus-related virus in prostate biopsy samples

To determine the association of Xenotropic murine leukemia virus related virus [XMRV] infection with prostate cancer and compare it with benign prostate hyperplasia. Case control study. Department of Histopathology and Molecular Pathology, Dow University of Health Sciences, Karachi, from January 2009 to December 2012. XMRV was screened in 50 prostate cancer and 50 benign prostatic hyperplasia biopsies using conventional end-point PCR. Other studied variables were family history of prostate cancer, patients age and Gleason score. XMRV was detected in 4 [8%] of the 50 prostate cancer biopsy specimens compared to none in biopsies with benign prostatic hyperplasia. However, there was no significant statistical association of XMRV infection with the other variables. A low frequency of XMRV infection was found in this case-control study. Men, who harbor XMRV infection, may be at increased risk of prostate cancer but this needs to be investigated further at a larger scale

Frequency of stressful activities amongst doctors, engineers and teachers

Background: Different professions are under a great deal of stress related to a variety of occupational stress factors. These factors contribute to decreased job satisfaction, decreased work output, mental and physical exhaustion and absenteeism due to sickness. It often occurs when individuals' cannot cope with their job demands, physically or emotionally

Objective: To determine the frequency of stress among three highly challenged occupations which are doctors, engineers and teachers

Methods: The cross sectional study was conducted in the District South of Karachi using separate questionnaires for doctors, engineers and teachers. In this research the total of 600 individuals were included, 200 from each profession. Only those individuals were surveyed who are currently working in government institutions of this district. The data obtained was analyzed using SPSS v.20

Results: The results showed that engineers are under a higher level of stress as compared to doctors and teachers. Workload, lack of power and influence, office politics, inadequate or poor quality of training/management development and lack of encouragement are the major factors that are contributing to build stress in engineers

Conclusion: As the frequency of stressful activities found higher in engineer, their workload should be minimized and divided among the relevant posts rather than putting the entire burden on an individual. Office politics must be discouraged as this has proved to have detrimental effects on individual's life. Lack of knowledge, power, influence, training and encouragement has led to increased stress. Stress management programs will improve management, and good intrapersonal relationships

Major flaws in technique of intramuscular injections

To identify the major flaws in technique of administering intramuscular injections by our health care professionals and to suggest improvements based upon a scientific study. Cross sectional [Jan-Feb, 2011].Place: Combined Military Hospital Sargodha, Pakistan Air Force Hospital Sargodha, Pakistan Air Force Hospital Mianwali. All staff involved in administration of IM injection to the patients. A detailed questionnaire was required to be filled in front of an observer and submitted. Injection sites were required to be marked on diagrams. The data were analyzed by SPSS 17. Major flaws were identified in the technique of administration of IMI

Percutaneous endoscopic colostomy [pec]: an effective alternative in high risk patients with recurrent sigmoid volvulus

Treatment of recurrent sigmoid volvulus is a major challenge in frail and elderly patients with multiple co-morbidities. Early management involves endoscopic decompression with high success rate, however, its recurrence make it a real challenge as most of these patients are not suitable for major colonic resection. The aim of this study was to assess the role of percutaneous endoscopic colostomy [PEC] in the treatment of recurrent sigmoid volvulus in these patients. Twelve PEC procedures were performed in 8 patients under our care. This prevented major colonic resection in 7 patients. One patient underwent sigmoid resection and died with postoperative complications. Two patients experienced minor complications. Three patients required repeat procedures for permanent PEC tube placement. Six patients managed permanently with PEC procedure. PEC is an effective treatment for recurrent sigmoid volvulus in high-risk elderly patients.

Nasal packing: is it necessary in septal surgery

Aim the study was carried out to evaluate the necessity of nasal packing following septoplasty

Methods: This observational study of 60 cases was carried out at the Department of ENT, Shaikh Zayed Federal Postgraduate Medical Institute and Hospital, Lahore from September 2008 to March 2009. Group A contained patients with nasal packing. Group B contained patients without nasal packing

Results: The incidence of headache in group A was very high as compared to group B. 90% patients in group A had headache as compared to 20% patients in group B [p<0.001] The incidence of sleep disturbance in group A was very high as compared to group B. 24 [80%] patients in group A had sleep disturbance as compared to 4 [13.3%] patients in group B [p<0.001] The incidence of hemorrhage following septoplasty was low in both groups. Only 2 [6.6%] patients developed hemorrhage in group B. It was not found in group A [0%]. The incidence of septal hematoma following septoplasty was low in both groups. Only 2 [6.6%] patients in group A developed septal hematoma and required incision and drainage, as compared to 0 [0%] patients in group B

Conclusion: Nasal packing is not necessary in each post operative patient of septoplasty

Effect of storage conditions on the morphological preservation of rabbit kidney and liver tissues

Objective: to see the effect of different solutions and storage temperature on morphological preservation of rabbit kidney and liver tissues

Material and Methods: in this experimental study, rabbit kidney and liver slices were stored in Ringer Lactate, Euro Collins and University of Wisconsin solutions [UW solution], for various fixed time intervals. The three solutions were tried at room temperature as well as at 0-4degreeC. Morphological preservation was assessed by a semi quantitative method

Results: adequate morphological preservation of both tissues was obtained in all solutions at room temperature for the first 24 hours. Lowering of storage temperature to 0-4degreeC was highly beneficial to both tissues in all solutions. UW solution is more effective for liver tissue preservation

Conclusion: anyone of the solutions may be used at room temperature, for preservation of tissue to be submitted for immuno-histochemistry for the first 24 hours. If prolonged storage is required, lowering of temperature is recommended

Assessment of lipid lowering effects of vitamin E

Aim of this study was to determine the role of antioxidant vitamin E in lowering the serum cholesterol and triglyceride levels. This study was conducted in the department of Pharmacology, Faculty of Pharmacy, University of Karachi, Karachi. Duration of study was 42 days froml-03-2008 to 11-4-2008. Male 20 rabbits were equally divided into 2 groups, group A was served as control and the group B was vitamin E treated. All the animals were maintained on cholesterol rich diet for a period of 30 days in order to induce hypercholesterolemia. After induction of hypercholesterolemia the group B was given vitamin E in a dose of 8.57mg/kg/day while the control group A was maintained on distilled water only for a period of 42 days. At the end of 42 days the blood samples were collected from marginal ear vein of rabbits and were analyzed to determine the levels of cholesterol and triglycerides. The results showed that there was decrease in the level of cholesterol but the level of triglyceride was reduced much significantly by administration of vitamin E. It has been reported earlier that vitamin E has potential to decrease levels of cholesterol and triglycerides. It can be concluded that vitamin E use can reduce the level of cholesterol and triglyceride in hypercholesterolemia and may prove to be beneficial

Dialysis-related factors affecting quality of life in patients on hemodialysis

Treatment modalities for end-stage renal disease affect quality of life [QOL] of the patients. This study was conducted to assess the QOL of patients on hemodialysis and compare it with caregivers of these patients. Cause of ESRD and dialysis-related factors affecting QOL were also examined. This cross-sectional study was conducted on patient on maintenance hemodialysis for more than 3 months at 3 dialysis centers of Lahore. Fifty healthy individuals were included as controls from among the patients' caregivers. The QOL index was measured using the World Health Organization QOL questionnaire, with higher scores corresponding to better QOL of patients. Eighty-nine patients [71.2%] were men, 99 [79.2%] were married, 75 [60.0%] were older than 45 years, and 77 [61.6%] were on dialysis for more than 8 months. Patients on hemodialysis had a poorer QOL as compared to their caregivers in all domains except for domain 4 [environment]. There was no difference in the QOL between the three dialysis centers of the study, except for domain 3 [social relationship] of the patients at Mayo Hospital [a public hospital], which was significantly better. Nondiabetic patients had a better QOL in domain 1 [physical health] as compared to diabetic patients. Duration of dialysis had a reverse correlation with the overall QOL. We found that QOL of hemodialysis patients was poor as compared to caregivers of the patients, especially that of diabetics. Also, duration of dialysis had a reverse correlation with QOL

Screening of some ethnobotanically important plants of Nagar area Gilgit-Baltistan, Pakistan

Certain species of ethnobotanical importance belonging to families Asteraceae, Berberidaceae, Cupressaceae, Elaeagnaceae, Gentianaceae, Salicaceae and Tamaricaceae, were collected from Gilgit during the months of June and July 2008 and were investigated for the presence of alkaloids, amino acids, anthraquinone [free and as glycosides] ascorbic acid, carbohydrates, coumarins, flavonoids, phenolics, proteins, saponins and steroids in their aqueous, ethanol and benzene extracts. Artemisia maritime L. [leaves] showed positive results for carbohydrates, coumarins, phenolics and proteins. Ephedra gerardiana Wall ex. Stapf. [stem] tested positive for alkaloids, ascorbic acid, coumarins, phenolics, proteins, saponins and steroids. Tamarix gallica L. tested positive for alkaloids, amino acids, anthraquinone as glycoside, ascorbic acid, carbohydrates, flavonoids, phenolics, proteins and steroids in stems, roots and leaves. Salix acmophylla Boiss. showed positive results for alkaloids, amino acids, anthraquinone [free and as glycosides] ascorbic acid, carbohydrates, flavonoids, phenolics, proteins, saponins and natural steroids. Hippophae rhamnoides L. showed positive results for alkaloids, amino acids, anthraquinone [free as glycosides] ascorbic acid, carbohydrates, coumarins, flavonoids, phenolics, proteins, saponins and steroids. Berberis glycocarpa Stapf. showed positive results for alkaloids, amino acids, ascorbic acid, carbohydrates, flavonoids, phenolics, proteins and steroids in stem, roots and leaves. Similarly Juniperus excelsa Wall ex. C.A. Meyer showed positive result for anthraquinone [both free and as glycosides], carbohydrates, phenolics, proteins, saponins and natural steroids

Preliminary phytochemical screening of some plants of ethnobotanical importance from district Gilgit of Northern Areas, Pakistan

Seven medicinal plants of ethnobotanical importance belonging to families Elaeganaceae, Gentianaceae, Cupressaceae, Asleraceae, Tamaricaceae, Berberidaceae and Salicaceae were investigated for the presence of alkaloids, amino acids, anthraquinone [free nad as glycosides] ascorbic acid, carbohydrates, coumarins, flavonoids, phenolics, proteins, saponins and steroids in their coumarins, phenolics and proteins. Ephedra gerardiana [stem] [family ephedraceae] tested positive for alkaloids, ascorbic acid, coumarins, phenolics, proteins, saponins and steroids. Tamarix gallica [Family Tamaricaceae] tested positive for alkaloids, amino acids, anthraquinone as glycoside, ascorbic acid, carbohydrates, flavonoids, phenolics, proteins and steroids in stems, roots and leaves. Salix accomophylla [family Silaceae] showed positive results for alkaloids, amino acids, anthraquinone [free and as glycosides] ascorbic acid, carbohydrates, flavonoids, phenolics, proteins, saponins and steroids. Hippophe rhamnoides [family Elaeganaceae] showed positive results for alkaloids, amino acids, anthraquinone [free and as glycosides] ascorbic acid, carbohydrates, coumarins, flavonoids, phenolics, proteins, saponins and steroids. Berberis aristata [family Berberidaceae] showed positive results for alkaloids, amino acids, ascorbic acid, carbohydrates, flavonoids, phenolics, proteins and steroids in stem, roots and leaves, Juniperus excelsa [Family Juniperaceae] showed positive results for anthraquinone [both free and as glycosides], carbohydrates, phenolics, proteins, saponins and steroids

Knowledge, attitudes and practices regarding human immunodeficiency virus/acquired immune deficiency syndrome and sexually transmitted infections among health care providers in Lahore, Pakistan

Human Immunodeficiency Virus [HIV] infection is a global problem of extraordinary dimensions and has so far resulted in nearly 25 million deaths worldwide. Health care providers [HCPs] are considered to play a pivotal role in the provision of preventive and curative services to individuals suffering from HIV/AIDS and sexually transmitted infections. Pakistan, which was previously categorised as having a low-prevalence, high-risk HIV epidemic, is now facing a concentrated HIV epidemic among its most at-risk populations such as injecting drug users. The objective of this study was to assess the knowledge, attitudes and reported practices relating to HIV/AIDS and STIs among private and public sector health care providers providing clinical services in areas where women sell sex. This was an exploratory quantitative study, where a structured questionnaire was administered in face-to-face interviews with 200 HCPs from the public and private sectors. Knowledge about AIDS and correct diagnosis of STIs were defined as according to the national guidelines of NACP. Pearson's chi-square analysis was performed to test associations between predictors and level of knowledge of STIs in each group separately. Multivariate logistic regression analysis was employed to indicate predicting factors for correct management of STIs. Forty-five percent of the HCPshad correct knowledge about the transmission and prevention of HIV, whereas 21% had seen a patient with advanced HIV infection, only two HCPs had been trained to manage such cases and 82% were not aware of syndromic management of STIs. Only 10% could cite the 'correct treatment' of gonorrhoea, syphilis and vaginal discharge. The odds of having the 'correct knowledge' of diagnosing gonorrhoea and syphilis were 2.1 [CI 95%, 1.2-3.8] if the HCP was a female medical doctor working in public sector. Further intensive training is needed to improve the ability of relevant HCPs to correctly diagnose and effectively treat patients infected with HIV and STIs