Haplotype properties differ between different antibiotic exposure

Haplotype properties differ between different antibiotic exposures Diversification of P. aeruginosa LESB58 in ASM cultured with and without the various antibiotics was observed only with respect to colony morphology, pyocyanin production and antibiotic susceptibilities (Table 1). The culture of LESB58 in ASM with sub-inhibitory concentrations of ceftazidime

and colistin led to diversity in antimicrobial susceptibilities, changes in colony morphology and a loss of pyocyanin production (Table 1). LESB58 cultured in the presence of these antibiotics, generated more isolates that were outside the normal range of the antibiotic sensitivity profiles of LESB58 controls (Figure 3). In addition, exposure to azithromycin and tobramycin promoted increased cross-resistance CRT0066101 purchase to other antibiotics (Table 1, Figure 3). There

was no variation in the auxotrophic phenotype in the isolates analysed in all experimental and control groups (LESB58 has an auxotrophic phenotype). The H 89 populations exposed to meropenem exhibited no clear phenotypic diversification (Table 1 and Figure 2). Figure 3 Variations in zones of inhibition within LESB58 populations. The 120 LESB58 isolates obtained from the triplicate ASM cultures were assessed for susceptibility to six commonly used antibiotics (ceftazidime, ciprofloxacin, BV-6 colistin, meropenem, tazobactam/piperacillin and tobramycin). Boxplots showing the range in the diameter of the zones of inhibition to these antibiotics are presented. 1. LB (18 hours) 2. ASM 3. ASM with ceftazidime 4. ASM with colistin 5. ASM with meropenem 6. ASM with tobramycin 7. ASM with azithromycin 8. Normal range of LESB58 (Groups 1–8: n = 120). The red line represents the cut-off for Histone demethylase the sensitivity of P. aeruginosa to the antibiotics tested, in accordance with the guidelines of Andrews

and Howe [37]. The values above the red line denote a higher sensitivity to antibiotics and the values below the line denote a higher resistance. Table 1 Number of isolates in each group (total of 120) exhibiting each of the traits measured   Colony morphology Virulence Mutations Outside normal range of antimicrobials susceptibility Culture Green non-mucoid Straw non-mucoid Pyocyanin Hypermutability Ceftazidime Ciprofloxacin Tobramycin Meropenem Colistin Tazobactam/piperacillin ASM 120 0 117 0 3 0 19 0 2 8 ASM + CAZ 110 10 92 0 16 19 20 18 10 11 ASM + CT 113 7 84 0 17 37 29 15 7 9 ASM + AZT 120 0 120 0 0 16 34 0 4 4 ASM + MEM 120 0 118 0 1 8 4 0 0 1 ASM + TOBI 118 2 119 0 1 24 69 3 22 1 LB (18 hours) 120 0 120 1 0 0 0 0 0 0 Isolates that were characterized as being outside the normal range of antimicrobial susceptibility typically observed in LESB58, included isolates that had either an increased or reduced susceptibility to the antibiotic under test. ASM = Artificial Sputum Medium, LB = Luria Bertani, CAZ = Ceftazidime, CT = Colistin, AZT = Azithromycin, MEM = Meropenem and TOBI = Tobramycin.

Since accumulation of YopJ/P in host cells upon Yersinia infectio

Since accumulation of YopJ/P in host cells upon Yersinia infection has been previously linked to cell death via activation LB-100 of apoptotic pathways, we assessed cell viability at various MOIs. We registered no decrease in cell viability in drug-free cells or cells treated with the JNK1 inhibitor, even after 20 h post-infection of THP-1 cells with virulent Y.entorocolitica at MOI 2 of the assay. (data not shown) Taken together, these findings indicate that c-KIT function is exploited

by Yersinia T3SS to suppress production of key transcription factors and cytokines involved in the regulation of the host immune response. Figure 5 c-KIT signaling is targeted by Yersinia T3SS to suppress pro-inflammatory immune response. (A) THP1 cells were pre-treated with 1 μM OSI-930 or 1 μM BI-78D3 for 18 h or NU7026 research buy untreated prior to infection with Y. enterocolitica (pYV+)

and Y. enterocolitica (pYV-) at MOI 2. The RNA levels are presented as fold change versus untreated THP1. Data is shown from three independent infection experiments performed in duplicate. A ‘*” denotes that relative RNA levels were significantly different (p<0.05) in OSI930-treated cells compared to untreated or BI-78D3-treated cells. (B) THP-1 cells were transfected with 50 nM siRNA targeting c-KIT or control (si-CTL) and incubated for 48 h. RNA levels are presented relative to transcript levels in siRNA-treated versus untreated THP-1. Data is shown from two representative experiments. A ‘*” denotes that relative PF-4708671 RNA levels were significantly different (p<0.05) in si-cKIT-treated cells compared to si-CTL-treated cells. (C) THP-1 cells were transfected with 50 nM siRNA against c-KIT (si-cKIT) or control (si-CTL) siRNA and incubated for 72 h prior to infection with Y. enterocolitica

FXR agonist WA at MOI 2 for 1 h. Gene transcript levels are depicted as a relative ratio to uninfected siRNA-treated THP-1 cells. Data is shown from three independent experiments performed in duplicate. A ‘*” denotes that relative RNA levels of immune genes were significantly different (p<0.05) in si-cKIT-treated cells compared to si-CTL-treated cells. (D) THP-1 cells, untreated or pretreated with 1μM OSI-930 for 5 h, were infected with Y. enterocolitica WA at MOI 40 for 45 min. Cell nuclei were purified, labeled with mouse anti-NF-κB RelA, and analyzed by flow cytometry. (left panel) The mean channel fluorescence was used to determine the fold change of RelA in the nuclei of Yersinia-infected compared to untreated THP-1 cells (middle panel). The statistical data was derived from two independent experiments (right panel). Figure 6 Yersinia infection activates c-KIT tyrosine phosphorylation.

Normal hospital response to severe trauma begins with trauma team

Normal hospital response to severe trauma begins with trauma team activation following advance notification. This is the ideal in isolated trauma scenarios but is even more imperative in mass casualty

scenarios. Communication has been identified as a key component of disaster preparedness and response. An analysis of the response to three sequential aircraft crashes in Texas, found communication to be one of the major problems encountered in the implementation of the community and hospital disaster learn more plan [5]. Its total absence meant that we were completely unprepared to receive the first surge of casualties and each subsequent surge was without advance warning. Communication was also needed for mobilizing personnel and other resources from within and outside the hospital, and for information and media management as well as the coordination of response efforts between medical personnel and other agencies of government involved in the disaster response such as the police, military, Red Cross, and other voluntary organizations. The lack of this communication made the overall response efforts disjointed and uncoordinated.

The crisis took place before the introduction of mobile telephony in our city and we do not have pagers or two way radios. The existing hospital intercom system and the fixed lines proved grossly inadequate for the internal and external communication needs respectively. Field triage was crude and did not follow any organized find more systems. 4SC-202 ic50 injured patients were merely conveyed to the hospital if they were fortunate

enough to chance upon a military patrol, aid workers and volunteers, or other good Samaritans who were willing and able to help. The aim of triage is to identify that minority of critically injured patients, out of the large pool of patients with less severe injuries so that trauma care assets can be prioritized in favor of the former. Effective triage is necessary to screen out the majority of non critically oxyclozanide injured survivors, and results are best when performed by a trained physician in the field [6]. A change in philosophy occurs in the approach to the management of mass casualty: the goal is to do the ‘greatest good for the greatest number’ and not the greatest good for the individual [2, 7]. Most effective triage systems accept an overtriage rate of up to 50%, i.e. patients who have been triaged as having critical injuries when in fact they had less severe injuries. This high rate is necessary to reduce the undertriage rate to below 0.5%, i.e. the proportion of patients who were triaged as having non critical injuries when in fact they had critical injuries [7]. In the absence of systematic field triage, a high proportion of patients brought to our facility had non critical injuries as every injured patient was evacuated to the hospital.

After careful removal of supra-gingival plaque, the curette

After careful removal of supra-gingival plaque, the curette

was placed subgingivally until the bottom MM-102 chemical structure of the probeable pocket was reached and subgingival plaque was collected by a single scaling stroke. The individual plaque samples were transferred into Eppendorf tubes containing 200 μl of sterile T-E buffer (10 mM Tris HCl, 1.0 mM EDTA, pH 7.6) and were not pooled at any stage of the processing described below. Processing of plaque samples Immediately after transfer to the laboratory the plaque pellet was re-suspended, vigorously vortexed, and 200 μl of a 0.5 M NaOH solution were added. Digoxigenin-labeled, whole genomic probes were prepared by random priming by the use of the High-Prime labeling kit (Roche/Boehringer-Mannheim, Indianapolis, IN, USA) from the following microbial strains: Aggregatibacter actinomycetemcomitans (ATCC 43718), Porphyromonas gingivalis (ATCC 33277), Tannerella forsythia (ATCC 43037), Treponema denticola (ATCC 35404), Prevotella intermedia (ATCC 25611), Fusobacterium nucleatum (ATCC 10953), Parvimonas micra (ATCC 33270), Campylobacter rectus (ATCC 33238), Eikenella corrodens (ATCC 23834), Veillonella parvula (ATCC 10790), and Actinomyces naeslundii (ATCC 49340). Further processing was carried out according to the checkerboard {Selleck Anti-cancer Compound Library|Selleck Anticancer Compound Library|Selleck Anti-cancer Compound Library|Selleck Anticancer Compound Library|Selleckchem Anti-cancer Compound Library|Selleckchem Anticancer Compound Library|Selleckchem Anti-cancer Compound Library|Selleckchem Anticancer Compound Library|Anti-cancer Compound Library|Anticancer Compound Library|Anti-cancer Compound Library|Anticancer Compound Library|Anti-cancer Compound Library|Anticancer Compound Library|Anti-cancer Compound Library|Anticancer Compound Library|Anti-cancer Compound Library|Anticancer Compound Library|Anti-cancer Compound Library|Anticancer Compound Library|Anti-cancer Compound Library|Anticancer Compound Library|Anti-cancer Compound Library|Anticancer Compound Library|Anti-cancer Compound Library|Anticancer Compound Library|buy Anti-cancer Compound Library|Anti-cancer Compound Library ic50|Anti-cancer Compound Library price|Anti-cancer Compound Library cost|Anti-cancer Compound Library solubility dmso|Anti-cancer Compound Library purchase|Anti-cancer Compound Library manufacturer|Anti-cancer Compound Library research buy|Anti-cancer Compound Library order|Anti-cancer Compound Library mouse|Anti-cancer Compound Library chemical structure|Anti-cancer Compound Library mw|Anti-cancer Compound Library molecular weight|Anti-cancer Compound Library datasheet|Anti-cancer Compound Library supplier|Anti-cancer Compound Library in vitro|Anti-cancer Compound Library cell line|Anti-cancer Compound Library concentration|Anti-cancer Compound Library nmr|Anti-cancer Compound Library in vivo|Anti-cancer Compound Library clinical trial|Anti-cancer Compound Library cell assay|Anti-cancer Compound Library screening|Anti-cancer Compound Library high throughput|buy Anticancer Compound Library|Anticancer Compound Library ic50|Anticancer Compound Library price|Anticancer Compound Library cost|Anticancer Compound Library solubility dmso|Anticancer Compound Library purchase|Anticancer Compound Library manufacturer|Anticancer Compound Library research buy|Anticancer Compound Library order|Anticancer Compound Library chemical structure|Anticancer Compound Library datasheet|Anticancer Compound Library supplier|Anticancer Compound Library in vitro|Anticancer Compound Library cell line|Anticancer Compound Library concentration|Anticancer Compound Library clinical trial|Anticancer Compound Library cell assay|Anticancer Compound Library screening|Anticancer Compound Library high throughput|Anti-cancer Compound high throughput screening| DNA-DNA hybridization method [26] as earlier described [27] with

the following modifications: The chemiluminescent substrate used for detection was CSPD (Roche/Boehringer-Mannheim). Evaluation of the chemiluminescence signal was performed in a LumiImager F1 Workstation (Roche/Boehringer-Mannheim) by comparing the obtained signals with the ones Torin 2 generated by pooled standard samples containing 106 or 105 of each of the species. Standard curves were generated for each

species by means of the LumiAnalyst software (Roche/Boehringer-Mannheim), and the obtained chemiluminescent signals were ultimately transformed into bacterial counts and exported into Excel files. Statistical Analysis In all analyses, either R version 2.3.1 (Linux OS) or SAS for PC version 9.1 (SAS Institute, Cary, NC) were used. Gene expression data Rebamipide were normalized and summarized using the log scale robust multi-array analysis (RMA, [28]) with default settings. Laboratory analysis provided a relative quantity of individual bacterial species for each plaque sample by comparison to known standards. Because the distribution of absolute bacterial counts was skewed, values were natural logarithm (ln) transformed, averaged within mouth and standardized by dividing each respective ln(bacterial count) by the population standard deviation for the respective species: one standard deviation on the ln scale (SDln) was treated as equivalent across microbes as previously described [29].

Coll Surf B 2012, 92:209–212 103 Klaus T, Joerger R, Olsson E,

Coll Surf B 2012, 92:209–212. 103. Klaus T, Joerger R, Olsson E, Granqvist CG: Silver-based crystalline nanoparticles, microbially fabricated. Proc Natl Acad Sci U S A 1999, 96:13611–13614. 104. Yong P, Rowson N, Farr JPG, Harris I, Macaskie L: Bioreduction and biocrystallization of palladium by Desulfovibrio selleck products desulfuricans NCIMB 8307. Biotechnol

Bioeng 2002, 80:369–379. 105. Corredor E, Testillano PS, Coronado MJ, González-Melendi P, Fernández-Pacheco R, Marquina C, Ibarra MR, de la Fuente JM, Rubiales D, Pérez-de-Luque A, Risueño MC: Nanoparticle penetration and transport in living pumpkin plants: in situ subcellular identification. BMC Plant Biol 2009, 9:45. 106. Taylor NJ, Fauquet CM: Microparticle bombardment as a tool in plant science and agricultural biotechnology. DNA Cell Biol 2002, 21:963–977. 107. BarathManiKanth S, Kalishwaralal K, Sriram M, Pandian SBRK, GSK690693 price Youn H, Eom SH, Gurunathan S: Antioxidant effect of gold https://www.selleckchem.com/products/pf-06463922.html nanoparticles restrains hyperglycemic conditions in diabetic mice. J Nanobiotech 2010, 8:16. 108. Mohanpuria P, Rana NK, Yadav SK: Biosynthesis of nanoparticles: technological concepts and future applications. J Nanopart Res 2008, 10:507–517. 109. Wu H, Huang X, Gao M, Liao X,

Shi B: Polyphenol-grafted collagen fiber as reductant and stabilizer for one-step synthesis of size-controlled gold nanoparticles and their catalytic application to 4-nitrophenol reduction. Green Chem 2011, 13:651–658. 110. Ghosh S, Patil S, Ahire M, Kitture R, Gurav DD, Jabgunde AM, Kale S, Pardesi K, Shinde V, Bellare J, Dhavale DD, Chopade BA: Gnidia glauca flower extract mediated synthesis of gold nanoparticles and evaluation

of its chemocatalytic potential. J Nanobiotechno 2012, 10:17. 111. Vankar PS, Bajpai D: Preparation of gold nanoparticles from Mirabilis jalapa flowers. Ind J Biochem Biophys 2010, 47:157–160. 112. Das RK, Gogoi N, Bora U: Green synthesis IMP dehydrogenase of gold nanoparticles using Nyctanthes arbortristis flower extract. Bioprocess Biosyst Eng 2011, 34:615–619. 113. Smitha SL, Philip D, Gopchandrana KG: Green synthesis of gold nanoparticles using Cinnamomum zeylanicum leaf broth. Spectro Acta A Mol Biomol Spectrosc 2009, 74:735–739. 114. Philip D: Rapid green synthesis of spherical gold nanoparticles using Mangifera indica leaf. Spectro Acta A Mol Biomol Spectrosc 2010, 77:807–810. 115. Noruzi M, Zare D, Khoshnevisan K, Davoodi D: Rapid green synthesis of gold nanoparticles using Rosa hybrida petal extract at room temperature. Spectro Acta A Mol Biomol Spectrosc 2011, 79:1461–1465. 116. Vanaja M, Paulkumar K, Baburaja M, Rajeshkumar S, Gnanajobitha G, Malarkodi C, Sivakavinesan M, Annadurai G: Degradation of methylene blue using biologically synthesized silver nanoparticles. Bioinor Chem App 2014, 742346:8. 117. Ganaie SU, Abbasi T, Anuradha J, Abbasi SA: Biomimetic synthesis of silver nanoparticles using the amphibious weed ipomoea and their application in pollution control.

J Bacteriol 2007, 189:3414–3424 PubMedCrossRef 42 Balasubramania

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B, Lavric M, Narat M, Bidovec A, Dovc P, Bencina D: Identification of major immunogenic proteins

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Talanta 1961, 7:163–174 CrossRef 24 Pomerantsev AP, Pomerantseva

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palindromic sequence. Infect Immun 2004,72(10):5814–5823.PubMedCrossRef Competing interests The authors declare that they have no competing interests. Authors’ contributions JE performed experiments, developed and performed analyses and assays, analyzed the data and contributed to the writing. YJ and CD designed the research, discussed the results and wrote the paper. All authors read and approved the final manuscript.”
“Background AZD0156 price Anandamide [1] is a mammalian endogenous lipid that binds cannabinoid receptors which are mainly present in the central nervous system and immune cells. Anandamide was identified in 1992 and named after the Sanskrit word ananda, meaning bliss or delight. Anandamide acts as an agonist for the central cannabinoid receptor (CB1) and is therefore referred to as cannabinoid. It mimics pharmacological effects of Δ9tetrahydrocannabinol, an active ingredient of marijuana [2]. Action of anandamide is selleckchem terminated

by the enzyme fatty acid amide hydrolase (FAAH) [3]. FAAH was originally identified in 1996 from rat liver plasma membrane and later FAAH homologs were identified from other sources including human, porcine, and Arabidopsis. FAAH belongs to a large group of proteins containing

a conserved amidase signature motif [4, 5]. FAAH can also hydrolyze, in addition to anandamide, other fatty acid derivatives like N-oleoylethanolamine Copanlisib chemical structure and N-palmitoylethanolamine collectively referred as N-acylethanolamines (NAEs) [6]. Studies on mammalian FAAH have provided more information on NAEs role in regulating Thiamine-diphosphate kinase various physiological functions like sleep and pain [7–9]. Recent studies on NAEs reveal further biological roles in appetite suppression, vasodilatation, cardiac function and inflammation [10–12]. Therefore any FAAH inhibitors which intervene in NAE’s bioactivity promise to be a novel class of therapeutics and much drug discovery research is being actively pursued in this regard [13, 14]. Anandamide is yet to be found in Dictyostelium, but its precursor N-acylphosphatidylethanolamine (NAPE) has previously been identified [15]. In mammalian cells anandamide is believed to originate from hydrolysis of NAPE by phospholipase D (PLD). In Dictyostelium, a PLD homolog PldB was identified and proposed to have a similar function [16]. Identification of FAAH suggests that regulation of NAE signalling could occur in Dictyostelium and thus Dictyostelium could be utilised as a simple eukaryotic model to study NAE functions in parallel with mammalian systems. Dictyostelium has been used to study cell motility, chemotaxis, cell differentiation and morphogenesis enabling significant contributions to an understanding of similar processes in mammalian systems.

Lancet Oncol 2004, 5 (7) : 430–442 CrossRefPubMed 5

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12. Susini C, Buscail L: Rationale for the use of somatostatin analogs as antitumor agents. Ann Oncol 2006, 17 (12) : 1733–1742.CrossRefPubMed 13. Lichtenauer-Kaligis EG, Dalm VA, Oomen SP, Mooij DM, van Hagen PM, Lamberts SW, Hofland LJ:

Differential expression of somatostatin receptor subtypes in human peripheral blood mononuclear cell subsets. Eur J Endocrinol 2004, 150 (4) : 565–577.CrossRefPubMed 14. Rosskopf D, Schurks M, Manthey I, Joisten M, Busch S, Siffert W: Signal transduction of somatostatin in human B lymphoblasts. Am J Physiol Cell Physiol 2003, 284 (1) : C179–190.PubMed 15. Ferone D, Resmini E, Boschetti M, Arvigo M, Albanese V, Ceresola E, Pivonello R, Albertelli M, Bianchi F, Giusti Amobarbital M, et al.: Potential indications for somatostatin analogues: immune system and limphoproliferative disorders. J Endocrinol Invest 2005, 28 (11 Suppl International) : 111–117.PubMed 16. Hatzoglou A, Kampa M, Castanas E: Opioid-somatostatin interactions in regulating cancer cell growth. Front Biosci 2005, 10: 244–256.CrossRefPubMed 17. Duran-Prado M, Malagon MM, Gracia-Navarro F, Castano JP: Dimerization of G protein-coupled receptors: New avenues for somatostatin receptor signalling, control and functioning. Mol Cell Endocrinol 2008, 286 (1–2) : 63–68.CrossRefPubMed 18. Chomczynski P, Sacchi N: Single-step method of RNA isolation by acid guanidinium thiocyanate-phenol-chloroform extraction. Anal Biochem 1987, 162 (1) : 156–159.CrossRefPubMed 19.

PLoS Pathog 2007,3(7):e110 CrossRefPubMed

32 Kana BD, Go

PLoS Pathog 2007,3(7):e110.CrossRefPubMed

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GF120918 research buy Mycobacterium tuberculosis produces pili during human infection. Proc Natl Acad Sci USA 2007,104(12):5145–5150.CrossRefPubMed 35. Calamita H, Ko C, Tyagi S, Yoshimatsu T, Morrison NE, Bishai WR: The Mycobacterium tuberculosis SigD sigma factor controls the expression of ribosome-associated gene products in stationary phase and is required for full virulence. selleck chemicals Cell Microbiol 2005,7(2):233–244.CrossRefPubMed 36. Malhotra V, Sharma D, Ramanathan VD, Shakila H, Saini DK, Chakravorty S, Das TK, Li Q, Silver RF, Selleck PCI 32765 Narayanan PR, et al.: Disruption of response regulator gene, devR, leads to attenuation in virulence of Mycobacterium tuberculosis. FEMS Microbiol Lett

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The duration of symptoms was not documented in 5 (5 9%) patients

The duration of symptoms was not documented in 5 (5.9%) patients. The commonest presenting symptoms were sudden onset of severe epigastric pain in 82 (97.6%), abdominal distention in 64 (76.2%) AR-13324 price and vomiting in 31 (36.9%) patients. Abdominal tenderness and classical signs of peritonitis were demonstrable in 74 (88.1%) and 56(66.7%) patients respectively

(Table 1). Table 1 Clinical presentation Clinical presentation Frequency Percentage Severe abdominal pain 82 97.6 Abdominal distention 64 76.2 Vomiting 31 36.9 Nausea 30 35.7 Severe dyspepsia 28 33.3 Constipation 25 29.8 Fever 18 21.4 Shock 28 33.3 Abdominal tenderness 74 88.1 Classical signs of peritonitis 56 66.7 Fifty-eight (69.0%) patients reported no previous history of treatment for peptic ulcer disease. Patients with a previous history of peptic ulcer disease had had symptoms for durations ranging from six months to 14 years and all of them were not on regular anti-ulcer therapy. Three (3.6%) patients presented with re-perforation. Nine (10.7%) patients reported history of recent ingestion of non-steroidal anti-inflammatory drugs (NSAIDS) for joint and back pains. Other risk factors recorded included alcohol consumption and smoking in 72 (85.7%) and 54 (64.3%) patients respectively. Most patients who smoked also took alcohol. In this study, six (7.1%) patients

had associated premorbid illness namely JIB04 chemical structure osteoarthritis in 3 patients and hypertension, diabetes mellitus and sickle cell disease in 1 patient each respectively. Eight (9.5%) patients were HIV positive. Of these, 3 (37.5%) patients were known cases on ant-retroviral therapy (ARV) and the remaining 5 (62.5%) patients were newly diagnosed patients. PIK3C2G CD4+ count distribution among HIV positive patients DMXAA cost ranged from 56 cells/μl to 650 cells/μl with the mean of 236 cells/μl and standard deviation of 86 cells/μl. The median and the mode were 220 cells/μl and 160 cells/μl respectively. A total of two HIV patients (25.0%) had CD4+ count below 200 cells/μl and the remaining 6 patients (75.0%) had CD4+ count of ≥200 cells/μl. Of the eight patients with HIV infection,

six (75.0%) patients reported to have risk factors for HIV infection. Of these, alcoholism [Odds Ratio 11.3, 95% C.I. (8.3-16.7), P = 0.021] and multiple sexual partners [Odds Ratio 10.8, 95% C.I. (6.7-14.9), P = 0.000] were found to be independently and significantly associated with increased risk to HIV infection Radiological, operative and histopathological findings Seventy-nine (94.0%) of the patients had plain abdominal and chest radiographs done, with free gas under the diaphragm (pneumoperitonium) demonstrated in 52 (65.8%) of them. All patients in this study underwent laparotomy. The time interval between the beginning of the symptoms of perforation and surgery ranged from12 to140 hours with the median of 72 hours. The majority of patients (76.2%) presented 48 hours or more after the onset of the symptoms of perforation.