Bugando Medical Centre (BMC) is a consultant, tertiary care and teaching hospital for the Catholic University of Health and Allied Sciences -Bugando (CUHAS-Bugando) with a bed capacity of 1000. All patients who were operated for typhoid intestinal perforation during the study period were included in the study. Patients with incomplete data and those who failed to consent for HIV infection were excluded from the study. The details of patients who presented www.selleckchem.com/products/Pazopanib-Hydrochloride.html from October 2006 to September 2008 were retrieved retrospectively from patient registers kept in the Medical record departments, the surgical

wards, and operating theatre. Patients who presented to the A & E department between October 2008 and September 2011 were prospectively enrolled in the study after signing an informed written consent for the study. The diagnosis of typhoid perforation was established by clinical features of typhoid fever and peritonitis which

were supported by positive SHP099 nmr Widal test, detection of free air under the diaphragm on chest and abdominal radiographs and free intra peritoneal fluid on ultrasound abdomen and confirmed by intraoperative findings of oval perforation on the antimesenteric border of the intestine and an acutely inflamed and edematous intestine. Peritonitis was recorded as general when the whole abdomen was involved; it was recorded as local when peritonitis was limited to the lower abdomen. The patients who developed clinical features of peritonitis after typhoid fever and presented within 24 hours were labeled as early Plasmin while those presented after 24 hours were marked as late cases. Inadequate prehospital therapy was defined as not being given a minimum of 3 days of effective antibiotic treatment for S. Typhi at the correct dose prior to admission. The time of typhoid intestinal perforation was subjectively determined as the time the patient felt an excruciating

sharp pain with worsening of symptoms. In small children it was taken as the time the mother noticed abdominal distention, constipation and vomiting. Preoperatively, all the patients had intravenous fluids to correct fluid and electrolyte deficits; nasogastric suction; urethral catheterization and broad-spectrum antibiotic coverage. Relevant preoperative investigations included packed cell check details volume, serum electrolytes, urea and creatinine, HIV testing (using Tanzania HIV Rapid Test Algorithm) and CD 4+ count (using FACS or FACSCALIBUR from BD Biosciences USA), Widal’s test; chest and abdominal radiographs to detect air under the diaphragm. Abdominal ultrasound was also performed in some patients suspected to have abdominal collections. They had pre-operative anaesthetic assessment using the American Society of Anesthetists (ASA) classification [24] as shown in Table 1.