Phylogenetic relationships between Mediterranean and middle-Asian wild species of the genus Hordeum L. as revealed by biochemical and molecular markers.

The phylogenetic relationships of 60 accessions of the genus Hordeum (29 Mediterranean and 20 middle-Asian wild accessions, together with nine American accessions and two of unknown origin), representing together nine species, were investigated by AFLP markers. Three hundred sixty six AFLP fragments were used for studying the molecular genetic diversity among the studied species, 339 out of them were polymorphic. Forty seven protein bands were obtained from the water soluble and the water insoluble seed storage protein by SDS-PAGE electrophoresis of 18 accessions representing nine species (two accessions/species). One band was common to all species and the other 46 bands were polymorphic. The phylogenetic tree deduced from AFLP analysis is concordant to a large extent with that deduced from seed storage protein. Highly significant cophenetic correlation coefficient was obtained between both AFLP (0.96) and seed storage protein (0.89) indicating the reliability of the results. The studied taxa were clustered according to their genome type. All Mediterranean and middle-Asian wild accessions could be integrated into the existing phylogenetic scheme.

Identification and differential expression of two dehydrin cDNAs during maturation of Jatropha curcas seeds.

Plant dehydrin proteins (DHNs) are known to be important for environmental stress tolerance and are involved in various developmental processes. Two full-length cDNAs JcDHN-1 and JcDHN-2 encoding two dehydrins from Jatropha curcas seeds were identified and characterized. JcDHN-1 is 764 bp long and contains an open reading frame of 528 bp. The deduced JcDHN-1 protein has 175 a.a. residues that form a 19.3-kDa polypeptide with a predicted isoelectric point (pI) of 6.41. JcDHN-2 is 855 bp long and contains an open reading frame of 441 bp. The deduced JcDHN-2 protein has 156 a.a. residues that form a 17.1-kDa polypeptide with a predicted pI of 7.09. JcDHN-1 is classified as type Y3SK2 and JcDHN-2 is classified as type Y2SK2 according to the YSK shorthand for structural classification of dehydrins. Homology analysis indicates that both JcDHN-1 and JcDHN-2 share identity with DHNs of other plants. Analysis of the conserved domain revealed that JcDHN-2 has glycoside hydrolase GH20 super-family activity. Quantitative real time PCR analysis for JcDHN-1 and JcDHN-2 expression during seed development showed increasing gene expression of both their transcript levels along with the natural dehydration process during seed development. A sharp increase in JcDHN-2 transcript level occurred in response to water content dropping from 42% in mature seeds to 12% in dry seeds. These results indicate that both JcDHNs have the potential to play a role in cell protection during dehydration occurring naturally during jatropha orthodox seed development.

Septicaemia in scald and flame burns: appraisal of significant differences.

One hundred and sixty burn patients suffering from septicaemia, hospitalized in the Al-Babtain Centre burns unit, Kuwait, between June 1992 and May 2001, were studied. Thirty-two patients (20%) had scalds and 128 (80%) flame burns, thus representing a ratio of 1:4 among septicaemic patients. There were 20 males (62.5%) in the scald group, compared to 73 (57%) with flame burns. Flame burns were significantly higher (p < 0.01) among non-Kuwaiti patients. The mean ages of the scald and flame burn patients were respectively 6.2 and 31.5 yr. The mean total body surface area burn in scalds was 20% and in flame burns 49%, which was significantly higher (p < 0.001). The 34 septicaemic episodes in 32 scald patients and 212 such episodes in 128 flame burn patients showed a significantly higher incidence in the latter group. The majority of septicaemic episodes, in scalds (82.4%) and flame burns (57.6%), were due to gram-positive organisms, mainly methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus epidermidis. A significantly increased number of episodes were due to S. aureus (p < 0.001) and Enterococcus (p < 0.05) in scald patients. More surgical operations were performed in flame burn patients and survival increased significantly with an increasing number of grafting sessions (p < 0.001). The mean hospital stay in flame burn patients (56 days) was significantly higher than in scald patients (23 days) (p < 0.001). It is significant to record that all the 38 deaths (29.7%) were in flame burn septicaemic patients (p < 0.001). The scald and flame burn patients were quite distinct in their demographic and clinical characteristics. The flame burn patients were more vulnerable to septicaemia, with a high risk of mortality.

Idiopathic purpura fulminans and varicella gangrenosa of both hands, toes and integument in a child.

Chicken pox is a common childhood illness and, though a vaccine is readily available, it is not routinely included in the vaccination schedule of most countries owing to its mild clinical nature. However, varicella gangrenosa is a rare complication of this disease, infrequently reported in the literature. We report the case of a child who developed purpura fulminans in the convalescent phase of chicken pox and subsequently presented with peripheral gangrene of both hands and the toes of the right foot, and skin gangrene. To our knowledge, bilateral gangrene of the hands has rarely been reported, and we present this case to highlight the serious nature of complications following varicella infection.

Burn mortality during 1982 to 1997 in Kuwait.

The study group is comprised of 234 patients (6.4%) who died out of 3680 patients treated for burn injuries during the period January 1982 to December 1997 in Kuwait. There were 112 (47.9%) males and 122 (52.1%) females and their mean age was 30 years (range 1-93) when compared with 24 years among survivors. The high mortality amongst two age groups 0-5 years (39 deaths, 16.7%) and 16-35 years (109 deaths, 46.6%) shows their vulnerability in the society. In 190 patients (81.2%) the burn injuries occurred at home. A total of 216 patients (92.3%) sustained flame burns mainly due to clothes on fire (40.6%) and cooking gas accidents (25.2%), and in 18 patients (7.7%) the burns were due to scalds. The suicidal burns occurred in 22 female and 5 male patients mainly of younger age groups. The mean percentage of burns was 71% (range 9-100%) as against 20% amongst survivors, and 195 patients (83.3%) had > or = 50% total body surface area (TBSA) burn. Four patients (1.7%) had superficial dermal burns, 94 (40.2%) had full thickness and 136 (58.1%) had mixed with full thickness burns predominance. The associated inhalation injury was diagnosed in 132 patients (56.4%). A total of 61 patients (26.1%) had either single or multiple pre-existing diseases and 51 of them sustained flame burns. The day of death varied from 1 to 103 days (mean 16 days) but 58 patients (24.8%) died within 48 hours of post burn. A total of 120 patients (51.3%) died due to septicaemia, 83 (35.5%) due to renal failure, 28 (10.2%) due to multi-organ failure, and 7 (3.0%) due to bronchopneumonia. The overall mortality rate was 6.4%, but this has significantly lowered to 4.4% (p = < 0.01) during last four years probably due to better burn care. The study thus shows that age group 0-5 and 16-35 years, domestic accidents, flame burn, inhalation injury, and pre-existing diseases are risk factors and septicaemia as the dominant cause of death in our patients.

Burn septicaemia: an analysis of 79 patients.

Out of 943 patients treated from June 92 to May 96 at the burns unit of the Al-Babtain Centre for Plastic Surgery and Burns, Kuwait, 280 (30%) required admission to the burns intensive care unit (ICBU) and were studied retrospectively. Seventy-nine (28.2%) developed clinically and microbiologically proven septicaemia. Forty-four (56%) were males, 35 (44%) females with a mean age of 26 years (range 45 days to 75 years) and mean total body surface area burn (TBSA) of 46% (range 10-90%). Sixty-two had flame burns, 16 a scald and one had an electric burn. These 79 patients had a total of 118 septicaemic episodes. Sixty (76%) had only one and 19 (24%) had multiple episodes of septicaemia. Fifty-four (68%) had their first episode within 2weeks, though the maximum number of episodes was between 6 and 10 days postburn. Septicaemia was also observed in 13% of patients within 3 days postburn. Out of the 118 episodes, 48 were due to methicillin resistant Staphylococcus aureus (MRSA), 17 due to methicillin resistant Staphylococcus epidemidis (MRSE), 15 to Pseudomonas, 12 to Acinetobacter, four to Streptococcus, another four to Enterococci, two to Klebsiella, one due to Serratia and 15 to more than one organism. Once the septicaemia was diagnosed appropriate therapy was instituted. Fifty-six (71%) patients had 143 sessions of skin grafting and the mortality was low in operated patients. Twenty-three (29.1%) patients died. The low mortality rate was probably due to factors such as continuous clinical and microbiological surveillance leading to quick detection of aetiology, appropriate antibiotic therapy, care for nutrition and early wound cover. This study suggests that flame burn patients are more vulnerable to sepsis. Onset of septicaemia may be as early as 3 days and commonly within 2 weeks. A surface wound is the likely source of entry to the blood stream. Gram positive organisms are dominant in the aetiology. Early detection and appropriate treatment including wound coverage result in a better outcome.

Scalds among children in Kuwait.

In a prospective study of 560 children treated for burns as in-patients over a period of four-and-a-half years in specialized hospitals responsible for the majority of burn cases in Kuwait, 388 patients (69%) had sustained scalds. The mean age of these 388 children, between 0 to 12 years, was 3.02 +/- 2.08, and male to female ratio 1.5 to 1. They were categorized into three age groups, first, up to 1 year comprised 17.5% cases, who were solely dependent on parents or childminder; second 2 to 5 years of age, who were inquisitive, independent, pre-school children, and constituted the majority of cases (73%), and third 6 to 12 years who were 9.5% school children. The pre-school children (2-5 years) thus formed a highly vulnerable group in the country. Accidents (99.4%) occurred at home and the kitchen being the commonest place. The hot water from pan and pots in the kitchen was the most common etiologic factor in 229 cases (59%), followed by tea/coffee 20.7%, soup 9.0%, hot oil 6.7%, and milk 4.6% patients. The most common circumstance was the child upsetting the pan of hot fluid in the kitchen. The mean total body surface areas of second and third degree burns were 14.21 +/- 9.66 (range 1 to 60%). The average length of stay in the hospital was 16.90 +/- 15.74 days, varying from one to 109 days. Thirty-nine children were ill prior to burn, and the commonest disease was respiratory tract infection. Three patients (0.8%) with 3rd degree burns were treated with primary excision and grafting, and 137 (35.3%) needed secondary skin grafting for residual burn wounds. Four patients (1%) died, one due to burn shock, two due to septicemia and one due to multiorgan failure. There is need for general awareness through public education, which may lead to the prevention of significant number of such accidents.

Foot reconstruction using vascularised fibula.

Vascularised fibula has been used to treat three patients with skin-bone defects of the foot following severe trauma. Similarity between fibula and metatarsal bone is obvious and makes fibula an ideal choice in the replacement of defects in the first metatarsal. Depending on the size of soft tissue defects, different combinations of fibula-skin transfer were used.

T flap hypospadias repair in circumcised patients.

Single stage repair of distal penile hypospadias with chordee in circumcised patients is described. A ventral 'T' flap is used, the horizontal part of the T flap forming the complete circumference of the new urethra and lying in the defect created due to chordee release. The vertical part of the T flap, in conjunction with the grooved glans, forms the neourethra like the flip flap procedure. Of 22 patients repaired in this way, 2 (9.0%) developed fistula and one (4.5%) had meatal stenosis, thus in 86.5% successful repair was achieved.

An analysis of childhood burns in Kuwait.

A prospective study of 394 burned children (in-patients) up to the age of 12 years old was carried out for the period from January 1984 to December 1986. They were categorized into three age groups, the infants and toddlers 0-2 years, early childhood 3-6 years and late childhood 7-12 years. In the first two groups scalding was the predominant cause of injury, while in late childhood there were many more flame burns. Ninety-five per cent of the accidents occurred at home and the majority happened in the presence of parents. The presence of parents was not a deterrent to the accident but ensured speedy transport to the hospital. In our review 3 per cent of patients sustained more than 50 per cent BSA burns, there were 12 deaths with a mortality rate of 3 per cent. An intense campaign to make parents aware of the risk factors and their avoidance is required to reduce the number of burn accidents.

Vulvar reconstruction with an abdominal flap.

There are many procedures for vulvar reconstruction after excision for cancer. The aim of which is to provide cosmetic and functional results with minimal secondary deformity. A patient presented with gross fibrous contracture and vaginal ectropion after radical vulvectomy and groin dissection for cancer. We used the pendulous lower abdominal tissue to reconstruct the vulva and mons pubis. There was no secondary deformity.

Scald accidents during water aerosol inhalation in infants.

A study of 193 infants admitted for burns over a 4-year period revealed 11 infants (5.7 per cent) had sustained scalds during the process of water aerosol inhalation. The water aerosol inhalation therapy was prescribed for respiratory tract infection and carried out at home using either an electric kettle or a saucepan. It appears that infants are prone to this type of injury because of the difficulty of keeping them still during therapy and their inquisitiveness to explore their surroundings. The resulting scalds added to the morbidity of those children already suffering from respiratory tract infections. These accidents can easily be prevented by the alternative use of a humidifier.