Impact of antibiotics on spermatozoa quality and bacterial load of chilled-stored camels (Camelus dromedarius) semen.

This experiment was conducted to assess the effect of different antibiotics in tris-fructose egg yolk-based diluent on bacterial load and sperm quality of dromedary camels during processing and cold storage. Ten semen ejaculates were collected from five male dromedary camels. Each sample was fractioned into four equally divided aliquots and diluted in one of four tris-fructose egg yolk. The first extender contained no antibiotic (NC). The second extender included streptomycin sulphate (1000 µg/ml) and benzyl penicillin (1000 IU/ml) (SP). The third extender was supplied with 250 µg/ml gentamicin sulphate (Gent). The fourth extender contained 500 µg/ml gentamicin sulphate,100 µg/ml tylosin tartrate, 300 µg/ml lincomycin hydrochloride and 600 µg/ml spectinomycin hydrochloride (GTLS). After dilution, the extended semen samples were cooled to 5 °C within 2 h and finally stored at 5 °C for 72 h. Microbial concentration, motility of spermatozoa, live spermatozoa, plasma membrane and acrosome integrity percentages were evaluated just after dilution at 35 °C, 0, 24, 48 and 72 h from the start of cooling to 5 °C. The results revealed that the diluent containing gentamicin had significantly (P<0.05) maximum motility percentage at the different examination intervals. The pattern of live spermatozoa percentage was varied between the different treatments at different examination intervals. The diluent supplied with Gent was distinguished with a significant peak percentage (P<0.05) of swelled spermatozoa among the other antibiotics supplied diluents. The number of colony-forming units isolated from the semen samples kept in diluent containing no antibiotics was significantly (P<0.05) higher than that isolated from the diluents supplemented with antibiotics. In conclusion, the semen diluents fortified with gentamicin generally keep the motility, acrosomal and plasma membrane integrity and live spermatozoa for 72-h preservation of dromedary semen.

Characterization of microbes associated with cervico-vaginal adhesion in the reproductive system of camels (Camelus dromedaries).

Vaginal and cervical adhesions are severe long-standing reproductive disorder in dromedaries and consequently result in a high culling rate. This study was designed to compare the microbial communities of the vaginae, cervices, and uteri of normal (n = 10) camels versus camels suffering from cervico-vaginal adhesion (n = 23). Vaginal, cervical, and uterine swab samples were collected from control and affected animals. Furthermore, serum samples were obtained for serological testing of Chlamydiosis and Coxiellosis. For bacteriological and fungal examination, swab samples were plated on Columbia and Saboraud's dextrose agar, respectively. Polymerase chain reaction (PCR) assay was applied to samples expressed seropositive for Chlamydiosis. Vaginal swab bacterial cultures showed that the affected animals were significantly infected with Staphylococcus aureus (P = 0.0322, CI: 0.25-0.95) than the control, while mycological cultures showed that both control and affected animals were infected with Cryptococcus and Candida albicans. Corynebacterium spp. (22.7%), Pseudomonas spp. (4.5%), Klebsiella spp. (9.1%), T. pyogenes (18.2%), and anaerobic bacteria (Fusobacterium necrophorum and Clostridium spp.; 34.78%) were also identified in affected animals. Cervical samples from affected animals were distinguished by the existence of S. aureus (27.8%), Klebsiella spp. (5.6%), Corynebacterium spp. (22.2%), Cryptococcus (16.7%), Proteus spp. (11.1% (, T. pyogenes (11.1%), Pseudomonas spp. (5.6%), and Fusobacterium necrophorum (17.4%). Uterine samples from affected animals were characterized by the presence of S. aureus (22.2%), Streptococcus (22.2%), Corynebacterium spp. (11.1%), E. coli (11.1%), and Pseudomonas spp. (11.1%). Anaerobic bacteria were not isolated from control nor affected animals. Enzyme immunoassays revealed that 50% and 34.8% of the control and affected animals were positive for Coxiella burnetii, respectively, Chlamydia was detected in 43.5% of samples from affected animals, only 60% of which were confirmed positive. These results show that microbial communities linked with cervico-vaginal adhesion in dromedary camels are likely to be polymicrobial. The findings of this study are helpful in designing antimicrobial therapies toward reducing the incidence for cervico-vaginal adhesion.

Effect of dystocia on some hormonal and biochemical parameters in the one-humped camel (Camelus dromedarius).

The present study compared some of the hormonal and biochemical constituents of serum from eutocic and dystocic one-humped camels (Camelus dromedarius). Sera were harvested from eutocic (n = 9) and dystocic (n = 20) camels within the first 15 minutes after delivery. Although there were no differences in the concentrations of estradiol-17ß (E2) and prostaglandin F2α (PGF2α) between the eutocic and the dystocic animals, the level of progesterone (P4) and cortisol was significantly higher (P < 0.01) in animals that experienced dystocia than those that had a normal birth. There were no differences between the concentrations of alkaline phosphatase, aspartate aminotransferase, calcium, cholesterol, creatine kinase, creatinine, or magnesium (Mg) in eutocic and dystocic animals. The nitric oxide concentration was significantly higher (P < 0.01) in the serum from animals with dystocia than those that had normal births. By contrast, the serum concentrations of glucose, phosphorus (P), and triglycerides were significantly lower (P < 0.01) in eutocic camels compared with dystocic camels. As the delayed decline of P4 is reported to be the major hormonal difference between eutocic and dystocic camels, we propose that the insensitivity of corpus luteum to luteolytic action may be a cause of dystocia. Moreover, stress and hormonal changes may affect the metabolic traits in dystocia camels.

Biochemical and hormonal analysis of follicular fluid and serum of female dromedary camels (Camelus dromedarius) with different sized ovarian follicles.

The current study aimed to compare some biochemical and hormonal constituents in follicular fluids and serum of female dromedary camels with different sized ovarian follicles. Therefore, follicular fluids from follicles sized 1.1-1.5cm (n=10), 1.6-2.1cm (n=10) and 2.2-2.5cm (n=10) and sera were harvested from 20 female camels. The concentrations of ascorbic acid, glucose, cholesterol and activities of acid phosphatase (ACP) and alkaline phosphatase (ALP) were not changed significantly neither in follicular fluids of all follicle sizes nor in sera of female camels with different sized follicles. The concentrations of estradiol-17ß (E2) in the follicular fluid of follicles sized 2.2-2.5cm were significantly lower (P<0.01) than its corresponding value in follicular fluid of other follicle sizes. The concentrations of progesterone (P4), tri-iodothyronine (T3), thyroxin (T4), cortisol and insulin-like growth factor-1 (IGF-1) remained comparable in follicular fluids of all examined different sized follicles. The concentrations of E2, P4, T3, T4, cortisol and IGF-1 were similar in the serum of camels with different sized follicles. Interestingly, mean concentrations of P4 and IGF-1 in follicular fluids were higher than their corresponding values in sera of camels with different sized follicles and the mean concentrations of glucose, cholesterol, ALP and cortisol in sera were higher than their corresponding values in follicular fluids of the examined camels. With the exception of E2, there were no significant differences in biochemical and hormonal constituents between follicular fluids from different sized follicles.

Effect of oxytocin and PGF2α on chlortetracycline absorption from the uterus of early postpartum camels (Camelus dromedarius).

Fifteen parturient camels given chlortetracycline (CTC) as intrauterine pessaries (3 g/head) were divided into the control group (n = 5), which remained untreated, oxytocin-treated group (50 IU, intramuscular; n = 5), and cloprostenol-treated group (Estrumate, 500 µg, intramuscular; n = 5). Serum samples were collected at 0, 1, 2, 4, 8, 24, 48, and 72 hours after treatment and CTC was determined. The CTC appeared in blood within 1 hour. The maximum concentration of CTC was detected in blood after 72 (543.58 ± 117.85 µg/L), 8 (520.48 ± 13.65 µg/L), and 1 hour (831.98 ± 111.01 µg/L) of administration in control, oxytocin-, and PGF2α-treated camels, respectively. There was a high significant effect of time (P < 0.001) and treatment-by-time interaction (P < 0.001) on serum CTC concentration. In the control group, there was a significant (P < 0.05) increase in CTC concentrations at 72 hours compared to the other times. In the oxytocin group, there was a significant (P < 0.05) decrease in CTC concentrations at 24, 48, and 72 hours compared to its level after 1 or 8 hours. In PGF2α, there was a significant (P < 0.001) decrease in CTC concentrations at 2, 4, 8, 24, 48, and 72 hours compared to its level after 1 hour. Treatment contrast at different time points showed a significant (P < 0.001) increase in CTC concentration after 1 hour in the PGF2α-treated group compared to oxytocin and control groups. By 72 hours, CTC concentrations were significantly (P < 0.05) lower in PGF2α and oxytocin groups than in the control group. In conclusion, serum CTC concentration in dromedary camels increases within 1 hour after intrauterine administration and remains elevated for at least 72 hours in control, oxytocin-, and PGF2α-treated animals.

Relationship between the size of the dominant follicle, vaginal electrical resistance, serum concentrations of oestradiol and progesterone and sexual receptivity during the follicular phase of the dromedary camel (Camelus dromedarius).

Thirteen dromedaries were used to study the relationship between the size of the dominant follicle, vaginal electrical resistance (VER), sexual receptivity, and serum concentrations of oestradiol-17ß (E2) and progesterone (P4) throughout the follicular phase. On a daily basis, the animals experienced teasing with a vasectomised camel, trans-rectal ultrasound examination of the ovaries, and measurement of VER and blood collection for serum E2 and P4. Results revealed no significant differences between the mean VER in the animals that had a follicle of 5-10mm (group I, n=11), 11-15mm (group II, n=12) and 16-20mm (group III, n=13). The VER did not correlate with the follicular size. The E2 concentrations in the animals in groups II (60.14pg/ml) and III (66.52pg/ml) were significantly (P<0.05) higher than those of animals in group I (48.31pg/ml). E2 was positively correlated (r=0.50; P<0.05) with the overall size of the follicles. The P4 concentration was significantly (P<0.05) lower in the animals of group II than in those in groups I and III. Serum P4 concentrations were inversely correlated (r=-0.40; P<0.05) with the overall size of the follicles. Complete sexual receptivity was reported in 63.64%, 16.67% and 76.92% of the animals in groups I, II and III, respectively. In group III, significant (P<0.05) complete sexual receptivity was confirmed. However, 23.08% of the animals were incompletely receptive. In conclusion, impedometric characteristics of the vaginal mucosa were not a reliable method for predicting the dominant follicular size during the follicular phase in dromedary camels.

Seminal plasma and serum fertility biomarkers in dromedary camels (Camelus dromedarius).

Eight healthy fertile (control) and 11 infertile male dromedaries were used to investigate whether specific seminal plasma and serum fertility biomarkers could be related to their in vivo fertility. Eight fertility biomarkers and testosterone were determined in both seminal plasma and serum of all studied camels during the rutting season using commercial kits. Results revealed a significant (P < 0.01) difference in semen parameters between the control and infertile camels. There was a significant (P < 0.01) difference between the control and infertile dromedaries in seminal plasma glutathione peroxidase (GPx) activity (15.04 ± 1.14 vs. 4.55 ± 0.96 nmol/min/mL, respectively) and both phospholipase A2 (sPLA2; 50.66 ± 6.28 vs. 23.56 ± 4.29 pg/mL, respectively) and testosterone concentrations (732.14 ± 57.12 vs. 396.36 ± 79.34 pg/mL, respectively). A significant (P < 0.05) difference was found between the control and infertile camels in seminal plasma concentrations of osteopontin, cysteine-rich secretory protein 3 (CRISP3), and prostaglandin D synthase (lipocalcin-type). There was a significant (P < 0.01) difference between the fertile and infertile camels in serum GPx activity 67.81 ± 12.41 vs. 21.31 ± 4.63 nmol/min/mL, respectively) and both testosterone (599.57 ± 110.90 vs. 176.09 ± 24.05 pg/mL, respectively) and clusterin concentrations (137.29 ± 14.15 vs. 253.00 ± 17.14 ng/mL, respectively). A significant (P < 0.05) difference existed between the control and infertile male dromedaries in serum concentrations of sPLA2, CRISP3, malonialdehyde, and insulinlike growth factor 1. In conclusion, CRISP3, sPLA2, GPx, and testosterone are fertility-associated biomarkers in both seminal plasma and serum of dromedary camels. Seminal plasma osteopontin is positively correlated and prostaglandin D synthase (lipocalcin-type) is negatively correlated with camels' fertility. Serum malonialdehyde, insulinlike growth factor 1, and clusterin are negatively correlated with fertility of male dromedary camels.

Evaluation of the breeding soundness of male camels (Camelus dromedarius) via clinical examination, semen analysis, ultrasonography and testicular biopsy: a summary of 80 clinical cases.

Male camel infertility is a heterogeneous disorder. A variety of factors may adversely affect sperm production and function and impair fertility. This study was designed to evaluate the sensitivity and specificity of ultrasonography and testicular biopsy in the evaluation of the breeding soundness of male dromedaries compared with results obtained by clinical examination and semen analysis. Eighty-four male dromedary camels (5-15 years old) were used in this study during the rutting season (November-May). Four sexually mature male camels were used as controls. These animals were apparently healthy and had histories of normal fertility. Eighty infertile male camels were subjected to an algorithmic approach based on information collected during careful examinations of the camels' breeding histories, clinical examinations, testicular evaluations, testicular ultrasonographies, the results of the semen analyses and testicular biopsies to diagnose the camels' infertilities. The differences in the semen parameters between the control and infertile male camels were highly significant (p < 0.01). Regarding the diagnoses of male camel infertility, the results of testicular ultrasonographies and biopsies were compared with those from the semen analyses, and the accuracies of these tests were 92.5% and 90%, respectively. Additionally, the results of the testicular ultrasonographies were matched with those of the testicular biopsies of the infertile animals, and this comparison resulted in 85% accuracy. Testicular biopsy is a promising method that, along with a carefully performed history, clinical examination, an appropriate testicular ultrasonography procedure and semen analysis, can afford veterinarians the opportunity for more precise diagnosis and treatment of many dromedary infertility disorders.

Evaluation of the microbial quality of fresh ejaculates of camel (Camelus dromedarius) semen.

A series of five factorial arranged experiments were conducted to investigate the effect of different management during semen collection on the microbial quality (bacterial load, type of microbes and frequency of isolation) of dromedaries' semen. Microbial analysis of seventy-nine fresh ejaculates from twenty-two camels showed the presence of nine variant colonies. The most prevalent organisms in the dromedary semen were species of Staphylococcus, Bacillus and Streptococcus. One yeast species was represented among the isolates. The middle aged camels (9-13 years) had significantly (P>0.05) higher mean bacterial loads than young (4-8 years) and old aged (14-18 years) animals. The mean bacterial populations of ejaculates collected by an electro-ejaculator were significantly (P>0.05) higher than those collected by an artificial vagina. Candida spp. was identified in 53.8% of the samples collected by an electro-ejaculator and was not detected in ejaculates collected by an artificial vagina. The mean semen bacterial load detected during the breeding season was significantly (P<0.01) higher than that collected during the non-breeding season. No fungi were isolated from semen samples collected in the non-breeding season. The difference between the mean semen bacterial loads in the first and the second ejaculate was highly significant (P<0.01). The preputial wash significantly (P<0.01) reduced the bacterial load. This study revealed that the microbial contamination of dromedaries' semen is found in different intensities during different management procedures of semen collection.

Comparison of some biochemical and hormonal constituents of oversized follicles and preovulatory follicles in camels (Camelus dromedarius).

The current study was carried out to compare some biochemical and hormonal constituents in follicular fluids from oversized follicles, preovulatory follicles, and serum in camels (Camelus dromedarius). Follicular fluids from oversized follicles (N = 10), preovulatory follicles (N = 10), and sera were harvested from 20 dromedaries. The follicular fluids and sera were subjected to biochemical and hormonal analysis. The results indicated no significant differences in the concentrations of ascorbic acid, glucose, cholesterol, acid phosphatase, and alkaline phosphatase between follicular fluid from oversized follicles and preovulatory follicles. In addition, there were no significant variations in the level of ascorbic acid, glucose, cholesterol, and acid phosphatase in the serum of animals with oversized follicles and those with preovulatory follicles. Serum alkaline phosphatase was significantly greater (P < 0.05) in camels with oversized follicles. The concentrations of estradiol-17ß (E2) and insulin-like growth factor-1 (IGF-1) in the follicular fluid of oversized follicles were significantly lower (P < 0.01) than that from preovulatory follicles. There were no differences in the concentrations of progesterone, tri-iodothyronine, and thyroxin between follicular fluid from oversized follicles and that of preovulatory follicles. The concentrations of E2, progesterone, tri-iodothyronine, thyroxin, cortisol, and IGF-1 were not different in the serum of camels with oversized follicles and camels with preovulatory follicles. The current study revealed that the significant differences of biochemical and hormonal constituents between follicular fluids from oversized follicles and preovulatory follicles were restricted on E2 and IGF-1. Relaying on the aforementioned outcome we can suggest that oversized follicle phenomenon is a form of follicular atresia of anovulatory follicles.

Immunization against GnRH in the male camel (Camelus dromedarius): effects on sexual behavior, testicular volume, semen characteristics and serum testosterone concentrations.

The effect of immunization against gonadotrophin releasing hormone (GnRH) on sexual behavior, total scrotal size, semen characteristics and serum concentrations of testosterone, was evaluated for 24 wks in sexually mature camels (Camelus dromedarius). Eight bull camels were randomly divided into a treatment and control group. Four male camels were immunized using 2 mg GnRH - tandem-dimer conjugated to ovalbumin, (Pepscan Systems, the Netherlands) administered subcutaneously, 4 wks apart. Control male camels received the same amount of saline solution. Significant decline in serum testosterone level was observed in three immunized camels out of four, whereas one camel showed no effect. The testosterone levels reached to <1.0 ng/mL serum by week 4 after booster injection and remained suppressed through the course of the study. The total testicular volume was not affected until the end of the experiment. In treated animals, the sexual behavior negatively affected after the booster injection. Anti-GnRH vaccine had a seriously detrimental effect on the acrosin amidase activity and normal acrosome percentages in treated male camels. It is concluded that the vaccine was effective in reducing serum testosterone levels and libido, and it had a serious harmful effect on the acrosin amidase activity and percentages of spermatozoa with normal acrosome. The immunogen did not affect the total testicular volume.

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.

Bovine blastocyst development rate in vitro is influenced by selection of oocytes by brillant cresyl blue staining before IVM as indicator for glucose-6-phosphate dehydrogenase activity.

The aim of this present study was to increase the efficiency of blastocyst production from cows after in vitro maturation/fertilization (IVM/IVF) by oocyte selection before maturation. Oocytes were selected on the basis of brillant cresyl blue (BCB) staining, used to indicate glucose-6-phosphate dehydrogenase (G6PDH) activity. To re-valuate the hypothesis that growing oocytes are expected to have a high level of active G6PDH, while mature oocytes have low G6PDH activity, cumulus oocyte complexes (COCs) were recovered from slaughterhouse ovaries by slicing the surface of the ovary. Only oocytes with a compact cumulus investment were used. Oocytes were placed into three groups: (1) control--placed immediately into culture; (2) holding control--COCs kept in PBS containing 0.4% BSA for 90 min before placement into culture; and (3) treatment--incubation with BCB for 90 min before culture. Treated oocytes were then divided into BCB- (colorless cytoplasm, increased G6PDH) and BCB+ (colored cytoplasm, low G6PDH) on their ability to metabolize the stain. Activity of G6PDH was determined via measurement of NADP reduction induced by G6P as substrate oxidized by G6PDH in the cytosol of control, BCB- and BCB+ groups; G6PDH activity was significant higher in BCB- COCs than in control and BCB+ COCs. After IVM, oocytes were fertilized in vitro. Embryos were cultured to day 8. The rate of maturation to metaphase II was significantly higher for control and BCB+ oocytes than for BCB- oocytes. The BCB+ oocytes yielded a significantly higher proportion of blastocysts (34.1%) than did control or holding control oocytes (18.3 and 19.2%); and both controls and BCB+ oocytes had significantly higher blastocyst development than did BCB- oocytes (3.9%). These results show that the staining of bovine cumulus oocyte complexes with BCB before in vitro maturation may be used to select developmentally competent oocytes for IVF. In addition, G6PDH activity may be useful as a marker for oocyte quality in future studies on factors affecting developmental competence.

Changes in cumulus-oocyte complexes of pregnant and non-pregnant camels (Camelus dromedarius) during maturation in vitro.

The aim of the present study was to examine the cumulus morphology and the oocyte chromatin quality of camel cumulus-oocyte complexes (COCs) at the time of recovery, and to monitor changes in oocyte chromatin configuration and apoptosis in cumulus cells from camel COCs during in vitro maturation (IVM) (0, 12, 24, 32, 36, 42, and 48 p.IVM) depending on pregnancy of donors. A total of 1023 COCs were isolated from sliced ovaries after slaughtering of 47 pregnant and 43 non-pregnant camels in an abattoir. The mean number of COCs per donor was 10.3 in pregnant and 12.5 in non-pregnant donors. The cumulus morphology of COCs was independent of the type of donor and was divided in COCs with compact (26.9 and 28%), dispersed (39.3 and 46%), corona radiata cumulus investment (27.9 and 21.7%) and without cumulus (6 and 4.2%), respectively for pregnant and non-pregnant donors. The highest proportion of COCs exhibited dispersed cumulus (P<0.05). Oocytes with meiotic stages of diplotene >50% were found only in compact (55 and 56.5%) and in dispersed COCs (58.4 and 60%), respectively for pregnant and non-pregnant donors. During IVM (0-48h) the first significant onset of specific meiotic stages were different in oocytes from pregnant donors: metaphase 1 (24-32h), metaphase 2 (36-42h), versus oocytes from non-pregnant donors: metaphase 1 (24h), metaphase 2 (32-48h) (P<0.05). The level of apoptotic cells in cumuli of matured COCs increased during IVM and was higher in matured COCs from non-pregnant donors for each time point during IVM (P<0.01). Camel oocytes meiosis during IVM is accompanied by a drastic increase of apoptosis in the surrounding cumulus cells 0-32 and 0-24h during IVM, respectively for pregnant and non-pregnant donors. The oocytes of pregnant camels require 36h of maturation to reach levels of >50% metaphase 2 stage in comparison to oocytes from non-pregnant donors where 32h are sufficient. The earlier onset of apoptosis in the COCs derived from non-pregnant donors possibly determines the faster progression of the oocytes through the final stages of meiosis.

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.

Treatment dilemma: conservative versus surgery in cutis aplasia congenita.

Cutis aplasia congenita (CAC), a congenital absence of skin and its appendages, may extend into underlying muscles and bones. The scalp is the commonest site and it may be associated with acrania. CAC presents either as a thin transparent membrane, a black eschar, an ulcer or a healed scar. The dilemma of either immediate surgical management or conservative treatment is much more pronounced in the presence of acrania. Two patients with scalp lesions measuring 12 x 8 cm and 14 x 12 cm respectively and one patient with 4 cm wide circumferential trunk cutis aplasia treated conservatively are presented. The conservative treatment is simple, easy to carry out, and effective even for large defects; therefore, it is recommended in cutis aplasia congenita till complete healing. Surgical interventions such as tissue expansion and resurfacing, contracture release, etc. are for the correction of subsequent deformity at a later date.

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.

Epidemiology and mortality of 162 major burns in Kuwait.

The burns intensive care unit at IBN Sina Hospital reopened in July 1991, following the Iraqi occupation of Kuwait and the Gulf War. Epidemiology and mortality of 162 burn patients with 30 per cent and over total body surface area (TBSA) burns, treated from July 1991 to December 1994, is presented. There were 91 males and 71 females with a ratio of 1.3 to 1. The median age was 30 years (range 4 months to 93 years) and 44 per cent of the patients were 15-40 years of age. 124 (76.5 per cent) accidents occurred at home and the flame burn was the commonest involving 131 (80.9 per cent) patients. The median burn surface area was 45.5 per cent and the majority of them sustained deep burns. The hospital stay of the surviving patients ranged from 11 to 174 days (median 38 days), while the day of the death was from 1 to 134 days. Forty-six deaths represent an overall mortality rate of 28.4 per cent amongst our patients. All the patients whose Baux score was 130 and above died. Burn shock was responsible for 10 deaths, and out of them eight were not actively resuscitated due to high Baux score. Sixteen deaths occurred within 48 h postburn. Septicaemia and its related effects were responsible for the majority of the deaths.