Prevalence of Ticks and detection of Rickettsial Agents from blood of Tick-Infested animals in Lower Sindh: A MOLECULAR APPROACH

Ticks are important vectors of human and animal pathogens. They are considered as main vectors for transmission of rickettsial agents affecting animal and human health. The study was designed to investigate district wise pattern and detection of rickettsial agents by using molecular and conventional techniques in blood samples of infected cattles, buffalos, sheeps and goats. A survey study was carried out in lower Sindh (Tharparkar, Badin, Hyderabad, Karachi, Tando Muhammad khan, Thatta and Mirpurkhas). Blood samples were collected randomly from infected Cattles, buffalos, sheeps and goats and transported to the Molecular Parasitology laboratory, Sindh Agriculture University, Tandojam, followed by examinations under stereomicroscope and Polymerase Chain Reaction (PCR). The study showed that overall infection of Rickettsial agents among infected animals was recorded follwoing Microscopy/ Blood smear test in cattles, buffalos, sheeps and goats was 41.79, 49.09, 46 and 41.66% respectively, whereas overall infection through PCR in cattle, buffalo, sheep and goat was 39.55, 43.55, 46 and 55.55% respectively. Whereas animal-wise data through PCR indicates that in case of Goats (55.55%) were more susceptible to rickettsial infection as compared to sheep (46%), buffaloes (43.55%) and cattle (39.55%). The highest rate of rickettsial agents was found in district Tharparkar and lowest rate was found in district Karachi. Microscopy/Blood smear method indicates that Buffaloes were more susceptible for infection. Whereas PCR indicates Goats were more susceptible for infection.

Treatment of large and ptotic breasts

The breasts have always been considered a sign of femininity. The correction of breast deformities is therefore important from a physical and psychological point of view, improving greatly the quality of life. Many surgical techniques have been proposed to correct the shape and volume of the breast, and in recent decades techniques have been proposed to preserve the nipple sensitivity and increase the vascular safety of the procedure. Templates (such as the Wise pattern) have been proposed to improve planning and different pedicles for the areola have been described. During the last 20 years, new techniques have been introduced to minimize scars, leaving normal sensitivity in almost all cases, the possibility of lactation, and a pleasing shape. The periareolar scar is, unfortunately, always necessary to reposition the nipple–areolar complex. The vertical scar is necessary to resect the excess of skin of the lower pole of the breast. Effort has been directed to reduce or eliminate the horizontal submammary scar, leading to a vertical scar only, even in large reductions.

Seat belt breast injury: a reconstructive approach to managing unilateral bisected breast deformity

Seat belt breast deformity can result in significant aesthetic, functional and psychosocial sequelae. Although seat belt breast deformity is well documented, there is a lack of literature describing their reconstructive management. We describe the surgical management of a 63-year-old woman presenting with stage 2b seat belt breast deformity, who underwent scar revision, repositioning of the nipple–areola complex and contralateral breast reduction using Wise-pattern incisions based on superior pedicles. She made an excellent recovery with an improved aesthetic result.

Wise-Pattern Superomedial Dermoglandular Pedicle Technique: Improves Breast Upper Pole Fullness and Breast Proportions

Background: This study aimed to analyze postoperative upper pole fullness, upper/lower pole ratios, bottoming-out deformity, and complication rates for patients who underwent planned bilateral reduction mammoplasty for gigantomastia using the superomedial dermoglandular pedicle technique and Wise-pattern skin excision. Methods: A total of 105 consecutive patients were evaluated postoperatively within a year in full lateral position, and the upper pole was between the lines drawn horizontally from the nipple meridian, where the breast became evident on the chest wall. Flat and slightly convex upper pole slopes were considered well-rounded; the concave ones were evaluated as exhibiting decreased fullness. The lower pole was the height between the horizontal line passing through the level of the inframammary fold and nipple meridian. Bottoming-out deformity was evaluated according to the 45/55% ratio developed by Mallucci and Branford, where the bottom pole was above 55%, at which it was held to be leaning toward bottoming-out deformity. Results: The upper and lower pole ratios were 44.79% ± 2.80% and 55.21% ± 2.80%, respectively. In 4 cases, a lower pole distance of >55% was leaning toward bottoming-out deformity. A minimum of 12 months was required after surgery to detect upper pole fullness and any possible bottoming-out deformity. The upper pole fullness was achieved in 94% of cases that underwent superomedial dermoglandular pedicle Wise-pattern breast reduction. Conclusion: The use of the superomedial dermoglandular pedicle technique with the Wise-pattern in breast reduction operations helps in ensuring upper pole fullness, resulting in less bottoming-out deformity and requiring less revision.

59 Should The ‘Normal’ And ‘Ideal’ Nipple Position in A Male Influence the Surgeon When Planning Severe Gynaecomastia Correction?

Background The ideal nipple position of the male chest following gynecomastia surgery is well documented however with increased development of the chest muscles, the NAC placement can change, leading to the medial displacement of the nipple giving a poor aesthetic outcome. Therefore, we feel these measurements need to be applied to the patients build and take into consideration the patient's future fitness goals. Method We have analysed photographs of 3 groups of men: super- athletes, athletes and severe gynaecomastia. We assessed the proportions of the chest in relation to the NAC and the degree of ptosis. Results There is wide variation in the position of the nipple to the chest wall between each group with minor variation within each group. Based on this research we believe that surgeons should be circumspect when considering breast reduction with a Wise pattern in patients with severe gynaecomastia. In patient with increased development of the pectoralis major muscles, the NAC placement can change, leading to medial displacement of the nipple and ptosis and poor aesthetic result. Conclusions We suggest a two-stage procedure, carried out on two separate occasions wound be more ideal than a single stage as this allows better long-term better positioning of the nipple.