Tranexamic acid in rhytidectomy: a scoping review.

Background: Intraoperative and postoperative bleeding is considered one of the most common risks in rhytidectomy. Recently, the use of antifibrinolytic agents in facial plastic and reconstructive surgeries has been evaluated, but their use in rhytidectomy remains a topic of ongoing discussion. Tranexamic acid (TXA) is an antifibrinolytic agent that prevents enzymatic degradation of the fibrin clot by blocking the conversion of plasminogen to plasmin, improves platelet function, and has a direct anti-inflammatory effect. This review covers pertinent literature to elucidate whether the use of TXA in rhytidectomy confers intraoperative and postoperative benefits. Methods: A systematic literature search was conducted in online databases: PubMed, Google Scholar, Cochrane, Scopus, and Web of Science for all articles on the topic of TXA in facelift published up to and including June, 2023 using the following terms: "TXA," "tranexamic acid," "plastic surgery," "aesthetic surgery," "facelift," "rhytidectomy". They were either searched individually or in combination. All relevant original research articles, of any study design were included and narratively discussed in this review. Studies not carried out in humans and studies centred on the use of TXA in other specialties were excluded. English Language was included. Results: Eight articles were reviewed in this paper. Through these articles, the authors provided in detail the possible beneficial effects of TXA in facelift patients in evaluating several clinical outcomes: intraoperative blood loss, postoperative drain output, postoperative oedema, ecchymosis, operative time, and surgical field quality. Conclusion: Although there is still a lack of information on TXA in facelift patients, we are not able to deny the beneficial effects of TXA on this topic. Therefore, further investigations including prospective, case-controlled multi-institutional studies comparing routes of delivery should be performed until reaching, at the end, an evidence-based guideline providing a clear protocol in terms of the administration and dosage of TXA in facelift.

A Rare Case of Microblading Complicated by Orbital Exenteration and Frontal Defect Reconstructed Using Crane Principle.

This is a case of a rare complication of microblading in a middle-aged woman in a developing country, resulting in a right orbital exenteration and a forehead defect associated with bone exposure reconstructed using the crane principle. To the best of our knowledge, this case is the first one to report such an entity. We are aiming to highlight the importance of proper hygiene in such cosmetic procedures and to shed light on the crane principle as a suitable reconstructive choice, especially in circumstances where other reconstructive options are not available, or in specific situations like mass causalities when shorter operation time is required.

An Analytical Study of Primus Stove Burns: A Catastrophic and Costly but Preventable Tragedy.

Burns are still considered to be an enormous public issue. Syrian burn centers have to deal, especially during the current war, with burns caused by manually processed petroleum derivatives, and particularly' primus stove injuries. This kind of burn is severe and devastating. Prevention is key in management. This is one of the leading studies to include this high number of cases in relative medical literature. Methods: This retrospective descriptive cross-sectional study was conducted at Al-Mouwasat University Hospital, from June 2021 to October 2021. Inclusion criteria included admitted patients with a clear history of kerosene primus stove burn, either gender, and any age. Exclusion criteria included no clear history of a primus stove burn, injuries with causes other than primus stove, and outpatients. Data were recorded in Microsoft Excel sheets, and analyzed using IBM SPSS Statistics 26 software. Results: In total, 135 burn patients were included. Of the total number of 135 patients, 65 (48%) patients were admitted with primus stove burns, with 70 (52%) non-primus stove injury patients. Of the 65 patients, 25 were men and 40 were women (38% and 62% respectively). The mean percentage of total body surface area was 45%. Average hospital stay was 30.5 days, whereas 16 of 65 (25%) primus stove admissions died. Conclusions: Primus stove injuries are catastrophic and costly, but preventable. This study provides a detailed analytic and epidemiological approach to these injuries, hoping to shed light on the severity of such cases' and stresses the importance of prevention, which is always better than cure.

Clinicopathological features of idiopathic granulomatous mastitis: A retrospective study & educational lessons from Syria.

Objective: to determine the clinical presentations and histopathological findings of idiopathic granulomatous mastitis, and to evaluate clinical outcomes after management. Methods: between 2007 and 2021, the files and histopathology reports of 17 patients with idiopathic granulomatous mastitis at Tishreen University Hospital, Latakia, Syria were reviewed. The data were analyzed and a scan through relevant literature was carried out to review related cases. Results: the age of patients ranged from 23 years to 57 years, and the mean age was 37.2 ± 9.57 years. All patients were female. The most common clinical presentation was breast lumps and the most common mammographic finding was ill-defined masses, which mimics breast carcinoma. Multinucleated giant cells, polymorphonuclear leukocytes, lipogranuloma-like changes and lobulocentric abscesses were the most common histopathological findings. Treatment options include: drainage of abscess along with antibiotics, steroid administration, and surgical excision. Antibiotic treatment was associated with a higher rate of complications, while use of steroids showed complete remission of the disease. Conclusion: idiopathic granulomatous mastitis is a spectrum of entities that should be differentiated from breast carcinoma and other mastitis conditions, the infectious or the non-infectious ones. The clinical and radiological features resemble those of breast carcinoma and infectious mastitis. The histopathological study is considered as the most crucial element in the multidisciplinary approach to diagnose idiopathic granulomatous mastitis (IGM) and determine the optimal management to be administered.

A scoping review of the role of ascorbic acid in modifying fluid requirements in the resuscitation phase in burn patients.

Background: Accurate fluid resuscitation in burn patients is the main therapy in improving clinical outcomes. The standard target is to provide adequate end-organ perfusion, taking into consideration the possible risks of fluid creep and over-resuscitation. Anti-oxidant therapies, especially vitamin C, have been evaluated as an adjuvant therapy in resuscitating burn patients in the acute phase. Methods: A scoping search in PubMed and Google Scholar was done using the search terms "ascorbic acid" "burn patients", "vitamin C″, "burn", and "fluid requirements". They were either searched individually or in combination. All relevant articles, of any study design (published till mid-October 2021), were included and narratively discussed in this paper. Results: Ten articles were reviewed in this paper. Through these articles, we provided in detail the beneficial effects of vitamin C on burn patients in reducing fluid requirements in the resuscitation phase. Additionally, we summarized the pathophysiology of vitamin C in this entity, shedding light on the potential adverse effects and the importance of conducting similar clinical trials. Conclusion: We cannot deny the beneficial effects of vitamin C on burn patients. Therefore, each burn center should conduct clinical trials until reaching, at the end, an evidence-based guideline providing a clear protocol in terms of its administration and dosage, aiming to minimize possible adverse effects.

A Resection of a Giant Mediastinal Teratoma in a Mayer-Rokitansky-Küster-Hauser Syndrome Patient.

This is a case of a giant mediastinal teratoma occupying the entire hemithorax, resulting in a complete lung whiteout. Both diagnosis and complete surgical resection of such tumors are considered a challenge, which is what we are reporting in detail in a 24-year-old Syrian woman previously diagnosed with Mayer-Rokitansky-Küster-Hauser syndrome. Here we report the simultaneous incidence of Mayer-Rokitansky-Küster -Hauser syndrome and a mediastinal mature teratoma.

"An unusual presentation of a sacral Ewing's sarcoma in a young Syrian female".

A primary spinal Ewing sarcoma is extremely rare to be found. To the best of our knowledge, it is the first reported case for bilateral foot drop as a prodromal symptom of sacral Ewing sarcoma. The case, we are presenting, is of an 18-year-old athletic female, who was presented to the emergency department suffering from sudden severe low back pain radiated to the lower limbs, associated with bilateral foot drop and later urinary incontinence. Following the indicated surgery and subsequent histopathology study, we diagnosed this rare type of tumors. In the following article, we are describing the clinical presenting features of this tumor and discussing the clinical aspects.

A rare manifestation of indolent systemic mastocytosis and its management during the coronavirus disease 2019 pandemic; educational lessons from Syria.

The diagnosis of indolent systemic mastocytosis can be quite a challenge due to its wide spectrum of clinical manifestations. We are reporting a case of misdiagnosed indolent systemic mastocytosis in a 41-year-old male that has been wrongly treated first as a Non-Hodgkin lymphoma. The patient had generalized lymphadenopathy and eosinophilia, which are rare manifestations of indolent systemic mastocytosis. The chronic neglected pruritus and elevated tryptase levels along with histological findings were the main clues that have led us to the final diagnosis of indolent systemic mastocytosis. Later during the coronavirus disease 2019 pandemic, the patient presented with symptoms that are common between coronavirus disease 2019 and mast cell activation syndrome. Coronavirus disease 2019 was confirmed with a polymerase chain reaction test. There were no clear guidelines for managing a case like ours, so our management plan was based on the latest recommendations published at that time.

A maxillary ameloblastic fibrosarcoma tumor: a rare case report from Syria.

Ameloblastic fibrosarcoma (AFS) is a rare, aggressive malignant odontogenic tumor. AFS is seen most frequently in second and third decades of life. We are reporting a case of a low grade AFS in a 21-year-old male complaining of a painless swelling in the right side of the maxilla. The patient was treated with surgical excision followed by radiotherapy, which is considered the most effective approach for most of soft tissue sarcomas. AFS has a high-reported recurrence rate (up to 37%); therefore, long-term surveillance for recurrence is crucial.

A scoping review of the impact of COVID-19 pandemic on surgical practice.

BACKGROUND: The current COVID-19 pandemic has challenged the infrastructure of the healthcare systems. To cope with the pandemic, substantial changes were introduced to surgical practice and education all over the world. METHODS: A scoping search in PubMed and Google Scholar was done using the search terms: "Coronavirus," "COVID-19", "SARS-CoV-2", "nCoV-2019", and "surgery." They were either searched individually or in combination. All relevant articles of any study design (published within December 15, 2019, till the mid of June 2020), were included and narratively discussed in this review. RESULTS: Sixty-six articles were reviewed in this article. Through these articles, we provide guidance and recommendations on the preoperative preparation and safety precautions, intraoperative precautions, postoperative precautions, postoperative complications (related to COVID-19), surgical scheduling, emergency surgeries, elective surgeries, cancer surgery, psychological impact on surgical teams, and surgical training during the COVID-19 pandemic. CONCLUSION: COVID-19 pandemic has affected nearly all aspects of surgical procedures, scheduling, and staffing. Special precautions were taken before, during, or after surgeries. New treatment and teaching modalities emerged in response to the pandemic. Psychological support and training platforms are necessary for the surgical team.

Burn management during the COVID-19 pandemic: recommendations and considerations.

Coronavirus disease-2019 (COVID-19) is a respiratory disease, caused by a novel coronavirus (SARS-COV-2). This disease has been raising international public health concerns since its recent outbreak in December 2019. As the virus is easily transmitted by respiratory droplets, all hospital departments needed to change their practices in an attempt to control the spread of this virus. Burn units and clinics are particularly affected by this pandemic because of the larger risk of contamination for both patients and caregivers. Furthermore, cross-clinical aspects especially pain management and complications such as coagulopathy might be caused by both extensive burns and COVID-19 infections, which makes the management of these patients particularly challenging. That's why we covered both main aspects in this review. In addition, we present briefly a synthesis of guidelines from several entities to help manage the health crisis and provide optimal care for all burn patients during this pandemic.

Two case reports of corticosteroid administration-prolonged and pulsed therapy-in treatment of pruritus in cholestatic hepatitis A patients.

Cholestasis following hepatitis A affects around 0.8% of hepatitis A patients. It is considered a distressing complication in spite of its good prognosis. Despite being subject to multiple studies, causes of cholestasis are still controversial. Many treatments (discussed later) have shown some improvements of the accompanied pruritus. In the following article, we present two cholestatic hepatitis A patients who suffered from severe pruritus. Prednisolone was administered via two different methods: prolonged and pulsed. Both showed great improvement of the pruritus in a short time frame. To the best of our knowledge, our management using pulsed corticosteroid therapy in treatment of pruritus in cholestatic hepatitis A is considered the first experimental management in medical literature. The importance of this experimental case lies in reducing the doses and the duration of steroid intake, thus reducing steroid side effects as far as possible.

A rare case report of gastro-duodenal fourth segment fistula secondary to a penetrating benign gastric ulcer.

A gastro-duodenal fourth segment fistula following a penetrating benign gastric ulcer is extremely rare to be found. To the best of our knowledge, our case is the eighth case to describe the gastro-duodenal third and fourth segment fistula, and it is the third to be diagnosed in living patients as all the other cases were diagnosed in autopsies. The case, we are presenting, is of an elderly patient with severe peptic symptoms and a primary diagnosis of gastric outlet obstruction. During our indicated surgery, we accidently diagnosed this rare type of fistula. In the following article, we will describe the clinical features of this fistula, discuss the steps of our unique surgical management, and summarize our follow-up for the patient.