Postoperative Ecchymosis in Upper Blepharoplasty: A Split Face Study of Tranexamic Acid Versus Etamsylate

Objective: To compare the efficacy of tranexamic acid (TXA) versus etamsylate (ETM) in reducing postoperative ecchymosis in upper blepharoplasty. Introduction: With an increase in demand for shortened recoveries after facial aesthetic surgery, various optional approaches have been sought out. In terms of ecchymosis, TXA and ETM have been most commonly used. Method: A prospective, intrapatient split face study was conducted from January 2020 to January 2021 in 40 patients who underwent upper blepharoplasty under local anesthesia. Two equal anesthetic solutions were prepared; Solution A contained TXA and solution B contained ETM. Solution A was injected in the right eyelid and solution B in the left eyelid. Postoperative ecchymosis was assessed by 2 blinded evaluators, the assisting surgeon (Observer 1) and an external surgeon (Observer 2) at 48 h and on the seventh day using a scale published by Sagiv et al. Results: Postoperative ecchymosis was found to be less at 48 h by both observers with TXA solution. Moreover, at the seventh day, no ecchymosis was found in 32.5% with TXA solution compared to 2.5% with ETM solution. Kappa analysis showed concordance between observers. Conclusion: In our study, TXA solution was a more effective therapy when compared to ETM solution for reducing ecchymosis. Larger case studies are required to prove the difference for validation.

Efficacy of Acetic Acid Irrigation in Management of Chronic Suppurative Otitis Media “A Prospective Study

Background: Prior to surgical management of chronic suppurative otitis media (CSOM) for the dry ear medical management is necessary. CSOM is a biofilm disease and due to this has antibiotic resistance. The pillar of its treatment included aural cleaning according to standard protocols, application of topical germ free antiseptic and use of antimicrobials. Acetic acid due to its ability in reducing the pH may be effective in reducing the growth of microorganisms. Objective: The aim of the study was to compare the efficacy of irrigation with acetic acid versus systemic antibiotics in CSOM patients. Materials & Methods: A total of 134 patients, who came to the ENT department of Sheikh Zayed Hospital, Lahore between 1st April 2020 to 30th September 2020, who had CSOM, of age 15 to 55 years and both genders were included in the study. The patients were divided randomly into two groups. Group A patients received aural toilets and irrigation with acetic acid and Group B received 500 mg of ciprofloxacin twice a day for 2 weeks. Results: The mean age (in years) of the patients in Group A was 37.45±7.32 and in Group B, it was 37.96±7.57. The efficacy of irrigation with acetic acid versus systemic antibiotics was 89.55% and 68.66% respectively and this difference between the two groups was found to be statistically significant (p=0.003). Conclusion: Irrigation with acetic acid was better than systemic antibiotics in managing patients with CSOM. Key words: Acetic acid, CSOM, Middle ear

Efficacy of oral tranexamic acid versus triple combination for the treatment of melasma: A prospective, double blinded randomised controlled trial

Melasma is a common acquired hypermelanosis characterized by irregular light to dark brown macules and patches seen mainly in women and over sun-exposed skin on the face. We have undertaken this RCT to compare the efficacy between oral Tranexamic acid and Topical Triple combination as Tranexamic acid is having good safety profile.To compare the therapeutic efficacy of oral Tranexamic acid versus Topical Triple combination for the treatment of Melasma using MASI score. To compare the adverse effects profile of each treatment modality. Total subjects (66 patients) were divided into 2 groups (A and B, each with 33 patients) by simple randomization method.Patients and analysers were blinded to treatments. Group-A received topical triple combination cream once daily (15-minutes) at night for 8 weeks followed by maintenance regimen of biweekly application of product for 4 weeks and oral placebo tablets (calcium gluconate 250mg) twice daily for 12 weeks. Group-B received oral Tranexamic acid tablets 250mg twice daily for 12 weeks with topical placebo cream (Moisturizer) once daily at night for 8 weeks followed by maintenance regimen of biweekly application of product for 4 weeks. MASI score was assessed at baseline and monthly follow-up visits along with simultaneous serial digital photographs, with the recording of side effects. Both groups showed significant decrease in MASI score in each followup visits without any statistically significant difference.In epidermal melasma topical triple combination is preferred over oral tranexamic acid. In dermal and mixed variety oral tranexamic acid is better.