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Mirecka J, Stańczyk M, Olejniczak A, Zamojska J, Gruca M, Kowara-Dzik K, Wosiak A, Szadkowska A, Smolewska E, Tkaczyk M. Are the Classical Symptoms of Hypertension in Children Still Sensitive Enough? Clin Pediatr (Phila) 2024; 63:1452-1458. [PMID: 38258756 DOI: 10.1177/00099228231225318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
The available literature is scarce on the initial symptoms of arterial hypertension in children. Our study aimed to analyze the initial clinical profile of patients referred to the hospital with suspected hypertension and those diagnosed with hypertension for the first time during a hospitalization for other reasons. This study was a retrospective analysis of medical records in 471 patients. More than half of the patients showed no symptoms. The most common symptom reported was a headache-28% (132) of patients. The diagnosis of elevated blood pressure or hypertension was more frequent in asymptomatic patients (P = 0.001). Headaches were seen more often in healthy patients than in patients with hypertension. Newly diagnosed hypertension is mainly diagnosed in asymptomatic children. Moreover, the symptoms previously described in the literature as the most common did not prove to be predictive of hypertension in our study.
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Affiliation(s)
- Julia Mirecka
- Department of Pediatrics, Immunology, and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Małgorzata Stańczyk
- Department of Pediatrics, Immunology, and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Department of Paediatrics, Nephrology, and Immunology, Medical University of Lodz, Lodz, Poland
| | - Aleksandra Olejniczak
- Department of Pediatrics, Endocrinology, Diabetology, and Nephrology, Medical University of Lodz, Lodz, Poland
| | - Justyna Zamojska
- Department of Cardiology and Paediatric Rheumatology, Medical University of Lodz, Lodz, Poland
| | - Marta Gruca
- Department of Cardiology and Paediatric Rheumatology, Medical University of Lodz, Lodz, Poland
| | - Karolina Kowara-Dzik
- Children's Department, Provincial Hospital Complex of S. Rybicki, Skierniewice, Poland
| | - Agnieszka Wosiak
- Institute of Information Technology, Lodz University of Technology, Lodz, Poland
| | - Agnieszka Szadkowska
- Department of Pediatrics, Endocrinology, Diabetology, and Nephrology, Medical University of Lodz, Lodz, Poland
| | - Elżbieta Smolewska
- Department of Cardiology and Paediatric Rheumatology, Medical University of Lodz, Lodz, Poland
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology, and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Department of Paediatrics, Nephrology, and Immunology, Medical University of Lodz, Lodz, Poland
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Raaj P, Hazra D, Chandy GM, Jacob CR, Ganesan P. Prospective review of 188 cases of epistaxis presenting to the emergency department: Etiology and outcome. J Family Med Prim Care 2023; 12:2721-2726. [PMID: 38186796 PMCID: PMC10771146 DOI: 10.4103/jfmpc.jfmpc_889_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 01/09/2024] Open
Abstract
Background Due to a myriad of risk factors, epistaxis is a very frequent presentation to the emergency room (ER). This study aims to ascertain the prevalence of epistaxis in our population, risk factors, effectiveness of ER treatment, complications, and ER outcome. Materials and Methods This was a prospective observational study performed in the ER of a referral tertiary care center in south India. Data were categorized, coded, and analyzed to determine the objective of the study. Results During the study's six-month duration, 188 (0.6%) patients presented with epistaxis. The mean age was 42.9 (SD: 16.49) years, with a male preponderance of 143 (76.1%). A majority of these patients (n: 156; 82.9%) were triaged as priority II, with hypertension (n: 53, 28.2%) as the commonest comorbidities. Trauma-related epistaxis (n: 107, 56.9%) was the most frequent cause. Anterior nasal packing was carried out for 85 (45.2%) patients, posterior nasal packing was carried out for one (0.5%) patient, and bleeding had spontaneously resolved in the majority (n: 102; 54.3%) patients. Seven (3.7%; p-value: 0.001) patients had recurrent epistaxis, and of those, three (1.6%) required urgent resuscitation with crystalloid fluid and blood products. Two of these patients had bleeding dyscrasias, four had history of trauma, and one patient presented with uncontrolled hypertension. Two (1.1%) patients came back to us with recurrent bleeding within 12 h of discharge. Majority (69.2%; 130) were discharged stable, (23.9%; 45) were admitted for observation and (6.9%; 13) were discharged against medical advice. There was no mortality among these study populations. Conclusion Middle-young, aged males most commonly presented with epistaxis. Most of them were secondary to trauma. Anterior nasal bleeding was the most common source and hemostasis could be obtained by anterior nasal packing. Majority could be discharged stable from the ER. However, this cohort had seen patients in life-threatening conditions, so the severity cannot be overlooked.
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Affiliation(s)
- Prethesh Raaj
- Department of Emergency Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Darpanarayan Hazra
- Department of Emergency Medicine, Peerless Hospitex Hospital and Research Center Ltd., Kolkata, West Bengal, India
| | - Gina M. Chandy
- Department of Emergency Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Christna R. Jacob
- Department of Otorhinolaryngology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Priya Ganesan
- Department of Emergency Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Vlaescu AN, Ionita E, Anghelina F, Mogoanta CA, Ciolofan SM, Rusescu A, Ionita IG, Voiosu C, Hainarosie R. Etiological Profile of Epistaxis: Pre-Pandemic Versus Pandemic. CURRENT HEALTH SCIENCES JOURNAL 2023; 49:362-370. [PMID: 38314226 PMCID: PMC10832887 DOI: 10.12865/chsj.49.03.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/20/2023] [Indexed: 02/06/2024]
Abstract
Nosebleed or epistaxis is one of the most common forms of presenting an emergency in the ENT field. Since March 11, 2020, the World Health Organisation has proclaimed COVID-19 a global pandemic, and the world has been closed down. The main objective of the study is to analyse and compare the dynamics of epistaxis aetiology among the cases that required hospitalisation in the pre-pandemic period and the period of the COVID 19 pandemic. The study is multicenter retrospective from October 2018 to May 2022, including 380 cases of hospitalised epistaxis, with the mention that March 2020 is considered the beginning of the pandemic period. 60.8% of the patients enrolled in the study in the pre-pandemic period (60.8%) and 39.2% in the pandemic period. Differences between groups were not statistically significant between study entries (pre-pandemic vs. pandemic) and age (p=0.331), gender (p=0.916) or existence of local causes for epistaxis (p=0.895). Patients with general causes for epistaxis were more frequently enrolled in the pandemic period, while patients without general causes for epistaxis were more frequently enrolled in the pre-pandemic period. Patients with a hospitalisation period of more than 5 days were more frequently enrolled in the pre-pandemic period while patients with a hospitalisation period of 3 to 5 days were more frequently enrolled in the pandemic period. Also, patients with idiopathic epistaxis were more frequently enrolled in the pre-pandemic period. Based on the results presented in our study, the period of the Covid 19 pandemic directly influenced both the number of patients and the period of hospitalisation.
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Affiliation(s)
- Andreea Nicoleta Vlaescu
- PhD Student, Department of Otorhinolaryngology, Doctoral School, University of Medicine and Pharmacy of Craiova, Romania
| | - Elena Ionita
- Department of Otorhinolaryngology, University of Medicine and Pharmacy of Craiova, Romania
| | - Florin Anghelina
- Department of Otorhinolaryngology, University of Medicine and Pharmacy of Craiova, Romania
| | | | - Sorin-Mircea Ciolofan
- Department of Otorhinolaryngology, University of Medicine and Pharmacy of Craiova, Romania
| | - Andreea Rusescu
- Department of Otorhinolaryngology and Ophthalmology of "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Irina-Gabriela Ionita
- Department of Otorhinolaryngology and Ophthalmology of "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Catalina Voiosu
- Department of Otorhinolaryngology and Ophthalmology of "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Razvan Hainarosie
- Department of Otorhinolaryngology and Ophthalmology of "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Ruhela S, Mittal HK, Bist SS, Luthra M, Kumar L, Agarwal VK. Clinico-Etiological Evaluation of Epistaxis. Indian J Otolaryngol Head Neck Surg 2023; 75:828-835. [PMID: 37206732 PMCID: PMC10188701 DOI: 10.1007/s12070-022-03458-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Epistaxis or bleeding from nose, a commonly confronted condition in the department of otorhinolaryngology can be a disquietening experience and sometimes a life threatening emergency for the patient. The aim of this study is to study the clinical profile and aetiology in epistaxis patients. An observational prospective study carried out over a period of 12 months in the Department of Otorhinolaryngology, Head and Neck Surgery, Swami Rama Himalayan University, Swami Ram Nagar, Dehradun, Uttarakhand. A total of 104 patients of all age groups and gender presenting with epistaxis were included in the study. Males formed majority of the patients (68.27%) as compared to female patients (31.73%). Most of the patients were in the age group of 51-70 years with majority being farmers (30.77%). The finding of variation with age was statistically significant (p < 0.05) with most patients in the age group of 51-60 years presenting in winter season. Local causes were observed to be more common (50.96%) among which trauma was the predominant cause (23.08%). Systemic causes formed 37.58% of cases, out of which hypertension was the commonest cause. In our study, non-surgical measures were most commonly employed treatment modality (85.58%) among which medical management was done in most patients. Trauma and hypertension contributed to the majority of patients presenting with epistaxis in our study with cold, dry winter months associated with increased incidence of epistaxis.
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Affiliation(s)
- Shivam Ruhela
- Department of Otorhinolaryngology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Dehradun, Uttarakhand 248016 India
| | - Himanshu Kumar Mittal
- Department of Otorhinolaryngology, Government Medical College and Hospital, Sec-32, Chandigarh, India
| | - S. S. Bist
- Department of Otorhinolaryngology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Dehradun, Uttarakhand 248016 India
| | - Mahima Luthra
- Department of Otorhinolaryngology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Dehradun, Uttarakhand 248016 India
| | - Lovneesh Kumar
- Department of Otorhinolaryngology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Dehradun, Uttarakhand 248016 India
| | - Vinish Kumar Agarwal
- Department of Otorhinolaryngology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Dehradun, Uttarakhand 248016 India
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Risk factors of epistaxis after endoscopic endonasal skull base surgeries. Clin Neurol Neurosurg 2022; 217:107243. [DOI: 10.1016/j.clineuro.2022.107243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/27/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022]
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Laurentino AOM, Solómon J, Tonietto BD, Cestonaro LV, Dos Santos NG, Piton YV, Izolan L, Marques D, Costa-Valle MT, Garcia SC, Sebben V, Dallegrave E, Schaefer PG, Barros EJ, Arbo MD, Leal MB. Levamisole, a cocaine cutting agent, induces acute and subchronic systemic alterations in Wistar rats. Toxicol Appl Pharmacol 2021; 426:115649. [PMID: 34273407 DOI: 10.1016/j.taap.2021.115649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/14/2021] [Accepted: 07/09/2021] [Indexed: 12/31/2022]
Abstract
The use of the anthelmintic levamisole as a cocaine adulterant has been increasing worldwide. Complications caused by this association include systemic vasculitis, agranulocytosis, neutropenia, tissue necrosis, pulmonary hemorrhage, and renal injury. Data about toxicity of levamisole are scarce, therefore the aim of this study was to evaluate the acute and subchronic toxic effects of levamisole in rats. Male Wistar rats received saline or levamisole by intraperitoneal route at the doses of 12, 24 and 36 mg/kg in the acute toxicity test; and at 3, 6 and 12 mg/kg in the subchronic toxicity test. Toxicity was evaluated using behavioral, cognitive, renal, hematological, biochemical and histopathological parameters. Acute administration of levamisole caused behavioral and histopathological alterations. Subchronic administration caused behavioral, cognitive and hematological alterations (p < 0.0001 and p < 0.05, respectively), impairment of liver and kidney functions (p < 0.05), and changes of antioxidant defenses (p ≤ 0.0001). Both administrations produced toxic effects of clinical relevance, which make levamisole a dangerous cutting agent. Furthermore, the knowledge of these effects can contribute to the correct diagnosis and treatment of cocaine dependents with unusual systemic alterations.
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Affiliation(s)
- Ana Olívia Martins Laurentino
- Programa de Pós-Graduação em Ciências Biológicas, Farmacologia e Terapêutica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/305, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil; Laboratório de Farmacologia e Toxicologia Neurocomportamental, Departamento de Farmacologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/305, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil
| | - Janaína Solómon
- Laboratório de Farmacologia e Toxicologia Neurocomportamental, Departamento de Farmacologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/305, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil
| | - Bruna Ducatti Tonietto
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia - Anexo I, Universidade Federal do Rio Grande do Sul (UFRGS), Rua São Luis, 150/3° andar, 90620-170 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752/1° andar, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil
| | - Larissa Vivan Cestonaro
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia - Anexo I, Universidade Federal do Rio Grande do Sul (UFRGS), Rua São Luis, 150/3° andar, 90620-170 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752/1° andar, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil
| | - Nícolas Guimarães Dos Santos
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia - Anexo I, Universidade Federal do Rio Grande do Sul (UFRGS), Rua São Luis, 150/3° andar, 90620-170 Porto Alegre, Rio Grande do Sul, Brazil
| | - Yasmin Vendruscolo Piton
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia - Anexo I, Universidade Federal do Rio Grande do Sul (UFRGS), Rua São Luis, 150/3° andar, 90620-170 Porto Alegre, Rio Grande do Sul, Brazil
| | - Lucas Izolan
- Programa de Pós-Graduação em Ciências Biológicas: Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/209, 90046-900 Porto Alegre, Rio Grande do Sul, Brazil
| | - Douglas Marques
- Laboratório de Farmacologia e Toxicologia Neurocomportamental, Departamento de Farmacologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/305, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Biológicas: Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/209, 90046-900 Porto Alegre, Rio Grande do Sul, Brazil
| | - Marina Tuerlinckx Costa-Valle
- Departamento de Farmacociências, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil
| | - Solange Cristina Garcia
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia - Anexo I, Universidade Federal do Rio Grande do Sul (UFRGS), Rua São Luis, 150/3° andar, 90620-170 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752/1° andar, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil
| | - Viviane Sebben
- Centro de Informação Toxicológica, Av. Ipiranga, 5400, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil
| | - Eliane Dallegrave
- Departamento de Farmacociências, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro Guilherme Schaefer
- Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2350, 90035-007 Porto Alegre, Rio Grande do Sul, Brazil
| | - Elvino José Barros
- Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2350, 90035-007 Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcelo Dutra Arbo
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia - Anexo I, Universidade Federal do Rio Grande do Sul (UFRGS), Rua São Luis, 150/3° andar, 90620-170 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752/1° andar, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil.
| | - Mirna Bainy Leal
- Programa de Pós-Graduação em Ciências Biológicas, Farmacologia e Terapêutica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/305, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil; Laboratório de Farmacologia e Toxicologia Neurocomportamental, Departamento de Farmacologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/305, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Biológicas: Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/209, 90046-900 Porto Alegre, Rio Grande do Sul, Brazil.
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Grencheski EA, Kochi MN, Politi FVA, dos Santos TM, de Brito CMM, Yamaguti WP, Righetti RF. Bleeding frequency during physiotherapy in thrombocytopenic patients undergoing hematopoietic stem cell transplantation. PLoS One 2021; 16:e0255413. [PMID: 34329360 PMCID: PMC8323874 DOI: 10.1371/journal.pone.0255413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/15/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND During hematopoietic stem cell transplantation (HSCT) the patients perform activities of low and moderate intensity because have reduced hematological lineages, leaving them susceptible to hemorrhagic events. The objective of this study was to describe the frequency of bleeding events, severity, and possible association with physical exercise in thrombocytopenic patients. METHODS A retrospective study with seventy-seven HSCT patients hospitalised, that had a platelet count ≤ 50,000 /μL and received physical exercise during physiotherapy intervention. RESULTS Regarding bleeding events, only six were related to physical exercise, and bleeding events occurred more frequently at platelet levels ≤ 10,000 /μL. The most frequent bleeding event was epistaxis, considered of low severity, and with the moderate possibility of being related to physical exercise; followed by extremity hematoma, considered of medium severity and highly related to physical exercise. In this study, there was no occurrence of bleeding events considered of high severity. CONCLUSION Bleeding frequency in supervised physical exercise during physiotherapy in adults with thrombocytopenia undergoing HSCT is minor and relatively rare but occurs more frequently in patients with platelet count ≤10,000 /μL. These results encourage the maintenance of physical activity in this population who is at high risk of developing immobility-related complications.
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Singh AK, Kasle DA, Torabi SJ, Manes RP. Adverse Events Associated With ClariFix Posterior Nasal Nerve Cryoablation: A MAUDE Database Analysis. Otolaryngol Head Neck Surg 2021; 165:597-601. [PMID: 33528303 DOI: 10.1177/0194599820986581] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Posterior nasal nerve (PNN) cryoablation is a novel surgical technique used to address chronic rhinitis. The purpose of this study is to review the medical device reports (MDRs) submitted to the Food and Drug Administration's (FDA) Manufacturer and User Device Facility Experience (MAUDE) database to identify adverse events related to the use of ClariFix, a device designed for office-based cryosurgical ablation of the PNN. A total of 12 adverse events associated with ClariFix from January 2017 to August 2020 were identified and analyzed. The most common adverse events associated with ClariFix PNN cryoablation include epistaxis and nasal swelling. Further studies are needed to clarify whether PNN cryoablation is associated with epistaxis in certain populations.
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Affiliation(s)
- Amrita K Singh
- Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - David A Kasle
- Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sina J Torabi
- Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - R Peter Manes
- Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
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9
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Ketterer MC, Reuter TC, Knopf A, Hildenbrand T. [Risk profile analysis of stationary epistaxis patients]. Laryngorhinootologie 2021; 101:120-126. [PMID: 33461228 DOI: 10.1055/a-1342-0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Epistaxis is a disease well known to general practitioners and ENT specialists in the outpatient sector as well as in hospitals. The aim of this study was to analyze data of patients that were treated as inpatients at the ENT university hospital Freiburg between 2014-2018. MATERIALS AND METHODS This retrospective study analyzes data of admitted patients with epistaxis regarding age, medication, bleeding site, underlying health conditions, radiological imaging and treatment. Risk factors for longer inpatient length of stay and readmission were identified. RESULTS Median length of stay was 3.5 days. 55 % of the patients suffered from posterior epistaxis. 72.3 % of patients were treated with anticoagulants at the time of admission. The most prevalent medical conditions were hypertension (66 %) and arrhythmia due to atrial fibrillation (36.1 %). 63.5 % of the patients were treated by nasal packing. 97 patients (14.6 %) had to be treated surgically. Surgical treatment, transfusion, posterior epistaxis and anticoagulant treatment were risk factors for longer length of inpatient stay. Preexisting hypertension, posterior bleeding and single anticoagulant treatment increased the risk of readmission. CONCLUSIONS Determination and consideration of risk factors allow identification of patients at risk of longer inpatient length of stay and readmission. Adequate management accounting for risk profiles of patients could help reduce morbidity.
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Affiliation(s)
- Manuel Christoph Ketterer
- Klinik für Hals- Nasen- Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs- Universität Freiburg, Deutschland
| | - Thea Charlott Reuter
- Klinik für Hals- Nasen- Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs- Universität Freiburg, Deutschland
| | - Andreas Knopf
- Klinik für Hals- Nasen- Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs- Universität Freiburg, Deutschland
| | - Tanja Hildenbrand
- Klinik für Hals- Nasen- Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs- Universität Freiburg, Deutschland
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10
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Simplified management of epistaxis. J Am Assoc Nurse Pract 2021; 33:1024-1029. [PMID: 33463979 DOI: 10.1097/jxx.0000000000000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/02/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT Primary care, urgent care, and emergency department providers periodically treat epistaxis, either as recurrent nosebleed or an acute persistent episode. Silver nitrate application to the decongested and anesthetized nasal mucosa addresses the former in most cases. The plethora of commercial nasal packing devices testifies to the discomfort, technical difficulty, and frustration associated with traditional gauze-packing methods. Inflatable anterior nasal balloon packs reliably control most nosebleeds. Addition of a Foley catheter nasopharyngeal balloon pack manages most posterior epistaxis. Cautery and the two packing techniques mentioned above should treat most cases not requiring otolaryngology consultation or interventional radiology. Appropriate anesthetic and analgesics lessen the unpleasantness for both the patient and the provider. Topical moisturizing facilitates mucosal healing. Oxymetazoline 0.05% nasal spray provides the patient means to address rebleeding after discharge from treatment.
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11
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Boiko NV. [Epistaxis and arterial hypertension: a pathogenic link]. Vestn Otorinolaringol 2021; 86:72-77. [PMID: 33720656 DOI: 10.17116/otorino20218601172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
THE AIM OF THIS RESEARCH Was to study changes in the nasal mucosa vessels in hypertensive patients suffering from recurrent epistaxis. PATIENTS AND METHODS 78 hypertensive patients aged between 50 and 70, admitted due to epistaxis were studied. Diabetic, coagulopathic patients and those taking anticoagulants were excluded from the research. All the patients were divided into 2 groups: group 1 (46 people) with a single epistaxis, group 2 (32 people) with a recurrent epistaxis. At the admission time all the patients showed elevated arterial pressure, yet the differences between the patients of group 1 and group 2 were not significant. 14 patients of group 2 did not reveal any source of hemorrhage due to a severely deviated septum. These patients underwent septoplasty followed by mucoperichondrium biopsy. Histological study of samples showed multiple erosions within the epithelial layer, as well as necrotic patches spreading to the deeper mucous coat layers. The microvasculature showed dystrophic changes in the endothelium, its focal desquamation with basal membrane exposure and thrombocytes and erythrocytes adhesion at such places, erythrocyte aggregation, plasma separation, erythrocyte and fibrinous thrombi formation. Ultrastructural investigation revealed dystrophic changes in the capillary endothelium of the nasal mucosa combined with rheological disorders expressed as erythrocytes sludge. Thus, the cause of epistaxis is not high arterial pressure, but those changes in the nasal mucosa vessels promoted by long arterial hypertension.
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Affiliation(s)
- N V Boiko
- Rostov State Medical University, Rostov-on-Don, Russia
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12
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Traumastem Powder in Treatment of Non-Traumatic Anterior Epistaxis in Emergency Department; a Randomized Clinical Trial. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2020; 8:e78. [PMID: 33134974 PMCID: PMC7588002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Various studies are being conducted because of the value of finding an appropriate medication to control bleeding in patients with epistaxis faster and more conveniently. This study aimed to compare the effect of Traumastem powder with routine tampons in treatment of non-traumatic epistaxis. METHODS This randomized clinical trial enrolled patients with epistaxis presenting to the emergency departments of two hospitals affiliated to Tabriz University of Medical sciences. Patients were divided into two groups using randomization software (intervention group: 107 patients, control group: 96 patients). Primary outcome variables included bleeding control time and patient satisfaction. Secondary outcome variable was recurrence of bleeding within the first 24 hours after treatment. Visual assessment scoring system was used to assess patient satisfaction. RESULTS Epistaxis was controlled in less than 5 minutes in 85 (79.4%) patients in the intervention group and 85 (88.5%) patients in the control group (P=0.058). Patient satisfaction in the intervention group was higher than that of the control group (P<0.05). In the intervention group, 10 patients experienced recurrence of epistaxis within 24 hours of treatment, while 9 patients in the control group experienced recurrence (P= 0.591). CONCLUSION Based on the findings, bleeding control time was similar in the two groups, but patient satisfaction was higher in Traumastem group. It is concluded that Traumastem can conveniently control anterior epistaxis, but it is not successful in cases with severe bleeding.
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Tunkel DE, Anne S, Payne SC, Ishman SL, Rosenfeld RM, Abramson PJ, Alikhaani JD, Benoit MM, Bercovitz RS, Brown MD, Chernobilsky B, Feldstein DA, Hackell JM, Holbrook EH, Holdsworth SM, Lin KW, Lind MM, Poetker DM, Riley CA, Schneider JS, Seidman MD, Vadlamudi V, Valdez TA, Nnacheta LC, Monjur TM. Clinical Practice Guideline: Nosebleed (Epistaxis). Otolaryngol Head Neck Surg 2020; 162:S1-S38. [PMID: 31910111 DOI: 10.1177/0194599819890327] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Nosebleed, also known as epistaxis, is a common problem that occurs at some point in at least 60% of people in the United States. While the majority of nosebleeds are limited in severity and duration, about 6% of people who experience nosebleeds will seek medical attention. For the purposes of this guideline, we define the target patient with a nosebleed as a patient with bleeding from the nostril, nasal cavity, or nasopharynx that is sufficient to warrant medical advice or care. This includes bleeding that is severe, persistent, and/or recurrent, as well as bleeding that impacts a patient's quality of life. Interventions for nosebleeds range from self-treatment and home remedies to more intensive procedural interventions in medical offices, emergency departments, hospitals, and operating rooms. Epistaxis has been estimated to account for 0.5% of all emergency department visits and up to one-third of all otolaryngology-related emergency department encounters. Inpatient hospitalization for aggressive treatment of severe nosebleeds has been reported in 0.2% of patients with nosebleeds. PURPOSE The primary purpose of this multidisciplinary guideline is to identify quality improvement opportunities in the management of nosebleeds and to create clear and actionable recommendations to implement these opportunities in clinical practice. Specific goals of this guideline are to promote best practices, reduce unjustified variations in care of patients with nosebleeds, improve health outcomes, and minimize the potential harms of nosebleeds or interventions to treat nosebleeds. The target patient for the guideline is any individual aged ≥3 years with a nosebleed or history of nosebleed who needs medical treatment or seeks medical advice. The target audience of this guideline is clinicians who evaluate and treat patients with nosebleed. This includes primary care providers such as family medicine physicians, internists, pediatricians, physician assistants, and nurse practitioners. It also includes specialists such as emergency medicine providers, otolaryngologists, interventional radiologists/neuroradiologists and neurointerventionalists, hematologists, and cardiologists. The setting for this guideline includes any site of evaluation and treatment for a patient with nosebleed, including ambulatory medical sites, the emergency department, the inpatient hospital, and even remote outpatient encounters with phone calls and telemedicine. Outcomes to be considered for patients with nosebleed include control of acute bleeding, prevention of recurrent episodes of nasal bleeding, complications of treatment modalities, and accuracy of diagnostic measures. This guideline addresses the diagnosis, treatment, and prevention of nosebleed. It focuses on nosebleeds that commonly present to clinicians via phone calls, office visits, and emergency room encounters. This guideline discusses first-line treatments such as nasal compression, application of vasoconstrictors, nasal packing, and nasal cautery. It also addresses more complex epistaxis management, which includes the use of endoscopic arterial ligation and interventional radiology procedures. Management options for 2 special groups of patients-patients with hereditary hemorrhagic telangiectasia syndrome and patients taking medications that inhibit coagulation and/or platelet function-are included in this guideline. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group. It is not intended to be a comprehensive, general guide for managing patients with nosebleed. In this context, the purpose is to define useful actions for clinicians, generalists, and specialists from a variety of disciplines to improve quality of care. Conversely, the statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. ACTION STATEMENTS The guideline development group made recommendations for the following key action statements: (1) At the time of initial contact, the clinician should distinguish the nosebleed patient who requires prompt management from the patient who does not. (2) The clinician should treat active bleeding for patients in need of prompt management with firm sustained compression to the lower third of the nose, with or without the assistance of the patient or caregiver, for 5 minutes or longer. (3a) For patients in whom bleeding precludes identification of a bleeding site despite nasal compression, the clinician should treat ongoing active bleeding with nasal packing. (3b) The clinician should use resorbable packing for patients with a suspected bleeding disorder or for patients who are using anticoagulation or antiplatelet medications. (4) The clinician should educate the patient who undergoes nasal packing about the type of packing placed, timing of and plan for removal of packing (if not resorbable), postprocedure care, and any signs or symptoms that would warrant prompt reassessment. (5) The clinician should document factors that increase the frequency or severity of bleeding for any patient with a nosebleed, including personal or family history of bleeding disorders, use of anticoagulant or antiplatelet medications, or intranasal drug use. (6) The clinician should perform anterior rhinoscopy to identify a source of bleeding after removal of any blood clot (if present) for patients with nosebleeds. (7a) The clinician should perform, or should refer to a clinician who can perform, nasal endoscopy to identify the site of bleeding and guide further management in patients with recurrent nasal bleeding, despite prior treatment with packing or cautery, or with recurrent unilateral nasal bleeding. (8) The clinician should treat patients with an identified site of bleeding with an appropriate intervention, which may include one or more of the following: topical vasoconstrictors, nasal cautery, and moisturizing or lubricating agents. (9) When nasal cautery is chosen for treatment, the clinician should anesthetize the bleeding site and restrict application of cautery only to the active or suspected site(s) of bleeding. (10) The clinician should evaluate, or refer to a clinician who can evaluate, candidacy for surgical arterial ligation or endovascular embolization for patients with persistent or recurrent bleeding not controlled by packing or nasal cauterization. (11) In the absence of life-threatening bleeding, the clinician should initiate first-line treatments prior to transfusion, reversal of anticoagulation, or withdrawal of anticoagulation/antiplatelet medications for patients using these medications. (12) The clinician should assess, or refer to a specialist who can assess, the presence of nasal telangiectasias and/or oral mucosal telangiectasias in patients who have a history of recurrent bilateral nosebleeds or a family history of recurrent nosebleeds to diagnose hereditary hemorrhagic telangiectasia syndrome. (13) The clinician should educate patients with nosebleeds and their caregivers about preventive measures for nosebleeds, home treatment for nosebleeds, and indications to seek additional medical care. (14) The clinician or designee should document the outcome of intervention within 30 days or document transition of care in patients who had a nosebleed treated with nonresorbable packing, surgery, or arterial ligation/embolization. The policy level for the following recommendation, about examination of the nasal cavity and nasopharynx using nasal endoscopy, was an option: (7b) The clinician may perform, or may refer to a clinician who can perform, nasal endoscopy to examine the nasal cavity and nasopharynx in patients with epistaxis that is difficult to control or when there is concern for unrecognized pathology contributing to epistaxis.
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Affiliation(s)
- David E Tunkel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Spencer C Payne
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Stacey L Ishman
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | | | | | | | - Rachel S Bercovitz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | | | | | | | - Jesse M Hackell
- Pomona Pediatrics, Boston Children's Health Physicians, Pomona, New York, USA
| | | | | | | | - Meredith Merz Lind
- Nationwide Children's Hospital/The Ohio State University, Columbus, Ohio, USA
| | | | | | - John S Schneider
- Washington University School of Medicine, St Louis, Missouri, USA
| | - Michael D Seidman
- AdventHealth Medical Group, Celebration, Florida, USA.,University of Central Florida, Orlando, Florida, USA.,University of South Florida, Tampa, Florida, USA
| | | | | | - Lorraine C Nnacheta
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Taskin M Monjur
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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14
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Lee CJ, Seak CJ, Liao PC, Chang CH, Tzen IS, Hou PJ, Lin CC. Evaluation of the Relationship Between Blood Pressure Control and Epistaxis Recurrence After Achieving Effective Hemostasis in the Emergency Department. J Acute Med 2020; 10:27-39. [PMID: 32995152 PMCID: PMC7517968 DOI: 10.6705/j.jacme.202003_10(1).0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 08/22/2019] [Accepted: 10/19/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Epistaxis is the most common cause of otorhinolaryngologic emergencies. There is a longstanding controversy regarding the relationship between epistaxis and hypertension (HTN), in terms of blood pressure (BP) control in the emergency department (ED) setting. The objective of this study is to evaluate the association between HTN, BP control, and recurrent epistaxis among patients initially admitted to the ED for epistaxis. METHODS This retrospective cohort study was conducted in the EDs of three different hospitals in Taiwan and included a total of 739 patients admitted for epistaxis. RESULTS Among ED patients with epistaxis, older age was significantly associated with a history of HTN, and a statistically significant difference in age was noted between groups classified according to the systolic BP/diastolic BP (SBP/DBP) at triage. Patients with a history of HTN had higher BP values at triage than did patients without a history of HTN (SBP: 175.68 ± 32.30 mmHg vs. 148.00 ± 26.26 mmHg, DBP: 95.04 ± 20.98 mmHg vs. 83.30 ± 16.65 mmHg; p < 0.0001). Antihypertensive medications were more commonly administered to patients with a history of HTN (p < 0.0001) and in those patients with SBP/DBP: ≥ 140/≥ 90 mmHg at triage (p < 0.0001). Among patients receiving antihypertensive medications, reductions in SBP by the time of discharge were significantly greater in patients with a history of HTN and in patients with SBP/DBP: ≥ 160/≥ 100 mmHg at triage. ED revisits due to recurrent epistaxis within 72 hours were significantly associated with male sex, a positive history of HTN, level of GOT, observation for recurrent epistaxis at ED, and duration of recurrent bleeding. CONCLUSIONS A positive history of HTN is related to recurrent epistaxis among ED patients. The effectiveness of administering antihypertensive agents before achieving hemostasis in patients admitted to the ED for epistaxis warrants further study.
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Affiliation(s)
- Cheng-Jung Lee
- Linkou Medical Center, Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan
| | - Chen-June Seak
- Linkou Medical Center, Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan
- Chang Gung University College of Medicine Taoyuan Taiwan
| | - Pin-Chieh Liao
- Linkou Medical Center, Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan
| | - Chia-Hsun Chang
- Linkou Medical Center, Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan
| | - I-Shiang Tzen
- Linkou Medical Center, Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan
| | - Po-Jen Hou
- Linkou Medical Center, Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan
| | - Chih-Chuan Lin
- Linkou Medical Center, Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan
- Chang Gung University College of Medicine Taoyuan Taiwan
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15
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Payne SC, Feldstein D, Anne S, Tunkel DE. Hypertension and Epistaxis: Why Is There Limited Guidance in the Nosebleed Clinical Practice Guidelines? Otolaryngol Head Neck Surg 2020; 162:33-34. [DOI: 10.1177/0194599819889972] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hypertension has long been thought to influence the risk and severity of epistaxis. However, evaluation of the relevant literature reveals articles with methodologic concerns or limited quality. In many instances, these studies are not adequately controlled, and lack of multivariate analyses calls into question any noted association between epistaxis and hypertension. The goal of this commentary is to explain why there is limited guidance about the management of hypertension and the possible association with nosebleed in the 2020 American Academy of Otolaryngology–Head and Neck Surgery Foundation clinical practice guideline for nosebleeds. Background on the literature that describes the association between hypertension and nosebleeds is provided.
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Affiliation(s)
- Spencer C. Payne
- Department of Otolaryngology–Head & Neck Surgery, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - David Feldstein
- Department of Internal Medicine, School of Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Samantha Anne
- Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio, USA
| | - David E. Tunkel
- Department of Otolaryngology–Head & Neck Surgery, School of Medicine, Johns Hopkins, Baltimore, Maryland, USA
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16
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Ko Y, Chee W, Im EO. Evaluation of the cardiovascular symptom index for midlife women in multiethnic/racial midlife women. Health Care Women Int 2019; 41:489-506. [PMID: 31809655 DOI: 10.1080/07399332.2019.1694521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The authors' purpose of this study was to evaluate the validity and reliability of the Cardiovascular Symptom Index for Midlife Women in four ethnic/racial groups of midlife women in the U.S. Data from two internet surveys were used for this secondary analysis. In the construct validity test, five factors were extracted among White and Hispanic women, while more than five factors were extracted among Asian and African American women. In the convergent validity test, all ethnic/racial groups showed similar patterns. Adequate internal consistency among was shown. The Cardiovascular Symptom Index for Midlife Women is useful for assessing cardiovascular symptoms in multiethnic/racial women.
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Affiliation(s)
- Young Ko
- College of Nursing, Gachon University, Incheon, South of Korea
| | - Wonshik Chee
- College of Nursing, Duke University, Durham, North Carolina, USA
| | - Eun-Ok Im
- School of Nursing, Duke University, Durham, North Carolina, USA
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Is epistaxis associated with high blood pressure and hypertension? Propensity score matching study. Am J Emerg Med 2019; 38:1319-1321. [PMID: 31831350 DOI: 10.1016/j.ajem.2019.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/17/2019] [Accepted: 10/20/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE We aimed to investigate whether high blood pressure and hypertension are associated with epistaxis. METHODS A retrospective study with a propensity score matching analysis was performed at the emergency departments (EDs) of a tertiary university hospital. The mean blood pressure (BP, systolic and diastolic) and proportion of subjects with elevated BP (systolic >120 and/or diastolic >80 mmHg) at presentation were compared between the epistaxis group and matched control group. The proportion of patients with newly diagnosed hypertension within six months between the two groups was also compared. RESULTS A total of 1353 patients with epistaxis and the same number of those with simple lacerations were matched. The mean systolic and diastolic BPs of the epistaxis group were significantly higher than those of the matched control group (157.1 ± 26.4 and 91.4 ± 17.0 mmHg versus 144.9 ± 32.4 and 84.2 ± 13.5 mmHg) (P < 0.001). The proportion of patients with elevated BP at presentation was also significantly higher in the epistaxis group (91.4%) than in the matched control group (86.2%) (P < 0.001). Of the 724 (53.5%) patients without pre-existing hypertension in the epistaxis group, 660 patients were followed, of whom 107 (16.2%) were newly diagnosed with hypertension within 6 months, which was a significantly higher percentage than among the matched controls (4.9%, P < 0.001) CONCLUSION: The patients with epistaxis had elevated BP at presentation and a higher proportion of newly diagnosed hypertension within six months compared to the matched controls.
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Bui R, Doan N, Chaaban MR. Epidemiologic and Outcome Analysis of Epistaxis in a Tertiary Care Center Emergency Department. Am J Rhinol Allergy 2019; 34:100-107. [DOI: 10.1177/1945892419876740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The association between hypertension and recurrent epistaxis is controversial. The objective of this study is to examine the factors associated with recurrent epistaxis visits to the emergency department (ED) and establish an otolaryngology (ENT [ear, nose, and throat]) consult algorithm to optimize treatment and minimize unnecessary consultation. Methods A retrospective review of 100 patients presenting to the ED for epistaxis requiring ENT consult from 2013 to 2018 was conducted. Patient demographics, comorbidities, epistaxis etiology, blood pressure measurements during admission, and treatment methods were analyzed. Patient charts were reviewed for ED admissions, complications, and procedures. A consult algorithm was subsequently devised and retrospectively applied to our cohort. Results Patients who required more than one ED visit for epistaxis were more often males (77.8% vs 49.3%, P = .01), required posterior packing (51.9% vs 17 .8%, P < .001), and had more comorbid hypertension (66.7% vs 38.4%, P = .01) compared to patients who had 1 visit. Compared to patients presenting during summer and fall (May–October), patients presenting during winter and spring (November–April) were more often treated for anterior epistaxis with Surgicel®/Surgifoam® rather than posterior nasal packing (57.4% vs 37.0%, P = .04). Application of our consult algorithm decreased consultation by 78% and liberated 58.5 hours of ENT resident time. Conclusion Patients with recurrent epistaxis tended to be male and had more comorbid hypertension. Further prospective studies are warranted to ascertain the factors associated with recurrent epistaxis. Our consult algorithm for epistaxis helped reduce unnecessary ENT consultation and facilitated reallocation of valuable resident work hours.
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Affiliation(s)
- Roger Bui
- School of Medicine, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Nicolette Doan
- School of Medicine, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Mohamad R. Chaaban
- Department of Otolaryngology, University of Texas Medical Branch at Galveston, Galveston, Texas
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Richardson C, Abrol A, Hamill CS, Maronian N, Rodriguez K, D'Anza B. Improving efficiency in epistaxis transfers in a large health system: Analyzing emergency department treatment variability as pretext for a clinical care pathway. Am J Otolaryngol 2019; 40:530-535. [PMID: 31036416 DOI: 10.1016/j.amjoto.2019.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/16/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Epistaxis is a common condition with an estimated $100 million in health care costs annually. A significant portion of this stems from Emergency Department (ED) management and hospital transfers. Currently there is no data in the literature clearly depicting the differences in treatment of epistaxis between Emergency Medicine (EM) physicians and Otolaryngologists. Clinical care pathways (CCP) are a way to standardize care and increase efficiency. Our goal was to evaluate the variability in epistaxis management between EM and Otolaryngology physicians in order to determine the potential impact of a system wide clinical care pathway. MATERIALS AND METHODS A retrospective case study was conducted of all patients transferred between emergency departments for epistaxis over an 18-month period. Exclusion criteria comprised patients under 18 years old, recent sinonasal surgery, bleeding disorders, and recent facial trauma. RESULTS 73 patients met inclusion criteria. EM physicians used nasal cautery in 8%, absorbable packing in 1% and non-absorbable packing in 92% (with 33% being bilateral). In comparison, Otolaryngologists used nasal cautery in 37%, absorbable packing in 34%, and non-absorbable packing in 23%. Eighty percent of patients treated by an Otolaryngology physician required less invasive intervention than previously performed by EM physicians prior to transfer. CONCLUSIONS Epistaxis management varied significantly between Emergency Medicine and Otolaryngology physicians. Numerous patients were treated immediately with non-absorbable packing. On post-transfer Otolaryngology evaluation, many of these patients required less invasive interventions. This study highlights the variability of epistaxis treatment within our hospital system and warrants the need for a standardized care pathway.
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Adoga AA, Kokong DD, Mugu JG, Okwori ET, Yaro JP. Epistaxis: The demographics, etiology, management, and predictors of outcome in Jos, North-Central Nigeria. Ann Afr Med 2019; 18:75-79. [PMID: 31070148 PMCID: PMC6521644 DOI: 10.4103/aam.aam_24_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Epistaxis, though a mere nuisance can have life-threatening consequences. This first study from Jos on epistaxis aims to determine its sociodemographic characteristics, causes, the treatment modalities and the predictors of patient outcome. Study Design A retrospective chart review. Methods Health records of patients that met the inclusion criteria for epistaxis at the Jos University Teaching Hospital, Jos, Nigeria, between February 2011 and December 2015 were retrieved manually using standardized codes in the International Classification of Diseases 10th revision and studied for age, gender, associated comorbidities, treatment modalities offered, and outcome of treatment. Results We managed 154 patients. Records of 92 patients were retrievable aged between 1 and 85 years (Mean = 37.7; standard deviation ± 16.2) with male to female ratio of 2.3:1. Patients in the third decade were the largest group. The most common cause was idiopathic. Anterior nasal bleeding occurred in 51.1%, posterior nasal bleeding in 34.8%. Conservative management was effective in 84.8%. Etiological factors other than chronic liver disease and otolaryngological malignancies showed statistically significant association with good patient outcomes (P = 0.013, P = 0.044, and P = 0.026, respectively). A mortality rate of 5.4% was recorded. Conclusion Epistaxis of idiopathic origin occurring mostly in young males is the most common with most resolving on conservative management. Early hospital presentation, normal blood pressure at presentation and all management modalities were positive predictors of outcome in our patients.
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Affiliation(s)
- Adeyi A Adoga
- Department of Otorhinolaryngology, Head and Neck Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Daniel D Kokong
- Department of Otorhinolaryngology, Head and Neck Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Joyce G Mugu
- Department of Otorhinolaryngology, Head and Neck Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Emoche T Okwori
- Department of Otorhinolaryngology, Head and Neck Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - John P Yaro
- Department of Otorhinolaryngology, Head and Neck Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
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Kunz SM, Holzmann D, Soyka MB. Association of epistaxis with atherosclerotic cardiovascular disease. Laryngoscope 2018; 129:783-787. [PMID: 30549051 DOI: 10.1002/lary.27604] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the association between epistaxis and atherosclerotic cardiovascular disease. STUDY DESIGN Case-control cohort study. METHODS This study included patients from the tertiary-care ear, nose, and throat department at the University Hospital of Zurich between December 1, 2016 and June 1, 2017. We assessed the cardiovascular risk profiles in a group of 41 patients presenting with epistaxis, and a group of 41 matched controls, focusing on a surrogate parameter for atherosclerosis: the carotid intima-media thickness (CIMT). RESULTS With a mean of 1.06 mm (standard deviation [SD] = 0.17), CIMT values were on average 26% higher in epistaxis patients than in their controls, with a mean of 0.84 mm (SD = 0.14; P < .001). Occurrence of severe epistaxis was also associated with lower ankle-brachial index values at 0.96 (SD = 0.12) versus 1.05 (SD = 0.17) (P < .001) and significantly higher QRISK2 relative risks (an algorithm for predicting cardiovascular risk) than found in the control group (1.81, SD = 0.97 vs. 1.35, SD = 0.28; P = .028). A binary logistic regression model, adjusted for possible confounders, showed an odds ratio of 2.5 for the occurrence of epistaxis per increase in CIMT of 0.1 mm in the study population (95% confidence interval: 1.56-4.11; P < .001). CONCLUSIONS The occurrence of severe epistaxis was shown to be closely associated with the prevalence of atherosclerotic cardiovascular disease. Accordingly, patients affected by epistaxis should be regarded as at an elevated cardiovascular risk, which indicates the need for appropriate further medical assessment and preventive measures. LEVEL OF EVIDENCE 3b TRIAL REGISTRATION: Clinical trials NCT03092973 Laryngoscope, 129:783-787, 2019.
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Affiliation(s)
- Seraina M Kunz
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - David Holzmann
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Michael B Soyka
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
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Effect of Intranasal Vasoconstrictors on Blood Pressure: A Randomized, Double-Blind, Placebo-Controlled Trial. J Emerg Med 2018; 55:455-464. [PMID: 30195946 DOI: 10.1016/j.jemermed.2018.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/18/2018] [Accepted: 07/02/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Treatment for epistaxis includes application of intranasal vasoconstrictors. These medications have a precaution against use in patients with hypertension. Given that many patients who present with epistaxis are hypertensive, these warnings are commonly overridden by clinical necessity. OBJECTIVE Our aim was to determine the effects of intranasal vasoconstrictors on blood pressure. METHODS We conducted a single-center, randomized, double-blind, placebo-controlled trial from November 2014 through July 2016. Adult patients being discharged from the emergency department (ED) at Mayo Clinic (Rochester, Minnesota) were recruited. Patients were ineligible if they had a contraindication to study medications, had a history of hypertension, were currently taking antihypertensive or antidysrhythmic medications, or had nasal abnormalities, such as epistaxis. Subjects were randomized to one of four study arms (phenylephrine 0.25%; oxymetazoline 0.05%; lidocaine 1% with epinephrine 1:100,000; or bacteriostatic 0.9% sodium chloride [saline]). Blood pressure and heart rate were measured every 5 min for 30 min. RESULTS Sixty-eight patients were enrolled in the study; of these, 63 patients completed the study (oxymetazoline, n = 15; phenylephrine, n = 20; lidocaine with epinephrine, n = 11; saline, n = 17). We did not observe any significant differences in mean arterial pressure over time between phenylephrine and saline, oxymetazoline and saline, or lidocaine with epinephrine and saline. The mean greatest increases from baseline in mean arterial pressure, systolic and diastolic blood pressure, and heart rate for each treatment group were also not significantly different from the saline group. CONCLUSIONS Intranasal vasoconstrictors did not significantly increase blood pressure in patients without a history of hypertension. Our findings reinforce the practice of administering these medications to patients who present to the ED with epistaxis, regardless of high blood pressure.
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Ekber Karabulut A, Çevik Y, Emektar E, Kerem Çorbacioğlu Ş, Dağar S, Yardim O. Analysis of mean platelet volume and red blood cell distribution width in recurrent epistaxis. Turk J Emerg Med 2018; 18:67-70. [PMID: 29922733 PMCID: PMC6005925 DOI: 10.1016/j.tjem.2018.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 12/15/2022] Open
Abstract
Objectives Recurrent epistaxis is one of the most common causes of emergency department visits. Although several localized and systemic conditions has been described, the exact cause is unknown in the majority of cases. In our study, we aimed to determine the effect of mean platelet volume (MPV) and red blood cell distribution width (RDW) levels on recurrent epistaxis. Method One hundred and thirty six patients with recurrent epistaxis and 170 healthy cases as control group were included in the study. Demographic data, vital signs and the results of complete blood counts were recorded. The patients who had clinical conditions that might affect the levels of MPV or RDW, were excluded. MPV and RDW levels were compared between the two groups. Results The median level of MPV was 7.6 fL (IQR25–75%: 7.1–8.4) in the study group and 8.2 fL (IQR25–75%: 7.8–8.9) in the control group (p < 0.001). The median levels of RDW were found in the patient and control groups in order %15.4 (IQR25–75%: 14.5–15.4) and %14.3 (IQR25–75%: 13.4–15.4) (p < 0.001). Systolic blood pressure, leukocyte count, age, sex, RDW and MPV levels that were variables with p levels<0.2, were included in the multivariate analyses. It was determined that high RDW levels increased epistaxis (p < 0.001; OR:1.89 [95% CI:1.53–2.33]) and high MPV levels decreased epistaxis (p < 0.001; OR:0.54 [95% CI:0.39–0.72]). Conclusion Low MPV and high RDW levels caused an increased bleeding tendency in patients with recurrent epistaxis. Although exact mechanism is not known, referring those patients for the assessment of etiologic causes would be proper.
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Affiliation(s)
- Ali Ekber Karabulut
- Department of Emergency Medicine, Van Training and Research Hospital, Van, Turkey
| | - Yunsur Çevik
- Department of Emergency Medicine, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Emine Emektar
- Department of Emergency Medicine, Kecioren Training and Research Hospital, Ankara, Turkey
| | | | - Seda Dağar
- Department of Emergency Medicine, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Oğuz Yardim
- Department of Emergency Medicine, Bayburt State Hospital, Bayburt, Turkey
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Özkan S, Ata N, Yavuz B. Increased masked hypertension prevalence in patients with obesity. Clin Exp Hypertens 2018; 40:780-783. [PMID: 29420079 DOI: 10.1080/10641963.2018.1431262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Masked hypertension is associated with an increased risk for cardiovascular conditions. The aim of the study was to evaluate the relationship obesity parameters, including body weight, waist circumference, and body mass index. METHODS The study group consisted of 251 consecutive outpatient subjects without overt hypertension. Subjects were classified according to BMI. After a complete medical history and laboratory examination, patients' height, weight, waist circumference heart rate, and office blood pressure were recorded. All subjects underwent ambulatory blood pressure monitoring. Masked hypertension is defined as normal office blood pressure measurement and high ambulatory blood pressure level. RESULTS Baseline characteristics in patients and controls were similar. Prevalence of Masked hypertension was significantly higher in patients with obesity than controls (30.9% vs 5.7%, p < 0.001). Body mass index (33.2 ± 4.3 vs 25.1 ± 2.7 p < 0.001), waist circumference (98.5 ± 11.7 vs 86.8 ± 8.8, p < 0.001), and weight (86.5 ± 11.8 vs. 69 ± 9.1, p < 0.001) in patients with obesity were significantly higher than in patients with normal weight. Office Systolic BP (121.8 ± 4.4 vs 120.5 ± 4.78, p = 0.035), ambulatory daytime systolic BP (128.8 ± 8.9 vs 124.5 ± 7.4, p < 0.001), ambulatory daytime diastolic BP (73.9 ± 9.5 vs 71.5 ± 7.0, p = 0.019), ambulatory night-time systolic BP in patients with obesity was significantly higher than in patients with normal weight. CONCLUSION This study demonstrated that masked hypertension prevalence is higher in patients with obesity than control patients. It can be suggested that predefining obesity might be helpful in early detection of masked hypertension.
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Affiliation(s)
- Selçuk Özkan
- a Department of Cardiology , Medical Park Ankara Hospital , Ankara , Turkey
| | - Naim Ata
- b Department of Internal Medicine , 29 Mayis Government Hospital , Ankara , Turkey
| | - Bunyamin Yavuz
- c Medical Park Ankara Hospital, Department of Cardiology , Kemerburgaz University , Ankara , Turkey
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Chaaban MR, Zhang D, Resto V, Goodwin JS. Factors influencing recurrent emergency department visits for epistaxis in the elderly. Auris Nasus Larynx 2017; 45:760-764. [PMID: 29208334 DOI: 10.1016/j.anl.2017.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/26/2017] [Accepted: 11/14/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Our objective is to determine the risk factors associated with recurrent epistaxis requiring emergency department (ED) visits in the elderly. METHODS We used a 5% national sample of Medicare data from January 2012 through December 2013. Our cohort included patients with a new diagnosis of epistaxis in the ED, defined as no epistaxis in the prior 12 months. We assessed the rates of ED visits for recurrent epistaxis in the 12 months following the incident visit. Our variables included demographics, geographic location, procedures performed during the incident visit and comorbidities. RESULTS Out of the 4120 patients with incident epistaxis, 775 were readmitted with recurrent epistaxis within 12 months. 60% presented in the first 30days and 75% within 90 days. There was a significant increase in ED visits for patients over 75 years of age and in men compared to women. Recurrent ED visits for epistaxis was higher in patients with congestive heart failure, diabetes mellitus, and obstructive sleep apnea compared to those without these comorbidities. CONCLUSION Additional ED visits for epistaxis are more common in the elderly and in males. Congestive heart failure, diabetes mellitus and obstructive sleep apnea were found to be independent risk factors.
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Affiliation(s)
- Mohamad R Chaaban
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, United States.
| | - Dong Zhang
- Sealy Center on Aging, Galveston, TX, United States
| | - Vicente Resto
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, United States
| | - James S Goodwin
- Sealy Center on Aging, Galveston, TX, United States; Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
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Côrte FC, Orfao T, Dias CC, Moura CP, Santos M. Risk factors for the occurrence of epistaxis: Prospective study. Auris Nasus Larynx 2017; 45:471-475. [PMID: 28844608 DOI: 10.1016/j.anl.2017.07.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/15/2017] [Accepted: 07/27/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Analyse and compare the characteristics of patients with epistaxis admitted to the otolaryngology emergency department with those provided by a control group. Establish a model to identify epistaxis predictive factors. METHODS Prospective analysis of 283 consecutive adults, admitted to the otolaryngology emergency department of a tertiary referral centre between 25 January and 25 February 2014. Comparison of gender, age, co-morbidities, usual medication, history of epistaxis or nasal trauma, presence of septal deviation and blood pressure value on admission, between the elements that were admitted to the emergency due to epistaxis (group 1) and a group composed of patients with other symptoms (group 2). Intergroup variations were analyzed using t student and chi-square tests. Multivariate logistic regression and a receiver operating characteristic curve were used to establish a predictive model and test its suitability. RESULTS Male gender (OR=2.57, 95% CI 1.1-6.0, p=0.029), older age (OR=1.03, 95% CI 1.0-1.1, p=0.002), existence of peripheral vascular disease (OR=13.47, 95% CI 1.9-95.3, p=0.009), cardiovascular disease (OR=3.91, 95% CI 1.6-9.7, p=0.003) and previous history of epistaxis (OR=5.53, 95% CI 2.5-12.1, p<0.001) were predictors of epistaxis when adjusted for the presence of elevated blood pressure, history of hypertension, cerebrovascular disease and chronic use of anticoagulants or antiplatelet drugs. The model revealed a good applicability (area under the curve of 0.852). CONCLUSIONS The only predictive factors of admission to the emergency department due to epistaxis were male gender, older age, peripheral vascular disease, cardiovascular disease and history of epistaxis.
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Affiliation(s)
- Filipa Camacho Côrte
- Department of Otorhinolaryngology, Hospital de São João EPE, Porto, Portugal; University of Porto Medical School, Porto, Portugal.
| | - Tiago Orfao
- Department of Otorhinolaryngology, Hospital de São João EPE, Porto, Portugal; University of Porto Medical School, Porto, Portugal
| | - Cláudia Camila Dias
- Centre for Research in Health Technologies and Information Systems, Porto, Portugal
| | - Carla Pinto Moura
- Department of Otorhinolaryngology, Hospital de São João EPE, Porto, Portugal; University of Porto Medical School, Porto, Portugal; Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Margarida Santos
- Department of Otorhinolaryngology, Hospital de São João EPE, Porto, Portugal
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Min HJ, Kang H, Choi GJ, Kim KS. Association between Hypertension and Epistaxis: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2017; 157:921-927. [PMID: 28742425 DOI: 10.1177/0194599817721445] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Whether there is an association or a cause-and-effect relationship between epistaxis and hypertension is a subject of longstanding controversy. The objective of this systematic review and meta-analysis was to determine the association between epistaxis and hypertension and to verify whether hypertension is an independent risk factor of epistaxis. Data Sources A comprehensive search was performed using the MEDLINE, EMBASE, and Cochrane Library databases. Review Methods The review was performed according to the Meta-analysis of Observational Studies in Epidemiology guidelines and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Results We screened 2768 unique studies and selected 10 for this meta-analysis. Overall, the risk of epistaxis was significantly increased for patients with hypertension (odds ratio, 1.532 [95% confidence interval (CI), 1.181-1.986]; number needed to treat, 14.9 [95% CI, 12.3-19.0]). Results of the Q test and I2 statistics suggested considerable heterogeneity ([Formula: see text] = 0.038, I2 = 49.3%). The sensitivity analysis was performed by excluding 1 study at a time, and it revealed no change in statistical significance. Conclusion Although this meta-analysis had some limitations, our study demonstrated that hypertension was significantly associated with the risk of epistaxis. However, since this association does not support a causal relationship between hypertension and epistaxis, further clinical trials with large patient populations will be required to determine the impact of hypertension on epistaxis.
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Affiliation(s)
- Hyun Jin Min
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Kang
- 2 Department of Anaesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Geun Joo Choi
- 2 Department of Anaesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung Soo Kim
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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Acar B, Yavuz B, Yıldız E, Ozkan S, Ayturk M, Sen O, Deveci OS. A possible cause of epistaxis: increased masked hypertension prevalence in patients with epistaxis. Braz J Otorhinolaryngol 2017; 83:45-49. [PMID: 27133905 PMCID: PMC9444775 DOI: 10.1016/j.bjorl.2016.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/15/2015] [Accepted: 01/15/2016] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Epistaxis and hypertension are frequent conditions in the adult population. Masked hypertension is defined as a clinical condition in which a patient's office blood pressure level is <140/90mmHg, but the ambulatory or home blood pressure readings are in the hypertensive range. Many studies have proved that hypertension is one of the most important causes of epistaxis. The prevalence of this condition in patients with epistaxis is not well defined. OBJECTIVE This study aimed to evaluate the prevalence of masked hypertension using the results of office blood pressure measurement compared with the results of ambulatory blood pressure monitoring. METHODS Sixty patients with epistaxis and 60 control subjects were enrolled in the study. All patients with epistaxis and controls without history of hypertension underwent physical examination, including office blood pressure measurement, ambulatory or home blood pressure, and measurement of anthropometric parameters. RESULTS Mean age was similar between the epistaxis group and the controls - 21-68 years (mean 42.9) for the epistaxis group and 18-71 years (mean 42.2) for the control group. A total of 20 patients (33.3%) in the epistaxis group and 7 patients (11.7%) in the control group (p=0.004) had masked hypertension. Night-time systolic blood pressure was significantly higher in patients with epistaxis than in the control group (p<0.005). However, no significant difference was found in daytime systolic blood pressure between the control group and the patients with epistaxis (p=0.517). CONCLUSION This study demonstrates increased masked hypertension prevalence in patients with epistaxis. We suggest that all patients with epistaxis should undergo ambulatory or home blood pressure to detect masked hypertension, which could be a possible cause of epistaxis.
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Affiliation(s)
- Baran Acar
- Kecioren Training and Research Hospital, Department of Otorhinolaryngology, Ankara, Turkey.
| | - Bunyamin Yavuz
- Medical Park Ankara Hospital, Department of Cardiology, Yenimahalle, Turkey
| | - Erdem Yıldız
- Kecioren Training and Research Hospital, Department of Otorhinolaryngology, Ankara, Turkey
| | - Selcuk Ozkan
- Kecioren Training and Research Hospital, Department of Otorhinolaryngology, Ankara, Turkey
| | - Mehmet Ayturk
- Kecioren Training and Research Hospital, Department of Otorhinolaryngology, Ankara, Turkey
| | - Omer Sen
- Kecioren Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Onur Sinan Deveci
- Kecioren Training and Research Hospital, Department of Otorhinolaryngology, Ankara, Turkey
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Chaaban MR, Zhang D, Resto V, Goodwin JS. Demographic, Seasonal, and Geographic Differences in Emergency Department Visits for Epistaxis. Otolaryngol Head Neck Surg 2016; 156:81-86. [DOI: 10.1177/0194599816667295] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To determine the demographics and seasonal and geographic variation of epistaxis in the United States. Study Design Retrospective cohort analysis based on data from Medicare claims. Setting Emergency department visits. Subjects and Methods We used a 5% sample of Medicare data from January 2012 to December 2012. Our cohort included patients with an incident diagnosis of epistaxis during a visit to the emergency department, excluding those with a diagnosis in the prior 12 months. Demographics included age, sex, race, and ethnicity. We compared the rate of emergency department visits for epistaxis by geographic division and individual states. Results In the 5% sample of Medicare data, 4120 emergency department visits for incident epistaxis were identified in 2012. Our results showed an increase in the emergency department visits for epistaxis with age. Compared with patients <65 years old, patients who were 66 to 76, 76 to 85, and >85 years old were 1.36 (95% confidence interval [95% CI], 1.23-1.50), 2.37 (95% CI, 2.14-2.62), and 3.24 (95% CI, 2.91-3.62) more likely to present with epistaxis, respectively. Men were 1.24 (95% CI, 1.17-1.32) times more likely to present with epistaxis than women. Blacks were 1.23 (95% CI, 1.10-1.36) times more likely to present with epistaxis when compared with non-Hispanic whites. Epistaxis emergency department visits were 40% lower in the summer months versus winter. The seasonal variation was more pronounced in the northern versus southern United States. Conclusion Emergency department visits for epistaxis increase with age and appear to be seasonal, with a more pronounced variation in the northern versus southern United States.
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Affiliation(s)
- Mohamad R. Chaaban
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Dong Zhang
- Sealy Center on Aging, Galveston, Texas, USA
| | - Vicente Resto
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas, USA
| | - James S. Goodwin
- Sealy Center on Aging, Galveston, Texas, USA
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
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Yukitatsu Y, Tsuzuki K, Takebayashi H, Sakagami M. Clinical Study of 1,515 Patients Presenting with Epistaxis Over the Last 6 Years. ORL J Otorhinolaryngol Relat Spec 2016; 78:232-40. [PMID: 27438263 DOI: 10.1159/000446187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 04/12/2016] [Indexed: 11/19/2022]
Abstract
AIM This study reviews our clinical experience of patients with epistaxis and discusses proper management. PATIENTS AND METHODS We retrospectively investigated 1,515 patients with epistaxis treated in our department between 2005 and 2010. RESULTS Men over 50 years old predominated. More than half of the patients (n = 828) first visited after consultation hours, and 40% (n = 606) were brought by ambulance. The most common underlying diseases were circulatory diseases (69%, n = 1,047). Antithrombotics were being administered to 23% (n = 345). Kiesselbach's plexus was the most commonly observed bleeding site (51%, n = 769). In 20% (n = 297), no bleeding point was confirmed because hemostasis had been achieved on arrival. Anterior packing was the most common primary treatment, followed by electrocauterization. Hospitalization was required in 2% (n = 30). Re-bleeding occurred within 14 days after primary treatment in 14% (n = 206). Surgical treatment was performed for 5% (n = 11). CONCLUSIONS Patients showing repeated pulsatile arterial bleeding require hospitalization for surgical therapy, although outpatient therapy is sufficient in most cases. A risk of re-bleeding should be considered if patients show unclarified bleeding points and circulatory diseases.
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Affiliation(s)
- Yoriko Yukitatsu
- Department of Otolaryngology-Head and Neck Surgery, Hyogo College of Medicine, Nishinomiya, Japan
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