Prevalence and characteristics of S-point bleeding compared to non S-point bleeding in severe epistaxis / Prevalência e características do sangramento no S-point em comparação com outros pontos sangramento na epistaxe grave

Abstract Introduction Stamm's S-point is gaining importance as a bleeding focus in severe epistaxis. However, prevalence and features of S-point bleeding compared to non S-point bleeding have not been studied. Objective To investigate the characteristics of patients with S-point bleeding among those with severe epistaxis and to compare the factors involved in the treatment of epistaxis. Methods We retrospectively analyzed medical records of 268 patients admitted to the otorhinolaryngology department of Konkuk University Hospital and Chung-Ang University Hospital with epistaxis of which the bleeding focus clarified. Patients with anterior nasal bleeding (n = 129) were excluded. The study was conducted at the department of otorhinolaryngology from January 2008 to August 2019. Collected data included patients' demographic information, bleeding focus, body mass index underlying medical and sinonasal diseases, laboratory test results (initial hemoglobin, platelet count, and triglyceride level), use of anticoagulants, direction of epistaxis, initial and final treatments, and need for blood transfusion. Results The prevalence of S-point bleeding was 28.8% of non-anterior bleeding cases. Mean body mass index score was lower in the S-point group (23.41 ± 3.71) compared to the non S-point group (24.93 ± 3.97) (p = 0.039). Underweight patients tended to show a greater incidence of S-point bleeding (15.0%) than non S-point bleeding (2.0%) (p = 0.010). Incidence of anemia was higher in the S-point group (67.5%) than in the non S-point group (36.4%). Anemia (Odds ratio [OR]: 3.635; 95% confidence interval [CI]: 1.669-7.914, p = 0.001) and underweight (body mass index < 18.5, OR: 8.559, CI: 1.648-44.445, p = 0.011) were significantly associated with S-point bleeding. Conclusion Prevalence of S-point bleeding was significant, underlining the importance of examining the S-point in patients with severe epistaxis. Patients with S-point bleeding had lower body mass index scores and a higher incidence of anemia than those with non S-point bleeding.

Resumo Introdução O S-point de Stamm tem ganhado importância como foco de sangramento na epistaxe grave. Entretanto, a prevalência e as características do sangramento no S-point em comparação com o sangramento em outros locais ainda não foram estudadas. Objetivo Investigar as características dos pacientes com epistaxe grave com sangramento no S-point e comparar os fatores envolvidos no tratamento da epistaxe. Método Analisamos retrospectivamente os prontuários médicos de 268 pacientes internados no Departamento de Otorrinolaringologia do Konkuk University Hospital e do Chung-Ang University Hospital com epistaxe cujo foco hemorrágico foi esclarecido. Pacientes com sangramento anterior (n = 129) foram excluídos. O estudo foi feito no Departamento de Otorrinolaringologia de janeiro de 2008 a agosto de 2019. Os dados coletados incluíram informações demográficas dos pacientes, foco hemorrágico, índice de massa corporal doenças médicas e nasosinusais subjacentes, resultados de exames laboratoriais (hemoglobina, contagem de plaquetas e nível de triglicerídeos iniciais), uso de anticoagulantes, direção da epistaxe, tratamentos iniciais e finais e necessidade de transfusão de sangue. Resultados A prevalência de sangramento no S-point foi de 28,8% dos casos de sangramento não anterior. O índice de massa corpórea médio foi menor no grupo com sangramento no S-point (23,41 ± 3,71) em comparação com o grupo não S-point (24,93 ± 3,97) (p = 0,039). Pacientes com baixo peso tenderam a apresentar maior incidência de sangramento no S-point (15,0%) do que sangramento em ponto não S (2,0%) (p = 0,010). A incidência de anemia foi maior no grupo com sangramento no S-point (67,5%) do que no grupo não S-point (36,4%). A anemia (odds ratio [OR]: 3,635; intervalo de confiança de 95% [IC95%]: 1,669-7,914, p = 0,001) e o baixo peso (IMC < 18,5, OR: 8,559, IC95%: 1,648-44,445, p = 0,011) foram significantemente associados com sangramento no S-point. Conclusão A prevalência de sangramento no S-point foi significativa, enfatizou a importância de examinar o S-point em pacientes com epistaxe grave. Pacientes com sangramento no S-point apresentaram escores mais baixos no índice de massa corpórea e maior incidência de anemia do que aqueles com sangramento em locais que não o S-point.

Manejo de epistaxis posterior en el Hospital Clínico de la Universidad de Chile entre los años 2013 y 2016 / Treatment of posterior epistaxis in the Clinical Hospital of the University of Chile between the years 2013 and 2016

Introducción: La epistaxis corresponde a una de las causas más frecuentes de consulta otorrinolaringológica en los servicios de urgencia. La epistaxis posterior es menos frecuente pero su presentación más severa. Existen varias alternativas terapéuticas, en las últimas décadas el manejo quirúrgico endoscópico de la arteria esfenopalatina (AEP) ha ido en aumento dado las ventajas en comodidad para el paciente y reducción de costos asociados. Objetivo: Revisar el manejo realizado en los cuadros de epistaxis posterior en el Hospital Clínico de la Universidad de Chile (HCUCh). Material y método: Estudio descriptivo en el Servicio de Otorrinolaringología del HCUCh de pacientes que presentaron epistaxis posterior entre el año 2013 y 2016. Resultados: Se revisó un total de 33 casos. La edad promedio de los pacientes fue 61,6 años siendo las comorbilidades más frecuentes la hipertensión arterial (36,3%) y fibrilación auricular (18,1%). Se realizó tratamiento quirúrgico en 57,6% de los pacientes siendo el clipaje de AEP la intervención quirúrgica más frecuente. Discusión y conclusiones: Tanto el manejo tradicional como las técnicas quirúrgicas presentaron eficacia similar en la serie revisada.

Introduction: Epistaxis corresponds to one of the most frequent causes of otorhinolaryngological consultation in the emergency services. Posterior epistaxis is less frequent but more severe. There are several therapeutic alternatives, in recent decades the surgical endoscopic management of the sphenopalatine artery (AEP) has been increasing given the advantages in comfort for the patient and reduction of associated costs. Aim: To review the management of posterior epistaxis in the Clinical Hospital of the University of Chile (HCUCh). Material and method: Descriptive study in the Otorhinolaryngology Service of the HCUCh of patients who presented posterior epistaxis between the years 2013 and 2016. Results: A total of 33 cases were reviewed. The mean age of the patients was 61.6 years, with the most frequent comorbidities being hypertension (36.3%) and atrial fibrillation (18.1%). Surgical treatment was performed in 57.6% of the patients, with AEP clipping being the most frequent surgical intervention. Conclusion: Both traditional management and surgical techniques presented similar efficacy in the revised series.

A Leech in the Nasopharynx of a Child: A Case Report.

Infestation with leeches can happen due to drinking from spring water or other unhealthy water from non-hygienic sources or swimming in infested water like Wells and swamps, and can lead to several complications in the aerodigestive tract. Epistaxis, melena, and foreign body sensation had been reported in the literature as manifestations of this condition. We described a 12-year-old child presented to our department with dry cough and spitting of blood after swimming in the water pond of a Well that led to leech entry into the nasopharynx. Removal was done, and the patient became symptom free. Infestation with a leech can lead to variable symptoms in the aerodigestive tract like spitting of blood and irritation at the site of its attachment. Hence, leech should be put in mind in dealing with patients visiting physicians with the above symptoms, especially, if they come from rural areas that drink spring or Well water.

Sangramiento nasal por crisis hipertensiva / Nasal hemorrhage caused by hypertensive crisis

La epistaxis constituye un frecuente motivo de consulta en los servicios de urgencias de otorrinolaringología, asociada generalmente a elevación de la presión arterial. Objetivo: caracterizar el comportamiento de la epistaxis por hipertensión arterial como urgencia en el servicio de otorrinolaringología del Hospital Universitario Martín Chang Puga, Nuevitas, Camagüey. Método: se realizó un estudio descriptivo retrospectivo, en pacientes con sangramiento nasal tratados en el Hospital Universitario Martín Chang Puga, Nuevitas, Camagüey desde el 2006 hasta el año 2007. El universo de estudio se conformó por 12 pacientes; la muestra la constituyeron nueve pacientes que presentaron crisis hipertensiva. Se estudiaron variables como: edad, sexo, antecedentes patológicos personales de hipertensión arterial, presencia de crisis hipertensiva en el momento del sangramiento, clasificación del sangramiento, tratamiento aplicado y complicaciones presentadas. Los datos se procesaron en Excel y sus resultados se expresaron en tablas, gráficos y textos. Resultados: La epistaxis fue más frecuente en edades entre 60-69 años; el 88,89 % fueron masculinos, el 100 % presentaron crisis hipertensiva en el momento del sangrado, el 66,67 % presentó epistaxis moderada tratándose con taponamiento anterior. Conclusiones: la epistaxis fue más frecuente en adulto mayor, donde prevaleció el sexo masculino.

The epistaxis constitutes a frequent reason of consultation in the otorhinolaryngology emergency services, generally associate to the arterial pressure increasing. Objective: to characterize the behavior of epistaxis for arterial hypertension as urgency in the otorhinolaryngology service at the University Hospital Martin Chang Puga, Nuevitas, Camagüey. Method: a retrospective descriptive study was performed, in patients with nasal bleeding treated in the hospital from 2006 to 2007. The study universe was constituted by 12 patients; the sample was formed of nine patients that presented hypertensive crisis. Variables as: age, sex, personal pathological antecedents of arterial hypertension, presence of hypertensive crisis when bleeding, bleeding classification, applied treatment and presented complications. Data were processed in Excel and results were expressed in tables, graphics and texts. Results: epistaxis was more frequent in ages among 60-69 years; 88,89% was masculine, 100% presented hypertensive crisis when bleeding, 66,67% presented moderate epistaxis treated with previous tamponing. Conclusions: epistaxis was more frequent in the aged, where the male sex prevailed.

An epidemic of dengue hemorrhagic fever and dengue shock syndrome in children in Delhi.

OBJECTIVE: To study clinical profiles and outcome of children of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) during 1996 Delhi epidemic. DESIGN: Retrospective study. SETTING: Hospital based study. METHODS: Children hospitalized from September to November 1996 were studied. All patients were diagnosed, managed and monitored according to a standard protocol. RESULTS: One hundred and thirty four children (80 (60%) males and 54 (40%) females) were studied. Sixty (45%) children were less than 6 years of age of which 12 presented during infancy. There were 92 (67%) cases of DHF and 42 (33%) cases of DSS. Common symptoms were fever (93%), abdominal pain (49%) and vomiting (68%). The commonest hemorrhagic manifestation was hematemesis (39%) followed by epistaxis (36%) and skin bleeds (33%). Hepatomegaly was observed in 97 (72%) cases and splenomegaly in 25 (19%). Serology was positive (IgM hemaglutination antibody titres > 1: 160) for dengue type 2 in 31 (80%) of 39 patients in whom sera was tested during the acute phase of illness. Mortality was 6%. Hematocrit > 40% was observed in only 25 (18%) patients and hence the management protocol was based on clinical signs and symptoms and not on hematocrit. CONCLUSIONS: A management protocol of DHF/DSS in which fluid therapy is not based on haematocrit values needs to be formulated.

Estudo epidemiológico de 80 pacientes com epistaxe atendidos no Hospital Joäo XXIII / Epidemiologic study of 80 patients with epistaxis attended in Hospital Joäo XXIII

Foram estudados prospectivamente 80 pacientes com epistase atendidos no serviço de ORL do Hospital Joäo XXIII no período de abril a setembro de 1993. Foram usados como parâmetros de avaliaçäo: anammese, exame físico e um protocolo específico; os exames laboratoriais foram realizados quando necessários. O objetivo dos autores foi correlacionar: idade e sexo com número de recidivas e localizaçäo do sangramento; tratamento e intensidade de epistaxe; etiologia com intensidade e idade dos pacientes. 55 porcento dos pacientes eram do sexo masculino; a história de recidivas foi positivas em 57,5 porcento dos casos; a epistaxe anterior foi verificada em 83,8 porcento. O tratamento mais utilizado foi a cauterizaçäo química (51,3 porcento); o sangramento de pequena intensidade foi encontrado em 47,5 porcento. As etiologias mais frequentes foram as causas sistêmicas (52,5 pocento) observou-se diferenças em relaçäo aos grupos etários e intensidade do sangramento. Os autores concluiram que näo houve diferença significativa entre recidivas e localizaçäo da epistaxe em relaçäo à idade dos pacientes estudados. Observou-se relaçäo importante entre a intensidade do sangramento e o tratamento realizado. Do mesmo modo, as etiologias diferem conforme o grupo etário e se apresentam com sangramento de diferentes intensidades

Manifestaçöes otorrinolaringológicas em pacientes infectados com o vírus da AIDS / Otolaryngologic manifestations in patients infected by the acquired immunodeficiency virus

A AIDS é uma epidemia mundial em expansäo provocada pelo retrovírus HIV (vírus da imunodeficiência humana), caracterizada por uma progressiva depressäo do sistema imune, que predispöe a ocorrência de infecçöes oportunistas e cânceres incomuns. Manifestaçöes otorrinolarigológicas e da regiäo anatômica da cabeça-e-pescoço säo encontradas com muita frequência em doentes infectados com o HIV, algumas vezes como sintoma inicial da doença. Neste trabalho é apresentada revisäo bibliográfica pormenorizada das manifestaçöes otorrinolarigológicas na AIDS