Epistaxis: The demographics, etiology, management, and predictors of outcome in Jos, North-Central Nigeria.

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.

RésuméContexte: Epistaxis, bien qu'une simple nuisance peut avoir des conséquences mortelles. Cette première étude de Jos sur l'épistaxis vise à déterminer ses caractéristiques sociodémographiques, ses causes, les modalités de traitement et les prédicteurs de l'issue du patient. Conception de l'étude: Une revue rétrospective des dossiers. Méthodes: Les dossiers médicaux des patients répondant aux critères d'inclusion de l'épistaxis au Jos University Teaching Hospital, Jos, Nigéria, entre février 2011 et décembre 2015 ont été récupérés manuellement à l'aide de codes normalisés dans la 10e révision de la Classification internationale des maladies. , les comorbidités associées, les modalités de traitement offertes et les résultats du traitement. Résultats: Nous avons géré 154 patients. Les dossiers de 92 patients étaient récupérables entre 1 et 85 ans (moyenne = 37,7; écart-type = +16,2) avec un ratio hommes / femmes de 2,3: 1. Les patients de la troisième décennie étaient le groupe le plus important. La cause la plus fréquente était idiopathique. Saignement nasal antérieur est survenu chez 51,1%, saignement nasal postérieur chez 34,8%. La gestion conservatrice était efficace dans 84,8%. Des facteurs étiologiques autres que la maladie hépatique chronique et les tumeurs malignes otolaryngologiques ont montré une association statistiquement significative avec de bons résultats pour les patients (P = 0,013, P = 0,044 et P = 0,026, respectivement). Un taux de mortalité de 5,4% a été enregistré. Conclusion: L'épistaxis d'origine idiopathique survenant principalement chez les jeunes hommes est le plus commun avec le plus de résolution sur la gestion conservatrice. La présentation hospitalière précoce, la pression artérielle normale à la présentation et toutes les modalités de prise en charge ont été des prédicteurs positifs des résultats chez nos patients.

The predictive factors of primary head and neck cancer stage at presentation and survival in a developing nation's tertiary hospital.

BACKGROUND: Stage of head and neck cancers at presentation is a strong determinant of outcomes. OBJECTIVE: To evaluate predictors of stage of head and neck cancers at presentation and survival in a Nigerian tertiary hospital. PATIENTS AND METHODS: Health records that met the inclusion criteria for head and neck cancers were retrieved using the International Classification of Diseases, 10th revision and analyzed with associations between variables modeled using logistic regression analysis. RESULTS: From a record of 487 head and neck neoplasms, 129 (26.5%) were malignant of which 122 health records met the criteria for analysis consisting of 83 (68.0%) males and 39 (32.0%) females aged 13-85 years (mean = 51 years; standard deviation = ±16 years). Alcohol (odds ratio = 1.99; 95% confidence interval = 1.08-3.69; p = 0.02) and tobacco exposure (odds ratio = 3.07; 95% confidence interval = 1.32-7.16; p = 0.01) were associated with increased odds for advanced tumor stage at presentation. Stage IV cancer (hazard ratio = 1.44; 95% confidence interval = 1.80-2.59), alcohol (hazard ratio = 2.19; 95% confidence interval = 1.18-4.10) and tobacco use (hazard ratio = 3.40; 95% confidence interval = 1.22-8.74) were associated with increased hazards for death. CONCLUSION: Alcohol, tobacco use and smoke from cooking wood are predictive factors for advanced HNC stage at presentation. Stage IV cancer, alcohol and tobacco use were associated with an increased hazard for death.

The epidemiology, treatment, and determinants of outcome of primary head and neck cancers at the Jos University Teaching Hospital.

INTRODUCTION: This study aims to evaluate the epidemiology, treatment, and factors that determine the outcomes of head and neck cancers (HNC). PATIENTS AND METHODS: Retrospective analytical review of HNC managed at the Jos University Teaching Hospital between May 2007 and April 2017 using the International Classification of Diseases version 10. RESULTS: Of 487 head and neck neoplasms, 129 (26.5%) were malignant and 122 health records met the criteria for analysis consisting of 83 (68.0%) males and 39 (32.0%) females aged 13 years to 85 years (mean = 51 years; standard deviation = ±16.0 years). The most common presenting feature was nasal obstruction (n = 47; 38.5%). The most common tumor site was the nasopharynx (n = 34; 27.9%). Mean duration of symptoms was 13.3 months. Alcohol (P = 0.02), cigarette smoking (P = 0.01), and cooking wood smoke (P = 0.01) were associated with advanced tumor stage. Squamous cell carcinoma was the most common histological type. Posttreatment complication rate was 47.5%. Lost to follow-up rate was 55.7%. The lungs were the most common distant metastatic site. The case fatality rate was 18.0%. CONCLUSION: HNC constitutes almost a quarter of head and neck tumors affecting twice the number of males in their sixth decade with nasopharyngeal cancers being the most common in both genders. Several modifiable variables are noted to target appropriate future cancer education for lifestyle modification, screening for early detection and treatment.

Identifying Risk Factors for Morbidity and Mortality in Patients with Primary Head and Neck Cancers in a Nigerian Population.

BACKGROUND: The risk factors for head and neck cancers (HNC) vary in different parts of the world. OBJECTIVES: To identify the risk factors for HNC and the correlation between these factors and the involved anatomical sites. METHODS: We retrieved and analyzed health records of patients that met the inclusion criteria for HNC managed at our facility in a 10-year period using the International Classification of Diseases (ICD) version 10. RESULTS: We studied 122 patients with a male to female ratio of 2.1:1 aged 13 years to 85 years (mean = 51 years). Alcohol (P = .02), cigarette smoking (P = .01), and cooking wood smoke (P = .01) were associated with advanced tumor stage. CONCLUSIONS: The strongest risk factors for HNC are alcohol, tobacco, HIV, agricultural chemicals, and cooking wood fumes in both sexes in their sixth and seventh decades.

Otorhinolaryngological manifestations in head trauma: A prospective study of the epidemiology, clinical presentations, management, and outcomes.

BACKGROUND: Otorhinolaryngological injuries following head trauma may be missed, overlooked, or forgotten in the acute phase resulting in worsened management outcomes. This study aims to report the epidemiology, clinical presentations, management, and outcomes of otorhinolaryngological injuries in head trauma with a view to creating awareness for early recognition and prompt treatment. PATIENTS AND METHODS: Head injured patients consecutively presenting over a 5-year period were prospectively studied for age, gender, otorhinolaryngological presentations, interventions, and outcome of interventions. Data obtained were statistically analyzed. RESULTS: There were 91 (1.3%) otorhinolaryngological presentations among 7109 head injured patients. Mean age of 34 years, standard deviation = ±15.6 with a male:female ratio of 2.4:1. Severe head injury (Glasgow coma scale <9) occurred in 46 (50.5%) patients. Patients aged 30-39 years were mostly affected (n = 30; 32.9%). Most injuries were from motor vehicular accidents (n = 61; 67%) and assaults (n = 23; 25.3%). The most common otorhinolaryngological presentations were cerebrospinal fluid (CSF) rhinorrhea (n = 26; 28.6%) and CSF otorrhea (n = 25; 27.5%). Conservative management was achieved in 59.3% of patients. Mean time of hospital presentation was 13.8 h. There was no statistical correlation between outcomes and each of etiology and time of presentation (P values 0.18 and 0.9, respectively). Seventy-five (82.4%) were discharged without neurological deficits. A case fatality rate of 6.6% was recorded. CONCLUSION: Frontal skull base and temporal bone fractures with CSF rhinorrhea and otorrhea are the most common injuries occurring mostly in young active males with favorable outcomes following conservative management.