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.

Minimal temperature, mean wind speed, and mean relative humidity are associated with spontaneous epistaxis in Seoul, Korea.

OBJECTIVE: Epistaxis is a commonly encountered condition; however, factors that have been associated with epistaxis are controversial. Although several previous studies have evaluated the relationship between meteorological factors and epistaxis, studies conducted in Korea has been nearly reported. We attempted to evaluate the meteorological factors associated with the frequency of patients presenting with epistaxis in a tertiary hospital. METHODS: We retrospectively reviewed the medical records of patients presenting with spontaneous epistaxis in an urban tertiary medical center, during one year. Patients with a clear etiology for epistaxis (such as trauma, previous surgery) were regarded as cases of secondary epistaxis and were excluded from this study. Daily climatic data were collected from the website of Korea Meteorological Administration. Meteorological factors affecting the frequency of patients presenting with epistaxis were statistically analyzed. RESULTS: Among 350 enrolled subjects, 219 were males and 131 were females, and the mean age was 44.94 ± 26.02 years. Univariate and multivariate regression analyses revealed that minimal temperature and mean wind speed were significant factors that affected the presence of patients presenting with epistaxis to the hospital. Furthermore, ordinal logistic regression analysis showed that decreases in minimal temperature and mean relative humidity were associated with a increase in the number of patients presenting with epistaxis. CONCLUSION: Minimal temperature and mean wind speed were significantly different between days with epistaxis and days without epistaxis patients presenting with epistaxis, and minimal temperature and mean relative humidity were associated with number of patients presenting with epistaxis. Our findings suggested that these meteorological factors might affect the spontaneous epistaxis in Seoul, Korea.

Prevalence and characteristics of S-point bleeding compared to non S-point bleeding in severe epistaxis.

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.

The effects of climate on the incidence of benign paroxysmal positional vertigo.

Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders. An investigation into the factors related to BPPV could contribute to its prevention and appropriate management. We investigated the association between climatic factors and incidence of BPPV in this study. A total of 365 patients who were diagnosed with idiopathic BPPV in the emergency room of our hospital in 2015 were included. The number of patients diagnosed with BPPV per week was calculated (every week). Climatic factors, including daily average humidity, temperature, atmospheric pressure, cloud amount, sunshine amount, and daylight time, were documented daily. The weekly mean climatic value in each week was calculated. Simple correlation analysis and multivariate regression analyses were performed to identify climatic factors associated with the number of patients diagnosed with BPPV. Simple correlation analysis revealed a significant association between the humidity (r = 0.276, p = 0.048), temperature (r = 0.275, p = 0.049), and cloud amount (r = 0.293, p = 0.035) and the number of BPPV patients diagnosed per week. Multivariate regression analysis revealed that only the cloud amount was a statistically significant factor associated with the number of BPPV patients diagnosed every week. A significant positive association was discovered between the cloud amount and BPPV incidence. Cloud amount can therefore have an association with the incidence of BPPV.

Differential Nasal Expression of Heat Shock Proteins 27 and 70 by Aerobic Exercise: A Preliminary Study.

Purpose: Exercise modifies airway immune responses and susceptibility to infection. We investigated the effects of exercise on two HSPs (heat shock proteins), quantifying expression levels in nasal mucosa of both professional competitive athletes and non-athletes for comparison. Method: We used western blot technique to determine expression levels of HSPs in primary human nasal epithelial cells (HNECs). Nasal lavage (NAL) fluids were collected from 12 male professional volley ball players and 6 healthy males pre-submaximal exercise (running for 30 min at 70-80% of maximal heart rate) and post-submaximal exercise. Expression levels of HSP27, HSP70, Interleukin (IL)-8, and Tumor necrosis factor (TNF)-α in NAL fluids were quantified by enzyme-linked immunosorbent assay (ELISA), and difference of the level between pre-submaximal exercise and post-submaximal exercise was statistically analyzed. Antibacterial assay using Staphylococcus aureus was performed to assess the immunological role of HSPs in NAL fluids. Results:. In non-athlete controls, HSP27, HSP70, and IL-8 were unchanged after exercise. In the professional athletes, HSP70 expression was declined significantly (p<0.05), but HSP27 was not significantly changed. IL-8 and TNF-α did not show significant difference, either. By antibacterial assay, it was found that the number of active bacterial populations were influenced by the presence or absence of HSP27 and HSP70 in NAL fluids. Conclusion: HSP27 and HSP70 were present in NAL fluids of enrolled subjects, and the effect of exercise on the level HSPs was different between professional athletic competitors and non-athletes. As the number of active bacterial population was influenced by the presence or absence of nasal HSP27 and HSP70, we suggest that HSP27 and HSP70 may play immunological function in NAL fluids.