Epistaxis, defined as bleeding from the nose, is one of the common ENT cases coming to emergency department. Epistaxis is experienced by at least 60% of the population once in their life time and about 6% of them will require medical attention. The different treatment modalities include: local pressure, application of topical vasoconstrictor substances, or nasal packing depending on personal physician preference. Tranexamic acid (TXA), a synthetic analogue of the amino acid lysine, belongs to a class of drugs known as antifibrinolytics. It acts by reversibly binding four to five lysine receptor sites on plasminogen and can be used in emergency department for reducing the bleeding time in epistaxis. To evaluate the efficacy of topical application of injection TXA compared to cases managed with anterior nasal packing for the treatment of patients with epistaxis. 100 patients presenting with epistaxis in emergency department, above the age of 18 years were randomly divided into two groups with 50 patients each. Group 1 were managed with anterior nasal packing with gel foam and Group 2 with topical application of injection TXA. Causes,duration to control epistaxis, and occurrence of rebleeding were recorded. Our study showed homogenous distribution of age and sex among the patients. Bleeding stopped within 10 min in 38 patients in group 2 compared to 17 patients in group 1. For 31 patients in group 1, bleeding stopped between 10 and 15 min compared to 12 in group 2. In group 1, 8 patients had rebleeding compared to 2 patients in group 2. Our study showed that topical application of TXA reduces the bleeding time and number of rebleeds compared to anterior nasal packing with gelfoam. Since it is easily available in an emergency setup and cheaper compared to gelfoam, it can be used as an elective method in managing epistaxis in emergency department.

BACKGROUND: Nasotracheal intubation is associated with a risk of epistaxis. Several drugs, including cocaine and xylometazoline may be used as decongestants prior to nasotracheal intubation to prevent this. We hypothesized that xylometazoline would prevent epistaxis more effectively than cocaine, demonstrated by a lower proportion of patients with bleeding after nasotracheal intubation.
METHODS: We conducted a single-center, outcome assessor and analyst-blinded, clinical randomized controlled trial following approval from the local research ethics committee and the national medicine agency. Written informed consent was obtained from all patients. Patients scheduled for surgery under general anesthesia with nasotracheal intubation were randomized to receive either 2 mL 4% cocaine or 2 mL 0.05% xylometazoline prior to nasotracheal intubation. Immediately following intubation, epistaxis was evaluated by the blinded intubating anesthetist on a four-point scale. We measured heart rate and blood pressure the first 5 min after drug administration. Adverse events were followed up after 24 h.
RESULTS: A total of 53 patients received cocaine and 49 patients received xylometazoline. Bleeding occurred in 32 patients receiving cocaine (60.4%) and in 34 patients receiving xylometazoline (69.4%) (p = .41, Fisher\'s exact test) with a difference of 9.0% (95% CI: -9.4% to 27%). There was no statistically significant difference between groups regarding the heart rate or blood pressure. No adverse cardiac events were recorded in either group.
CONCLUSIONS: We found no statistically significant difference between cocaine and xylometazoline in preventing epistaxis after nasotracheal intubation, and the choice of vasoconstrictor should be based on other considerations, such as pricing, availability and medicolegal issues.

OBJECTIVE: Epistaxis is a common condition that affects about 60% of the population in their lifetime, with 6% needing medical attention. Little is known about the epidemiology and risk factors of epistaxis outside the health care system. This study aimed to investigate the prevalence and risk factors of epistaxis in a rural Danish population using data from the Lolland-Falster Health Study (LOFUS).
METHODS: We conducted a cross-sectional survey based on data from LOFUS, a household-based, prospective cohort study in the rural provincial area of Lolland-Falster, Denmark. We enrolled 10,065 participants (≥ 50 years) and collected data on demographics, comorbidities, medication, lifestyle factors, and laboratory parameters. Logistic regressions were used to test for correlations between epistaxis and different risk factors.
RESULTS: In total 5.3% of the participants had experienced epistaxis within the past 30 days, and 7.9% had sought medical attention for epistaxis at some point in their lives. We identified several factors that were significantly correlated with increased odds of epistaxis, such as male gender, age group 50-59 years, high BMI (> 25), allergy, diabetes, hypertension, atherosclerosis, angina, and anticoagulant treatment. Excellent or good self-reported health was correlated to significantly lower odds of epistaxis.
CONCLUSIONS: This study provides a comprehensive overview of the prevalence and risk factors of epistaxis outside the health care system. Our study suggests that preventive measures targeting these risk factors may reduce the incidence and severity of epistaxis in this population.

UNASSIGNED: Epistaxis is one of the most common ear, nose, and throat (ENT) emergencies that present to the emergency or primary care centers.
UNASSIGNED: This study aimed to assess the knowledge of the Saudi general public toward epistaxis.
UNASSIGNED: This study adopted a cross-sectional analytical study design. The questionnaire link was distributed using social media channels. The participants were adult Saudi nationals that live in Saudi Arabia. The data was collected using a self-administered questionnaire that assessed knowledge related to epistaxis. The knowledge score was calculated using the 10 knowledge evaluation questions. Each correct response was assigned a value of \"one.\" The scores ranged from \"zero\" to \"ten,\" with higher scores signifying greater knowledge. A percentage score was computed, and the participants\' knowledge was classified as poor (% score: ≤50%), moderate (% score: 51 to 70%), and good (% score: 71 to 100%). Statistical Package for Social Sciences (SPSS) version 26 was used for statistical analysis.
UNASSIGNED: The study included 452 participants of whom 70.1% were females. Married individuals comprised 60.8% of the sample. The prevalence of self-reported epistaxis was 43.6% in the last 6 months. Among the participants, 42.9%, had \"Poor\" knowledge score, followed by 39.6% who had \"moderate\" score, and 17.5% had \"Good\" score. These results show that most participants had poor to moderate knowledge, with a minority demonstrating a good level of knowledge. All demographic variables have significantly influenced the adequacy of knowledge about epistaxis. Furthermore, participants who believed that the general public has insufficient knowledge on epistaxis had a significantly lower knowledge score (p = 0.001).
UNASSIGNED: The present study found a non-satisfactory, low-to-moderate knowledge level of the Saudi general public toward epistaxis. We propose emphasizing public knowledge and education about first aid for epistaxis because proper first aid can minimize significant complications when done properly.

OBJECTIVE: To assess the knowledge and confidence level regarding the basic first-aid for treating epistaxis among medical staff, including nurses and physicians across various medical disciplines. The study focused three aspects of first aid management: location of digital pressure, head position and duration of pressure.
METHODS: The study involved 597 participants, categorized into five groups according to their specialties: emergency medicine, internal medicine, surgery, pediatrics, and community-based healthcare. A paper-based multiple-choice questionnaire assessed knowledge of managing epistaxis. Correct answers were determined from literature review and expert consensus.
RESULTS: Most medical staff showed poor knowledge regarding the preferred site for applying digital pressure in epistaxis management. For head position, pediatricians and internal medicine physicians were most accurate (79.4% and 64.8%, respectively, p < 0.01), and nurses from the emergency department outperformed nurses from other disciplines; internal medicine, surgery, pediatrics, and community-based healthcare (61.1%, 41.5%, 43.5%, 60%, 45.6%, respectively, p < 0.05). While most medical staff were unfamiliar with the recommended duration for applying pressure on the nose, pediatricians and community clinic physicians were most accurate (47.1% and 46.0%, respectively, p < 0.01), while ER physicians were least accurate (14.9%, p < 0.01). Interestingly, a negative correlation was found between years of work experience and reported confidence level in managing epistaxis.
CONCLUSIONS: Our findings indicate a significant lack of knowledge concerning epistaxis first-aid among medical staff, particularly physicians in emergency departments. This finding highlights the pressing need for education and training to enhance healthcare workers\' knowledge in managing epistaxis.

UNASSIGNED: It\'s approximated that 60% of the population globally experience epistaxis during lifetime. Despite epistaxis being prevalent in Tanzania, there are limited studies that have explored experience of participants on epistaxis. This study aims to determine knowledge on the causes, first aid management and practices of epistaxis among patients attending a health facility in Eastern Tanzania.
UNASSIGNED: A descriptive cross-sectional study was conducted where 371 participants aged 15 years and above were interviewed using structured questionnaires. Data was analyzed using Statistical Package of Social Sciences version 23. Chi-square tests were performed and a p-value <0.05 was considered to be statistically significant.
UNASSIGNED: About two-thirds (60.9%) of the study participants had good knowledge of the causes of epistaxis. Majority of participants knew excessive nose manipulation (95.1%) to be the commonest cause of epistaxis and the least cause mentioned was chronic liver disease (24.8%). On the other hand, 77.6% of the participants had good knowledge while 22.4% had poor knowledge regarding first aid management of epistaxis. In this study, 328(88.4%) participants knew pressing the nose could stop epistaxis, while 164(44.2%) knew the best position to stop epistaxis and that is to tilt the head forward and those who had history of epistaxis, 150 (73.2%) out of 205 pinched the nose as the first aid. Similarly, 133(35.8%) participants thought cessation of smoking has effect on decreasing the occurrence of epistaxis. A significant association was noted between knowledge of first aid management of epistaxis and some socio-demographic characteristics such as age and educational level. There was also a significant association between knowledge of the causes of epistaxis and educational level.
UNASSIGNED: Majority of the participants had good knowledge of the causes and first aid management of epistaxis.

BACKGROUND: Epistaxis, commonly known as nose bleeding, is a prevalent condition in pediatric patients, often managed either at home or in clinical settings. This study aimed to explore the differences in the management of pediatric epistaxis between home and clinical settings, focusing on gender distribution, clinical presentations, and treatment methods.
METHODS: A retrospective review was conducted, analyzing pediatric epistaxis cases managed both at home and in clinical settings. Data on gender distribution, clinical presentation, and treatment methods were collected and analyzed. Home remedies, first aid management, and clinical interventions like the use of nasal sprays and septoplasty were evaluated.
RESULTS: The study found significant differences in gender distribution between home (46.2% males) and clinical settings (61% males). Recurrent nasal bleeding was more common in home settings (75%), whereas more complex cases were predominant in clinical settings. Nasal sprays containing decongestants were widely used in clinical settings (62.1%), contrasting with a preference for first aid measures at home. Surgical interventions like septoplasty were occasionally employed in clinical scenarios.
CONCLUSIONS: The study highlights distinct approaches to managing pediatric epistaxis in home versus clinical settings. It underscores the importance of tailored treatment strategies, considering the severity and frequency of epistaxis episodes. These findings suggest a need for comprehensive guidelines to assist caregivers and healthcare professionals in effective decision-making for pediatric epistaxis management. The study also emphasizes the necessity for ongoing research and education in this area.

OBJECTIVE: To analyze variability in the distance between the Anterior Ethmoidal Artery (AEA) and the anterior Skull Base (SB), as well as the frequency of lateral asymmetry in a Latin American population using computed tomography.
METHODS: A total of 250 computed tomography scans of paranasal sinuses in coronal reconstruction (500 AEAs) were analyzed. After determining the image with the best anatomical view of the artery, the distance between its midpoint and the ethmoidal roof was measured, and the images were independently interpreted by 2 physicians.
RESULTS: Of the 500 AEAs, 279 (55.8%) adhered to or passed through the SB at a distance of 0mm. A total of 221 AEAs (44.2%) were at some distance from the SB, of which 107 (48.4%) were on the right side, ranging from 1.18 to 6.75mm, and 114 (51.5%) were on the left side, ranging from 1.15 to 6.04mm. The overall mean distance between the AEA and SB was 1.22 (SD=1.57) mm, increasing to 2.77 (SD=1.14) when the arteries adhered to the SB were excluded. Seventy-six individuals (30.4%) had a lateral distance variation > 1mm.
CONCLUSIONS: Our study includes the largest sample of AEA analyzed with computed tomography scans of paranasal sinuses. There was some distance between the AEA and SB in almost half the patients, and we found a high rate of lateral variability >1mm.
METHODS: Level 3.

BACKGROUND: Paediatric patients with acute lymphoblastic leukaemia or lymphoma are at increased risk of venous thromboembolism resulting in increased mortality and morbidity. We hypothesised that apixaban, a direct oral anticoagulant, would safely reduce venous thromboembolism in this patient population.
METHODS: PREVAPIX-ALL was a phase 3, open-label, randomised, controlled trial conducted in 74 paediatric hospitals in 9 countries. Participants aged 1 year or older to younger than 18 years with newly diagnosed acute lymphoblastic leukaemia (pre-B cell or T cell) or lymphoblastic lymphoma (B cell or T cell immunophenotype) and a central venous line in place throughout induction were randomly assigned 1:1 to standard of care (SOC, ie, no systemic anticoagulation) or weight-adjusted twice-daily apixaban during induction. Randomisation was performed centrally and stratified by age (those <10 years or those ≥10 years). Participants weighing 35 kg or less were administered 2·5 mg twice daily of apixaban as a 2·5 mg tablet, 0·5 mg tablets, or 0·4 mg/mL oral solution, while those weighing more than 35 kg were administered weight-adjusted prophylactic doses using 0·5 mg tablets or the 0·4 mg/mL oral solution twice daily. Primary outcomes were assessed by a blinded central adjudication committee. The primary efficacy outcome for the intention to treat population was the composite of symptomatic or clinically unsuspected venous thromboembolism, the primary safety outcome was major bleeding, and secondary safety outcomes included clinically relevant non-major (CRNM) bleeding. Patients were screened for venous thromboembolism by ultrasound and echocardiogram at the end of induction. The trial was registered with ClinicalTrials.gov (NCT02369653) and is now complete.
RESULTS: Between Oct 22, 2015, and June 4, 2021, 512 participants were randomly assigned and included in analyses (222 [43%] female and 290 [57%] male; 388 [76%] White, 52 [10%] Asian, 24 [5%] Black or African American, and 48 [9%] other races; and 122 [24%] Hispanic or Latino ethnicity). During a median follow-up period of 27 days (IQR 26-28), 31 (12%) of 256 patients on apixaban had a composite venous thromboembolism compared with 45 (18%) of 256 participants receiving SOC (relative risk [RR] 0·69, 95% CI 0·45-1·05; p=0·080). Two major bleeding events occurred in each group (RR 1·0, 95% CI 0·14-7·01; p=1·0). A higher incidence of CRNM bleeding, primarily grade 1 or 2 epistaxis, occurred in the apixaban group (11 [4%] of 256 participants) compared with the SOC group (3 [1%] of 256; RR 3·67, 95% CI 1·04-12·97, p=0·030). The most frequent grade 3-5 adverse events in both groups were thrombocytopenia (n=28 for the apixaban group and n=20 for the SOC group) or platelet count decreased (n=49 and n=45), anaemia (n=77 and n=74), febrile neutropenia (n=27 and n=20), and neutropenia (n=16 and n=17) or neutrophil count decreased (n=22 and n=25). Five deaths occurred, which were due to infection (n=3 in the SOC group), cardiac arrest (n=1 in apixaban group), and haemorrhagic cerebral sinus vein thrombosis (n=1 in the SOC group). There was one apixaban-related death (coagulopathy and haemorrhage after cardiac arrest of unknown cause).
CONCLUSIONS: PREVAPIX-ALL is, to our knowledge, the first trial assessing primary thromboprophylaxis using a direct oral anticoagulant in paediatric patients with acute lymphoblastic leukaemia or lymphoma. No statistically significant treatment benefit was identified in participants receiving apixaban. Major and CRNM bleeding were infrequent overall, but a higher incidence of CRNM bleeding (primarily epistaxis in younger children) occurred in participants receiving apixaban. For patients deemed to be at particularly high risk of thrombosis, PREVAPIX-ALL provides encouraging safety data for the use of apixaban in clinical settings in which the potential benefits are thought to outweigh the risk of bleeding.
BACKGROUND: Bristol Myers Squibb-Pfizer Alliance.

UNASSIGNED: To evaluate the effectiveness of computed tomography-guided nasotracheal intubation procedure in predicting tube advancement difficulty and preventing epistaxis.
METHODS: The prospective study was conducted at Erciyes University Faculty of Dentistry from April 2018 to June 2019 and comprised maxillofacial surgery patients of either gender aged 18-50 years who were due to undergo bimaxillary orthognathic surgery, which was defined as American Society of Anaesthesiology grade I or II. The space where the tube was to be passed in the internal nasal valve region was measured horizontally and vertically using computed tomography. A single experienced anaesthesiologists intubated all the patients who were later divided into \'easy\' group A and \'difficult\' group B on the basis of the effort required to advance the tube through the nasal passage. Data was analysed using JASP version 0.14.1.0).
RESULTS: Of the 60 patients, 42(70%) were females and 18(30%) were males. The overall mean age was 29.0±10.5 years and the mean body mass index value was 23.6±4.0 kg/m 2 (p>0.05). There were 28(46.6%) patients in group A, and 32(53.3%) in group B. Median distances were significantly shorter and epistaxis was significantly higher in group B compared to group A (p<0.001). The cut-off values to reveal the distance at which difficulty may be experienced while advancing the tube, determined through receiver operating characteristic analysis, were 1.09 cm for vertical and 0.39cm for horizontal distances.
CONCLUSIONS: The nasotracheal intubation procedure under the guidance of computed tomography could help predict the difficulty of tube advancement, and could thus prevent epistaxis and other related nasal intubation complications. Clinical trial number: NCT05525754.