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Objectives: To monitor the different antithrombotic drug combinations, determine the incidence, magnitude of bleeding and the association of HAS-BLED risk scoring schema with the magnitude of bleeding as defined using TIMI bleeding criteria., Methods: A prospective observational study in a cohort of patients for a period of 8 months, at one of the tertiary care center-Krishna Institute of Medical Sciences, Hyderabad, was conducted. Consecutive patients were enrolled and followed from the date of admission till the adverse events are perceived/date of discharge. Pearson Correlation Statistics (Fisher's z Transformation) is applied to assess the association between HAS-BLED risk factors and the total risk score with bleeding criteria., Results: A total of 400 cases were collected during the 8-month study period, of which 372 satisfied the inclusion criteria. Among them 34 (9.1%) bleeding cases were reported with mean (+/- SD) age of 57.8 (+/- 14.19) years. Bleeding occurred mostly in males 79.4% and a HAS-BLED Score of > or = 3 has been observed in 67.6% (n = 23) patients out of 34 bled patients. Two antiplatelets + One anticoagulant is the most common combination which caused bleeding in 41.2% (n = 14). Stroke history, bleeding predisposition, labile INR's are the HAS-BLED risk factors which are significant (< 0.05) with the TIMI Bleeding Criteria., Conclusion: There was a linear correlation between the HAS-BLED risk score and the TIMI bleeding criteria-higher the risk score the more frequent is the incidence of major bleeding. A HAS-BLED risk score of > or = 3 is associated with TIMI major bleeding.

Epistaxis though common, is rarely life threatening. Routinely nose pinching, anterior find posterior nasal packing and endoscopic cauterization of bleeding points is sufficient to control epistaxis in 99% of the cases. It is mandatory to rule out local and systemic causes before labeling a case as idiopathic by using a battery of investigative modalities. Here are two interesting cases of epistaxis which did not respond to conventional therapeutic modalities in which transantral internal maxillary artery ligation was attempted leading to complete cure.

The present study was done to evaluate the rote of Duplex colour Doppler Sonography in neck metastasis. 30 patients with primary head and neck cancer were evaluated by Duplex colour Doppier sonography and results analysed. In more than 95% of cases, the vascular status could be established before any form of therapy was instituted. Compression and infiltration of carotids and internal jugular vein (IJV) could be demonstrated and a structured and dynamic relationship of metastatic nodes to the vessel wall was established.Doppier ultrasonography was found to be of high value in evaluating medium and large sized neck vessels but was of limited utility in the analysis of ncovascularisatlon within a metastatic node. This provided an operating roadmap for planning treatment. It is suggested that Colour Doppier Sonographic evaluation should be made a standard protocol in assessment of metastatic neck disease before instituting any form of therapy.

Ear, Nose and Throat practice presents the surgeons with an amazing variety of foreign bodies to deal with, some of them truly unusual. Presented here are two cases with foreign bodies unusual in nature, extracted by improvisation.