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Background/Aim: Centrofacial fractures resulting from high-impact violence can be considered mild traumatic brain injuries. Given the complexities and associated risks, a comprehensive examination of these fractures is warranted. These fractures are increasingly prevalent among young adult patients and are commonly associated with road traffic accidents. In the literature, only a few studies have focused on this particular type of facial bone lesion. In Ivory Coast, no studies have been conducted on these fractures, which highlights the importance of our research aimed at describing the epidemiological and anatomicalclinical characteristics of centrofacial fractures in the stomatology and maxillofacial surgery department of the Cocody Teaching Hospital. Methods: This descriptive cross-sectional study was conducted in the Stomatology and Maxillofacial Surgery Department of the Cocody University Hospital Center from January 2016 to December 2020. Results: The prevalence of these fractures was 24.20%, with a predominance of male subjects. The age group most affected was 20 to 40 years old, accounting for 70.96% of cases, and most patients resided in Abidjan (59%). All socio-economic categories were represented, with a higher proportion of individuals in liberal professions (91.4%). Road traffic accidents involving two-wheeled vehicles were the primary cause of these fractures (76.8%), with the most common injury site being the naso-ethmoido-maxillo-frontoorbital complex (NEMFOC) (32.5%). Conclusion: The epidemiological characteristics of centrofacial fractures associated with two-wheeled vehicles in the Abidjan metropolis of Côte d'Ivoire suggest the need for increased accountability among motor vehicle drivers and stricter enforcement of traffic laws. [ABSTRACT FROM AUTHOR]

Background: To investigate the association between erectile dysfunction (ED) as well as epistaxis (ES) in relation to the extent of iliac atherosclerosis. Methods: In this retrospective cross-sectional study, all consecutive male patients treated at our institution from 01/2016 to 12/2020 undergoing abdominal CT scan were evaluated. Patients (n = 1272) were invited by mail to participate in the study in returning two questionnaires for the evaluation of ED (IIEF-5) and ES. Patients who returned filled-in questionnaires within a 3-month deadline were included in the study. The extent of atherosclerosis in the common iliac artery (CIA) and the internal iliac artery (IIA) was assessed by calcium scoring on unenhanced CT. Stratification of results was performed according to reported IIEF-5 scores and consequential ED groups. Results: In total, 437 patients (34.4% of contacted) met the inclusion criteria. Forty-two patients did not fulfill predefined age requirements (< 75 years) and 120 patients had to be excluded as calcium scoring on nonenhanced CT was not feasible. Finally, 275 patients were included in the analysis and stratified into groups of "no-mild" (n = 146) and "moderate-severe" (n = 129) ED. The calcium score (r=-0.28, p < 0.001) and the number of atherosclerotic lesions (r=-0.32, p < 0.001) in the CIA + IIA showed a significant negative correlation to the IIEF-5 score, respectively. Patients differed significantly in CIA + IIA calcium score (difference: 167.4, p < 0.001) and number of atherosclerotic lesions (difference: 5.00, p < 0.001) when belonging to the "no-mild" vs. "moderate-severe" ED group, respectively. A multivariable regression model, after adjusting for relevant baseline characteristics, showed that the number of atherosclerotic CIA + IIA lesions was an independent predictor of ED (OR = 1.05, p = 0.036), whereas CIA + IIA calcium score was not (OR = 1.00031, p = 0.20). No relevant correlation was found between ES episodes and IIEF-5 scores (r=-0.069, p = 0.25), CIA + IIA calcium score (r=-0.10, p = 0.87) or number of atherosclerotic CIA + IIA lesions (r=-0.032, p = 0.60), respectively. Conclusions: The number of atherosclerotic lesions in the iliac arteries on nonenhanced abdominal CT scans is associated with the severity of ED. This may be used to identify subclinical cardiovascular disease and to quantify the risk for cardiovascular hazards in the future. Trial registration: BASEC-Nr. 2020 − 01637. [ABSTRACT FROM AUTHOR]

Background: Acute mastoiditis is an intratemporal complication due to acute otitis media (AOM). Common risk factors include young age (often < 24 months), high values of C-reactive protein and previous antibiotic therapy, previous middle ear infection, or history of ear surgery. The main factor of acute mastoiditis is obstruction of the aditus antrum by granulation tissue or mucosa edema, inhibiting purulent drainage from the mastoid. Retained foreign body in the nose is a rare indirect cause of acute mastoiditis. It may be due to mucosal inflammation and accumulation of secretion causing nasal tract or nasopharyngeal infection leading to otitis media and later manifesting as an intratemporal complication. Case presentation: We report a case of acute mastoiditis as a late sequela of retained foreign body in the nose, and we also emphasize the incidental radiological finding of a star-shaped foreign body in the nose, which was a miss during the initial presentation. Further questioning revealed a history of recurrent unilateral blood-stained, foul-smelling nasal discharge, which was left untreated for years, leading to a delayed presentation of acute mastoiditis. After removing the foreign body and broad-spectrum antibiotic administration, complete disease resolution was achieved. Conclusion: Although rare, retained foreign bodies of the nose must be ruled out in certain cases of mastoiditis. A thorough history with a high index of clinical suspicion is recommended for early diagnosis to prevent complications. [ABSTRACT FROM AUTHOR]

Objectives: Endovascular embolization has emerged as an effective treatment for intractable epistaxis. This systematic review and meta-analysis aimed to calculate the rates of success, rebleeds, and complications and to identify the etiologies and complications of patients who undergo endovascular embolization. Methods: This systematic review and meta-analysis was conducted per the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were extracted from Scopus, PubMed, Web of Science, and Cochrane Central and were filtered by a systematic review process using Rayyan software. A random-effects model was used to quantify the rates success, rebleeds, and complications. Results: Forty-two studies were included, totaling 1660 patients. The pooled success rate was 89% (95% confidence interval [CI] 86%-92%) and the pooled rebleed rate was 19% (95% CI 16%-22%). The pooled minor complication rate was 18% (95% CI 11%-27%). The most common major complication was soft tissue necrosis followed by stroke. The most common minor complication was facial pain. No minor complications were reported to be permanent. Of the patients who failed initial embolization, 42% underwent repeat embolization and 34% underwent surgical arterial ligation. Conclusions: Endovascular embolization is an effective treatment for intractable epistaxis. The decision to perform embolization should be carefully weighed given the rare but significant major complications. [ABSTRACT FROM AUTHOR]

Nasal masses are a clinical entity with great diversity. They present with various symptoms such as nasal obstruction, facial pain, discomfort, epistaxis, headache, anosmia and visual disturbances. Especially unilateral nasal masses are very suspicious and must be differentiated between benign and malignant lesions. Nasal endoscopy is a weapon in the quiver of otorhinolaryngologists. It is an innovative, quick, direct and inexpensive examination that can be performed even at the otorhinolaryngologist’s office. Immediate imaging of lesions within the nasal cavity allows rapid initiation of treatment. This article highlights the importance of correct differential diagnosis of a unilateral nasal mass in a 37-year-old female patient. [ABSTRACT FROM AUTHOR]

A high number of patients seek health information online, and large language models (LLMs) may produce a rising amount of it. This study evaluates the performance regarding health information provided by ChatGPT, a LLM developed by OpenAI, focusing on its utility as a source for otolaryngology-related patient information. A variety of doctors from a tertiary otorhinolaryngology department used a Likert scale to assess the chatbot's responses in terms of accuracy, relevance, and depth. The responses were also evaluated by ChatGPT. The composite mean of the three categories was 3.41, with the highest performance noted in the relevance category (mean = 3.71) when evaluated by the respondents. The accuracy and depth categories yielded mean scores of 3.51 and 3.00, respectively. All the categories were rated as 5 when evaluated by ChatGPT. Despite its potential in providing relevant and accurate medical information, the chatbot's responses lacked depth and were found to potentially perpetuate biases due to its training on publicly available text. In conclusion, while LLMs show promise in healthcare, further refinement is necessary to enhance response depth and mitigate potential biases. [ABSTRACT FROM AUTHOR]

Epistaxis means bleeding from nostrils, nasal cavity or nasopharynx. To summarize the available epistaxis treatment options. Methods: 61 articles published in the last 20 years were included. Duplicate records, irrelevant and inaccessible ones were excluded. Epistaxis can be treated with first aid measures such as external pressure and ice packing and applying topical agents, e.g. oxymetazoline that stops 65–75% of nosebleeds in A&E. Also, with electrocautery which is more effective and has fewer recurrences (14.5% vs. 35.1%) than chemical cauterization and applying tranexamic acid that promotes hemostasis in 78% of patients, versus 35% and 31% respectively in patients treated with oxymetazoline and nasal packing. Furthermore, nasal packing can be applied with non-absorbable materials, e.g. petroleum jelly, BIPP gauze, PVA nasal tampons (Merocel), Foley catheter, balloons (Rapid-Rhino), absorbable materials, e.g. nasal tampon (Nasopore), and with newer hemostatic materials which are more effective and with fewer complications, e.g. hemostatic gauzes (Surgicel), thrombin matrix (Floseal), gelatin sponge (Spongostan) and fibrin glue. Moreover, epistaxis can be achieved with endoscopic ligation of arteries, mainly SPA, which is more effective than conventional nasal packing (97% vs. 62%), and with endoscopic cauterization which is more effective than ligation. Finally, for intractable cases embolization can be applied using gelatin sponge, foam, PVA and coils with 80% success rate and comparable efficacy and complications to surgical methods. Epistaxis can be dealt with various methods depending on patient's history and available resources. Newer hemostatic agents in combination with endoscopic methods have advantages over traditional methods. [ABSTRACT FROM AUTHOR]

Epistaxis, commonly encountered in the Otolaryngology practice, refers to bleeding that occurs as a result of vascular pathologies and coagulation disorders. It can develop due to traumatic, iatrogenic, or spontaneous etiologies. In our study, we aim to retrospectively examine the epistaxis patients treated in our clinic to investigate the etiology causing epistaxis, associated diseases, and the use of anticoagulants-antiplatelets. Additionally, we plan to evaluate hemogram and coagulation parameters. The study included patients diagnosed with epistaxis and admitted for treatment at Samsun Education and Research Hospital ENT Clinic between 2019 and 2022. A retrospective analysis of the patients' medical records was conducted to gather data on demographic characteristics, comorbidities, medications used regularly, laboratory values, and clinical findings. A total of 130 patients were included in the study. No statistically significant difference was observed between the location of the bleeding focus and gender, presence of hypertension, use of antihypertensive medication, or anticoagulant use. When comparing patients with and without antiplatelet-anticoagulant use, a significantly longer nasal packing duration was found in patients who used these medications. In terms of the need for electrocauterization, statistically significant higher intervention rates were observed in patients who did not use anticoagulant medication. Our study identified a higher rate of surgical intervention in hospitalized epistaxis patients, potentially due to the inclusion of more severe cases requiring specialized care. Further research is needed to investigate the factors influencing the need for surgical management and to develop appropriate guidelines for the management of different severities of epistaxis. [ABSTRACT FROM AUTHOR]

Background: In severe refractory epistaxis, the anterior ethmoidal artery may need to be ligated. Previously described endonasal or transorbital approaches are not always effective, or they have suboptimal aesthetic outcomes. This paper describes a safe and effective surgical technique, with a consistent landmark allowing quick identification. Technical description: A transcaruncular incision is made, oriented medially in the direction of the medial orbital wall towards the level of the nasion. Once onto bone, a subperiosteal plane is developed and an endoscope is used to dissect posteriorly at the level of the nasion, until the anterior ethmoidal artery is identified, and subsequently ligated. Conclusion: The nasion is an easy, constant landmark to use for ligation of the anterior ethmoidal artery in refractory epistaxis. The traditional method of identifying the anterior ethmoidal artery is not applicable or constant enough for use during the transorbital approach. The described technique avoids injury to surrounding structures and has a satisfactory aesthetic outcome. [ABSTRACT FROM AUTHOR]

Background: There is limited evidence supporting the usage of prophylactic antibiotics in the setting of nasal packing for epistaxis. It is unclear what current antiobiotic usage patterns are by otolaryngologists. Objectives: Characterize the antibiotic prescribing practices employed by otolaryngologists in the management of epistaxis patients treated with packing as well as the underlying rationale. Explore the impact of experience, geography, and academic affiliation on treatment decisions. Methods: An anonymous survey of antibiotic prescribing patterns for patients with epistaxis requiring nasal packing was distributed to all physician members of the American Rhinologic Society. Responses to each question were descriptively summarized including 95% confidence intervals and were linked to demographics using Fisher's exact tests. Results: One thousand one hundred and thirteen surveys were distributed with 307 responses (27.6%). Antibiotic prescription rates varied based on packing type, with 20.0% prescribing antibiotics for dissolvable packing compared to 84.2% to 84.6% for nondissolvable packing. The absorbance of nondissolvable packing does not impact the decision to prescribe antibiotics (P >.999). Precisely 69.7% (95% CI: 64.0%-74.8%) stop antibiotics immediately following packing removal. Precisely 85.6% (95% CI: 81.6%-89.9%) cite the risk of toxic shock syndrome (TSS) when prescribing antibiotics. Notable regional differences include greater utilization of amoxicillin-clavulanate in the Midwest (67.6%) and Northeast (61.4%) as compared with the South (42.1%) and West (45.1%) (P =.013). Further, years in practice were positively associated with several patterns including prescribing antibiotics for patients with dissolvable packing (P =.008), citing prevention of sinusitis as a rationale for antibiotic use (P <.001), and a higher likelihood of having treated a patient with TSS (P =.002). Conclusions: Antibiotic use in patients with epistaxis controlled with nondissolvable packing is common. Treatment patterns are influenced by geography, years in practice, and practice type. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

This article, titled "Epistaxis revealing a ruptured post-radiation aneurysm of the internal carotid artery: case report," discusses a rare and fatal complication of external radiotherapy in a patient with nasopharyngeal cancer. The patient experienced recurrent epistaxis (nosebleeds) after completing treatment, and a CT angiography revealed a vascular ectasia of the internal carotid artery. Despite receiving treatment, the patient ultimately died due to severe nosebleeds. The article highlights the association between radiotherapy and the development of post-radiation aneurysms, emphasizing the need for further research in this area. [Extracted from the article]

Angiomyolipoma is a benign, mesenchymal, hamartomatous lesion often described in the kidney and may be associated with tuberous sclerosis. Nasal angiomyolipoma is an extremely rare tumor with fewer than 20 cases reported in the literature. We report a case of angiomyolipoma arising in the right nasal vestibule in a 68-year-old male with mild, recurrent right-sided epistaxis, and nasal obstruction. With the exception of arterial hypertension, the patient did not have any comorbidities. Gross examination showed a well-circumscribed, lobulated mass. On the microscopic level, it was composed of mature smooth muscle cells, thick-walled blood vessels of varying sizes, and islands of mature adipose tissue. Angiomyolipoma should be considered as a differential diagnosis for unilateral nasal masses, especially those situated in the nasal vestibule. [ABSTRACT FROM AUTHOR]

This article discusses a case of an elderly patient with recurrent epistaxis (nosebleeds) and purple vascular stains on the skin. The patient was diagnosed with hereditary hemorrhagic telangiectasia (HHT), a rare genetic disorder characterized by abnormal blood vessels and arteriovenous malformations. The patient had a late onset of the disease and no family history, which can be attributed to sporadic mutations or non-recognition of the disease in affected parents. The article provides information on the diagnostic criteria, genetic mutations, and management options for HHT. [Extracted from the article]

Background: This study is the first to have been assessing epistaxis cases in respect of the geographic and seasonal variations in 2 distinct cities 900 km apart in 2 different regions of Turkey, whereas most studies in the literature about this entity had evaluated patients in the same residential area. The purpose of this study was to compare seasonal and regional variations in the presentations of patients with epistaxis in the regions of Central Anatolia, which has a continental climate, and the Eastern Black Sea, which has a marine climate. Methods: This retrospective study was conducted in Karaman Training and Research Hospital and Trabzon Kanuni Training and Research Hospital throughout 2019, a total of 2141 cases (Central Anatolia: 1247; Eastern Black Sea: 894). The data of patients who presented with epistaxis were scanned retrospectively from patient records. Weather parameter data on the day of admission to hospital were obtained from the Regional Institutes of Meteorology. Results: The number of cases (1247 vs. 894, P < .001) was significantly higher in the Central Anatolia than in the Eastern Black Sea, in which higher results of mean humidity, air pressure, rainfall, and wind speed were recorded. A weak positive correlation was determined between the number of cases and mean temperature (r = 0.397) and a weak negative correlation between the number of cases and air pressure (r = -0.261) and rainfall (r = -0.288). Conclusion: The study results suggest that the meteorological parameters of mean temperature, rainfall, and air pressure could have a significant effect on epistaxis. [ABSTRACT FROM AUTHOR]

Secretion analysis is a useful tool in forensic genetics, since it establishes the (cellular) origin of the DNA prior in addition to the identification of the DNA donor. This information can be crucial for the construction of the crime sequence or verification of statements of people involved in the crime. For some secretions, rapid/pretests already exist (blood, semen, urine, and saliva) or can be determined via published methylation analyses or expression analyses (blood, saliva vaginal secretions, menstrual blood, and semen). To discriminate nasal secretion/blood from other secretions (like oral mucosa/saliva, blood, vaginal secretion, menstrual blood, and seminal fluid), assays based on specific methylation patterns at several CpGs were set up in this study. Out of an initial 54 different CpG markers tested, two markers showed a specific methylation value for nasal samples: N21 and N27 with a methylation mean value of 64.4% ± 17.6% and 33.2% ± 8.7%, respectively. Although identification or discrimination was not possible for all nasal samples (due to partial overlap in methylation values to other secretions), 63% and 26% of the nasal samples could be unambiguously identified and distinguished from the other secretions using the CpG marker N21 and N27, respectively. In combination with a blood pretest/rapid test, a third marker (N10) was able to detect nasal cells in 53% of samples. Moreover, the employment of this pretest increases the proportion of identifiable or discriminable nasal secretion samples using marker N27 to 68%. In summary, our CpG assays proved to be promising tools in forensic analysis for the detection of nasal cells in samples from a crime scene. [ABSTRACT FROM AUTHOR]

Aim: This prospective study aimed to assess the knowledge and awareness of aetiological and risk factors as determinants of the health-seeking pattern of parents of children with epistaxis in a tertiary health institution. Materials and Methods: This was a 7-year cross-sectional prospective study where copies of the questionnaire were distributed to consenting parents whose children presented to our institution with epistaxis between January 2015 and December 2021. A total of 570 parents were enrolled in the study in the research time period. Results: Out of 570 patients, majority (39%) were aged between 11 and 15 years, followed by 35% aged between 6 and 10 years, 17% aged between 1 and 5 years and 11% aged between 16 and 18 years. Three hundred and eighty (66.67%) were male and 190 (33.33%) were female. Two hundred and ninety-five (51.75%) patients had primary education, followed by 189 (33.16%) patients with secondary education and 86 (15.09%) patients with preschool education. Three hundred and seventy-three (65.44%) patients had anterior bleeding and 107 (18.77%) patients had posterior bleeding while 90 (15.79%) patients had both anterior and posterior bleeding. The majority of the parents, 399 (70%), were aware about the epistaxis while 171 (30%) parents were unaware about the epistaxis. Conclusion: A significant number of parents are unaware of the epistaxis and also unaware of the various aetiological and risk factors of the epistaxis and these issues need a more nuanced analysis in light of Africa's rich cultural diversity. [ABSTRACT FROM AUTHOR]

Nosebleed or epistaxis is one of the most common forms of presenting an emergency in the ENT field. Since March 11, 2020, the World Health Organisation has proclaimed COVID-19 a global pandemic, and the world has been closed down. The main objective of the study is to analyse and compare the dynamics of epistaxis aetiology among the cases that required hospitalisation in the pre-pandemic period and the period of the COVID 19 pandemic. The study is multicenter retrospective from October 2018 to May 2022, including 380 cases of hospitalised epistaxis, with the mention that March 2020 is considered the beginning of the pandemic period. 60.8% of the patients enrolled in the study in the pre-pandemic period (60.8%) and 39.2% in the pandemic period. Differences between groups were not statistically significant between study entries (pre-pandemic vs. pandemic) and age (p=0.331), gender (p=0.916) or existence of local causes for epistaxis (p=0.895). Patients with general causes for epistaxis were more frequently enrolled in the pandemic period, while patients without general causes for epistaxis were more frequently enrolled in the pre-pandemic period. Patients with a hospitalisation period of more than 5 days were more frequently enrolled in the pre-pandemic period while patients with a hospitalisation period of 3 to 5 days were more frequently enrolled in the pandemic period. Also, patients with idiopathic epistaxis were more frequently enrolled in the pre-pandemic period. Based on the results presented in our study, the period of the Covid 19 pandemic directly influenced both the number of patients and the period of hospitalisation. [ABSTRACT FROM AUTHOR]

Epistaxis is a common presenting symptom either emergency condition or ambulatory in Otorhinolaryngology, affecting people of all ages. A multicentric retrospective descriptive study of 380 patients who were hospitalized with epistaxis over a 3.8 year period was carried out. Data collected was analyzed using IBM SPSS Statistics 25 and illustrated using Microsoft Office/Word 2016. The current study showed that male adults after 60 years old are most affected by nasal bleeding. More than half of hospitalized patients have severe epistaxis at the time of hospitalization. However, further studies are necessary to be done in order to fully elucidate the epidemiology of nosebleeds requiring hospitalization. [ABSTRACT FROM AUTHOR]

Background: Epistaxis is a common condition but with diverse etiology dependent on geography, season, climate, and demography. Aims and Objectives: To describe the demographic, clinical, and etiological profile and management strategies of epistaxis cases at a tertiary center in U.P. (west). Materials and Methods: Patients were identified from the emergency and outpatient department, and their demographic and clinical details were noted. Local examination was performed, and necessary investigations were carried out. Management strategies were noted. Duration of hospital stay and mortality, if any, was documented. Descriptive analytics were used. Data were represented as numbers and percentages, mean±standard deviation, and median. Results: A total of 189 epistaxis patients were enrolled in the study. The mean age of patients was 32.89±17.92 (range 1-85 years). The sex ratio (M: F) was 2.71. Majority of patients presented to the emergency department (60.3%) within 1 day (64.6%), had single episode (66.7%), the presence of old clot (72%) and the anterior location of bleeding (91.5%). 119 (63%) cases required admission. Nasal endoscopy and computed tomography scan were performed in 49 (25.9%) and 24 (12.7%) cases, respectively. The most common etiology was trauma (49.2%), followed by idiopathic cause (14.8%), hypertension (12.7%), and others. Nasal packing and cauterization were required in 16.4% and 15.9% of cases, respectively. Surgery was required in 5 (2.6%) cases. A minuscule percentage of cases required blood transfusion. There was no mortality. Conclusion: Epistaxis is a common emergency with males predominating over females. Causes are varied. Most patients can be managed conservatively with favorable outcomes if timely intervention is done. [ABSTRACT FROM AUTHOR]

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A new idea of nosebleed air jets with strong coupled internal and external flow is put forward using the lateral jet control principle to improve the maneuverability and fast reaction capabilities of hypersonic vehicles. The hypersonic vehicle's nose stagnant high-pressure and high-temperature gas is utilized as the drive source for long-term jet control. The significant coupled jet interaction of the internal and external flow changes the aerodynamic characteristics. As a result, the structure is basic and does not rely on any external source to achieve flight attitude control. The complicated flow characteristics of the nosebleed jet in supersonic crossflow surrounding the vehicle were numerically and experimentally investigated. The jet interaction characteristics and the aerodynamic characteristic changes generated by the nosebleed air jet are verified by comparing the flow field with and without the jet. Results indicate that the nosebleed air jet alters the center-of-pressure coefficient, which is subsequently coupled with the interference aerodynamic force. This results in a variation in pitch moment. The jet decreases the pitching moment coefficient when compared with the case without a jet. It is probable that combining nosebleed air jets with model centroid adjustment yields an optimal trim angle of attack. [ABSTRACT FROM AUTHOR]

Background and Objectives: Endoscopic sphenopalatine artery cauterization (ESPAC) has become a reliable and effective surgical procedure for managing posterior epistaxis. The objectives of our study were to evaluate the effectiveness of ESPAC in the management of posterior epistaxis and the possible factors that lead to the failure of the procedure. Materials and Methods: We performed a retrospective analysis of all patients who underwent ESPAC between 2018 and 2022. We retrospectively reviewed the demographic data, patients' co-morbidities, medical treatment conditions, whether other surgical procedures were performed in addition to the ESPAC, and the success rate of ESPAC. Results: 28 patients were included in our study. After ESPAC, epistaxis was successfully managed in 25 patients (89.28%). Of all patients undergoing ESPAC, three (10.7%) presented re-bleeding. In two patients, we performed an endoscopic revision surgery with re-cauterization of the sphenopalatine foramen area, together with anterior and posterior ethmoidectomy, followed by fat occlusion/obliteration of these sinuses. In one patient, fat obliteration of the anterior and posterior ethmoid was also unsuccessful, and we performed an external carotid artery ligation at the level of the neck with no recurrence afterwards. Conclusions: Endoscopic cauterization of the sphenopalatine artery remains a safe, effective, and reliable surgical procedure in the management of recurrent posterior epistaxis. The use of anticoagulant drugs and the association of hypertension and other heart and liver diseases do not materialize as factors influencing surgical failure. [ABSTRACT FROM AUTHOR]

The OBJECTIVE was to show the effectiveness of a new method for stopping nosebleeds in patients with nasopharyngeal cancer using endovascular superselective chemoembolization of the tumor arterial bed with HepaSphere 50–100 μm microspheres saturated with the cytostatic doxorubicin.METHODS AND MATERIALS. The results of treatment of 94 patients who against the background of progressive growth of nasopharyngeal cancer and ongoing combined treatment in oncology centers experienced nosebleeds are presented. In all these patients, according to the results of examinations in cancer centers, no convincing source of nosebleeds was identified. In the conditions of Polenov Neurosurgical Institute, 94 patients underwent endovascular superselective chemoembolization of the vasculature of nasopharyngeal cancer. The embolizate was a mixture of HepaSphere 50–100 μm microspheres saturated with the cytostatic doxorubicin (50 mg). All patients were included in the study in the absence of contraindications and after signing a voluntary informed consent approved by the ethics committee. The selection of patients was carried out according to the following criteria: thorough morphological verification of the neoplasm; locally advanced process of III and IV stages (T2-4 N0-2M0); no history of other cancers; absence of individual hematogenous metastases; absence of competitive pathology in the stage of decompensation; age was over 18 years old. All patients underwent induction-simultaneous chemoradiotherapy (CRT) with the use of radiation therapy in the usual dose fractionation regimen.RESULTS. The hemostatic effect was achieved in all 94 patients due to sequential superselective chemoembolization of the vasculature of the tumor itself with embolizate, which was a mixture of HepaSphere 50–100 μm microspheres saturated with the cytostatic doxorubicin (50mg). In the future, nosebleeds in these patients did not occur. The main sources of nosebleeds were the following branches of the external carotid artery: in 46.2 % of cases – the maxillary artery, in 37.6 % – the ascending pharyngeal artery, in 8.6 % – the occipital artery, in 5.4 % – the artery of the carotid node, in 2.2 % – other branches of the external and internal carotid arteries on one side or on both sides.CONCLUSION. The method of endovascular superselective chemoembolization with doxorubicin of the vasculature of nasopharyngeal cancer complicated by nosebleeds developed and introduced into medical practice was the initial stage of the combined treatment of these neoplasms. A good hemostatic effect was achieved in all 94 patients.

Background: Giant prolactinoma (> 4 cm in dimension) is a rare disorder. Invasive macroprolactinoma has the potential to cause base of skull erosion and extend into the nasal cavity or even the sphenoid sinus. Nasal bleeding caused by intranasal tumor extension is a rare complication associated with invasive giant prolactinoma. We report a case of giant invasive macroprolactinoma with repeated nasal bleeding as the initial symptom. Case presentation: A 24-year-old man with an invasive giant prolactinoma in the nasal cavity and sellar region who presented with nasal bleeding as the initial symptom, misdiagnosed as olfactory neuroblastoma. However, markedly elevated serum prolactin levels (4700 ng/mL), and a 7.8-cm invasive sellar mass confirmed the diagnosis of invasive giant prolactinoma. He was treated with oral bromocriptine. Serum prolactin was reduced to near normal after 6 months of treatment. Follow-up magnetic resonance imaging showed that the sellar lesion had disappeared completely and the skull base lesions were reduced. Conclusion: This case is notable in demonstrating the aggressive nature of untreated invasive giant prolactinomas which can cause a diagnostic difficulty with potential serious consequences. Early detection of hormonal levels can avoid unnecessary nasal biopsy. Early identification of pituitary adenoma with nasal bleeding as the first symptom is particularly important. [ABSTRACT FROM AUTHOR]

Artemisiae argyi (A. argyi) is a traditional medical plant, with medicinal and economic value. It has been used to treat diseases for more than 2000 years, and its application has been expanded in recent years with the in-depth research on the chemical composition and pharmacology. It is mainly used clinically for the treatment of "cold pain in the abdomen, cold clotting in the menstrual channels, cold infertility in the uterus, fetal movement, vomiting blood, epistaxis, pus and blood dysentery, and external treatment of itchy skin" and other symptoms. This paper reviews the research on the biological activity and chemical composition of A. argyi by scholars in recent decades. [ABSTRACT FROM AUTHOR]

Objectives: Epistaxis among children is considered a scary issue for both the child and the parents. In Saudi Arabia, one third of children suffer from epistaxis. In our study, we aimed to assess the level of knowledge among parents regarding first-aid management of epistaxis in Taif city, Saudi Arabia. Method: We carried out a descriptive cross-sectional study among parents who visited Alhada Armed Forces Hospital and Prince Mansour Military Hospital between May 2022 and July 2022 in Taif, Saudi Arabia. A questionnaire with 17 questions was distributed among the participants. We excluded parents with children who were older than 18 years. Results: A total of 502 parents were included in the study. About two thirds (67.5%) of parents had a moderate level of knowledge and around one third (30.9%) showed a good level of knowledge regarding epistaxis first aid. Furthermore, higher knowledge scores were found among parents who had epistaxis previously (P = 0.026), who attended a course on first aid (P = 0.002), and who were aged more than 35 years (P = 0.017). Conclusion: Our study demonstrated that most Saudi parents had a moderate level of knowledge regarding first-aid management of epistaxis. Additionally, several factors, such as the number of children, age, those attending first-aid courses, and experience treating others with epistaxis, were associated with the level of knowledge among parents. Further larger studies are required among Saudi parents to examine the knowledge, practice, and related factors regarding first-aid management of epistaxis. [ABSTRACT FROM AUTHOR]

Objectives: To describe management, and to assess factors associated with antithrombotic prescription thereafter in patients who had epistaxis referred to emergency department (ED). Design: Prospective cohort study. From EDs, clinical, biological and hospital data were collected. The clinical database was linked to the French Health Insurance Database where we retrieved antithrombotic drug deliveries in a 3‐month period before and after referral. Setting: Multicentric population‐based cohort study within five well‐defined areas. Participants: We considered 306 patients referred for epistaxis with a stable oral antithrombotic regimen before referral. Main Outcome Measures: We considered management, hospital outcome and case fatality. Antithrombotic prescription in a 3‐month follow‐up period was categorised into three classes: no change, class change, or discontinuation. During follow‐up, hospitalisation for epistaxis or ischaemic events was searched. Results: Among 306 adult individuals (mean age: 76 years), 166 took oral anticoagulant and 140 an antiplatelet drug. Blood transfusion was needed in 13.7% of patients and anterior packing alone in 61%. Half of the patients were hospitalised; 301 were discharged alive. Considering antithrombotic prescription thereafter we observed no change in 219 patients (72.8%), class changes in 47 patients (15.6%) and discontinuation in 35 patients (11.6%). We identified four independent predictors for antithrombotic prescription: hospitalisation (vs. returning home, p =.05), age (p =.03), haemoglobin level (p =.03) and oral anticoagulant (vs. antiplatelet agent, p <.001). During the 3 months following discharge, 2 thrombotic and 15 bleeding events were identified. Conclusions: Epistaxis referred to emergency department had an impact on subsequent antithrombotic prescription. Clinical Trial Registration: Clinical Trials.gov identifier: NCT02886533. [ABSTRACT FROM AUTHOR]

Introduction: Unilateral nasal obstruction is a common complaint with a broad differential diagnosis that includes anatomic asymmetry, unilateral infective or inflammatory conditions, and benign and malignant sinonasal masses. A rhinolith is an uncommon foreign body in the nose, which serves as a nidus for calcium salt deposition. The foreign body can be endogenous or exogenous in origin and may remain asymptomatic for many years before incidental discovery. When left untreated, stones may cause unilateral nasal obstruction, rhinorrhea, nasal discharge, epistaxis or, in rare cases, progressive destruction leading to septal/palatal perforation or oro-antral fistula. Surgical removal is an effective intervention with limited complications reported. Case Report: This article describes a 34-year-old male who presented to the emergency department (ED) with unilateral obstructing nasal mass and epistaxis, which was found to be an iatrogenic rhinolith. Successful surgical removal was performed. Conclusion: Epistaxis and nasal obstruction are common presentations to the ED. Rhinolith is an uncommon clinical etiology that if left undiagnosed may lead to progressive destructive disease; it should be included in the differential for any unilateral nasal symptoms of unclear origin. Appropriate work-up for any suspected rhinolith includes computed tomography, as biopsy is risky given the broad differential of unilateral nasal mass. When identified, surgical removal has a high success rate with limited complications reported. [ABSTRACT FROM AUTHOR]

Simple Summary: Epistaxis (bleeding from the nostrils) can be caused by exercise-induced pulmonary hemorrhage (EIPH) in Thoroughbred racehorses. EIPH is a common disease in racehorses and 55–75% of horses experience EIPH after racing. In addition, horses with severe EIPH are likely to have poor performance compared to horses without EIPH. The risk factors have been surveyed by several reports, but the results may vary. This retrospective study aimed to identify the risk factors for epistaxis in Japanese flat races between April and September, from 2001 to 2020. Nine factors were significantly associated with epistaxis, including racecourse, body weight, ambient temperature, age, sex, surface condition, racing distance, training center, and race year. While 7 of the factors have been considered in previous studies, we have confirmed that the location of the racecourse and a higher body weight can affect the incidence of epistaxis. We investigated the risk factors for epistaxis in Japanese flat races over a 20-year period. The veterinary records of horses identified as having epistaxis by endoscopy on the race day, and the official racing records of all flat races from April to September between 2001 and 2020, were reviewed. The racecourses (n = 10), surface type, surface condition, race class, race distance, race year, sex, age, two training centers, ambient temperature, and body weight on race days were assessed using multivariable logistic regression (p < 0.05). Of 475,709 race starts, 616 (1.30 cases per 1000 starts; 95% confidence interval [CI], 1.20–1.40) included an epistaxis event. Nine variables were significantly associated with epistaxis. Seven of the variables have been reported in previous studies: lower ambient temperature, soft surface conditions, shorter racing distances (≤1400 m), increasing age, females and geldings compared to males, training center, and race year. However, two novel variables were identified as significantly associated with epistaxis, increasing body weight per 20 kg (p < 0.001, odds ratio [OR], 1.33; 95% CI, 1.25–1.41) and the racecourses that the horses were running at (p < 0.001, especially Sapporo [OR; 4.74, 95% CI, 3.07–7.31], Hakodate [OR, 4.66; 95% CI, 3.05–7.11], and Kokura [OR, 4.14; 95% CI, 2.65–6.48] compared to the reference racecourse [Kyoto]). These results can facilitate developing interventions to reduce epistaxis in flat racing. [ABSTRACT FROM AUTHOR]

Introduction: Aneurysmal bone cysts (ABCs) are a rare benign bone lesion, which are divided into primary and secondary categories, and occur mainly in the vertebra and the long tubular bones. Primary ABCs in the nasal cavity and the sinuses are rare. Case presentation: We reported on a one-year-old boy who suffered from progressive nasal obstruction and intermittent nosebleeds over a period of approximately 1 month. The patient had no history of trauma or surgery. Physical examination showed a red tumor in his right nasal cavity. A magnetic resonance imaging scan showed a multicystic lesion arising from the ethmoid sinus. The lesion was resected under a nasal endoscope without any complications. Histological evaluation confirmed that the lesion was an aneurysmal bone cyst. Because an osteoma was found during the surgery on the cyst, the lesion was considered secondary clinically. However, fluorescence in situ hybridization testing showed a rearrangement of the USP6 (ubiquitin-specific protease 6) oncogene on chromosome 17. No recurrence was observed after 1 year. Conclusion: An ABC of the nasal cavity and sinuses in such a young child is very rare and needs to be further analyzed according to postoperative pathology and combined with a genetic examination to make a diagnosis. Endoscopic sinus surgery is an effective method of treatment for this kind of disease. [ABSTRACT FROM AUTHOR]

Objective: To find out the incidence, characteristics and laboratory parameters of epistaxis in children with β-thalassemia major visiting a tertiary healthcare facility of South Punjab, Pakistan. Study Design: Retrospective study. Setting: Department of Hematological Diseases, Thalassemia and Bone Marrow Transplantation Centre, and Department of Biochemistry, Bahawal Victoria Hospital, Quaid e Azam Medical College, Bahawalpur, Pakistan. Period: January 2021 to November 2022. Material & Methods: The hospital record of children of both genders aged from 2 to 18 years of age with blood transfusion dependent β-thalassemia was analyzed. Children reporting at least 1 episode of epistaxis in the preceding period were included in the final analysis to find out the incidence, characteristics and laboratory findings of children presenting with of epistaxis. Results: Out of 3772 children with β-thalassemia major, 85 reported at least 1 episode of epistaxis showing the incidence of epistaxis as 22.5/1,000 cases of β-thalassemia major. The mean age of the children at the time of enrollment and at the time of diagnosis of thalassemia was 9.93±3.48 years and 1.23±1.26 years respectively. The mean monthly frequency of blood transfusion was 1.71±0.75 blood transfusions per month. The mean monthly epistaxis frequency was reported to be 2.35±1.71 while 59 (69.4%) children had 2 or more than 2 monthly episodes of epistaxis. The mean serum ferritin level was noted to be 4058±2173 ng/ml. Ultrasonography findings revealed mean spleen size to be 9.25±5.80 cm. Conclusion: The incidence of epistaxis episodes among children with β-thalassemia was very high. Chronic iron-overload seemed to be common abnormality among children with β-thalassemia that should be addressed to potentially reduce the risk of epistaxis among these children. [ABSTRACT FROM AUTHOR]

Background: Endovascular embolization (EE) is a treatment option for epistaxis refractory to first-line interventions. Data regarding embolization is limited to small case series and a meta-analysis has not been performed. Methods: PubMed, Scopus, and EMBASE were used to identify studies that reported outcomes for at least 10 patients undergoing EE for epistaxis. Outcomes included procedural success, rebleeding, and complications. Pooled rates for each outcome were obtained with random effects models. Results: A total of 44 studies comprising 1664 patients met the inclusion criteria. The mean age ranged from 28.1 to 67 years and there were 28.4% females. The pooled procedural success rate was 87% (95% CI 83.9–89.6, I 2 = 53%). Age (OR 0.95, 95% CI 0.91–1) and hereditary hemorrhagic telangiectasia ([HHT], OR 0.97, 95% CI 0.96–0.99) were associated with decreased odds of success. The pooled rebleeding rate was 16.4% (95% CI 13.6–19.6, I 2 = 48%), and HHT was associated with greater odds of rebleeding (OR 1.02, 95% CI 1–1.03). The pooled overall complication rate was 14.4% (95% CI 9.8–20.6, I 2 = 85.8%). The pooled rates of stroke and vision loss were 2.1% (95% CI 1.5–3.1, I 2 = 1.5%) and 1.8% (95% CI 1.2–2.6, I 2 = 0%), respectively. Conclusion: EE for epistaxis has a high rate of procedural success. Interventionalists should be aware of the risk for rebleeding, especially among patients with HHT. [ABSTRACT FROM AUTHOR]

Recurrent epistaxis represents an alarming sign that may suggest a sinister aetiology, especially in patients with previous head and neck malignancy. The recognition of certain potentially life-threatening conditions, namely pseudoaneurysm or tumour recurrence, remains prudence to avoid disastrous repercussion. Nasal endoscopy has become an essential tool in otolaryngology. It can aid identify the underlying cause of epistasis and facilitate therapeutic management. On the other hand, radio imaging is highly sensitive in detecting vascular lesions, besides providing a pre-operative mapping if surgical intervention is planned. This paper reported a patient with sphenoidal sinus squamous cell carcinoma in remission presented with torrential epistaxis not relieved with nasal packing. Despite a repeated angiogram and magnetic resonance image, the identification of the source of bleeding remained futile, culminating in an examination under general anaesthesia. The diagnosis of carotid blowout syndrome was made intraoperatively, and the bleeding was temporarily secured with a muscular patch, preceded by the insertion of a vascular stent. The authors wish to highlight the importance of examination under general anaesthesia if radio imaging does not correlate to the clinical findings. Management options for carotid blowout should be tailored to the patients' medical conditions. [ABSTRACT FROM AUTHOR]

Objective: We report four cases of migraine induced epistaxis and reviewed the published literature of migraine with epistaxis to establish demographic profiles, types of migraine, severity, family history of headache and other associated disorders in adults. Methods: A panoramic search of the Medline database through Pubmed was done in May 2022 using search terms: {Migraine with Epistaxis}, case reports. All articles/case reports in English from January 2001 to April 2022 where age of patients was > 18 years were included in our review. Results: Our search recognized total of three cases and with inclusion of the four cases who reported to us, we reviewed these seven cases and studied demographic profile, clinical features, association of epistaxis with types and severity of migraine and relationship with other medical disorders. Mean age of presentation was 28.7 years (range 18–49), with five female and two male patients. The intensity of headache was severe in three of seven cases and there was one case each of moderate and mild category. Five of seven (71%) patients had reduction in intensity of headache with onset of bleeding and various types of migraine (Migraine with and without Aura, vestibular migraine, sporadic familial hemiplegic migraine) according to ICHD classification were associated with epistaxis. Four of seven had positive family history of migraine. There was no diagnostic finding in any patient and all patients responded to migraine preventive medication. Conclusion: Recurrent epistaxis is not so uncommon manifestation of various types of migraine and specialist should keep this clinical diagnosis in mind to avoid misdiagnosis. [ABSTRACT FROM AUTHOR]

Epistaxis or bleeding from nose, a commonly confronted condition in the department of otorhinolaryngology can be a disquietening experience and sometimes a life threatening emergency for the patient. The aim of this study is to study the clinical profile and aetiology in epistaxis patients. An observational prospective study carried out over a period of 12 months in the Department of Otorhinolaryngology, Head and Neck Surgery, Swami Rama Himalayan University, Swami Ram Nagar, Dehradun, Uttarakhand. A total of 104 patients of all age groups and gender presenting with epistaxis were included in the study. Males formed majority of the patients (68.27%) as compared to female patients (31.73%). Most of the patients were in the age group of 51–70 years with majority being farmers (30.77%). The finding of variation with age was statistically significant (p < 0.05) with most patients in the age group of 51–60 years presenting in winter season. Local causes were observed to be more common (50.96%) among which trauma was the predominant cause (23.08%). Systemic causes formed 37.58% of cases, out of which hypertension was the commonest cause. In our study, non-surgical measures were most commonly employed treatment modality (85.58%) among which medical management was done in most patients. Trauma and hypertension contributed to the majority of patients presenting with epistaxis in our study with cold, dry winter months associated with increased incidence of epistaxis. [ABSTRACT FROM AUTHOR]

Hereditary haemorrhagic telangiectasia, also known as Rendu–Osler–Weber disease, is an autosomal dominant disorder of the fibrovascular tissue common in Western countries. It is characterized by the classical triad of mucocutaneous telangiectasia, arteriovenous malformations with recurrent epistaxis. Here we report a rare case of Hereditary haemorrhagic telangiectasia in a 66-year-old Indian male who presented with a history of recurrent epistaxis of forty years duration. The nasal telangiectasias were ablated under narrow band imaging guidance. The rarity of diagnosis was aided by clinical exome sequencing to confirm the disease. [ABSTRACT FROM AUTHOR]

Purpose: Epistaxis is a common symptom and can be caused by various diseases, including nasal diseases, systemic diseases, etc. Many misdiagnosis and missed diagnosis of epistaxis are caused by lack of clinical knowledge and experience, especially some interns and the clinicans in primary hospitals. To help inexperienced clinicans improve their diagnostic accuracies of epistaxis, a computer-aided diagnostic system based on Dynamic Uncertain Causality Graph (DUCG) was designed in this study. Methods: We build a visual epistaxis knowledge base based on medical experts' knowledge and experience. The knowledge base intuitively expresses the causal relationship among diseases, risk factors, symptoms, signs, laboratory checks, and image examinations. The DUCG inference algorithm well addresses the patients' clinical information with the knowledge base to deduce the currently suspected diseases and calculate the probability of each suspected disease. Result: The model can differentially diagnose 24 diseases with epistaxis as the chief complaint. A third-party verification was performed, and the total diagnostic precision was 97.81%. In addition, the DUCG-based diagnostic model was applied in Jiaozhou city and Zhongxian county, China, covering hundreds of primary hospitals and clinics. So far, the clinicians using the model have all agreed with the diagnostic results. The 432 real-world application cases show that this model is good for the differential diagnoses of epistaxis. Conclusion: The results show that the DUCG-based epistaxis diagnosis model has high diagnostic accuracy. It can assist primary clinicians in completing the differential diagnosis of epistaxis and can be accepted by clinicians. [ABSTRACT FROM AUTHOR]

Objectives: Epistaxis is the most common otolaryngological emergency and one-third of epistaxis patients regularly take low-dose acetylsalicylic acid (ASA) for the prevention of cardiovascular disease (CVD). The shift in contemporary guidelines identifies little benefit of ASA intake in patients who have not previously had an infarction. Existing evidence confirms ASA intake as a factor for severe epistaxis, while the evidence concerning its impact on recurrence is ambiguous. There are no available studies which justify the administration of these drugs nor are there any studies correlating the effects of these drugs to the SCORE2 CVD risk stratifying scale. Study design: A retrospective analysis of all admitted epistaxis patients in a tertiary academic hospital for the 10 year period 2011 to 2021. Methods: Patient data were analysed using the hospital information software. A recurrence was defined as an epistaxis episode requiring hospital readmittance for at least one night. Patients taking anticoagulants were excluded (N = 421). Results: 444 patients were included: 246 were taking ASA and 198 were not (NoASA). ASA patients had more frequent recurrence in general (p = 0.03), more recurrences per patient (p = 0.002), and more changes in bleeding localisation (p = 0.04). Recurrence in the ASA group was associated with lower haemoglobin values (HR 0.62, p < 0.0001), while surgery (HR 6.83, p < 0.0001) was associated with recurrence in the NoASA group. ASA patients had a statistically significant (r 0.33, p = 0.032) correlation between the total number of epistaxis recurrences and SCORE2. The indication for drug intake was highly questionable in as much as 40% of ASA patients. Follow-up time was 5.27 years. Conclusions: Epistaxis patients taking prophylactic ASA are significantly more burdened by recurrence, because they have more frequent recurrences, a greater number of recurrences per patient, and more changes in bleeding localisations when compared to control patients. The drug indication is questionable in up to 40% of ASA patients, exposing them unnecessarily to recurrence. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

Leeches are rare cause of foreign body in airways. A 23-year-old male, experiencing epistaxis and difficulty in swallowing is presented. During nasopharyngoscopy, a moving leech was observed on the nasopharynx posterior wall in midline location, and removal of the leech was decided under general anaesthesia. The flexible nasopharyngoscopy was inserted, but removal was unsuccessful due to the leech's movements. Leeches are blood-sucking parasites, so neuromuscular blocking agent was given to prevent the movement. After administration, motion of the leech was lost and easily removed undamaged. In patients presenting with unexplained epistaxis, hemoptysis, dyspnea, and foreign body sensation in the airway, leech infestation should be included as the differential diagnosis and history of contact with stream water should be questioned. We concluded that use of low dose neuromuscular blocking agents facilitates the gentle removal, and could be necessary for successful management of removal of leech under general anaesthesia. [ABSTRACT FROM AUTHOR]

Background: Epistaxis can be life-threatening. Simple first aid management can stem bleeding. This study compared knowledge of first aid management methods of epistaxis between the general public and healthcare workers. Method: A cross-sectional study of 100 healthcare workers and 103 adult members of the public was conducted at a large London teaching hospital. Respondents completed a survey assessing knowledge on nasal pinching site, head tilt and appropriate adjunct treatment use for first aid management of epistaxis. Results: Twenty-four per cent and 68 per cent of healthcare workers compared with 25.2 per cent and 37.9 per cent of the public answered correctly on nasal pinching position and head tilt position, respectively, with a statistical difference for head tilt position. Two per cent, 2 per cent and 24 per cent of healthcare workers mentioned ice use on the nose, ice use in the mouth or ice use but not site, respectively, compared with 0 per cent, 0 per cent and 4.9 per cent of the public, with a statistical difference for ice without site. Conclusion: Healthcare workers and the public lack knowledge on first aid management of epistaxis. Improved education on first aid management is required, targeting healthcare workers and the public. [ABSTRACT FROM AUTHOR]

BACKGROUND: Rare bleeding disorder (RBDs) encompasses a deficiency of one or more of FXIII, FXI, FX, FVII, FV, FII, and FI clotting factors, leading to bleeding disorders with variable presentations and outcomes ranging from none or minimal to life-threatening events. RBDs are still underdiagnosed and underreported, especially in Saudi population with a high prevalence of consanguinity. OBJECTIVES: The study aimed to determine the frequency of RBDs, grading of their bleeding severity, and assessment of clinical manifestations and management of RBDs in tertiary Saudi Arabian hospitals. DESIGN AND SETTINGS: This retrospective study of RBDs describes the clinicopathological features of refereed cases to both Prince Sultan Military Medical City and King Khaled University Hospital in Riyadh, Saudi Arabia, from September 2018 to September 2021. Any patient who had already been diagnosed or suspected to have RBDs was enrolled in the study. PATIENTS AND METHODS: Patient's medical records were reviewed for demographic data, clinical presentations, bleeding and family history, consanguinity, treatment outcomes, and molecular testing. Samples were run in specialized coagulation laboratories. Patients with liver dysfunction or acquired factor deficiency were excluded. Patients were categorized into four groups according to the severity of bleeding episodes: asymptomatic, Grade I, Grade II, and Grade III. RESULTS: A total of 26 cases with RBDs were identified during the study period. Most of the included patients are males and pediatrics (<14 years) representing 15 (57.7%) and 14 (53.8%), respectively. FVII was the most common factor deficiency encountered in 9 (35%) patients, followed by FXIII in 5 (19%), FXI in 4 (15%), FX in 3 (11.5%), FV in 3 (11.5%), and combined factor deficiency in 2 (8%) patients. 17 (65.4%) RBD patients presented with bleeding manifestation either with Grade I (9%), Grade II (39%), or Grade III (15%), whereas 47% were asymptomatic. CONCLUSION: The study emphasizes on importance of establishing a national registry of RBDs in Saudi Arabia and the need for further genetic studies to clarify the genotype/phenotype relationships. [ABSTRACT FROM AUTHOR]