AYURVEDA MANAGEMENT IN EPISTAXIS DURING PREGNANCY: A CASE REPORT

Epistaxis refers to nasal bleed or haemorrhage from nose. Few cases of epistaxis, not associated with nasal lesions or clotting disorders, were described in literature. Pregnancy exaggerates the prevalence of epistaxis in pregnant women compared with non-pregnant women. In many cases epistaxis with minimal nasal bleeding is self-limiting but during pregnancy it should be taken at most care to treat immediately because of its unpredictable complications. Raktapitta (haemorrhage disorders) is a bleeding disorder were in Rakta (blood) which is vitiated by Pitta flows out through all orifices of body. The vitiated Pitta and Rakta due to their Ushna (hot) and Drava(liquid) property moves upwards or downwards and bleeding occurs through all the external orifices. If the bleeding occurs through nose, then it is known as Nasagata Rakta Pitta (epi-staxis). Durva Swarasa (Cynodon dactylion) and Dadima Pushpa Swarasa (punica granatam) explained in Charaka Samhita with reference to Rakta Pitta Chikista is selected as treatment modality in this study.

Foreign Body Nose: An Unusual Presentation

Introduction This is a very interesting case of retained homicidal foreign body in the nose in contrast to most of the foreign bodies which are accidental. Case Report A 27 year old male presented to ENT emergency with alleged history of assault over face with sharp object following which patient developed nasal bleed. On examination vertical laceration of approximately 8 cm in length was present along left naso-orbital groove extending superiorly from medial canthus of left eye and inferiorly to nasal alar cartilage. On anterior rhinoscopy a metallic foreign body was seen in both nasal cavities, which appeared to be crossing from left to right side piercing the nasal septum. Foreign body was removed via open approach. Discussion Penetrating maxillofacial injury with foreign body impaction are less common. High index of suspicion is required in diagnosing these cases. Radiological intervention should be done to get idea of exact location and extent of foreign body. Lateral rhinotomy is a useful approach in removing these foreign bodies.

Nasal Schwannoma

Introduction A schwannoma is a benign nerve sheath tumuor of myelinated nerves arising from Schwann cells. In the head and neck region, the most common site is the eighth cranial nerve (vestibulocochlear). Only 4% of schwannomas seen in the head and neck region arise from the nose and paranasal sinuses involving branches of the trigeminal nerve (ophthalmic or maxillary) or from the autonomic nervous system. Case Report A 29 year old female patient presented to the Ear, Nose and Throat Out Patient Department with the complaints of left sided nasal obstruction and left sided nasal bleed. On anterior rhinoscopy, a single, smooth, greyish, non-pulsatile polypoidal mass was seen in the left nasal cavity seeming to be arising medial to middle turbinate. A provisional diagnosis of benign nasal mass was made and the patient underwent excision under general anaesthesia. On histopathology, an impression of Schwannoma was made. Discussion Sino-nasal schwannomas are a very rare entity with non specific imaging studies. A confirmatory diagnosis can be made only after histopathology. The treatment modality of choice is surgical excision of the mass, taking care to leave no residual, so as to prevent a recurrence.

Multiple Viral Co-infections in a Pediatric Patient of Acute Encephalitis Syndrome (AES) - An Unique Case Report

The occurrence of viral co-infection is always a challenging issue in pediatrics which indicates underestimation of causal viral pathogens. A 6-year-old girl child from Patna had diagnosed a rare case of multi-viral co-infection in February 2020. She was manifested with oblivion along with high-grade fever, weakness, nasal bleed, headache, and body ache. She had altered sensorium with mildly dilated pupils. Her three classical meningeal sign i.e. Kernig's sign, Brudzinski's sign, and nuchal rigidity were found positive. She clinically investigated with a strong suspicion of viral infectivity. Awfully, she was diagnosed with multi-viral co-infection including Japanese Encephalitis, Dengue, Chikungunya, Cytomegalovirus, and Rubella where as HSV and VZV detected borderline. The IgM detection for JE using the CSF sample was found equivocal. The infection was also confirmed by CECT brain scanning. She got proper medication including antiemetic, antipyretic, antiepileptic drugs, antibiotics, anti-viral drugs, and 20% Mannitol for reducing the intra cranial pressure. After medication under proper clinical supervision, she improved completely with any seizures and viral infections. She advised for follow-up after a month. Such occurrences of multi-viral co-infections deserve proper attention and awareness among the healthcare experts about the severity of drugs.

Successful Treatment of Mucosal Bleeding with Tranexamic Acid in Pediatric Patients with Hemostatic Disorders

Objects Hemostatic disorders, including thrombocytopenia and/or coagulation disorders, sometimes cause mucosal bleeding and/or bleeding risks. In some cases, severe mucosal bleeds cannot be adequately controlled by standard therapy. Tranexamic acid (TA) is used in preventing and reducing bleeding in such medical settings. But there is little information on useful TA management of mucosal bleeding in hemostatic disorders. Materials and Methods 4 patients with ITP, 2 hemophilia A patients and one VWD patient were treated with TA (1.5 - 3.0 g/day ) due to recognizable mucosal bleeding. 2 patients were under regular treatment for ITP. The remaining 2 patients with ITP did not require additional therapy. 2 hemophilia A patients were mild case and require on demand therapy of FVIII concentrates. VWD patient did not require any therapy with no mucosal bleeds. Results One of the ITP patients were suffering from frequent nasal bleeding and kept her away from school for 1.5 years. She had been going back to school without limitation of physical activity in spite of low PLT count. Remaining 3 patient of ITP who was suffering from frequent nasal bleeds had been managed with TA ( 1.5 g/day ). 2 hemophilia patients who were experienced oral mucosal bleed after tooth extraction were successfully managed with TA ( 1.5 g/day ). VWD patient who were suffering from frequent nasal bleed were ceased after initiation of TA. Conclusions Cessation or, at least significant improvement of bleeding was achieved shortly after initiation of TA in all cases. TA was well tolerated and discontinued after cessation of bleeding. We recommend the use of TA in hemostatic disorder patients with bleeding and/or an increased bleeding risk. Ultimately, cessation of bleeding plays a key role in the QOL improvement of such affected patients. However, future studies are required to optimize dose and administration routes (intravenous or oral). Disclosures No relevant conflicts of interest to declare.

Epistaxis in children: a clinical study

<p class="abstract"><strong>Background:</strong> Epistaxis is a common condition among children. Most cases are due to vascular fragility in the nasal vestibule aggravated by digital trauma. Epistaxis is rare below 2 years. 30% of children of all children between 0-5 years, 56% aged between 6-10 years, 64% of those aged between 11-15 years have had at least 1 episode of epistaxis in their lifetime.</p><p class="abstract"><strong>Methods:</strong> A retrospective analysis was done on 56 patients of nasal bleed, at Institute of child health and Hospital for children / Madras Medical College, Chennai, between June 2015 - June 2016. The records of children were analysed. All the patients under went blood investigation. The statistical analysis was done for the age group. </p><p class="abstract"><strong>Results:</strong> There were 56 cases of nasal bleed enrolled in our study, out of which 35 were boys and 21 girls. The most common age group was between 6-10 years accounting for 27 cases. In laterality of nasal bleed right side was common. The most common site in nostril noted was from little’s area of nasal septum in 27 cases. The most common cause was idiopathic in 15 cases. Most of the cases were managed conservatively.</p><p class="abstract"><strong>Conclusions:</strong> Epistaxis is a common clinical condition among the paediatric age group. In all cases, ENT examination should be done to rule out nasal pathology or foreign body in nasal cavity and haematology workup is necessary. Majority of nasal bleed stops with digital pressure.</p>

Epistaxis: etiological profile and treatment outcome in a teaching hospital in South India

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Epistaxis is the most common otorhinolaryngological emergency worldwide. Minor bleeding episodes occur more frequently in children and adolescents, whereas severe bleed requiring otolaryngologic intervention often occur in older individuals. Treatment options can be conservative or surgical, the selection of which should be made considering the parameters: efficiency, complications, and cost-benefit. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This was a prospective study done in 131 patients with epistaxis, in the Department of ENT, Government Medical College, Trivandrum, with the aim to determine the etiology and the outcome of the conservative and surgical management. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The most common causes of epistaxis were trauma and hypertension. The age incidence increased after forty years and majority had unilateral, anterior nasal, mild-moderate bleed. 79% of the cases were managed by conservative measures as opposed to only 21% who required surgical intervention. Success rate of anterior nasal pack and cauterisation of bleeding point was nearly 84%. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Majority of cases of epistaxis can be successfully managed by conservative measures and surgical intervention may not be necessary in most cases. Cauterization of bleeding point is the best conservative method which can be offered to the patient though anterior nasal packing still remains the most preferred method to control the bleed. The most common causes of epistaxis being trauma and hypertension, reducing road traffic accidents and lifestyle illness can reduce the incidence of nasal bleed.</span></p>