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Background: The mainstay of management of epistaxis refractory to first aid and cautery is intranasal packing. This review aimed to identify evidence surrounding nasal pack use. Method: A systematic review of the literature was performed using standardised methodology. Results: Twenty-seven eligible articles were identified relating to non-dissolvable packs and nine to dissolvable packs. Nasal packing appears to be more effective when applied by trained professionals. For non-dissolvable packs, the re-bleed rates for Rapid Rhino and Merocel were similar, but were higher with bismuth iodoform paraffin paste packing. Rapid Rhino packs were the most tolerated non-dissolvable packs. Evidence indicates that 96 per cent of re-bleeding occurs within the first 4 hours after nasal pack removal. Limited evidence suggests that dissolvable packs are effective and well tolerated by patients. There was a lack of evidence relating to: the duration of pack use, the economic effects of pack choice and the appropriate care setting for non- dissolvable packs. Conclusion: Rapid Rhino packs are the best tolerated, with efficacy equivalent to nasal tampons. FloSeal is easy to use, causes less discomfort and may be superior to Merocel in anterior epistaxis cases. There is no strong evidence to support prophylactic antibiotic use. [ABSTRACT FROM AUTHOR]

Introduction: The association between hormonal contraceptive use and bone mineral density remains controversial. Hypothesis: Hormonal contraceptive use is positively associated with bone mass in young premenopausal women. Methods: Cross-sectional analysis of data collected from women aged 26-36 years ( n = 687) in the Childhood Determinants of Adult Health study-a longitudinal study investigating childhood determinants of cardiovascular disease, diabetes, and other chronic diseases in adulthood. Participants were not currently pregnant or breast-feeding. Contraceptive use was obtained by self-administered questionnaire. Women were categorized as combined oral contraceptive users ( n = 219), progestogen-only contraceptive users ( n = 43), and non-users of hormonal contraceptives ( n = 425). Bone mass was measured by quantitative ultrasound. Results: Compared with women who were not using any hormonal contraceptives, women using combined oral contraceptives had significantly higher values of broadband ultrasound attenuation (BUA), speed of sound, and quantitative ultrasound index. These associations remained after adjustment for confounders. Progestogen-only contraceptive users had higher BUA than non-users, but the differences were not statistically significant in this small group. Conclusion: Combined oral contraceptive use was associated with higher bone mass measured by quantitative ultrasound in this population-based sample of premenopausal women aged 26-36 while progestogen-only contraceptives appeared to have no deleterious effect on bone mass. [ABSTRACT FROM AUTHOR]