These blood vessels include the sphenopalatine, anterior and posterior ethmoidal arteries. More rarely the maxillary or a branch of the external carotid artery can be ligated. The bleeding can also be stopped by intra-arterial embolization using a catheter placed in the groin and threaded up the aorta to the bleeding vessel by an interventional radiologist. There is no difference in outcomes between embolization and ligation as treatment options, but embolization is considerably more expensive. Continued bleeding may be an indication of more serious underlying conditions. Other
The utility of local cooling of the head and neck is controversial. Some state that applying ice to the nose or forehead is not useful. Others feel that it may promote vasoconstriction of the nasal blood vessels and thus be useful. In Indonesian traditional medicine, betel leaf is used to stop nosebleed as it contains tannin which causes blood to coagulate, thus stopping active bleeding. Society and culture
In the visual language of Japanese manga and anime, nosebleeding often indicates that the bleeding person is sexually aroused. In Western fiction, nosebleeds often signify intense mental focus or effort, particularly during the use of psychic powers.In American and Canadian usage, "nosebleed section" and "nosebleed seats" are common slang for seating at sporting or other spectator events that are the highest up and farthest away from the event. The reference alludes to the propensity for nasal hemorrhage at high altitudes, usually owing to lower barometric pressure.
This ADP-ribosylation involves the transfer of an ADP-ribose from NAD+ to a diphthamide (a modified histidine) residue within the EF-2 protein. Since EF-2 is needed for the moving of tRNA from the A-site to the P-site of the ribosome during protein translation, ADP-ribosylation of EF-2 prevents protein synthesis.ADP-ribosylation of EF-2 is reversed by giving high doses of nicotinamide (a form of vitamin B3), since this is one of the reactions end products, and high amounts drive the reaction in the opposite direction. Diagnosis
The current clinical case definition of diphtheria used by the United States Centers for Disease Control and Prevention  is based on both laboratory and clinical criteria. Laboratory criteria
Isolation of C. diphtheriae from a Gram stain or throat culture from a clinical specimen,
Histopathologic diagnosis of diphtheria by Alberts stain

Toxin demonstration
In vivo tests (guinea pig inoculation): Subcutaneous and intracutaneous tests
In vitro test: Eleks gel precipitation test, detection of tox gene by PCR, ELISA, ICA

Clinical criteria
Upper respiratory tract illness with sore throat
Low-grade fever (above 39 °C (102 °F) is rare)
An adherent, dense, grey pseudomembrane covering the posterior aspect of the pharynx: in severe cases, it can extend to cover the entire tracheobronchial tree. Case classification
Probable: a clinically compatible case that is not laboratory-confirmed and is not epidemiologically linked to a laboratory-confirmed case
Confirmed: a clinically compatible case that is either laboratory-confirmed or epidemiologically linked to a laboratory-confirmed caseEmpirical treatment should generally be started in a patient in whom suspicion of diphtheria is high.