Clinical factors predicting rotavirus diarrhea in children:A crosssectional study from two hospitals

BACKGROUND Rotavirus is still a significant contributing morbidity and mortality in pediatric patients.AIM To look at clinical signs and symptoms and laboratory findings that can predict rotavirus gastroenteritis compared to non-rotavirus gastroenteritis.METHODS This was a cross-sectional study with medical records obtained from December 2015 to December 2019.Inclusion criteria for this study include all hospitalised pediatric patients(0-18 years old)diagnosed with suspected rotavirus diarrhea.The receiver operating curve and Hosmer-Lemeshow test would be used to assess the final prediction findings'calibration(goodness of fit)and discrimination performance.RESULTS This study included 267 participants with 187(70%)rotavirus-diarrhea cases.The patients were primarily male in both rotavirus(65.2%)and non-rotavirus(62.5%)groups.The median age is 1.33 years old(0.08-17.67 years old).Multivariate analysis shows that wet season(OR_(adj)=2.5;95%CI:1.3-4.8,Padj=0.006),length of stay(LOS)≥3 days(OR_(adj)=5.1;95%CI:1.4-4.8,Padj=0.015),presence of abdominal pain(OR_(adj)=3.0;95%CI:1.3-6.8,Padj=0.007),severe dehydration(OR_(adj)=2.9;95%CI:1.1-7.9,Padj=0.034),abnormal white blood cell counts(OR_(adj)=2.8;95%CI:1.3-6.0,Padj=0.006),abnormal random blood glucose(OR_(adj)=2.3;95%CI:1.2-4.4,Padj=0.018)and presence of fecal leukocytes(OR_(adj)=4.1,95%CI:1.7-9.5,Padj=0.001)are predictors of rotavirus diarrhea.The area under the curve for this model is 0.819(95%CI:0.746-0.878,P value<0.001),which shows that this model has good discrimination.CONCLUSION Wet season,LOS≥3 d,presence of abdominal pain,severe dehydration,abnormal white blood cell counts,abnormal random blood glucose,and presence of fecal leukocytes predict rotavirus diarrhea.

Systematic review of hematidrosis: Time for clinicians to recognize this entity

BACKGROUND Hematidrosis is a sporadic disease,to a point where its existence is still denied up to date.It is also linked to stigmata,psychological roots,and religious beliefs,whih has strengthened clinicians'disbelief in hematidrosis.AIM To conduct a thorough review to classify the likelihood of hematidrosis cases.METHODS We searched PubMed,Science Direct,Medline,and Google Scholar,as well as four different preprint databases,including Medrxiv,Research Square,SSRN,and Biorxiv.We included studies from 1996 onwards,with no limitation on language.Hematidrosis was classified as"unlikely","likely",and"highly likely".RESULTS There are 74 articles with 106 hematidrosis cases.India(n=40)and China(n=11)report the most cases.Patients are mostly female(76.5%)with a median age of 13 years.The head region is the most common bleeding site(n=168/254).Headaches(26.9%)and abdominal pain(16.4%)are the most common prodromes.Beta-blockers(43%)and anxiolytic(23.2%)are the most commonly prescribed pharmacotherapy.Psychotherapy(37.5%)and counseling(32.5%)are the most utilized non-pharmacotherapy measures.Only 41.1%and 19.8%of all cases reach complete resolution and are highly likely to be hematidrosis,respectively.CONCLUSION Although hematidrosis is rare and the pathophysiology is still largely unknown,that does not mean hematidrosis does not exist.It is important to note that the most frequent trigger factors are either anxiety,fear,or excessive stress.Clinicians need to exclude other diagnoses and search for stressors to alleviate the bleeding.