Serological and molecular surveillance of West Nile virus in domesticated mammals of peninsular Malaysia.

West Nile virus is a mosquito-borne neurotropic pathogen with a wide host range that constitutes a significant risk to public and animal health. There is limited information on WNV infection in domesticated mammals in Malaysia; however, current reports indicate infections in birds, macaques, bats and pigs from Malaysia. In this study, 203 serum samples from cattle, goats, and horses were tested for the presence of anti-WNV IgG using a competitive enzyme-linked immunosorbent assay (c-ELISA). Additionally, using one-step RT-PCR, nasopharyngeal swabs were analyzed for WNV RNA from all 203 animals in this study. The WNV seroprevalence was 32.53% (27/83) at 95% CI (0.2342-0.4319) in cattle, 48.27% (14/29) at 95% CI (0.3139-0.6557) in goats and 53.84% (49/91) at 95% CI (0.4366-0.6373) in horses. Cross-reactive JEV antibodies were detected in two cattle and 34 horses. None of the cattle or goats tested positive for WNV RT-PCR. Seven horses were positive for WNV RT-PCR, a molecular prevalence of 7.69% (7/91) at 95% CI (0.0353-0.1528). This is the first reported detection of WNV in domesticated mammals of Malaysia, a significant addition to the growing evidence that WNV is being transmitted from vectors to susceptible hosts in Malaysia.

A microbiological identification and recovery actions of critical symptoms of anammox image bacteria.

Currently, the risks posed by bacteria are becoming increasingly important. It now appears that the cell wall of Anammox image bacteria is very different from what has been generally considered for many years. Not every textbook contains the peptidoglycan on the cell wall of Anammox image bacteria - the sugar-protein chain that strengthens the cells of most bacteria. Most researchers in this Anammox image bacteria diseased identification wanted to find out what gave the Anammox image cell its stability. It used powerful cryo-electron microscopes to examine the bacterial cell wall and find the exact structure of the peptidoglycan. A new algorithm is proposed to discover that Anammox image bacteria contain peptidoglycan, which completes a theory in microbiology. The identification of different diseases is listed, and the proposed model compares the exact results while comparing the parameters like accuracy, precision, recall, and F1-Score. Keywords: Anammox image bacteria, cell wall, cell stability, cryo-electron, microscope images, accuracy, precision, recall, F1-score.

Snacking behavior is associated with snack quality, overall diet quality, and body weight among US college students.

Snacking behavior may affect snack quality, overall diet quality, and body weight; however, the associations between these variables have not been studied among college students. The objective of this study was to associate snacking behaviors with snack quality, diet quality, and weight status among college students with overweight and obesity. We hypothesized that a higher snacking frequency, accessibility and availability of unhealthy snacks, and lack of knowledge would be associated with lower snack and diet quality, and higher weight. Participants (n = 140) completed a snack behavior questionnaire, three 24-hour dietary recalls to assess diet quality using Healthy Eating Index 2015 (HEI-2015), and snack score using an algorithm based on the US DA Smart Snack guidelines and reported weight and height to calculate body mass index (BMI). Analysis of variance and Pearson correlation was used in the analyses. After adjusting for confounders, snack frequency was not associated with snack score, HEI-2015 score, or BMI, but evening snacks had a significantly lower snack score compared with late afternoon snacks (P = .017). Also, those with more accessibility and availability of unhealthy snacks had a lower snack score (P = .001), lower HEI-2015 score (P = .006), and higher BMI (P = .019). Snacking for pleasure was significantly associated with a lower snack score (P = .037). Snack score was positively correlated with HEI-2015 score but not with BMI. In conclusion, late snacking, unhealthy snack environment, and snacking for pleasure were associated with lower snack and diet quality. These findings could be used in future intervention strategies to improve snacking behaviors and the food environment.

Circulation of West Nile virus in mosquitoes approximate to the migratory bird stopover in West Coast Malaysia.

Being a tropical country with a conducive environment for mosquitoes, mosquito-borne illnesses such as dengue, chikungunya, lymphatic filariasis, malaria, and Japanese encephalitis are prevalent in Malaysia. Recent studies reported asymptomatic infection of West Nile virus (WNV) in animals and humans, but none of the studies included mosquitoes, except for one report made half a century ago. Considering the scarcity of information, our study sampled mosquitoes near migratory bird stopover wetland areas of West Coast Malaysia located in the Kuala Gula Bird Sanctuary and Kapar Energy Venture, during the southward migration period in October 2017 and September 2018. Our previous publication reported that migratory birds were positive for WNV antibody and RNA. Using a nested RT-PCR analysis, WNV RNA was detected in 35 (12.8%) out of 285 mosquito pools consisting of 2,635 mosquitoes, most of which were Culex spp. (species). Sanger sequencing and phylogenetic analysis revealed that the sequences grouped within lineage 2 and shared 90.12%-97.01% similarity with sequences found locally as well as those from Africa, Germany, Romania, Italy, and Israel. Evidence of WNV in the mosquitoes substantiates the need for continued surveillance of WNV in Malaysia.

Selective modulation of monocyte and neutrophil responses with activated protein C in preterm infants.

BACKGROUND: Inflammation is associated with many disorders of preterm infants including periventricular leukomalacia, chronic lung disease, and necrotizing enterocolitis. Activated protein c (APC) has shown positive immunomodulatory effects. OBJECTIVES: We aimed to study neutrophil and monocyte function in response to lipopolysaccharide (LPS) and APC stimulation ex vivo in preterm infants <32 weeks gestation over the first week of life compared to neonatal and adult controls. METHODS: Peripheral blood was taken on day 1, 3, and 7 and stimulated with LPS in the absence or presence of APC. Expression of toll-like receptor 4 (TLR4) and CD11b and reactive oxygen intermediate (ROI) release from neutrophils and monocytes was examined by flow cytometry. RESULTS: LPS induced neutrophil ROI in adults and preterm infants and was significantly reduced by APC. Baseline and LPS-induced monocyte ROI production in preterm neonates was increased compared to adult and term controls. Neutrophil TLR4 baseline expression was higher in term controls compared to preterm infants. CONCLUSION: Increased systemic ROI release in preterm infants may mediate tissue damage, ROI was reduced by APC. However, due to the high risk of hemorrhage further examination of APC mutant forms with anti-inflammatory but decreased anticoagulant properties is merited.

Pathogenic role of Twist-1 protein in hydatidiform molar pregnancies and investigation of its potential diagnostic utility in complete moles.

BACKGROUND: Complete and partial moles (PM) are the most common gestational trophoblastic diseases. Due to some overlapping morphological findings, ancillary studies may be necessary. METHODS: In this cross-sectional study, 47 cases of complete mole (CM) and 40 cases of PM were randomly selected based on histopathological criteria. Only those cases that were agreed upon by two expert gynecological pathologists and confirmed by the P57 IHC study were included. The expression level of the Twist-1 marker in villi stromal cells, as well as syncytiotrophoblasts, was evaluated quantitatively (percentage of positive cells), qualitatively (staining intensity) and as a total comprehensive score. RESULTS: Expression of Twist-1 is higher and more intense in villous stromal cells of CMs (p < 0.001). Moderate to strong staining intensity in more than 50% of villous stromal cells, can differentiate CM and PM with 89.5% sensitivity and 75% specificity. In syncytiotrophoblasts of CM, Twist-1 expression was significantly lower than PM (p < 0.001). Negative or weak staining intensity in less than 10% of syncytiotrophoblasts, can distinguish CM and PM with 82.9% sensitivity and 60% specificity. CONCLUSION: A higher expression of Twist-1 in villous stromal cells of hydatidiform moles is a sensitive and specific marker for the diagnosis of CMs. An elevated expression of this marker in villous stromal cells suggests another pathogenic mechanism for more aggressiveness of CMs in addition to the characteristics of trophoblast cells. The opposite result was obtained in the expression of Twist-1 in the syncytiotrophoblasts, compatible with defects in the process of formation of these supportive cells in CMs.

Update on allergic fungal rhinosinusitis.

Allergic fungal rhinosinusitis (AFRS) is a unique clinical entity that falls under the broader umbrella of chronic rhinosinusitis with nasal polyps with type 2 inflammation. It is characterized by nasal polyposis, production of characteristic thick eosinophilic mucin, and expansile change of involved sinus cavities. The diagnosis is classically made using the Bent and Kuhn criteria. However, recent studies have indicated the lack of specificity of some major criteria. The need to fulfill all 5 criteria before diagnosing AFRS partially mitigates this but renders the criteria cumbersome to use, and highlights the need to develop more specific criteria. Our understanding of AFRS pathophysiology has advanced significantly and has helped elucidate the lack of histatins contributing to the inability to clear fungal spores, consequently leading to fungi-induced disruption of the epithelial barrier and stimulation of sinonasal epithelial cells. These trigger a cascade of type 2 inflammatory cytokines driven by both the adaptive and innate immune system. Although more research is needed, these findings could hypothetically point to a limited type 3 immune response at the sinus mucosa, resulting in a compensatory overstimulation of type 2 inflammatory processes. Treatment for AFRS remains centered on surgery and topical corticosteroids. Short courses of systemic corticosteroids may be used with caution, and fungal-specific immunotherapy and systemic antifungals are options in recalcitrant disease. Biologics show early promise, as we await data from randomized controlled trials under way. Finally, new insights into AFRS pathology provide opportunities for novel therapeutic strategies.

Osteoradionecrosis of the lamina papyracea leading to recurrent orbital infections-A case study.

Osteoradionecrosis (ORN) is a well-known complication of radiotherapy (RT) to the sino-nasal cavity and nasopharynx. Here, we report a case of recurrent orbital infections secondary to ORN of the lamina papyracea (LP). A 66-year-old female presented to our unit with right periorbital swelling and pain after having undergone chemotherapy and proton beam irradiation to her ethmoid sinuses for sino-nasal undifferentiated carcinoma (SNUC) 5 years prior. She had also undergone endoscopic sinus surgery for chronic rhinosinusitis about a year prior to the current presentation. Her post-operative course was notable for recurrent episodes of pre-septal cellulitis occurring about 3 months apart that were increasingly severe. Examination revealed right proptosis, and endoscopy showed an exposed and denuded LP with scant crusting of the ethmoid sinuses. Microbial studies did not yield any significant growth, and imaging showed enhancement of the right orbit. The working diagnosis was acute right orbital cellulitis secondary to ORN of the right LP. She was treated with broad spectrum intravenous antibiotics and systemic steroids, but experienced minimal symptomatic improvement. She then underwent endoscopic resection of the right LP, and histopathological examination showed osteonecrosis on an inflammatory background. Post-operatively, all orbital symptoms resolved and she was well at 6 months' follow up. In the discussion, we highlight additional factors in our patient that may have contributed to this clinical presentation, and hope that this report raises awareness of a rare complication of RT to the sino-nasal cavity.

Inflammatory gene silencing in activated monocytes by a cholesterol tagged-miRNA/siRNA: a novel approach to ameliorate diabetes induced inflammation.

There is a major unmet need for the development of effective therapies for diabetes induced inflammation. Increased adenosine-uridine rich elements (AREs) containing mRNAs of inflammatory molecules are reported in inflamed monocytes. Destabilizing these inflammatory mRNAs by the miR-16 could reduce inflammation. DNA microarrays and in vitro cell studies showed that exogenous miR16 and its mimic treatment, in LPS/PMA induced monocytes, significantly downregulated several ARE containing inflammatory cytokine mRNAs similar to those seen in the normal monocytes. Ingenuity pathway analyses showed exogenous miR-16 or its synthetic mimic treatment alleviates inflammatory responses. To selectively target uptake, especially to inflamed cells, one of the CD36 substrate cholesterol was tagged to miR16/siRNA. Cholesterol tagged miR-16/ARE-siRNA showed enhanced uptake in CD36 expressing inflamed cells. In LPS or PMA, treated monocytes, candidate genes expressions levels such as IL-6, IL-8, IL-12ß, IP-10, and TNF-α mRNA were increased, as measured by RT-qPCR as seen in primary monocytes of diabetes patients. Exogenous miR16 or ARE-siRNA transfection reduced mRNAs of pro-inflammatory cytokines levels in monocyte, and its adhesion. Increased uptake of cholesterol tagged miR-16 through the CD36 receptor was observed. This destabilizes numerous inflammatory ARE containing mRNAs and alleviates inflammatory responses. Cholesterol-tagged miR-16 and its mimic are novel anti-inflammatory molecules that can be specifically targeted to, via through CD36 expressing, "inflamed" cells and thus serve as therapeutic candidates to alleviate inflammatory diseases.

Olfactory recovery following infection with COVID-19: A systematic review.

Olfactory loss has been identified as one of the common symptoms related to COVID-19 infection. Although olfactory loss is recognized, our understanding of both the extent of loss and time to olfactory recovery following infection is less well known. Similarly, knowledge of potential impactful patient factors and therapies that influence olfactory recovery is desirable but is not overtly clear in the literature. Our systematic review sought to fill this knowledge gap. We included studies that: involved either an observational or an interventional design that reported data on patients with olfactory dysfunction due to Reverse Transcription Polymerase Chain Reaction (RT-PCR) diagnosed COVID-19 infection; and reported data regarding olfactory recovery measured by an objective olfactory test, Likert scale and/or visual analog scale (VAS). The study methods were determined a priori and registered in PROSPERO (Registration Number CRD42020204354). An information specialist searched Medline, Embase, LitCovid and the Cochrane Register of Controlled Trials up to March 2021, and two reviewers were involved in all aspects of study selection and data collection. After screening 2788 citations, a total of 44 studies of assorted observational designs were included. Patients had undergone objective COVID-19 testing, and most were adult patients with mild to moderate COVID-19. Olfactory recovery was found to occur as early as 7 days, with most patients recovering olfaction within 30 days. Few studies included prolonged follow-up to 6 months or longer duration. Poor olfaction at initial presentation was associated with poor recovery rates. Only a small number of studies assessed olfactory retraining and steroid therapy. Additional trials are underway.

Exposure to Zoonotic West Nile Virus in Long-Tailed Macaques and Bats in Peninsular Malaysia.

The role of wildlife such as wild birds, macaques, and bats in the spreading and maintenance of deadly zoonotic pathogens in nature have been well documented in many parts of the world. One such pathogen is the mosquitoes borne virus, namely the West Nile Virus (WNV). Previous research has shown that 1:7 and 1:6 Malaysian wild birds are WNV antibody and RNA positive, respectively, and bats in North America may not be susceptible to the WNV infection. This study was conducted to determine the status of WNV in Malaysian macaques and bats found in mangrove forests and caves, respectively. Archive sera and oropharyngeal swabs from long-tailed macaques were subjected to the antibody detection using WNV competitive enzyme-linked immunosorbent assay (c-ELISA) and WNV RNA using RT-PCR, respectively, while the archive oropharyngeal and rectal swabs from bats were subjected to RT-PCR without serological analysis due to the unavailability of serum samples. The analysis revealed a WNV seropositivity of 29.63% (24/81) and none of the macaques were positive for WNV RNA. Meanwhile, 12.2% (5/41) of the bats from Pteropodidae, Emballonuridae, and Rhinolophidae families tested positive for WNV RNA. Here, we show a high WNV antibody prevalence in macaques and a moderate WNV RNA in various Malaysian bat species, suggesting that WNV circulates through Malaysian wild animals and Malaysian bat species may be susceptible to the WNV infection.

An Experimental Slope Method for a More Accurate Measurement of Relative Radiation Doses using Radiographic and Radiochromic Films and Its Application to Megavoltage Small-Field Dosimetry.

PURPOSE: An experimental method using the linear portion of the relative film dose-response curve for radiographic and radiochromic films is presented, which can be used to determine the relative depth doses in a variety of very small, medium, and large radiation fields and relative output factors (ROFs) for small fields. MATERIALS AND METHODS: The film slope (FS) method was successfully applied to obtain the percentage depth doses (PDDs) for external beams of photon and electrons from a Synergy linear accelerator (Elekta AB, Stockholm, Sweden) under reference conditions of 10 cm × 10 cm for photon beam and nominal 10 cm × 10 cm size applicator for electron beam. For small-field dosimetry, the FS method was applied to EDR2 films (Carestream Health, Rochester, NY) for 6 MV photon beam from a linac (Elekta AB, Stockholm, Sweden) and small, circular radiosurgery cones (Elekta AB, Stockholm, Sweden) with diameters of 5, 7.5, 10, 12.5, and 15 mm. The ROFs for all these cones and central axis PDDs for 5, 10, and 15 mm diameter cones were determined at source-to-surface distance of 100 cm. The ROFs for small fields of CyberKnife system were determined using this technique with Gafchromic EBT3 film (Ashland, NJ, USA). The PDDs and ROFs were compared with ion chamber (IC) and Monte Carlo (MC) simulated values. RESULTS: The maximum percentage deviation of PDDFS with PDDIC for 4, 6, and 15 MV photon beams was within 1.9%, 2.5%, and 1.4%, respectively, up to 20-cm depth. The maximum percentage deviation of PDDFS with PDDIC for electron beams was within 3% for energy range studied of 8-15 MeV. The gamma passing rates of PDDFS with PDDIC were above 96.5% with maximum gamma value of >2, occurring at the zero depths for 4, 6, and 15 MV photons. For electron beams, the gamma passing rates between PDDFS with PDDIC were above 97.7% with a maximum gamma value of 0.9, 1.3, and 0.7 occurring at the zero depth for 8, 12, and 15 MeV. For small field of 5-mm cone, the ROFFS was 0.665 ± 0.021 as compared to 0.674 by MC method. The maximum percentage deviation between PDDFS and PDDMC was 3% for 5 mm and 10 mm and 2% for 15 mm cones with 1D gamma passing rates, respectively, of 95.5%, 96%, and 98%. For CyberKnife system, the ROFFS using EBT3 film and MC published values agrees within 0.2% for for 5 mm cone. CONCLUSIONS: The authors have developed a novel and more accurate method for the relative dosimetry of photon and electron beams. This offers a unique method to determine PDD and ROF with a high spatial resolution in fields of steep dose gradient, especially in small fields.

Enhanced mucosal immune responses, immune related genes and growth performance in common carp (Cyprinus carpio) juveniles fed dietary Pediococcus acidilactici MA18/5M and raffinose.

The present study was conducted to evaluate the effects of dietary Pediococcus acidilactici (PA) and raffinose (RF) alone or in combination on growth performance, mucosal immune factors and immune related genes expression in common carp (Cyprinus carpio) juveniles. Fish with initial weight of 10.0 ±â€¯2.5 g were fed the following experimental diets for 60 days: control (without supplementation), prebiotic (2 g RF kg-1 diet), probiotic (6 × 108 CFU g-1PA) and synbiotic (2 g RF kg-1+ 6 × 108 CFU g-1PA). Carp fed synbiotic and probiotic diets had the highest (19.53 ±â€¯0.16) and the lowest (18.05 ±â€¯0.65) final body weight, respectively and the other experimental groups showed intermediate values. Singular administration of PA or in combination with 2 g RF kg-1 significantly increased skin mucus total immunoglobulin (Ig) and protein compared other groups, meanwhile, values of skin mucus protease activity enhanced by dietary immunostimulants administration in comparison with the control (P < 0.05). The expression of gene encoding lysozyme in skin pronouncedly increased by supplementing diets with singular or mixture of PA and RF; however, the expression of intestinal lysozyme gene as well as tumor necrosis factor-α genes expression in skin and intestine were not affected by administrating different immunostimulants (P > 0.05). The highest growth performance was noticed in fish fed synbiotic (P < 0.05). Overall, the combination of 2 g RF kg-1 with 6 × 108 CFU g-1PA is recommended for improving immunological responses of C. carpio juveniles.

Prediction of Novel Drugs and Diseases for Hepatocellular Carcinoma Based on Multi-Source Simulated Annealing Based Random Walk.

Computational techniques for foreseeing drug-disease associations by means of incorporating gene expression as well as biological network give high intuitions to the composite associations amongst targets, drugs, disease genes in addition to the diseases at a system level. Hepatocellular Carcinoma (HCC) is a malevolent tumor containing a greater rate of sickness as well as mortality. In the present work, an Integrative framework is presented with the aim of resolving this problem, for identifying new Drugs for HCC dependent upon Multi-Source Random Walk (PD-MRW), in which score the complete drugs by means of building the drug-drug similarity network. On the other hand, the collection of clinical phenotypes as well as drug side effects in combination with patient-specific genetic info. As a result, the formation of disease-drug networks that denotes the prescriptions, which are allotted to treat those diseases that are not concentrated by means of PD-MRW model. With the aim of overcoming this issue, this research offers an integrative framework for foreseeing new drugs as well as diseases for HCC dependent upon Multi-Source Simulated Annealing based Random Walk (PDD-MSSARW). Primarily, build a Gene-Gene Weighted Interaction Network (GWIN), dependent upon the gene expression as well as protein interaction network. After that, construct a drug-drug similarity network, dependent upon multi-source random walk in GWIN, disease-drug similarity network with the help of Similarity Weighted Bipartite Graph Network (SWBGN) that is build up in which the nodes are drugs as well as association among one node to another node that explains the disease diagnoses. Lastly, dependent upon the known drugs for HCC, score the entire drugs in the similarity networks. The sturdiness of the likelihoods, their overlap with those stated in Comparative Toxicogenomics Database (CTD) as well as kinds of literature, and their enhanced KEGG pathway illustrate PDD-MSSARW method be capable of efficiently find out novel drug signs.

Infodemiological data of high-school drop-out related web searches in Canada correlating with real-world statistical data in the period 2004-2012.

The present data article describes high-school drop-out related web activities in Canada, from 2004 to 2012, obtained mining Google Trends (GT), using high-school drop-out as key-word. The searches volumes were processed, correlated and cross-correlated with statistical data obtained at national and province level and broken down for gender. Further, an autoregressive moving-average (ARMA) model was used to model the GT-generated data. From a qualitative point of view, GT-generated relative search volumes (RSVs) reflect the decrease in drop-out rate. The peak in the Internet-related activities occurs in 2004 (56.35%, normalized value), and gradually declines to 40.59% (normalized value) in 2007. After, it remains substantially stable until 2012 (40.32%, normalized value). From a quantitative standpoint, the correlations between Canadian high-school drop-out rate and GT-generated RSVs in the study period (2004-2012) were statistically significant both using the drop-out rate for academic year and the 3-years moving average. Examining the data broken down by gender, the correlations were higher and statistically significant in males than in females. GT-based data for drop-out resulted best modeled by an ARMA(1,0) model. Considering the cross correlation of Canadian regions, all of them resulted statistically significant at lag 0, apart from for New Brunswick, Newfoundland and Labrador and the Prince Edward island. A number or cross-correlations resulted statistically significant also at lag -1 (namely, Alberta, Manitoba, New Brunswick and Saskatchewan).

Digital necrosis with squamous cell carcinoma of the tonsil.

BACKGROUND: Digital necrosis is a rare phenomenon of paraneoplastic syndrome associated with squamous cell carcinoma of the tonsil. Since 1965, more than 70 cases have been reported worldwide in the literature. CASE REPORT: A 54-year-old male smoker presented with Raynaud's phenomenon, proceeding to frank gangrene of the fingers. Working up the case finally pointed toward carcinoma of the tonsil as the underlying cause - a rare paraneoplastic manifestation. CONCLUSION: No definite etiology has been found to be the cause of Raynaud's phenomenon in this case of the squamous cell carcinoma of the tonsil. A brief discussion of the literature is also presented.

Transciptomic study of mucosal immune, antioxidant and growth related genes and non-specific immune response of common carp (Cyprinus carpio) fed dietary Ferula (Ferula assafoetida).

A 8-weeks feeding trial was conducted to examine the effects of different levels (0, 0.5, 1 and 2%) of dietary Ferula (Ferula assafoetida) on expression of antioxidant enzymes (GSR, GPX and GSTA), immune (TNF-alpha, IL1B, IL- 8 and LYZ) and growth (GH, IGF1 and Ghrl) genes as well as cutaneous mucus and serum non-specific immune response in common carp. The results revealed Ferula significantly increased antioxidant gene expression (GSR and GSTA) in a dose dependent manner (P < 0.05). The expression of immune growth related genes were significantly higher in Ferula fed fish compared control group (P < 0.05). The effects of Ferula on expression of genes was more pronounced in higher doses. Feeding on Ferula supplemented diet remarkably increased skin mucus lysozyme activity (P < 0.05). However, evaluation of mucus total Ig and protease activity revealed no significant difference between control and treated groups (P > 0.05). Regarding non-specific humoral response, serum total Ig, lysozyme and ACH50 showed no remarkable variation between Ferula fed carps and control group (P > 0.05). These results indicated up-regulation of growth and health related genes in Ferula fed common carp. Further studies using pathogen or stress challenge is required to conclude that transcriptional modulation is beneficial in common carp.

Child Who Presented with Facial Hematohidrosis Compared with Published Cases.

Hematohidrosis is a rare condition in which an individual sweats blood from intact, unbroken skin. The aetiology of hematohidrosis is not clear, although various theories exist to explain such a phenomenon. The general consensus however in the literature relates the finding to dermal capillary blood vessels that rupture under extreme emotional or physical stress exuding blood through the skin. In this case report we disclose a case of 12-year-old girl who presented with unusual painless bleeding from her face, eye, and tear duct. The condition was investigated intensively during hospital admission for a cause, and no actual cause was speculated. The management mostly involved supportive care and medical advice.