Ground truth labels challenge the validity of sepsis consensus definitions in critical illness

Background Sepsis is the leading cause of death in the intensive care unit (ICU). Expediting its diagnosis, largely determined by clinical assessment, improves survival. Predictive and explanatory modelling of sepsis in the critically ill commonly bases both outcome definition and predictions on clinical criteria for consensus definitions of sepsis, leading to circularity. As a remedy, we collected ground truth labels for sepsis. Methods In the Ground Truth for Sepsis Questionnaire (GTSQ), senior attending physicians in the ICU documented daily their opinion on each patient’s condition regarding sepsis as a five-category working diagnosis and nine related items. Working diagnosis groups were described and compared and their SOFA-scores analyzed with a generalized linear mixed model. Agreement and discriminatory performance measures for clinical criteria of sepsis and GTSQ labels as reference class were derived. Results We analyzed 7291 questionnaires and 761 complete encounters from the first survey year. Editing rates for all items were > 90%, and responses were consistent with current understanding of critical illness pathophysiology, including sepsis pathogenesis. Interrater agreement for presence and absence of sepsis was almost perfect but only slight for suspected infection. ICU mortality was 19.5% in encounters with SIRS as the “worst” working diagnosis compared to 5.9% with sepsis and 5.9% with severe sepsis without differences in admission and maximum SOFA. Compared to sepsis, proportions of GTSQs with SIRS plus acute organ dysfunction were equal and macrocirculatory abnormalities higher (p < 0.0001). SIRS proportionally ranked above sepsis in daily assessment of illness severity (p < 0.0001). Separate analyses of neurosurgical referrals revealed similar differences. Discriminatory performance of Sepsis-1/2 and Sepsis-3 compared to GTSQ labels was similar with sensitivities around 70% and specificities 92%. Essentially no difference between the prevalence of SIRS and SOFA ≥ 2 yielded sensitivities and specificities for detecting sepsis onset close to 55% and 83%, respectively. Conclusions GTSQ labels are a valid measure of sepsis in the ICU. They reveal suspicion of infection as an unclear clinical concept and refute an illness severity hierarchy in the SIRS-sepsis-severe sepsis spectrum. Ground truth challenges the accuracy of Sepsis-1/2 and Sepsis-3 in detecting sepsis onset. It is an indispensable intermediate step towards advancing diagnosis and therapy in the ICU and, potentially, other health care settings.

Large Body Movements on Video-Polysomnography are Associated with Daytime Dysfunction in Children with Restless Sleep Disorder

Restless sleep disorder (RSD) is a newly defined sleep related movement disorder characterized by large muscle movements (LMM) in sleep. We examined the sleep study, clinical characteristics, and daytime functioning in children with RSD and compared them to children with Periodic Limb Movement Disorder (PLMD) or Restless Legs Syndrome (RLS). Video polysomnography from 47 children with restless sleep was retrospectively reviewed for LMM and age- and sex- matched to 34 children with PLMD and 12 children with RLS. Data examined included PSG characteristics, ferritin, Pediatric Quality of Life (PedsQL), and Epworth Sleepiness Scores (ESS). Fourteen children met the clinical criteria for RSD with a LMM index of 5 or more per hour of sleep . Mean ESS was elevated in RSD patients compared to either the PLMD or RLS groups though the result did not reach statistical significance (RSD = 10.20 ± 6.81, PLMD = 6.19 ± 4.14, RLS = 6.25 ± 4.90). The PedsQL score was significantly decreased in the RLS group compared to RSD and was reduced overall in all three groups (PedsQL Total RSD= 70.76 ± 18.05, PLMD = 57.05 ± 20.33, RLS = 53.24 ± 16.97). Serum ferritin values were similar in all three groups (RSD= 26.89 ± 10.29, PLMD = 33.91 ± 20.31, RLS = 23.69 ± 12.94 ng/mL, P= NS). Children with RSD demonstrate increased daytime sleepiness compared to PLMD or RLS and all three disease groups decreased quality of life. Further studies are needed to examine long term consequences of RSD.

Computerized cognitive training in people with depression: a protocol for a systematic review and meta-analysis

Background People with depression often present with concurrent cognitive impairment. Computerized cognitive training (CCT) is a safe and efficacious strategy to maintain or enhance cognitive performance in a range of clinical populations. However, its efficacy in people with depression and how it varies across populations and design factors are currently unclear. Methods We searched MEDLINE, EMBASE, and PsycINFO from inception to 13 July 2021 for randomised controlled trials examining the efficacy of CCT vs any control condition on cognitive, mood, psychiatric symptoms, psychosocial, and daily functioning in adults with depression. Eligible samples include studies specifically targeting people with major depressive disorder as well as those with other diagnoses where at least 50% of the sample meets the clinical criteria for depression, with the exception of major psychiatric disorders or dementia. The primary outcome is change in the overall cognitive performance. Multivariate analyses will be used to examine the effect sizes on each outcome category as well as possible effect modifiers and correlations between categories. The risk of bias will be assessed using the Cochrane risk of bias tool version 2. Discussion To the best of our knowledge, this will be the first systematic review and meta-analysis of narrowly defined CCT across clinical populations with depression. We aim to investigate not only whether CCT is efficacious for cognition, but also how such effects vary across design factors, what other clinically relevant outcomes might respond to CCT, and the extent to which they differ across populations. Systematic review registration PROSPERO CRD42020204209

Development of a Social Play Evaluation Tool for Preschool Children

Play has been used as an intervention or evaluation tool for children. Developing a social play evaluation tool can provide clinical criteria for intervening in social play. We aimed to develop a social play evaluation tool for preschool children based on Parten’s stages of development. We tested the construct validity of the scale using confirmatory factor analysis and Rasch analysis, and the known-groups validity by examining the Rasch-calibrated mean score differences across age groups. A total of 40 preliminary items—17 items for associative play and 23 items for cooperative play—were examined. There were significant differences in the scores for associative play between ages 3 and 6 (F = 2.65, p = 0.049), and for cooperative play between ages 3 and 5, 3 and 6, and 4 and 6 (F = 10.44, p < 0.0001). The findings could contribute to subsequent development and validation of occupational therapy programs on play.

Validation of the Digital Eye Strain Questionnaire and pilot application to online gaming addicts

Introduction ‘Digital eye strain’ (DES) is a clinical syndrome with eyesight symptoms related to continuous engagement in front of a screen-enabled digital device. With use of these devices constantly on the rise, the related symptoms have become prominent, even in younger ages. This study describes the process of validating the Digital Eye Strain Questionnaire (DESQ), a thirteen-item self-report scale in a yes-no format designed to offer a measure of complaints related to digital eye strain syndrome (DES). Methods The validation process included 150 outpatients with no long-standing eye disease who were examined for various eye complaints and 50 outpatients who were diagnosed with gaming addiction according to WHO ICD-11 clinical criteria. All participants filled in a demographics questionnaire, the DESQ, the Computer Vision Syndrome Questionnaire (CVS-Q) and the Problematic Internet Use Questionnaire-9 (PIUQ-9). Results Principal component analysis of categorical variables confirmed the proposed three-factor DES structure with a total of 61.02% of explained variance and Cronbach's alpha equal to.94. Concurrent validity was assessed by comparing the results of the DESQ to the CVS-Q while convergent validity was assessed by examining correlations of the DESQ with results from the PIUQ-9 questionnaire. In all cases the DESQ demonstrated excellent reliability and validity. Conclusions Results indicate that the DESQ questionnaire can be employed to reliably measure the symptomatology of digital eye strain in clinical populations who present either with eye issues or with excessive use of the gaming and screen-enabled devices in general.

THE PREVALENCE OF VULVOVAGINAL CANDIDIASIS (VVC) AMONG WOMEN SUFFERING VAGINITIS ATTENDED A PRIVATE GYNECOLOGICAL CLINIC, ADEN-YEMEN

The study was carried out to determine the prevalence of vulvovaginal candidiasis among women suffering vaginitis. This prospective cross-sectional study was conducted among 120 women between the age of 15 to 45 years (mean age 39 years), attended a private gynecological clinic in Aden with symptoms of vaginitis between January and June 2019. A questionnaire was used to obtain information on the participants’ sociodemographic data and medical history. Direct microscopic examination (10% KOH), culture on SDA, germ tube test and gram staining were used to determine the prevalence of vulvovaginal candidiasis and to differentiate between C.albicans and non-albicans species. Out of 120 women, 25 (20.8%) were diagnosed with vulvovaginal candidiasis (VVC) and 95 (79.2%) with non-candidal vaginitis. C.albicans was the most prevalent with a prevalence rate of 17.5%. Although not statistically significant, vulvovaginal candidiasis tended to be more prevalent among women with 25-34 years. No statistically significant association between the prevalence of vulvovaginal candidiasis and educational level and marital status. Vulvovaginal candidiasis (VVC) was slightly high in Aden and Candida albicans was the most common causative agent of VVC. In the clinical diagnosis of VVC, both clinical criteria and microbiological tests must be used. Further study is needed to find out the prevalence of RVVC among women in the Aden governorate.

Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden

Background Healthcare systems in dengue-endemic countries are often overburdened due to the high number of patients hospitalized according to dengue management guidelines. We systematically evaluated clinical outcomes in a large cohort of patients hospitalized with acute dengue to support triaging of patients to ambulatory versus inpatient management in the future. Methods/Principal findings From June 2017- December 2018, we conducted surveillance among children and adults with fever within the prior 7 days who were hospitalized at the largest tertiary-care (1,800 bed) hospital in the Southern Province, Sri Lanka. Patients who developed platelet count ≤100,000/μL (threshold for hospital admission in Sri Lanka) and who met at least two clinical criteria consistent with dengue were eligible for enrollment. We confirmed acute dengue by testing sera collected at enrollment for dengue NS1 antigen or IgM antibodies. We defined primary outcomes as per the 1997 and 2009 World Health Organization (WHO) classification criteria: dengue hemorrhagic fever (DHF; WHO 1997), dengue shock syndrome (DSS; WHO 1997), and severe dengue (WHO 2009). Overall, 1064 patients were confirmed as having acute dengue: 318 (17.4%) by NS1 rapid antigen testing and 746 (40.7%) by IgM antibody testing. Of these 1064 patients, 994 (93.4%) were adults ≥18 years and 704 (66.2%) were male. The majority (56, 80%) of children and more than half of adults (544, 54.7%) developed DHF during hospitalization, while 6 (8.6%) children and 22 (2.2%) adults developed DSS. Overall, 10 (14.3%) children and 113 (11.4%) adults developed severe dengue. A total of 2 (0.2%) patients died during hospitalization. Conclusions One-half of patients hospitalized with acute dengue progressed to develop DHF and a very small number developed DSS or severe dengue. Developing an algorithm for triaging patients to ambulatory versus inpatient management should be the future goal to optimize utilization of healthcare resources in dengue-endemic countries.

Application of CT Radiomics Combined with Machine Learning Methods in Predicting the Recurrence or Metastasis of Gastrointestinal Stromal Tumors

Background: The study aimed to evaluate the diagnostic performance of machine learning-based CT radiomics models for predicting the recurrence and metastasis of gastrointestinal stromal tumors (GISTs) preoperatively.Methods: A total of 382 patients with histopathological confirmed GISTs were retrospectively included. According to postoperative follow-up, patients were classified into non-recurrence and metastasis group (NRM) and recurrence or metastasis group (RM). Radiomics features were extracted from arterial and portal venous phase CT images. Four feature selection methods and ten machine learning techniques were used to train predicting models on training cohort with internal validation by 10-fold cross-validation. F1 score was used to evaluate the performance of the classification model. The best model of two phase were stacked to build an ensemble model. The area under the curve (AUC), recall, precision, accuracy, and F1 score were used to evaluate the performance of the models and compare with clinical criteria based on diameter.Results: Eighty machine learning models in two phases were built and the ensemble model was integrated by analysis of variance and Naive Bayes (ANOVA_NB) model in arterial phase which selected only 5 features provided the highest F1 Score of 0.560 and Kruskal Wallis and Adaptive Boosting (KW_ AdaBoost) model in venous phase which selected only 4 features provided the highest F1 Score of 0.500. The AUC of the generated ensemble model and the clinical criteria showed no difference (0.866 vs 0.857; DeLong Test, P = 0.865). But the ensemble model had higher accuracy (0.961), recall (0.826), precision (0.905), F1 Score (0.864), and the area under the Precision-Recall curve (0.774; 95%CI, 0.552 - 0.917), compared with clinical criteria, of which, the accuracy was 0.942, recall was 0.367, precision was 0.478, the F1 Score was 0.415 and the area under the Precision-Recall curve was 0.354(95%CI, 0.552 - 0.917).Conclusions: Our findings highlight the potential of machine learning techniques based on CT radiomics in the prediction of recurrence and metastasis of GISTs preoperatively.

Use of homeopathic formula in malnourished children

The present intervention study sought to assess the results of homeopathic treatment in malnourished children aged 1-19 years old below the 3th percentile in the weight-height ratio at San Juan Policlinic, Ranchuelo County, Cuba, between November 2004 and December 2005. A total of 99 children were randomly allocated by Mathcad in two groups, one (n=50) was given homeopathic treatment, and the control group (n=49) that did not. Administration of medication was defined by clinical criteria. Inclusion, exclusion and exit criteria were defined. Variables were identified and operationalized, and the information collected from both groups was interpreted. After one-year follow-up, 42 out of 50 children (84%) treated with homeopathy attained normal weight, whereas only 15 out of 49 (30%) of the children in the control group attained normal weight.