Orientia tsutsugamushi is the causal agent of scrub typhus, a public health problem in the Asia-Pacific region and a life-threatening disease. O. tsutsugamushi is an obligate intracellular bacterium that mainly infects endothelial cells. We demonstrated here that O. tsutsugamushi also replicated in monocytes isolated from healthy donors. In addition, O. tsutsugamushi altered the expression of more than 4,500 genes, as demonstrated by microarray analysis. The expression of type I interferon, interferon-stimulated genes and genes associated with the M1 polarization of macrophages was significantly upregulated. O. tsutsugamushi also induced the expression of apoptosis-related genes and promoted cell death in a small percentage of monocytes. Live organisms were indispensable to the type I interferon response and apoptosis and enhanced the expression of M1-associated cytokines. These data were related to the transcriptional changes detected in mononuclear cells isolated from patients with scrub typhus. Here, the microarray analyses revealed the upregulation of 613 genes, which included interferon-related genes, and some features of M1 polarization were observed in these patients, similar to what was observed in O. tsutsugamushi-stimulated monocytes in vitro. This is the first report demonstrating that monocytes are clearly polarized in vitro and ex vivo following exposure to O. tsutsugamushi. These results would improve our understanding of the pathogenesis of scrub typhus, during which interferon-mediated activation of monocytes and their subsequent polarization into an M1 phenotype appear critical. This study may give us a clue of new tools for the diagnosis of patients with scrub typhus.

BackgroundThe English version of the 4 ‘A’s Test (4AT) is a rapid screening tool for delirium with a high sensitivity and specificity among hospitalized elderly patients.ObjectiveTo develop the Thai version of the 4AT (4AT-T) and assess its validity.Subjects and settingA total of 97 elderly patients aged 60 years or above who were admitted to the general medical wards were included.MethodsBoth authors independently translated the English version of the 4AT into Thai and thereafter developed a single reconciled forward translation by consensus. Back translation was performed by a bilingual native English speaker and it was then reviewed to ensure its agreement with the original one. After 24 hours of admission, subjects were enrolled and clinical data collected. Definite diagnosis of delirium was made by a psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text-Revision criteria and the 6-item Thai Delirium Rating Scale; the 4AT was then administered to participants by nurses within 30 minutes. A 4AT score ≥4 was considered positive for delirium screening. The optimal cut-off point of the 4AT-T was identified by Youden’s index.ResultsIn all, 24 out of 97 participants met the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text-Revision criteria for delirium. At a cut-off score of 4 or greater, the 4AT-T exhibited satisfactory diagnostic performance with a sensitivity of 83.3% (95% confidence interval (CI): 62.6%–95.3%) and specificity of 86.3% (95% CI: 76.3%–93.2%). The area under the receiver operating characteristic curve was 0.92. The specified score provided maximal Youden’s index, suggesting an optimal criterion value for delirium screening.ConclusionThe 4AT-T is a valid delirium-screening instrument for hospitalized elderly patients with acute medical illnesses.

The 15‐item Systemic Clinical Outcome and Routine Evaluation (SCORE‐15) Thai version was developed. This study aims to assess the test‐retest reliability and the criterion validity of the SCORE‐15 Thai version. The assessment of the test‐retest reliability was performed on twenty‐four non‐clinical participants who gave two ratings two to four weeks apart. Furthermore, sixty‐two clinical and seventy‐three non‐clinical subjects were included for the assessment of the criterion validity. The SCORE‐15 Thai version exhibited excellent test‐retest reliability with an intraclass correlation coefficient of 0.94. The validity study revealed that the effect sizes of score differences between clinical and non‐clinical groups were large (0.90–1.85). In conclusion, the SCORE‐15 Thai version can be a choice for routine clinical practice to determine family functioning in systemic family therapy.Practitioner points Assessment of family functioning is an essential process for both initial evaluations and monitoring the progress of family interventions The SCORE‐15 Thai version exhibited excellent test‐retest reliability and criterion validity The SCORE‐15 Thai version can be used as an instrument to determine family functioning in clinical practice and research

Background: Many studies have shown that the prevalence of psychiatric disorders in patients with epilepsy (PWE) appears higher than that in general population. However, most epidemiological studies regarding psychiatric comorbidities among PWE were conducted in Western countries. This work aimed to determine the prevalence of psychiatric disorders in Thai PWE, including potential variables that could be associated with psychiatric disorders. Methods: A cross-sectional study was conducted at Ramathibodi Hospital. A total of 170 patients (aged 18 years or older) diagnosed as having epilepsy by a neurologist were recruited at the outpatient neurology clinic. Demographic and clinical characteristics were collected. Participants were evaluated for any psychiatric disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, using a structured diagnostic interview. The prevalence of psychiatric disorders was determined. The associations between potential variables and the presence of psychiatric disorders in PWE were analyzed using chi-square or Fisher's exact tests, t-test, and logistic regression. Results: Among 170 patients, 43 (25.3%) fulfilled diagnostic criteria for one or more psychiatric disorders. The prevalence of depressive disorders was shown to be highest at 17.1%, followed by psychotic disorders (8.2%), bipolar disorder (7.1%), anxiety disorders (5.3%), and obsessive-compulsive disorder (OCD) (2.9%). Electroencephalogram (EEG) abnormalities in the temporal lobe was found to be a significant predictor of having psychiatric disorders in PWE (adjusted odds ratio (OR): 4.01, 95% confidence interval (CI): 1.47-10.92, P-value = 0.007). Conclusions: The prevalence of psychiatric disorders among Thai PWE was higher than that in general population. Screening for psychiatric disorders in PWE is recommended, especially among those who have EEG abnormalities in the temporal lobe.