Determination of a cut-off value for the serological diagnosis of scrub typhus by detecting anti-Orientia tsutsugamushi immunoglobulin M.

Background & objectives: The diagnosis of scrub typhus (ST) is usually done using enzyme-linked immunosorbent assay (ELISA) due to its ease of performance and reading objectivity. The cut-off value for ELISA needs to be calculated for each geographical location as it depends on zonal endemicity of the disease. This study was, therefore, undertaken to calculate the pan-India cut-off for anti-Orientia tsutsugamushi (OT) immunoglobulin M (IgM) by ELISA. Methods: Samples from cases (cases of ST) and controls (voluntary, consenting, healthy adults) were collected by a network of 29 laboratories across India and tested for anti-OT IgM by immunofluorescence assay (IFA), the considered gold standard test. These samples were retested by ELISA for anti-OT IgM and their optical densities (ODs) were used for cut-off estimation by receiver operating characteristic (ROC) curve. Results: Anti-OT IgM ELISA ODs from 273 controls and 136 cases were used for the cut-off estimation. The ODs of the anti-OT IgM ELISA on healthy individuals and those of confirmed ST cases ranged from 0.1 to 0.75 and 0.5 to 4.718, respectively. ROC curve-based cut-off for ELISA was calculated as 0.554 at a sensitivity of 95.2 per cent and specificity of 95.1 per cent. A value of >1 was noted to have a specificity of 100 per cent in diagnosing ST. Interpretation & conclusions: The cut-off calculated for India was similar to the previous cut-off that was used until now.

Advocating, Unlearning, Tearing It All Down? How BIPOC Young Adults with Mental Health Concerns Perceive and Engage with the Media.

The COVID-19 pandemic has increased the salience of issues related to social justice, mental health, and health equity. During this time, the media have been instrumental in amplifying social movements but also in spreading mis/disinformation, violence, and hatred. Among communities who have been affected heavily during this time are Black, Indigenous, and People of Color (BIPOC) young adults who have a mental illness/significant mental health concerns. As frequent engagers and creators of media, their perspectives are critical to informing what aspects of the media should be leveraged to promote the health, well-being, and safety of people who have been marginalized. Thus, our study asks: How do BIPOC young adults (in the United States) who have a behavioral health diagnosis or significant mental health concerns perceive the media? Guided by intersectionality and grounded theory, we conducted in-depth interviews with 20 participants. The results reveal participants' 1) deep recognition of how the media uphold oppressive structures and 2) identification of ways that people have used and can use the media to fight those same structures. Researchers and media leaders should listen to, center the experiences of, collaborate with, and follow the lead of people who have been marginalized. This is critical to transforming the media such that they promote the well-being of all people.

Tuberculous myelitis: a prospective follow-up study.

BACKGROUND: Prospective studies regarding tuberculous myelitis are lacking. We aimed to prospectively evaluate patients with tuberculous myelitis to identify the features that distinguish tuberculous myelitis from other myelitis. METHODS: This was a prospective study. Patients presenting with paraparesis/quadriparesis, and MRI showing myelitis were included. All patients were subjected to clinical, neuroimaging, and laboratory evaluation. Diagnosis of definite tuberculous myelitis was made if GeneXpert test in CSF was positive. Probable tuberculous myelitis was diagnosed if there was evidence of tuberculosis elsewhere in the body. Patients were treated with methylprednisolone and antituberculosis treatment. Patients were followed for 6 months. We compared the clinical, laboratory, and neuroimaging parameters and response to treatment of tuberculous myelitis with other myelitis. P values were adjusted using the Benjamini-Hochberg (BH) procedure to control false discovery rate. RESULTS: We enrolled 52 patients. Eighteen (34.6%) patients had tuberculous myelitis. Headache (P = 0.018) was significantly more common in tuberculous myelitis. The CSF protein (P < 0.001), and CSF cell count (P < 0.001) were significantly higher in tuberculous myelitis. On neuroimaging, a LETM was common in tuberculous myelitis. Spinal meningeal enhancement (14; 77.8%), extra-axial collection, and CSF loculation (6; 33.4%), arachnoiditis (3;16.7%), and concomitant spinal tuberculoma (2;11.1%) were other common imaging features of tuberculous myelitis. Tuberculous myelitis patients showed a better response (P = 0.025) to treatment. CONCLUSION: Tuberculous myelitis was seen in approximately 35% of all myelitis cases, in a high tuberculosis endemic zone. Headache, markedly elevated CSF protein and spinal meningeal enhancement were distinguishing features. Tuberculous myelitis patients responded well to corticosteroids.

CNS paraganglioma: 15-year experience in a tertiary care hospital with literature review.

Paraganglioma that involves the CNS may mimic clinico-radiologically many other commoner entities. The current study presents a wide view of the clinical, radiological, and histomorphological spectrum along with rare associations that can occur concurrently with this lesion. The most common site of infliction in CNS is the spine and, in the current series, involvement of the lumbar spine was most frequent. Both clinical and radiological features point towards other more common differentials, including neurofibroma/schwannoma and ependymoma. Some studies suggest rich vascularity (cap sign) and salt pepper appearance in T2-weighted images to serve as soft pointers towards diagnosing it on magnetic resonance imaging, however, in our series we did not encounter the same.

PTSD Coverage in the New York Times: Implications for the State of Mental Health in the U.S.

Post-Traumatic Stress Disorder (PTSD) has been portrayed in media in a skewed way such that the coverage overrepresents combat-precipitated trauma and neglects to communicate treatment options, which has direct implications for people with PTSD. Given the traumatic nature of contemporary events such as the COVID-19 pandemic and the emergence of social movements concerning traumatic violence such as #MeToo and Black Lives Matter, this study examines if media coverage of PTSD has evolved to account for these changes. We specifically examined sourcing and framing in PTSD news coverage published by The New York Times from 1999 to 2020 using quantitative content analysis. The findings indicate that the coverage overrepresents combat trauma and neglects to communicate treatment options; favors men over women in sourcing of the news stories; and uses more thematic, compared to episodic framing. The theoretical and practical implications of the findings are discussed.

The Stereotype Content Model as an Explanation of Biased Perceptions in a Medical Interaction: Implications for Patient-Provider Relationship.

This experimental investigation uses the stereotype content model (SCM) to explain the biases associated with the perceptions of healthcare providers and the subsequent impact of such biased perceptions. Specifically, the 2 (gender: male, female) by 2 (race: Arab, Caucasian) between-subjects experiment examined the impact of physician race and gender on people's perceptions regarding physician's communication competence, trust, and intentions to visit. The findings indicate that female physicians are considered not only warmer but also more competent than male physicians. White physicians are considered less competent overall than their minority counterparts, though no differences in perceived patient-centered communication behaviors were observed. In addition, perceived competence and warmth mediated the effect of physician gender and race (only warmth) on the perceptions of trust, physician's use of patient-centered communication, and intentions to visit. The theoretical and practical implications of the study are discussed.

A Comparative Analysis of Health News in Indigenous and Mainstream Media.

It is important to evaluate the media's health coverage of Indigenous communities both because these communities have been hit very hard by health inequities, and because misinformation can negatively affect the future health of Indian Country. This study takes the unique angle of examining both Indigenous and non-Indigenous ("mainstream") news publications to evaluate information gaps in health, health policy, and health efficacy coverage. The Indigenous media examined, which covered 14 times more health stories than mainstream media, highlighted health issues in Indian Country through the lens of resilience by using framing to emphasize unequal power, while at the same time providing depth and specificity. Instead of putting Indigenous health stories into historical and cultural context, mainstream media focused on the lack of resources and the chronic struggle of Indigenous communities. Mainstream media often only covered the topic once per outlet; however, those outlets with connections to Indigenous communities did provide more balanced coverage. Instead of promoting change, most mainstream media stories blamed Indigenous people for their situation and offered a doom trajectory for tribes hit hardest by health disparities. This study reveals how embedded framing and mediatization direct non-Native readers' attention away from the systemic deprivation of support to U.S. Indigenous tribes that was guaranteed to them by the U.S. government in tribal agreements. The implications for journalism and policy are discussed.

Analysis of Corneal Scheimpflug Densitometry and Ocular Wavefront Aberrations Post Descemet Stripping Automated Endothelial Keratoplasty.

PURPOSE: To assess the role of corneal densitometry and wavefront aberrations post Descemet stripping automated endothelial keratoplasty (DSAEK) and their correlation with visual acuity. METHODS: Twenty-seven eyes of 25 patients with nonresolving corneal edema for more than 3 months as a result of Fuchs endothelial corneal dystrophy, pseudophakic bullous keratopathy, or secondary endothelial dysfunction were enrolled in a prospective interventional study and underwent DSAEK. Postoperative evaluation for corneal aberrations, including Higher order aberrations (HOAs) and corneal densitometry (CD), was performed using anterior-segment optical coherence tomography (Avanti RTvue XR; Optovue) and Scheimpflug imaging (Pentacam, Oculus Optikgeräte GmbH, Wetzlar, Germany) at 6 months. A correlation analysis of corneal aberrations, including HOAs and CD, with postoperative best-corrected visual acuity at 6 months was performed. RESULTS: Mean best-corrected visual acuity (BCVA) improved from 1.67±0.53 log of minimum angle of resolution (logMAR) to 0.2±0.22 logMAR post DSAEK at 6 months (P≤0.0001). At 6 months, mean root-mean-square (RMS) total corneal aberrations (includes HOA and low-order aberration [LOA]), RMS total HOA, and RMS LOA of the central 6-mm zone were 4.99±2.64, 1.80±0.9, and 4.55±2.64, respectively. The mean corneal densitometry from anterior, central, and posterior zones were 39.12±12.77, 23.9±7.2, and 13.54±2.04 gray scale units, respectively. Total anterior aberrations (r=0.051; P=0.006), anterior LOA (r=0.049; P=0.009), total corneal aberrations (r=0.051; P=0.001), total HOAs (r=0.095; P=0.057) and LOAs (r=0.050; P=0.002), and total CD from 0 to 2 mm (r=0.010; P=0.038) and 2 to 6 mm (r=0.014; P=0.018) showed a significant inverse correlation with postoperative BCVA. CONCLUSION: There was an inverse relationship between post DSAEK BCVA and total corneal HOAs and full-thickness densitometry at 6 months. Scheimpflug imaging with added tools for corneal aberration and densitometry analysis gives further insight into the suboptimal vision achieved despite transparent corneas post DSAEK.

The COVID-19 Pandemic and Positive Psychology: The Role of News and Trust in News on Mental Health and Well-Being.

As of writing of this paper, over 94 million people worldwide have been diagnosed with COVID-19 infection and over 2 million people have died. During crisis situations, people seek news to gain information and reduce uncertainty. Although news could provide some means of control, the constant access may also cause emotional distress. Research suggests that consumption of crisis news leads to high psychological distress and fear that may impact intentions to engage in healthy behavior. Fake news and widespread misinformation during this pandemic have obliterated public trust in news which can also affect mental health. Therefore, in this research we explore the impact of news exposure on mental well-being and test for plausible explanations. Utilizing survey methodology, we examine the role of news exposure on perceived stress, happiness, satisfaction, gratitude and the moderating impact of interest in COVID-19 news on the same. In addition, we propose trust in news as a mediator of the relationship between news exposure and abovementioned variables. The findings suggest that high levels of news exposure, combined with low levels of interest in COVID-19 news, led people to experience more stress and low satisfaction, gratitude, and happiness. However, when interest in COVID-19 news was high, people experienced more gratitude and happiness with increasing exposure. High levels of news exposure led to lower levels of trust that led to low satisfaction and happiness. Theoretical and practical implications of the study are discussed.

Laboratory preparedness for SARS-CoV-2 testing in India: Harnessing a network of Virus Research & Diagnostic Laboratories.

Background & objectives: An outbreak of respiratory illness of unknown aetiology was reported from Hubei province of Wuhan, People's Republic of China, in December 2019. The outbreak was attributed to a novel coronavirus (CoV), named as severe acute respiratory syndrome (SARS)-CoV-2 and the disease as COVID-19. Within one month, cases were reported from 25 countries. In view of the novel viral strain with reported high morbidity, establishing early countrywide diagnosis to detect imported cases became critical. Here we describe the role of a countrywide network of VRDLs in early diagnosis of COVID-19. Methods: The Indian Council of Medical Research (ICMR)-National Institute of Virology (NIV), Pune, established screening as well as confirmatory assays for SARS-CoV-2. A total of 13 VRDLs were provided with the E gene screening real-time reverse transcription-polymerase chain reaction (rRT-PCR) assay. VRDLs were selected on the basis of their presence near an international airport/seaport and their past performance. The case definition for testing included all individuals with travel history to Wuhan and symptomatic individuals with travel history to other parts of China. This was later expanded to include symptomatic individuals returning from Singapore, Japan, Hong Kong, Thailand and South Korea. Results: Within a week of standardization of the test at NIV, all VRDLs could initiate testing for SARS-CoV-2. Till February 29, 2020, a total of 2,913 samples were tested. This included both 654 individuals quarantined in the two camps and others fitting within the case definition. The quarantined individuals were tested twice - at days 0 and 14. All tested negative on both occasions. Only three individuals belonging to different districts in Kerala were found to be positive. Interpretation & conclusions: Sudden emergence of SARS-CoV-2 and its potential to cause a pandemic posed an unsurmountable challenge to the public health system of India. However, concerted efforts of various arms of the Government of India resulted in a well-coordinated action at each level. India has successfully demonstrated its ability to establish quick diagnosis of SARS-CoV-2 at NIV, Pune, and the testing VRDLs.

Opioids on Twitter: A Content Analysis of Conversations regarding Prescription Drugs on Social Media and Implications for Message Design.

As many as 130 lives are lost every day in the United States due to prescription drug misuse. The opioid crisis is gripping the country and disrupting the lives of millions. Not surprisingly, health organizations are desperately seeking solutions to educate and inform people regarding the issue, often seeking the help of various social media platforms. In this study, we do a content analysis of Twitter messages related to opioids in order to understand the factors that are most likely to influence content sharing. Our findings indicate that structure, source, and the actual content of the post all influence the likelihood of the content's being shared. Specifically, certain types of content enhanced the likelihood of content sharing whereas use of the term "addiction" discouraged retweeting. Theoretical and practical implications for message design are discussed.

Patient-centered Communication Behaviors on Primetime Television.

Previous research suggests that television programming may influence viewers' health-related knowledge, perceptions, and behaviors but has yet to examine patient-provider interactions on the most popular primetime television programs. We aimed to characterize the frequency and nature of patient-centered communication (PCC) behaviors on these programs, as cultivation and social cognitive theories suggest that these depictions may influence viewers' expectations of real-life health-care experiences. We examined 203 patient-provider interactions across 84 episodes of 22 primetime television programs-both medical and non-medical-that aired during the spring of 2016 and spring of 2017. Each interaction was analyzed for the presence of 21 optimal PCC behaviors. This study found that the most frequently observed PCC behaviors focused on the provider making good eye contact and displaying good manners. However, PCC behaviors related to managing patient uncertainty and self-management were rare. Overall, providers in medical programs were significantly more likely to exhibit certain PCC behaviors, such as asking a patient questions, having good manners, and self-disclosing personal information, compared to providers in non-medical programs. Implications of these findings include the potential for such depictions to influence patient expectations of real-life experiences and health outcomes. Future research is needed to examine these potential influences.

Normative Influences on the Role of Prescription Medicine Misuse among College Students in the United States.

Prescription medicine misuse is a growing problem in college campuses across the US. The Center for Disease Control (CDC) recently declared that the problem has reached epidemic proportions and is leading to a significant loss of lives every day. Norms-based public health campaigns that have been used in the past to address substance abuse issues among college students have had mixed success rates. Using the theory of normative social behavior, this study argues that a lack of focus on relevant mediators and moderators could be responsible for the failure of previous norms-based campaigns. Specifically, we test and support the mediating influence of perceived outcome expectations and injunctive norms on the effect of descriptive norms on intentions to misuse prescription medicines. In addition, perceived self-efficacy and trait reactance moderated the role of descriptive norms on outcome variables. Theoretical and practical implications of the findings are discussed.

Crescentic Tuck in Lamellar Keratoplasty-A Novel Technique in a Case of Advanced Pellucid Marginal Corneal Degeneration.

PURPOSE: To describe a new surgical technique "crescentic tuck in lamellar keratoplasty" for the management of advanced pellucid marginal corneal degeneration (PMCD). METHODS: A 45-year-old man with advanced PMCD and maximal thinning in the inferior juxtalimbal periphery underwent a crescentic lamellar keratoplasty in the right eye. Best-corrected visual acuity was 6/60 with no further improvement because of severe irregular astigmatism. Thinnest pachymetry in the peripheral cornea was 280 µm. Peripheral crescent-shaped lamellar corneal dissection of 3.5-mm width was performed, and an intrastromal pocket was fashioned from 4 to 8 O'clock, extending beyond limbus. A crescent-shaped donor corneal button of 3.5-mm width was denuded of its endothelium and beveled in inferior periphery to create a flange. The flange was tucked into the peripheral scleral pocket. The donor graft was secured to the host bed using 10-0 nylon interrupted sutures. RESULTS: Donor cornea integrated with the host bed over time and best spectacle-corrected visual acuity at 1 year improved to 6/9 with -1.25/-3.5 D × 90°. The simK (simulated keratometry) changed from 41.6/56.3 diopters (D) to 45.1/50.6 D. The astigmatism reduced from 14.6 D to 5.5 D. CONCLUSION: Crescentic tuck in lamellar keratoplasty provides good apposition of the donor lenticule and tectonic support to the peripheral thin cornea while preserving the peripheral limbal stem cells. Additionally, there is a significant reduction in the astigmatism, resulting in visual improvement.

Perceived Efficacy and Intentions Regarding Seeking Mental Healthcare: Impact of Deepika Padukone, A Bollywood Celebrity's Public Announcement of Struggle with Depression.

The current research examines the impact of Deepika Padukone's (one of the most popular Bollywood celebrities) public announcement of struggle with depression on people's perceived efficacy and intentions to seek help for mental healthcare. A survey conducted with 206 participants from India, the country with the highest depression rates in the world, revealed that parasocial interaction with the celebrity mediated the effect of exposure on intentions and efficacy perceptions regarding seeking mental healthcare. Our study expands the research on celebrity influence on health conditions in an international realm and in a mental health context. The findings have immense practical implications and may raise awareness about mental health in India given the popularity and reach of Bollywood among audiences in India and beyond, the level of stigmatization attached to mental health issues in India, and the lack of available resources for care. Theoretically, the study explores processes and effects of involvement with a celebrity and discusses potential implications for the behaviors related to health.

Effect of Message Format and Content on Attitude Accessibility Regarding Sexually Transmitted Infections.

Sexually transmitted infections (STIs) are widespread in the United States among people ages 15-24 years and cost almost $16 billion yearly. It is therefore important to understand message design strategies that could help reduce these numbers. Guided by exemplification theory and the extended parallel process model (EPPM), this study examines the influence of message format and the presence versus absence of a graphic image on recipients' accessibility of STI attitudes regarding safe sex. Results of the experiment indicate a significant effect from testimonial messages on increased attitude accessibility regarding STIs compared to statistical messages. Results also indicate a conditional indirect effect of testimonial messages on STI attitude accessibility, though threat is greater when a graphic image is included. Implications and directions for future research are discussed.

Using Health Conditions for Laughs and Health Policy Support: The Case of Food Allergies.

Health conditions are sometimes included in entertainment media comedies as a context for and as a source of humor. Food allergies are a typical case in point: They are potentially life-threatening yet may be used in humorous contexts. We conducted a content analysis of food allergies in entertainment media and tested the effects of humorous portrayals from an exemplar entertainment program. The content analysis confirmed that when food allergies were portrayed in television and the movies, it was most frequently in a humorous context and often contained inaccurate information. A follow-up experiment showed viewing a humorous portrayal of food allergies had an indirect negative effect on related health policy support via decreased perceived seriousness of food allergies. Inclusion of an educational video eliminated this effect on reduced policy support, with cognitive dissonance as a mediator. Findings support the hypothesis that portraying a health condition in a humorous context may reduce perceptions of seriousness and willingness to support public health policies to address risks associated with the condition, supporting and extending prior research findings.

Aetiology of acute encephalitis syndrome in Uttar Pradesh, India from 2014 to 2016.

BACKGROUND & OBJECTIVES: It is imperative to know the aetiology of acute encephalitis syndrome (AES) for patient management and policy making. The present study was carried out to determine the prevalence of common aetiological agents of AES in Uttar Pradesh (UP) state of India. METHODS: Serum and/or CSF samples were collected from AES patients admitted at Gandhi Memorial and Associated Hospital, King George's Medical University, Lucknow, a tertiary care centre, UP during 2014-16. Cerebrospinal fluid (CSF) and serum samples from cases were tested for IgM antibodies against Japanese encephalitis virus (anti-JEV), and dengue virus (anti-DENV) by ELISA; and for enterovirus, herpes simplex virus (HSV) and varicella zoster virus (VZV) by real-time PCR. Serum samples of cases having sufficient CSF volume, were also tested for anti-scrub typhus IgM antibodies and for Neisseria meningitides, Streptococcus pneumoniae and Haemophilus influenzae. RESULTS: JEV and DENV (8% each) were the most common identified aetiology from the 4092 enrolled patients. Enterovirus, HSV and VZV, each were detected in <1% AES cases. Co-positivity occurred in 48 cases. Scrub typhus (31.8%) was the most common aetiology detected. Haemophilus influenzae and S. pneumoniae were detected in 0.97 and 0.94% cases, respectively, however, N. meningitides was not detected in any of the cases. About 40% of the JEV/DENV positive AES cases were adults. The gap between the total number of AES cases and those with JEV/ DENV infection increased during monsoon and post-monsoon seasons. INTERPRETATION & CONCLUSION: Scrub typhus, JEV and DENV are the main aetiological agents of AES in UP. DENV and JEV can no longer be considered paediatric diseases. The prevalence of non-JEV/DENV aetiology of AES increases in the monsoon and post-monsoon seasons.

Genotype 3b of human parvovirus B19 detected from hospitalized children with solid malignancies in a North Indian tertiary care hospital.

Human parvovirus B19 (B19V) infection is known to cause serious consequences in immuno-compromized individuals. The present cross sectional study was designed to estimate the prevalence and genotype distribution of B19V in children receiving chemotherapy for solid malignancies at a tertiary care hospital in North India during October 2013 to May 2015. Serum samples from all the patients were tested for anti-B19V IgM and IgG antibodies and for B19V-DNA as soon as received. Samples testing positive for B19V-DNA were subjected to viral load estimation and to genotype determination by sequencing. Total 96 children were enrolled of which 9 (9.3%), 32 (33.3%), and 25 (26%) tested positive for anti-B19V IgM, anti-B19V IgG, and B19V-DNA, respectively. The viral load of B19V-DNA positive children ranged from 5.5 × 10(2) to 3.5 × 10(12) copies/ml. Accordingly children were divided into three groups: group I, with acute infection (n = 25); group II, previously exposed (n = 27), and group III, negative for B19V infection or with inappropriate antibody response (n = 44). B19V positivity was significantly associated (P-value < 0.0001) with a history of blood transfusion in the past 6 months, severe anemia (hemoglobin levels <6 gm%) and thrombocytopenia (platelets <150,000/cu.mm.). Sequence analysis of 21 of 25 DNA positive samples showed that all of them were Genotype 3b that clustered into three groups. All the sequences within each cluster were identical. The nucleotide identity of the sequences suggests a nosocomial outbreak of B19V during the study period. Children on chemotherapy for solid tumors should be routinely screened for B19V infection by both serology and PCR. J. Med. Virol. 88:1922-1929, 2016. © 2016 Wiley Periodicals, Inc.