User:Asalomon2023/sandbox

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 * Note: Please use your sandbox to submit assignment # 3 by pasting it below. When uploading your improvements to the article talk page please share your exact proposed edit (not the full assignment 3).


 * Talk Page Template: CARL Medical Editing Initiative/Fall 2019/Talk Page Template

= Hodgkin Lymphoma - CARL Wikipedia Assignment =

Assignment 2:
Student name: Angela Salomon (Student # 10063108)

Acronyms: HL - Hodgkin Lymphoma; EBV – Epstein-Barr Virus; HIV – Human Immunodeficiency Virus

1)    How you searched for a source:
I searched Pubmed using the following search string:


 * ((("hodgkin disease"[MeSH Terms] OR ("hodgkin"[All Fields] AND "disease"[All Fields]) OR "hodgkin disease"[All Fields])) AND ("herpesvirus 4, human"[MeSH Terms] OR "human herpesvirus 4"[All Fields] OR ("epstein"[All Fields] AND "barr"[All Fields] AND "virus"[All Fields]) OR "epstein barr virus"[All Fields])) AND review[Publication Type]
 * I further limited the results by date to those published January 1, 2008 to present, in order to identify a review with up-to-date evidence.

2)   What potential sources were identified and considered:

 * 1) Okano, Motohiko, and Thomas G. Gross. "Acute or chronic life-threatening diseases associated with Epstein-Barr virus infection." The American journal of the medical sciences 343.6 (2012): 483-489.
 * 2) Koh, Young Wha, et al. "Changing trend of Epstein-Barr virus association in Hodgkin lymphoma in the Republic of Korea." Annals of hematology 92.12 (2013): 1653-1660.
 * 3) CHOSEN SOURCE: Grewal, Ravnit, et al. "Hodgkin’s lymphoma and its association with EBV and HIV infection." Critical reviews in clinical laboratory sciences 55.2 (2018): 102-114.

3)   Why the source was chosen:
I chose Grewal et al. because it is a review covering the topics of interest (plus their interaction with HIV, which I know to be an important factor in the relationship between HL and EBV). Unlike other choices listed above, it is a broad, well-referenced review which specifically covers the role of EBV and HIV in the pathogenesis of HL in geographies/populations that are most relevant to this relationship (with high HIV incidence).

4)   3 reasons why the source meets Wikipedia’s (MEDRS) criteria:

 * 1) Peer-reviewed article published in reputable academic journal
 * 2) Uses up-to-date evidence
 * 3) Summary of scientific consensus, with a neutral perspective

5)   How do you plan to use the source for improving the article:

 * I plan to use this source to better elucidate the relationship between HL, EBV, and HIV beyond the single sentence currently in the article which states, “About half of cases of Hodgkin's lymphoma are due to Epstein–Barr virus (EBV)… Other risk factors include a family history of the condition and having HIV/AIDS.” Specifically, I will explain the various schools of thought surrounding how EBV may lead to HL, and how this relationship differs depending on the setting (and epidemiology of HIV in the region in question).

Proposed change #1:
Old: "In 2015, about 574,000 people had Hodgkin lymphoma, and 23,900 died."

New: "In 2015, about 574,000 people around the world had Hodgkin lymphoma, and 23,900 died (global case fatality = 4.2%)."

Rationale for proposed change: The rest of this introductory paragraph focuses on U.S. statistics, and it is important to specify that this is a global statistic to differentiate it from the rest of the paragraph. It is also helpful to add a case fatality rate to put the prevalence and mortality into context.

References:

GBD 2015 Disease Injury Incidence Prevalence Collaborators (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.

2.      GBD 2015 Mortality Causes of Death Collaborators (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.

Controversy or varied opinion: none

Proposed change #2:
Old: “About half of cases of Hodgkin lymphoma are due to Epstein–Barr virus (EBV). Other risk factors include a family history of the condition and having HIV/AIDS… The virus-positive cases are classified as a form of the Epstein-Barr virus-associated lymphoproliferative diseases.”

New: “About half of cases of Hodgkin lymphoma are associated with a virus called Epstein–Barr virus (EBV), the majority of which are cases of classic Hodgkin Lymphoma. (**********minor details: I noticed the original wiki article used "classical Hodgkin lymphoma" instead of "classic". They are interchangeable. However, I suggest we stay with "classical" for consistency****) EBV, also known has human herpesvirus 4, attaches to B-lymphocyte cells of the immune system and becomes incorporated into the host DNA. Here, the virus causes the B-cells to replicate and grow uncontrollably, leading to Hodgkin Lymphoma and other cancers. Human Immunodeficiency Virus (HIV) is also commonly associated with Hodgkin Lymphoma, likely because HIV is a significant risk factor for infection with EBV (almost all cases of HIV-associated HL are also infected with EBV). Hodgkin Lymphoma is more common among people living with HIV who are being treated with antiretroviral therapy (ART) compared to those not on ARTs, although use of ARTs is associated with better prognostic outcomes .”

Rationale for proposed change: The current text does not adequately describe how EBV and HIV are risk factors for developing Hodgkin Lymphoma. I feel that the proposed changes give a sufficient (but not overly complex) description of the pathology behind this association and potential changes in outcomes.

References:

Grewal, Ravnit, et al. "Hodgkin’s lymphoma and its association with EBV and HIV infection." Critical reviews in clinical laboratory sciences 55.2 (2018): 102-114.

Jacobson, C and Abramson, J. “HIV-Associated Hodgkin's Lymphoma: Prognosis and Therapy in the Era of cART.” Advances in hematology 2012 (2012).

Franceschi, S., et al. "Changing patterns of cancer incidence in the early-and late-HAART periods: the Swiss HIV Cohort Study." British journal of cancer 103.3 (2010): 416.

Controversy or varied opinion: It is not clear exactly why the prevalence of Hodgkin Lymphoma among people with HIV continues to be so high, despite the fact that progression from HIV to AIDS has been significantly reduced by antiretroviral use in the modern era. There is some speculation that it is because people living with HIV (PLHIV) are living longer and more frequently reaching the age at which HL is most common (50-65). The association is also strongest among patients with a “moderate” CD4 count (150-199 cells/ μL), and less common among those with extremely low CD4 counts, possibly because in advanced HIV the environment and cells that support and signal the affected Reed-Sternberg cells are also negatively affected. I don’t believe this uncertainty affects the proposed changes to my section, as it may be too in-depth for the purposes of the HL Wikipedia article.

Critique of Source
The chosen sources are susceptible to several biases which affect their validity, including:


 * 1) Selection bias: because this is a non-systematic review, there is no strict methodology that authors followed for including articles (and thus it would be difficult to replicate the search strategy/ they may have included data from limited sources).


 * 1) Publication bias: Similar to above – limitations may have been placed on included articles including publication year and language (limitations were not specified!)
 * 2) Bias due to geography: the primary source (Grewal et al.) focuses on studies examining HL and HIV/EBV infection in African countries (where HIV/EBV incidence is high), but this may not have external validation to other geographical settings
 * 3) Author bias: written by “experts” in the field, and although it is published in a peer-reviewed journal, may be susceptible to bias due to personal viewpoints.

********* excellent work********