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Practice Editing Here (Nov 23rd in-class Wiki session work)

 * This is a place to practice clicking the "edit" button and practice adding references (via the citation button).
 * Amyloidosis

Assignment # 3
Article: Amyloidosis

Subsection: Diagnosis

Proposed changes:

Original:

“Tissue can come from any involved organ, but in systemic disease the first-line site of the biopsy is subcutaneous abdominal fat, known as a "fat pad biopsy", due to its ease of acquisition versus biopsy of the rectum, salivary gland or internal organs. An abdominal fat biopsy is not completely sensitive, and sometimes, biopsy of an involved organ (such as the kidney) is required to achieve a diagnosis. For example, in AL amyloidosis only 85% of people will have a positive fatpad biopsy using Congo red stain. By comparison, rectal biopsy has sensitivity of 74–94%.”

Change to:

A sample of tissue can be biopsied or obtained directly from the affected internal organ, but the first-line site of biopsy is subcutaneous abdominal fat, known as a “fat pad biopsy”, due to its ease of acquisition. An abdominal fat biopsy is not completely sensitive and may result in false negatives, which means a negative result does not exclude amyloidosis diagnosis. However, direct biopsy of the affected organ may still be unnecessary as other less invasive methods of biopsy can also be used, including rectal salivary gland biopsy, lip, or bone marrow biopsy which can achieve a diagnosis in up to 85% of people.

Rationale for proposed change:

The article editors previously did not explain what they meant by “involved” organ, and lists the “rectum, salivary gland, or internal organs” as examples. I wanted to be more clear and specify that there is a difference between sampling the internal organ and sampling other tissue. I also provided an explanation for what it means when a test is not “completely sensitive” by explaining that false negatives may occur, which means that a diagnosis cannot be excluded yet. The article then states that the biopsy of the “involved” organ is required to achieve diagnosis, but then proceeds to give “rectal biopsy” as an example, yet the rectum is not related to the usual “involved” internal organs (i.e. rectal biopsy is not biopsy of the “involved organ”; it is another alternative to direct organ biopsy). I wanted to make it clear that direct organ biopsy (e.g. if you suspect the kidney has amyloid tissue, then you would sample the kidney) is often unnecessary as many less invasive diagnostic techniques exist. I also wanted to update the provided statistic using a more recent source.

The information for the above changes came from recent review articles:

Main source: Merlini, G., Dispenzieri, A., Sanchorawala, V., Schönland, S. O., Palladini, G., Hawkins, P. N., & Gertz, M. A. (2018). Systemic immunoglobulin light chain amyloidosis. Nature reviews. Disease primers, 4(1), 38. https://doi.org/10.1038/s41572-018-0034-3

Additional reading: Wechalekar, A. D., Gillmore, J. D., & Hawkins, P. N. (2016). Systemic amyloidosis. Lancet (London, England), 387(10038), 2641–2654. https://doi.org/10.1016/S0140-6736(15)01274-X

There is controversy about what should be the gold standard of tissue biopsy. While direct organ biopsy would lead to a diagnosis, the negative side effects and risks of the procedure may outweigh the usefulness of the technique, especially if less harmful methods exist to achieve the same diagnosis. I decided to provide more examples of these alternative techniques and make it clear that they exist. I believe it is important for the public to know that a step-wise approach can be taken in diagnosis to avoid unwanted complications of invasive procedures.

Critique of source:

The source I am using is much more recent (2018) than the current citations in the article. It is also a review article, a secondary source presenting a compilation of studies, and published in a reputable journal (Nature Reviews: Disease Primers). As a literature review article, the paper has not conducted a study so there is no bias from that perspective. However, the paper (Merlini et al., 2018) focuses more on AL amyloidosis than other types, although it also describes ATTR amyloidosis, and so their discussion may apply more to certain types of amyloidosis than others. This paper was also focused on systemic AL amyloidosis, and did not explore if there are diagnostic differences between localized and systemic amyloidosis. Consulting multiple papers would be necessary to garner a wider scope of background information on amyloidosis. Finally, the authors received funding from various pharmaceutical companies which may indicate competing financial interests for certain treatment methods examined in the paper. However, no specific diagnostic methods are funded or patented by these companies, which is the focus of my subsection.

Talk page post:

Talk:Amyloidosis

Please see "Suggested Change #4"

What to post on the talk page?

 * This will also be covered on Nov 23rd in class. Your group should use the below template to share an outline of your proposed improvements (including your new wording and citations). Article talk pages are not places to share your assignment answers. The Wikipedia community will be more interested in viewing your exact article improvement suggestions including where you plan to improve the article (which section), what wording you suggest, and the exact citation (Note: all citations must meet WP:MEDRS)
 * You will not be able to paste citations directly from your sandbox to talk pages (unless you are interested in editing/learning Wiki-code in the "source editing" mode). We suggest re-adding your citations on the talk page manually (using the cite button and populating the citation by pasting in the DOI, website, or PMID). You will have to repeat this process yet again when you edit the actual article live.
 * Talk Page Template: CARL Medical Editing Initiative/Fall 2020/Talk Page Template