User talk:Doc James/Dengue

Please add comments below. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:50, 17 February 2014 (UTC)

Comments
1. Note, i included the first para of an intro as an abstract, as we'll need it for PubMed.
 * Thanks Doc James  (talk · contribs · email) (if I write on your page reply on mine) 09:12, 17 February 2014 (UTC)

2. the introduction, for our purposes, should be referenced. it is too long for a typical abstract in pubmed, etc, and even if it was used, all clinical articles would need a referenced introduction. if we want to increase the uptake of wikipedia to academics, and legitemacy of it in academic circles, there will be some interest in adopting a standard format. the reason an abstract is unreferenced is that it is for medline/NLM, but once "clicked on", the body of the text needs references throughout, so the interested reader can do his/her "fact-checking".
 * Done Doc James  (talk · contribs · email) (if I write on your page reply on mine) 09:12, 17 February 2014 (UTC)

A number of problems with the last sentence in the first paragraph of the Introduction, i.e. Most infected people recover spontaneously, but a small proportion progress to a more severe form of disease, life-threatening dengue hemorrhagic fever, resulting in hemorrhage, thrombocytopenia and blood plasma leakage, or to dengue shock syndrome.[17]: (i) most people with dengue virus infection are asymptomatic; (ii) even people with hemorrhagic fever recover spontaneously - "self-limited" is not the determinant; (iii) "proportion" is singular whereas "progress" is plural form - and I think the sentence needs to be refactored to fix this; (iv) the cited reference (#17, WHO) does not seem to support this sentence at all. -- Scray (talk) 09:42, 18 February 2014 (UTC)

This reference may be useful with regard to the cytokine effects: '''Tisoncik JR, et al. Into the eye of the cytokine storm. Microbiol Mol Biol Rev 2012;76(1):16-32'''  -- Scray (talk) 09:49, 18 February 2014 (UTC)
 * Okay have reworded by separating the sentence into two. What is wrong with the grammar? Doc James  (talk · contribs · email) (if I write on your page reply on mine) 22:29, 19 February 2014 (UTC)
 * There was a problem with agreement, but you've fixed it by refactoring the sentence. No further concerns. -- Scray (talk) 03:25, 20 February 2014 (UTC)

CLINICAL COURSE
3. What is a measles-like rash? Maculopapular and erythematous, starts from head to toe?
 * Maculopapular. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 09:07, 17 February 2014 (UTC)

4. re: fever for how long has been described? minutes, hours? you say it is variable in how often it happens (note, i removed "actually", as it is not scientific language), but is it standard when it does? please provide some detail here.
 * Clarified. Usually two to 7 days. Fever and than gets better than than fever again. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 11:55, 17 February 2014 (UTC)

5 .disease proceeds to a critical phase around the time the fever resolves..."around the time" is not specific enough language, and can be replaced with "as".
 * Done Doc James  (talk · contribs · email) (if I write on your page reply on mine) 09:07, 17 February 2014 (UTC)

6. i'm not sure the critical phase (if you define it as such because someone develops serious deterioration) lasts one to two days, ie, if someone gets pulmonary edema during this phase, or shock, the sequelae can last longer. perhaps you mean to say "as the fever resolves, some patients are at risk for developing complications"?
 * Thanks and clarified. It is the plasma leakage that lasts one to two days. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 12:06, 17 February 2014 (UTC)

7.I'm not sure why this has changed from James' previous version, but in it, we had assumed more specific language, ie, "fluid accumulation in chest and abdominal cavity" should be replaced by "pulmonary edema' and "ascites". Similarly, "depletion of fluid and decreased blood supply" should be hypovolemia and shock.
 * Done Doc James  (talk · contribs · email) (if I write on your page reply on mine) 09:07, 17 February 2014 (UTC)

8. "severe itching and a slow heart rate" should be "pruritis and bradycardia"
 * Done Doc James  (talk · contribs · email) (if I write on your page reply on mine) 09:07, 17 February 2014 (UTC)

9. "peeling of the skin" should be desquamation
 * Done Doc James  (talk · contribs · email) (if I write on your page reply on mine) 09:07, 17 February 2014 (UTC)

ASSOCIATED PROBLEMS
10. again, in James' previous mansucript, the text read more scientifically, like: Dengue can occasionally affect several other body systems,[8] either in isolation or along with the classic dengue symptoms.[6] A decreased level of consciousness occurs in 0.5–6% of severe cases, which is attributable either to encephalitis or indirectly as a result of impairment of vital organs, for example, hepatic encephalopathy.[6][12] Other neurological disorders have been reported in the context of dengue, such as transverse myelitis and Guillain–Barré syndrome.[6] Myocarditis and acute liver failure are among the rarer complications.[5][8]
 * Yes related to too many versions of the article. We are now working just on Wikipedia so hopefully this will stop occurring. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 09:17, 17 February 2014 (UTC)

TRANSMISSION
11. "The virus seems to have no detrimental effect on the mosquito, which remains infected for life"- reference?
 * Done Doc James  (talk · contribs · email) (if I write on your page reply on mine) 10:35, 17 February 2014 (UTC)

MECHANISM
12. "As a result, less blood circulates in the blood vessels, and the blood pressure becomes so low that it cannot supply sufficient blood to vital organs. Furthermore, dysfunction of the bone marrow due to infection of the stromal cells leads to reduced numbers of platelets, which are necessary for effective blood clotting;" again, James recent piece had this replaced with "shock" and "thromocytopenia" in the appropriate places
 * Done Doc James  (talk · contribs · email) (if I write on your page reply on mine) 10:39, 17 February 2014 (UTC)

13. " Meanwhile, the virus genome is translated in membrane-bound vesicles on the cell's endoplasmic reticulum, where the cell's protein synthesis apparatus produces new viral proteins that replicate the viral RNA and begin to form viral particles." - Reference?
 * Done Doc James  (talk · contribs · email) (if I write on your page reply on mine) 11:04, 17 February 2014 (UTC)

14. "mediated by the JAK-STAT pathway.:" reference ?
 * Done Doc James  (talk · contribs · email) (if I write on your page reply on mine) 11:04, 17 February 2014 (UTC)

15" "Some serotypes of dengue virus appear to have mechanisms to slow down this process. " - reference?
 * Done Doc James  (talk · contribs · email) (if I write on your page reply on mine) 11:04, 17 February 2014 (UTC)

VIRAL REPLICATION/SEVERE DISEASE
16. low platelets in the blood - should be "thromocytopenia"
 * Done Doc James  (talk · contribs · email) (if I write on your page reply on mine) 09:08, 17 February 2014 (UTC)

DIAGNOSIS
17. "low white blood cell " do you mean leukopenia, or neutropenia, or lymphopenia, etc?
 * Done Doc James  (talk · contribs · email) (if I write on your page reply on mine) 09:56, 17 February 2014 (UTC)

18. "low white blood cell count (and) low platelets"...see above
 * Done Doc James  (talk · contribs · email) (if I write on your page reply on mine) 09:56, 17 February 2014 (UTC)

19, Is this an accepted "diagnosis"? This is mostly how it is diagnosed in children. Ie, delayed cap refill, cold extremities. One would expect something more scientific, ie, a suspected diagnosis of dengue and evidence of end-organ ischemia, or hemodynamic abnormalities including hypotension and persistent tachycardia. "Peripheral vascular collapse", is not a commonly understood or used medical term. It might not be necessary to have this sentence here, as you clarify DSS in the subsequent paragraph.
 * Agree and trimmed. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 11:29, 17 February 2014 (UTC)

PREVENTION
20. "This is done by emptying containers of water or by adding insecticides or biological control agents to these areas" - which areas? containers of water? or to other standing bodies of waters? if the latter, are these ditches, ponds?
 * The WHO document does not state explicitly. Have changed to "sources of water" as it applies to ditches, saucers, eve troughs, old tires, etc. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 11:21, 17 February 2014 (UTC)

21. "although spraying with organophosphate or pyrethroid insecticides is not thought to be effective" - does this mean that people are spraying with "organosphosphate" is not effective but people are doing it anyway, or the "spraying" is not effective, ie, other modes would be more useful?
 * Done but not effective. Clarified. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 11:21, 17 February 2014 (UTC)

22. "However, these methods appear not to sufficiently effective" - effective for what? to control the disease? or to prevent epidemics?
 * Adjusted wording Doc James  (talk · contribs · email) (if I write on your page reply on mine) 10:23, 17 February 2014 (UTC)

23. "..urbanization". - how does urbanization affect control/prevention efforts?
 * Adjusted wording to mention that urbanization increases habitat. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 10:32, 17 February 2014 (UTC)

MANAGEMENT
24. - " Treatment depends on the symptoms, varying from oral rehydration therapy at home" for which patients? can you offer recommendations based on classification?
 * Done Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:51, 17 February 2014 (UTC)

EPIDEMIOLOGY
25. "he most common viral disease transmitted by arthropods, dengue has a disease burden estimated to be 1600 disability-adjusted life years per million population, which is similar to tuberculosis, another childhood and tropical disease. As a tropical disease dengue was deemed in 1998 second in importance to malaria, though the World Health Organization counts dengue as one of seventeen neglected tropical diseases " - dengue does not cause nearly the morbidity of TB, and it does not serve to try to establish its importance by comparing it to that disease, or any other. Most recent evidence cites that its burden is lower than other ND's, and much of this paragraph can be edited out. These are more recent papers that describe the burden of ND's. 1) http://www.ncbi.nlm.nih.gov/pubmed/22325616 2) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2100367/
 * Good points and adjusted the text in question Doc James  (talk · contribs · email) (if I write on your page reply on mine) 12:27, 17 February 2014 (UTC)

26. " the United States, the rate of dengue infection among those who return from an endemic area with a fever is 3–8%, and it is the second most common infection after malaria to be diagnosed in this" - enteric diseases are more common than dengue, though it is true to say that in patients with "general febrile illness", in the absence of diarrhea, dengue is more common. Can the sentence be changed to reflect this?
 * Gastroenteritis usually does not give you a fever. Also it is many causes not one. And the cause is often not "diagnosed" specifically. Clarified some. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 12:17, 17 February 2014 (UTC)

27. please more para that starts with: "Infections are most commonly acquired" - to the start of this section, as it will help people know if their patient is coming from a region of endemnicity, and that is something they will be more interested in than which mosquito carries the virus.
 * Moved to second paragraph. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 10:20, 17 February 2014 (UTC)

28. please add that dengue is found through much of Africa, in fact, is more common than people thought

http://wwwnc.cdc.gov/eid/article/17/8/10-1515_article.htm

and that up to 20% of africans are at risk; LeDuc JW, Esteves K, Gratz NG. Dengue and dengue haemorrhagic fever. In: Murray CJ, Lopez AD, Mathers CD, editors. The global epidemiology of infectious diseases. Vol. IV. Global burden of disease and injury series. Geneva: World Health Organization; 2004. p. 219–42. RESEARCH
 * Done Doc James  (talk · contribs · email) (if I write on your page reply on mine) 10:16, 17 February 2014 (UTC)

29. "There are ongoing programs working on a dengue vaccine to cover all four serotypes" - at the beginning of the article, you describe FIVE serotypes, can you clarify which it is, and be consistent throughout the article?
 * The fifth was just discovered a couple of months ago. Thus current efforts have only been trying to develop a vaccine that covers the 4 previously known ones. Mentioned in that section. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 10:00, 17 February 2014 (UTC)

*Introduction says, "around 50–390 million people infected yearly"; Epidemiology says, "It infects 50 to 100 million people worldwide a year". -- Scray (talk) 07:46, 18 February 2014 (UTC)
 * Thanks have updated. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 22:13, 19 February 2014 (UTC)

*First paragraph of Epidemiology says dengue is present in 22 countries in Africa. Second paragraph says, Dengue fever, which was once confined to Southeast Asia, has now spread to Southern China, countries in the Pacific Ocean, and the Americas.[4] It could also pose a threat to Europe.[3] The latter seems incomplete. -- Scray (talk) 07:49, 18 February 2014 (UTC)
 * Excellent points. Have fixed the ordering and reworded slightly. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 22:18, 19 February 2014 (UTC)

Further comments

 * 1) Intro and epidemiology: 50-390 million seems like a large range, a 600% difference. Can you clarify this, or say “up to 390 million?
 * It depends on how one does the calculation. WHO says 50-100 million http://www.who.int/mediacentre/factsheets/fs117/en/, this ref says around 390 million maybe up to 528 million http://www.ncbi.nlm.nih.gov/pubmed/23563266
 * This is the thing with a disease which is often without symptoms. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 05:47, 9 March 2014 (UTC)
 * OMEDnote - Do you think it's possible to write a sentence, like: "Estimates of the incidence of Dengue vary, from 50 million per year (ref), as high as 528 million new infections (ref)." - it allows the reader to assess both sources a bit more cleanly. Maskalyk (talk) 19:40, 12 March 2014 (UTC)
 * Sure. Like that suggestion. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 19:53, 12 March 2014 (UTC)
 * 1) Epidemiology: This reference does not say that dengue is “likely” present in all of them, but that it is underreported.
 * The ref says "The presence of disease and high prevalence of antibody to dengue virus in limited serologic surveys suggest endemic dengue virus infection in all or many parts of Africa." Have changed it to "likely present in most" rather than all. Thoughts? Doc James  (talk · contribs · email) (if I write on your page reply on mine) 05:44, 9 March 2014 (UTC)
 * OMEDnote - agreed. Maskalyk (talk) 19:40, 12 March 2014 (UTC)
 * 1) Please number tables and figures.
 * Done Doc James  (talk · contribs · email) (if I write on your page reply on mine) 05:39, 9 March 2014 (UTC)
 * OMEDnote - great.Maskalyk (talk) 19:40, 12 March 2014 (UTC)
 * 1) Management: Please clarify what “warning signs” are. Lab? Clinical? Can you make/find a box for this?
 * It is one of the figures that will be included Doc James  (talk · contribs · email) (if I write on your page reply on mine) 05:33, 9 March 2014 (UTC)
 * OMEDnote - ok. Maskalyk (talk) 19:40, 12 March 2014 (UTC)
 * 1) Prevention: Is it fair to add “which include standing water in urban areas, such as ponds,drainage ditches, and open barrels.”
 * Sure have added "such as within discarded tires, ponds, drainage ditches, and open barrels" Doc James  (talk · contribs · email) (if I write on your page reply on mine) 05:39, 9 March 2014 (UTC)
 * OMEDnote - thanks. Maskalyk (talk) 19:40, 12 March 2014 (UTC)