WikiJournal of Medicine is an open-access, free-to-publish, Wikipedia-integrated academic journal for Medical and Biomedical topics.
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The WikiJournal of Medicine is an open access, free-to-publish Wikipedia-integrated journal devoted to medicine and biomedicine. It is part of the larger WikiJournal publishing group. Its function is to put articles through academic peer review for stable, citable versions, whose content can potentially benefit Wikipedia and other Wikimedia projects.
Dioxins and dioxin-like compounds comprise a group of chemicals including polychlorinated dibenzo-p-dioxins (PCDD) and polychlorinated dibenzofurans (PCDF), as well as certain dioxin-like polychlorinated biphenyls (dl-PCB), and potentially others. They act via a common mechanism, stimulation of aryl hydrocarbon receptor (AH receptor, AHR), a vital transcription factor in cells. There are very high differences in potency among these compounds, i.e. in the ability to stimulate the receptor. This leads to ten thousand fold or higher differences in doses causing similar toxic effects. Most of these compounds are eliminated very slowly in the environment, animals, or humans, which makes them persistent. They are much more soluble in fat than in water, and therefore they tend to accumulate in lipid or fatty tissues, and concentrate along the food web (bioaccumulation and biomagnification). [...]
PCDD/PCDFs are formed mostly as side products in burning processes, but PCBs were oils manufactured for many purposes. Because of toxicity and persistence, dioxin-like compounds have been regulated strictly since 1980s, and their levels in the environment and animals have decreased by an order of magnitude or more. Therefore the effects on wildlife have clearly decreased, and even populations at the top of the food web such as fish-eating birds or seals have recovered after serious effects on their reproductive capacity and developmental effects in their young especially in 1970s and 1980s. This does not exclude the possibility of some remaining effects. In humans the intake is mostly from food of animal sources, but because our diet is much more diverse than that of such hallmark animals as white-tailed eagles or seals, the concentrations never increased to similar levels. However, during 1970s and 1980s effects were probably also seen in humans, including developmental effects in teeth, sexual organs, and the development of immune systems. Both scientists and administrative bodies debate at the moment about the importance of remaining risks. This is very important, because the AH receptors seem to be physiologically important regulators of growth and development of organs, immunological development, food intake and hunger, and in addition regulate enzymes protecting us from many chemicals. Thus a certain level of activation is needed, although inappropriate stimulation of the receptor is harmful. This dualism emphasizes the importance of benefit versus risk analysis. As a whole, regulating the emissions to the environment is still highly important, but one should be very cautious in limiting consumption of important and otherwise healthy food items and e.g. breast feeding. Distinct toxic effects of high doses of dioxins in humans have been clearly demonstrated by frank poisonings and the highest occupational exposures. Hallmark effects have been skin lesions called chloracne, various developmental effects of children, and a slightly increased risk of total cancer rate. The highest dioxin levels have been ten thousand fold higher than those seen in the general population today.
Objective: To assess and compare the readability of the twenty-five most accessed English medical articles on Wikipedia 0, 1, 5 and 10 years ago. Design: The twenty-five most accessed Wikipedia articles on diseases in August 2018 were identified for this study. The content of the lead paragraphs was formatted to remove any hyperlinks, decimals, colons, semicolons and periods used in abbreviations. An online tool was then used to assign a score to the readability of each text sample using the following formulae: Gunning FOG (Frequency of Gobbledygook) index, Flesch-Kincaid Grade Level (F-K), Simple Measure of Gobbledygook (SMOG) and Flesch Reading Ease (FRE). A single reading grade (RG) was calculated for each passage by averaging scores from the FOG, SMOG and F-K tests to facilitate interpretation. These steps were repeated for the lead paragraph of the same medical articles as visible 1, 5 and 10 years ago on Wikipedia. Main Outcome Measures: Readability grade (RG) and reading ease (FRE score) [...]
Results: The average (mean) RG of the twenty-five most accessed Wikipedia articles on diseases in 2018 was 12.73 (95% CI = 12.07-13.38), and the average FRE score was 39.91 (95% CI = 36.09-43.74), a score considered “difficult”. The number of articles that were easier to read (lower RG and higher FRE) in 2018 was significantly higher when compared to 2013 and 2008 (p<0.0001), but not significantly different when compared to 2017. When paired by titles and compared over time, a statistically significant difference in readability (RG and FRE) was seen in 2018 when compared to earlier years: 2017 (Friedman Chi-squared=13.70, p=0.0002), 2013 (Friedman Chi-squared=46.08, p<0.0001) and 2008 (Friedman Chi-squared=33.03, p=0.0001). None of the pages were written at the 7th or 8th grade level as recommended by the U.S. National Institutes of Health (NIH). Conclusions: The average readability of English Wikipedia’s medical pages has improved in 2018 when compared to previous years. Most of the health information, however, remains written at a level above the reading ability of average adults.
Authors: Gloria Likupe, Roger Watson, Salma Rehman
Aim: To evaluate the evidence published in systematic reviews on the effectiveness of interventions aimed at alleviating mealtime difficulties in older people with dementia. [...]
Background: Older people with dementia gradually lose their self-care abilities as the condition of dementia progresses and this includes the ability to eat independently. There is a large body of research into this phenomenon, including into the effectiveness of interventions to alleviate the problems which arise. Recently there have also been several systematic reviews with different conclusions about the effectiveness of these interventions. Design: A systematic review of systematic reviews. Methods: Databases MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Excerpta Medica Database (EMBASE), the Cochrane Library and the Joanna Briggs Library) were searched between January 2005-December 2018 using the search strategy: (feeding OR mealtimes OR eating OR intake OR food and drink OR nutrition OR difficulty) AND dementia AND intervention AND systematic review. The Critical Appraisal Skills Programme (CASP) checklist for Systematic Reviews was used to evaluate the reviews. Results: Eight eligible studies were retrieved; three scored 10 and five scored 8 according to the CASP checklist. Conclusion: The quality of the reviews included in the review were high. There is no strong evidence to support the use of any particular intervention for the alleviation of mealtime difficulties in older people with dementia. Methodological problems related to sample size and bias were apparent in the studies included in all the reviews and there was a lack of standardisation around interventions and outcomes across studies. Behavioural intervention, specifically Montessori education and spaced retrieval methods were considered promising and worthy of further research. Registration: The review is registered on PROSPERO
Dyslexia is a neurodevelopmental disorder characterized by difficulty learning to read and spell. Underlying deficits typically include impaired phonological awareness (an awareness of the sound structure of words) and processing; difficulty with verbal working memory; and slow verbal processing speed. Observable problems include frequent spelling errors that same-age children do not exhibit; difficulty learning how to decode individual words, including "sounding out" words; and struggling to pronounce words correctly and fluently when reading aloud. Deficits in reading comprehension often occur as a secondary consequence. [...]
Dyslexia is a heterogeneous disorder, which means that not all people with dyslexia have the same signs, symptoms, underlying deficits, or functional impairment. Children and adults with dyslexia exhibit higher rates of comorbid conditions such as developmental language disorders; attention-deficit/hyperactivity disorder (ADHD); and difficulties with motor coordination, mental calculation, concentration, and personal organization, but these are not, by themselves, markers of dyslexia. Dyslexia manifests on a continuum of severity—it is a dimensional disorder. People with this disorder have a normal desire to learn. Dyslexia is believed to be caused by both genetic and environmental factors, and their interaction. Dyslexia often runs in families. Dyslexia that develops subsequent to a traumatic brain injury, stroke, or dementia is usually called acquired dyslexia. The underlying mechanisms of dyslexia are problems within the brain's language processing. Dyslexia is diagnosed through a series of tests of memory, spelling, and reading skills. Dyslexia is separate from reading difficulties caused by hearing or vision problems or by insufficient teaching or opportunity to learn. Treatment involves adjusting teaching methods to meet the person's needs. While not curing the underlying problem, it may decrease the degree or impact of symptoms. Treatments targeting vision are not effective. Dyslexia is the most common learning disability and occurs in all areas of the world. It affects 3–7% of the population, however, up to 20% of the general population may have some degree of symptoms.
Orientia tsutsugamushi is a mite-borne bacterium belonging to the family Rickettsiaceae and is responsible for the disease scrub typhus in humans. It is an obligate intracellular parasite of trombiculid mites, in which natural transmission is maintained from the female to its eggs (transovarial transmission) and from the eggs to adults (transstadial transmission). With a genome of only 2.0–2.7 Mb, it has the most repeated DNA sequences among bacteria. It is transmitted by mite larvae (chiggers) from rodents, the natural hosts of mites, to humans through accidental bites. Naosuke Hayashi first described it in 1920, giving it the name Theileria tsutsugamushi, but it was renamed to Orientia tsutsugamushi in 1995, owing to its unique properties. Unlike other Gram-negative bacteria, its cell wall lacks lipophosphoglycan and peptidoglycan. It instead has a unique 56-kDa type-specific antigen (TSA56), which gives rise to many strains (sub-types) of the bacterium such as Karp, Gilliam, Kato, Shimokoshi, Kuroki, and Kawasaki. It is most closely related to Candidatus Orientia chuto, a species described in 2010. Primarily indicated by undifferentiated febrile illnesses, the infection can be complicated and often fatal. Diagnosis is difficult and requires laborious detection methods such as the Weil–Felix test, rapid immunochromatographic test, immunofluorescence assays, ELISA, or PCR. Eschar, if present on the skin, is a good diagnostic indicator. One million infections are estimated to occur annually in the endemic region called the Tsutsugamushi Triangle, which covers the Russian Far East in the north, Japan in the east, northern Australia in the south, and Afghanistan in the west. However, infections have also spread to Africa, Europe and South America. Antibiotics such as azithromycin and doxycycline are the main prescription drugs. There is no vaccine for the infection.
Hepatitis E is inflammation of the liver caused by infection with the hepatitis E virus. It is one of five known human hepatitis viruses: A, B, C, D, and E. HEV is a positive-sense, single-stranded, nonenveloped, RNA icosahedral virus. HEV has mainly a fecal-oral transmission route. Infection with this virus was first documented in 1955 during an outbreak in New Delhi, India. A preventive vaccine (HEV 239) is approved for use in China. [...]
Although hepatitis E often causes an acute and self-limiting infection (the viral infection is temporary and the individual recovers) with low death rates in the western world, it bears a high risk of developing chronic hepatitis in people with a weakened immune system with substantially higher death rates. Organ transplant recipients who receive medications to weaken the immune system and prevent organ rejection are thought to be the main population at risk for chronic hepatitis E. Hepatitis E infection has a clinical course comparable to hepatitis A, but in pregnant women, the disease is more often severe and is associated with a clinical syndrome called fulminant liver failure. Pregnant women, especially those in the third trimester, have a higher rate of death from the disease of around 20%. In total there are 8 genotypes; genotypes 3 and 4 cause chronic hepatitis in the immunosuppressed. Hepatitis E incidence in 2017 was more than 19 million.
Lassa fever is a viral hemorrhagic fever caused by Lassa virus (Lassa mammarenavirus), a negative-sense single-stranded RNA virus of the Arenaviridae family. In most cases Lassa virus infection is asymptomatic (presenting no symptom). When symptomatic it is characterized by mild acute febrile disease to a chronic fatal disease with severe toxaemia, capillary leak, hemorrhagic situations, shock and multiple organ failure. Early diagnosis of Lassa fever is very important because of the transmissibility of infection, the need for potent isolation of infected persons and for containing potentially infectious specimens during laboratory testing. Lassa fever was first elucidated in the 1950s, but the virus was not recognized until 1969 when it infected two missionary nurses in Lassa Village, Borno State, Northeastern Nigeria. Natal multimammate rat or common African rat of Mastomys genus are the reservoir of Lassa virus. When the rodents become infected with Lassa virus, they infect humans through their urine and faeces, but remain unharmed. Because of its similarities with other febrile diseases such as malaria, typhoid, Ebola hemorrhagic fever, early detection is difficult. Thus when persons have persistent fever not responding to normal conventional therapies, they should be screened for other possible causes (especially in endemic regions). When the presence of Lassa fever is established in a community, immediate isolation of infected individuals, screening, standard infection prevention and control practices and meticulous contact tracing can halt outbreaks. Treatment involves supportive measures and early use of the antiviral drug ribavirin.
The Western African Ebola virus epidemic (2013–2016) was the most widespread outbreak of Ebola virus disease (EVD) in history—causing major loss of life and socioeconomic disruption in the region, mainly in the countries of Guinea, Liberia, and Sierra Leone. The first cases were recorded in Guinea in December 2013; later, the disease spread to neighboring Liberia and Sierra Leone, with minor outbreaks occurring elsewhere. It caused significant mortality, with the case fatality rate reported which was initially considerable, while the rate among hospitalized patients was 57–59%, the final numbers 28,616 people, including 11,310 deaths, for a case-fatality rate of 40%.* Small outbreaks occurred in Nigeria and Mali,* and isolated cases were recorded in Senegal, the United Kingdom and Italy. In addition, imported cases led to secondary infection of medical workers in the United States and Spain but did not spread further.* The number of cases peaked in October 2014 and then began to decline gradually, following the commitment of substantial international resources. As of 8 May 2016 , the World Health Organization (WHO) and respective governments reported a total of 28,616 suspected cases and 11,310 deaths (39.5%), though the WHO believes that this substantially understates the magnitude of the outbreak.* [...]
On 8 August 2014, a Public Health Emergency of International Concern was declared and on 29 March 2016, the WHO terminated the Public Health Emergency of International Concern status of the outbreak. Subsequent flare-ups occurred; the last was declared over on 9 June 2016, 42 days after the last case tested negative on 28 April 2016 in Monrovia. The outbreak left about 17,000 survivors of the disease, many of whom report post-recovery symptoms termed post-Ebola syndrome, often severe enough to require medical care for months or even years. An additional cause for concern is the apparent ability of the virus to "hide" in a recovered survivor's body for an extended period of time and then become active months or years later, either in the same individual or in a sexual partner.* In December 2016, the WHO announced that a two-year trial of the rVSV-ZEBOV vaccine appeared to offer protection from the variant of EBOV responsible for the Western Africa outbreak. The vaccine has not yet been given regulatory approval, but it is considered to be effective and is the only prophylactic which offers protection hence 300,000 doses have been stockpiled.*
Authors: Suzanne M Cutts, Sean McGrath, Alison Cheong
Anthracyclines are a clinically important class of antineoplastic agents used to treat a wide variety of solid and blood cancers. The first described anthracycline, daunorubicin, was first isolated from a strain of Streptomyces peucetius in the early 1960s. Clinically the most widely used are doxorubicin, daunorubicin and their semi-synthetic derivatives epirubicin and idarubicin. They primarily act by intercalating with DNA and inhibiting topoisomerase II, resulting in DNA breaks and abrogated DNA synthesis. The most serious side effect of anthracycline use is cumulative dose-dependent cardiotoxicity, limiting recommended maximum lifetime treatment to 400-450 mg/m2. Several liposomal formulations of doxorubicin are in use, having the benefits of prolonging retention rate while reducing peak plasma concentration of free drug. Several clinical trials of anthracycline-loaded nanoparticles are currently underway.
Authors: Rochelle Tixeira, Ivan Poon, Georgia Atkin-Smith, Aaron Smith, Michael AF Parkes
The disassembly of a dying cell into smaller fragments is a fundamental biological process during apoptosis. Recently, a number of distinct morphologic changes have been identified that could mediate the fragmentation of an apoptotic cell. Presented here is a figure that describes the progression of apoptotic cell disassembly.
Rotavirus is the most common cause of diarrhoeal disease among infants and young children. It is a genus of double-stranded RNA viruses in the family Reoviridae. Nearly every child in the world is infected with rotavirus at least once by the age of five. Immunity develops with each infection, so subsequent infections are less severe; adults are rarely affected. There are eight species of this virus, referred to as A, B, C, D, E, F, G and H. Rotavirus A, the most common species, causes more than 90% of rotavirus infections in humans. [...]
The virus is transmitted by the faecal-oral route. It infects and damages the cells that line the small intestine and causes gastroenteritis (which is often called "stomach flu" despite having no relation to influenza). Although rotavirus was discovered in 1973 by Ruth Bishop and her colleagues by electron micrograph images and accounts for approximately one third of hospitalisations for severe diarrhoea in infants and children, its importance has historically been underestimated within the public health community, particularly in developing countries. In addition to its impact on human health, rotavirus also infects animals, and is a pathogen of livestock. Rotavirus is usually an easily managed disease of childhood, but in 2013, rotavirus caused 37 percent of deaths of children from diarrhoea and 215,000 deaths worldwide, and almost two million more become severely ill. Most of these deaths occurred in developing countries. In the United States, before initiation of the rotavirus vaccination programme, rotavirus caused about 2.7 million cases of severe gastroenteritis in children, almost 60,000 hospitalisations, and around 37 deaths each year. Following rotavirus vaccine introduction in the United States, hospitalisation rates have fallen significantly. Public health campaigns to combat rotavirus focus on providing oral rehydration therapy for infected children and vaccination to prevent the disease. The incidence and severity of rotavirus infections has declined significantly in countries that have added rotavirus vaccine to their routine childhood immunisation policies.
Gastrointestinal bleeding (GI bleed) is a common and potentially life-threatening reason for emergency room and intensive care unit admission. This article reports the case of an 83-year-old man with acute GI bleeding from an unusual cause. The clinical information is presented in a step-by-step and question-answer format for learning purposes. This paper is particularly aimed at an internal medicine readership.
Background: Community-acquired pneumonia (CAP) is a major cause of mortality and morbidity among infants and children, particularly in low and middle income countries. Vitamin D, which plays a role in innate as well as adaptive immunity, is a candidate low-cost intervention as an adjunct for treatment of CAP. [...]
Methods: We searched multiple electronic databases as well as grey literature to search for randomised controlled trials (RCTs) on vitamin D as an adjunct in infants and children with CAP. We used the Cochrane methodology for assessing risk of bias and, where adequate data was available, conducted a meta-analysis using a fixed or random-effects model as applicable. We assessed overall evidence quality using the GRADE approach. Findings: We screened 272 unique papers and 25 clinical trial registry records and identified three completed and three ongoing trials based on our inclusion criteria. Two completed trials were from India and one from Afghanistan. These three RCTs included a total of 977 participants. Baseline and follow-up vitamin D status was reported in only one RCT. There was no significant effect of vitamin D noted on clinical cure rates (risk ratio (RR) 1.01; 95% confidence interval (CI) 0.91, 1.13; one study, 200 participants, low quality on GRADE), and all-cause mortality (RR 1.01; 95% CI 0.23, 4.41; three trials, 977 participants, low quality on GRADE). Pooled analyses was not possible for the outcomes of time to clinical recovery of pneumonia and total duration of hospital stay, but none of the trials which studied them demonstrated any significant effect of vitamin D on these outcomes individually. Conclusions: There is insufficient evidence available from RCTs to justify the routine use of vitamin D in infants and children with CAP currently and more research is needed to understand several issues related to this. Registration: PROSPERO ID 2014:CRD42014010259
Plasmodium falciparum erythrocyte membrane protein 1 (PfEMP1) is a family of proteins present on the membrane surface of red blood cells (RBCs or erythrocytes) that are infected by the malarial parasite Plasmodium falciparum. PfEMP1 is synthesized during the parasite's blood stage (erythrocytic schizogony) inside the RBC, during which the clinical symptoms of falciparum malaria are manifested. Acting as both an antigen and adhesion protein, it is thought to play a key role in the high level of virulence associated with P. falciparum. It was discovered in 1984 when it was reported that infected RBCs had unusually large-sized cell membrane proteins, and these proteins had antibody-binding (antigenic) properties. An elusive protein, its chemical structure and molecular properties were revealed only after a decade, in 1995. It is now established that there is not one but a large family of PfEMP1 proteins, genetically regulated (encoded) by a group of about 60 genes called var. Each P. falciparum is able to switch on and off specific var genes to produce a functionally different protein, rendering evasion from the host's immune system. RBCs carrying PfEMP1 on their surface stick to endothelial cells, which facilitates further binding with uninfected RBCs (through the processes of sequestration and rosetting), ultimately helping the parasite to both spread to other RBCs as well as bringing about the fatal symptoms of P. falciparum malaria.
The hippocampus (named after its resemblance to the seahorse, from the Greek ἱππόκαμπος, "seahorse" from ἵππος hippos, "horse" and κάμπος kampos, "sea monster") is a major component of the brains of humans and other vertebrates. Humans and other mammals have two hippocampi, one in each side of the brain. It belongs to the limbic system and plays important roles in the consolidation of information from short-term memory to long-term memory and spatial memory that enables navigation. The hippocampus is located under the cerebral cortex;(allocortical) and in primates it is located in the medial temporal lobe, underneath the cortical surface. It contains two main interlocking parts: the hippocampus proper (also called Ammon's horn) and the dentate gyrus. [...]
In Alzheimer's disease (and other forms of dementia), the hippocampus is one of the first regions of the brain to suffer damage; short-term memory loss and disorientation are included among the early symptoms. Damage to the hippocampus can also result from oxygen starvation (hypoxia), encephalitis, or medial temporal lobe epilepsy. People with extensive, bilateral hippocampal damage may experience anterograde amnesia (the inability to form and retain new memories). In rodents as model organisms, the hippocampus has been studied extensively as part of a brain system responsible for spatial memory and navigation. Many neurons in the rat and mouse hippocampus respond as place cells: that is, they fire bursts of action potentials when the animal passes through a specific part of its environment. Hippocampal place cells interact extensively with head direction cells, whose activity acts as an inertial compass, and conjecturally with grid cells in the neighboring entorhinal cortex. Since different neuronal cell types are neatly organized into layers in the hippocampus, it has frequently been used as a model system for studying neurophysiology. The form of neural plasticity known as long-term potentiation (LTP) was first discovered to occur in the hippocampus and has often been studied in this structure. LTP is widely believed to be one of the main neural mechanisms by which memories are stored in the brain.
Genes consist of multiple sequence elements that together encode the functional product and regulate its expression. Despite their fundamental importance, there are few freely available diagrams of gene structure. Presented here are two figures that summarise the different structures found in eukaryotic and prokaryotic genes. Common gene structural elements are colour-coded by their function in regulation, transcription, or translation.
Authors: Thomas Shafee, Mikael Häggström, Diptanshu Das, Gwinyai Masukume
WikiJournal of Medicine is an open access, peer reviewed journal free of publication charges for its authors. It publishes both original research and reviews. It was created in 2014 and has grown rapidly since then. This editorial will highlight its unique features and the developments seen in 2016.
