User:Hbultra/sandbox

Endocarditis edits (active concurrent to curriculum)

Lead (citations; section out; improve S/Sx descriptions (painful v nonpainful osler/janeway); pictures)

Diagnosis: Duke criteria; Modalities (echo, labs)

Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves. Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or the surfaces of intracardiac devices. Endocarditis is characterized by lesions, known as vegetations, which is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells.^[1] In the subacute form of infective endocarditis, the vegetation may also include a center of granulomatous tissue, which may fibrose or calcify.^[2]

There are several ways to classify endocarditis. The simplest classification is based on cause: either infective or non-infective, depending on whether a microorganism is the source of the inflammation or not. Regardless, the diagnosis of endocarditis is based on clinical features, investigations such as an echocardiogram, and blood cultures demonstrating the presence of endocarditis-causing microorganisms.

Signs and symptoms include fever, chills, sweating, malaise, weakness, anorexia, weight loss, splenomegaly, flu-like feeling, cardiac murmur, heart failure, petechia (red spots on the skin), Osler's nodes (subcutaneous nodules found on hands and feet), Janeway lesions (nodular lesions on palms and soles), and Roth's spots (retinal hemorrhages).

Outline:

Lead:

Classification: IF/NIF

Risk factors for developing:

Diagnosis: Duke,

Prognoses:

Pathogens: B/V/F/O

Pathophys: (sequelae)

Epidemiology

Treatment recommendations: Valve, Class I, IIa, IIb, Surgery v Abx; WHO; CDC; other?

Thiazide peer review thoughts

Lede: The main point is buried. I may approach with a medical bias, and will care less for the organic chemistry information than medical uses or drug class info. I recommend restructuring the intro lead paragraph for more succinct clarity: Thiazides are medications that act as diuretics to treat hypertension.

• The first mention of hypertension is in regards to how they are inexpensive all over the world.
• The reader must make the leap from diuretics to hypertension, which probably not obvious to most people
• History, organic chemistry, and naming confusion are probably best in a second paragraph, away from the information about primary indication and mechanism of action. This should improve clarity and organization.
• The organic chem/compound information makes more sense in the second paragraph because it helps the reader understand the distinction from thiazide and thiazide like

Medical Uses

Water Balance/Hypertension:

• The intro paragraph about hypertension may be important for a reader to understand, but it may be best if it's linked to the internal wiki article instead of written out explicitly here. Why? Two reasons: one is that the HTN page will be updated if/when new research is published and the understanding of HTN causes, pathophys, or treatments develops because it will be closely and directly monitored for HTN science changes; secondly, an encyclopedic discussion of a HTN drug should focus on the drug more so than the disease it treats. I think it's appropriate to link to hypertension, but I think it doesn't add much to spell out HTN explicitly here.

• Second paragraph: "decades as a cornerstone..." this sentence reads not neutral, and difficult to verify. Decades as standard practice is not evidence for correctness or optimal treatment approach (consider any number of mainstay medical procedures that are by the wayside despite decades+ of use (ie surgery without anesthesia).
• Good discussion about clinical guidelines globally; this paragraph is pretty well written and could be moved up in this section. It's important information.
  • Recommendation: World Health Organization's recommendations or inputs. Which diuretics are on the essential medicines list?
• The discussion about thiazides vs low dose thiazides is not entirely clear and forces a reader to make some leaps. I think some people will get lost in the process, so a sentence explicitly stating the differences and why each would be used would benefit greatly.

Water Balance/Diabetes Insipidous

• When you click to read about DI, there is a paragraph describing thiazide's MOA for treating the disease. The discussion there, however, does not have any citations. I think the thiazide article would benefit from discussion about how thiazides accomplish a paradoxical increase in urine output.

Calcium Balance

• urinary stones, second sentence has an unneccesary comma
• Dent's Disease, the use of a case study as a reference makes me pause. It may be worth linking to case study because most people may not understand the limitations of conclusions you can draw from n=2, n=7, etc. While it's addressed in the next sentence because Dent's is rare, the whole paragraph/section could be moved to the bottom of this list. More people suffer from osteoporosis than Dent's disease. recommendation: move to bottom of medical uses.

Other uses

Recommend removing capitalization of Loop diuretics --> loop diuretics

Hyperkalemia?

Adverse effects

hypokalemia -- long, wordy paragraph about a pathway. Got me thinking a picture of the pathway for the mechanism of action may help clarify things.

Mechanism of Action

Would benefit greatly from supplementation of a diagram, picture, or flow chart.

Breast Milk

Are all thiazides safe in pregnancy? Which ones? Consider linking to the association mentioned (wiki article about them or their external site).

Other/Overall

• Consider adding a pictures of pathways to help people understand the physiology
• Consider adding picture(s) of the more popularly prescribed drug (realizing there are many, this may not actually be helpful)
• The organization of information in each paragraph could be reordered, and the strength of the article could be improved. If you're writing for people who take this drug or prescribe this drug, front load the pertinent info.
• Include discussion about HTN treatment/management in pregnancy
• May benefit by listing several trade/generic names of common thiazides for US or elsewhere
• Consider adding WHO references

Amantadine

Goal: By 2 August 2019, provide concise, accessible, current information to medical professionals and patients about the drug amantadine including:

• mechanism of action
• side effects

• contraindications
• uses
• off label (?)
• pharmacologic interactions (males and females if studies are done)
• resistance concerns

The above information is relevant if you're going to take the drug to understand risks and benefits. The above information is important if you're a medical professional to limit risks, educate patients, and obtain a good working understanding of the pharmacokinetics, dynamics, mechanism of action, and current approved/off label uses. Also considering generic v brand and costs in US/abroad

Thinking outloud with SMART:

Specifically improve and/or add the above 7 categories for readability (for patient, professional, and learner) and completeness.

Measurable: 7 goal topics → 7 categories to monitor and make progress

Attainable: Extremely confident it's possible to make progress on 1 area; remain confident it's possible to address all 7 in time frame. Also believe that by laying out the goals and intentions in writing on the talk page, it will still help improve the article

Relevant: this article will be relevant for patients/loved ones/providers of people with Parkinsonian symptoms; also for people who may get the flu and need to know about viral resistance. It's listed on wikiprojects medicine, pharm, neuro, chemical, viruses (5).

Time bound: one month, broken out weekly with smaller contributing goals.

Editing in the Sandbox:

Lede goals: improve readability via hemingway app // align lede sentence in accordance with pharm manual of style // improve citations (7/12 first draft, publish)

Lede

Per Wiki Project Pharmacology manual of style: need drug NAME, classification, indications.

Amantadine is an antiviral drug used to prevent influenza A infections. Amantadine also treats parkinsonian symptoms.

The antiviral mechanism of action is antagonism of influenza A surface protein. M2 inhibition prevents viral shedding. The drug treats parkinsonian tremors as an muscarinic antagonist and acts as a noncompetitive NMDA antagonist.

Brand names/generics xxxxx.

Parkinson's disease

Amantadine is used to treat Parkinson's disease and drug-induced parkinsonism syndromes.^[7] Amantadine may be used alone or combined with another anti-parkison or anticholinergic drug. The specific symptoms targeted by amatadine therapy are dyskinesia and rigidity. Levodopa and amantadine is a common combination.

A 2003 Cochrane review concluded evidence inadequately proved the safety or efficacy of amantadine to treat dyskinesia.^[8]

An extended release formulation is used to treat dyskinesia, a side effect of levodopa which is taken by people who have Parkinsons.^[9]

Extra-pyramidal Side Effects

An extended release formulation is used to treat dyskinesia, a side effect of levodopa which is taken by people who have Parkinsons.^[9]

Influenza

Amantadine is no longer recommended for treatment or prophylaxis of influenza A in the United States. Amantadine has no effect preventing or treating influenza B infections. For the 2008-2009 flu season, the Centers for Disease Control found that 100% of seasonal H3N2 and 2009 pandemic flu samples tested showed high levels of resistance to adamantanes. Adamantanes include amantadine and rimantidine.^[10] The CDC issued an alert to doctors to prescribe neuraminidase inhibitors oseltamivir and zanamivir. The CDC currently recommends against amantadine and rimantadine to treat influenza infections.^[11][12][13]

A 2014 Cochrane review did not find benefit for the prevention or treatment of influenza A.^[14]

Fatigue in multiple sclerosis

Amantadine also seems to have moderate effects on multiple sclerosis (MS) related fatigue.^[15]

Candidates for project article summer of 2019

• Amantadine; high importance, C class; pharm; neuro
• Haemophilus influenzae because it's a C and high priority; micro; lethal hx; vax possible; detailed list of things to fix
• Schistosoma; start, high importance; micro; lethal and common, high disability burden; citations to fix
• Malassezia furfur; start class, high importance; micro; fungus; unusual and unique because vast majority of fungi are non-pathogenic to mammals (revisit later)
• Echinococcus
• Clostridium; High, C; micro;

Tips to Myself: Finding and Using Good References

• If someone may use the article information to make a decision on their health, use the medical citation guidelines
• Primary research isn't a good enough summary, therefore use meta analyses and literature reviews as the preferred sources
• Collaborate early and often: signal intentions to wikipedians; cite often; assume best intentions

References

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0184311