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Ajpolino, that is all for now; [1] have not read article, pls ping me as you get closer to FAC and I will do a prose review. Not a fan of the word “just” as it is a value judgment ... unless sources use it. SandyGeorgia ( Talk) 18:31, 6 July 2020 (UTC)
Lead says:
Body says:
SandyGeorgia ( Talk) 11:44, 8 July 2020 (UTC)
Lead says 2,000 cases, but infobox and body mention 2 to 5. SandyGeorgia ( Talk) 11:46, 8 July 2020 (UTC)
See top of User:SandyGeorgia for links on however, subsequently, consequently and other prose redundancies. SandyGeorgia ( Talk) 11:59, 8 July 2020 (UTC)
Etcetera SandyGeorgia ( Talk) 01:19, 9 July 2020 (UTC)
WhatamIdoing will inquire about In pregnancy ... several journal articles describe treatment issues. SandyGeorgia ( Talk) 01:22, 9 July 2020 (UTC)
I don't speak HarvRef, but my gadget is reporting an error here:
SandyGeorgia ( Talk) 18:23, 5 September 2020 (UTC)
I noticed there is not much info on social and psychological effects of the disease - [5] looks like it could be a good source for this. [6] this may be useful as well. Spicy ( talk) 13:40, 21 September 2020 (UTC)
Ajpolino, are you back at it ? Don't forget to follow the Spicy trail! SandyGeorgia ( Talk) 22:11, 13 October 2020 (UTC)
Some thoughts while skimming, feel free to disagree with my nitpicking... Thank you! Leaving comments inline so I can keep track a bit better. I hope red doesn't come off as hostile. Just wanted a color that stood out...
resulting in tissue death and immune suppression.- systemic immunosuppression or only at the site of the ulcer? The latter (thankfully). Clarified in lead
mostly in rural sub-Saharan Africa and Australia- are you saying "mostly in ... rural Australia" or "mostly in... Australia"? The former. Clarified in lead
in 1897 Uganda.I find this phrasing a bit awkward. Cleaned up.
by an Australian group at Melbourne University.- I would think that a group at Melbourne University would be Australian by definition Fixed. Not sure how I missed that one. It all sounded so good in my head...
More to come... Spicy ( talk) 02:44, 31 October 2020 (UTC)
In some people, the ulcer may heal on its own or remain small and linger unhealed for years- the phrase "remain small and linger unhealed" seems to imply that the small size is connected to the fact that it doesn't heal, but I'd think a larger ulcer would be less likely to heal on its own? would "remain small but linger unhealed" be better? (I haven't checked the source so not sure if this is accurate) I'm trying to get across three possible outcomes: 1. heal on its own. 2. Remain small but doesn't heal. 3. Gets larger. Switched the wording to "but" per your suggestion. I hope that's clearer?
mycolactone ... diffuses into host cells and blocks the action of Sec61, the core translocation protein that serves as the gateway to the endoplasmic reticulum.[10] When Sec61 is blocked, proteins that would normally enter the endoplasmic reticulum are instead translated into the cytosol, causing a pathological stress response that results in cell death by apoptosis.- this is going to be really hard to understand for anyone who hasn't at least taken an AP biology class. Is it possible to explain this in more plain language while sticking to the sources? At least, Host (biology), Translation (biology) and Protein translocation should be linked. Just marking this to remind myself, I'm thinking about a better way to present this material...
causing the large open ulcer characteristic of disease- the disease?
cases are near stagnant bodies of water- "cases occur" sounds a lot better to me
Supporting this,- I would change this to "supporting this hypothesis" to make it entirely clear what you're referring to
Equipment required to run real-time PCR is prohibitively expensive and often available only at centralized diagnostic laboratories,- is this true for all areas? I would imagine it's not a problem in urban Australia and Japan for example Looking back, the source I used for that statement is clearly referring to the bulk of cases that are diagnosed in low-resource areas. I tried rephrasing this a few ways to reflect that, but then when I read it all back I realized I'm just restating the opening two sentence of the paragraph. So I cut the sentence for now. Hopefully it still flows ok?
An additional method of diagnosis is microscopic examination of ulcer tissue by a trained pathologist. However, this requires more invasive sampling of ulcer tissue, as well as specifically trained personnel- does microscopy from swabs not require specially trained personnel?
For routine diagnosis of BU in the endemic African countries, histopathological analysis of tissue samples is impractical, as it necessitates sophisticated technology as well as specifically trained and highly experienced personnel. Moreover, adequate tissue specimens obtained from the centre of a non-ulcerative lesion or from the edge of an ulcer by invasive sampling techniques are required.I suppose I could cut
as well as specifically trained personnelfrom my sentence without much changing its meaning. Do you have an alternative suggestion? (Sorry dispensed with the red so I didn't make a mess of the red+green). Ajpolino ( talk) 23:17, 10 November 2020 (UTC)
several animals- pedantic, but do you mean "several animals" or "several species of animals"? the latter of course, though I suppose both are true. Clarified.
In some endemic areas, particularly rural communities in African endemic countries, people are aware of Buruli ulcer's association with the environment, yet simultaneously associate it with witchcraft or other supernatural causes- need to be very careful with how you phrase this. The source says
are commonly perceived by the local population as somewhat mysterious ... are often associated with witchcraft or sorcery ... a concept of dual causality is frequently encountered... but the article states this without qualification, leading to the unintentionally racist implication that everyone in those areas believes this. I would imagine that African pathologists don't believe it's caused by witchcraft. Thanks. I moved a "some" and added an "often" to soften the language. Happy to do more clarifying if you feel the paragraph is still misleading as written.
While M. ulcerans may have infected humans throughout history,"throughout history" is vague. The 19th and 20th centuries are history too. Can we be more specific - is there any archeological evidence predating the first description of the disease, for example? Looking at those sources, I'm scratching my head. I'm not sure where I even got "throughout history" from. I've removed it for now, and will take a look for sources this evening. Good catch, and shame on me.
Cook noted several patients with slow-healing ulcers, consistent with Buruli ulcer- phrasing - he couldn't have noted that they were consistent with Buruli ulcer since the concept of the disease didn't exist at the time. I don't think the second part of the sentence is necessary at all because the preceding and following sentences clearly connect Cook's observation to Buruli ulcer.Cut. Thank you.
For much of the modern era- "modern era" is very vague, can we give an approximate date range? Clarified and added a couple sentences of extra treatment history
: "Cu001", isolated from a person in Adzopé, Côte d'Ivoire in 1996; "Mu1615", from a person in Malaysia in the 1960s; and "S1013" from someone in Cameroon in 2010- we have "A person", "a person", then "someone". This is a little jarring.
Forgive my nitpicking. This is a very clearly written and informative article. Spicy ( talk) 04:57, 31 October 2020 (UTC)
Buruli ulcer does not kill, but it is an important cause of morbidity because of scarring and fibrosis, my now-declared favorite review (2018) says only
[Ulcers could remain small, or grow enormous and cause major disability]. With any course, the patients maintained general good health.The background of the Cochrane review calls out a specific study
Vincent 2014a reported that among their 1043 laboratory-confirmed cases of Buruli ulcer in Benin, 229 people (22%) developed permanent functional impairment one year after their treatment, but without seeing other numbers around, I wasn't sure how to contextualize that information in the article... Anyway, will keep an eye out for anything usable... Ajpolino ( talk) 23:48, 14 November 2020 (UTC)
In practice microscopy correctly detects M. ulcerans in just 30–40% of infected people, making it a relatively insensitive diagnostic test.. The source's wording is
Microscopic study of smears made from swabs or FNA specimens that have been stained with Ziehl-Neelsen stain (an acid-fast stain), similar to what is used for tuberculosis, is used in many parts of Africa (20). A study in Ghana showed that this technique has a diagnostic sensitivity of 40% for nodules, which decreases to 30% for ulcers (21).I interpreted that to mean that if you had 20 samples, 10 each true positive/negative, the microscopists would have called 3 or 4 of the true positives as positives, and that the sentence gave no information on how they would rule on the true negative samples. So I meant to get across information about false negatives only. But I could be misinterpreting what the source meant. A second review claims
When compared with [qPCR] the reported sensitivity rates of direct smear microscopy for the detection of M. ulcerans ranged between 26% and 67%. The efficacy of the detection of small numbers of [bacteria] depends strongly on technical skills of the microscopist and on quality of the microscopic equipment(this last bit raises the obvious question of how anyone could use microscopic equipment!?). I used the numbers from the first review because I've landed on the opinion that it is the best review of the bunch, and so I find its numbers most trustworthy. Anyway, laying all this out because this is more in your wheel house than mine, and I'm happy to hear your thoughts! Ajpolino ( talk) 23:17, 14 November 2020 (UTC)
there has been no documentation of human-to-human transmission, and thus BU is not considered a contagious disease[7], and
There is no evidence to support the possibility of human-to-human transmission of BU.[8]. Now that I'm looking back at those two reviews, I've half a mind to switch to their wording... Thoughts? Ajpolino ( talk) 00:33, 1 November 2020 (UTC)
That's it ... a whole lot of this is trivial. I won't ping in anyone else until you've had time to deal with comments from Spicy and me. Or would you prefer to put a call at WT:MED yourself? If so, remember to ping Casliber, Graham Beards, Colin, Jfdwolff, WhatamIdoing ... anyone else familiar with FA standards? Once all the med people are through, there are several non-med editors I can ping in for a non-med jargon review before you head to FAC. Bst, SandyGeorgia ( Talk) 17:39, 31 October 2020 (UTC)
I hadn't thought much about the images as I was working on the text. Now that I do, I'm not sure I've picked a batch that represent the disease well. Today I added images of early signs (lumps and bumps) and images of ulcers. My question for both of you (and anyone else watching)... have I overdone it? Since the pre-ulcer and ulcer can have many different forms, I'd like to illustrate that. But I get that it's not Wikipicturebooks. Thoughts? Ajpolino ( talk) 21:55, 1 November 2020 (UTC)
On the picture, the lesion of a Nigerian 10 years old child on the right thigh and with the typical characteristic of a late stage of the disease: large painless ulceration with presence of necrosis and undermined edges.. As far as adding images, if the collages are ok, then I think I'm happy. If not, perhaps a gallery to show the different categories of ulcer and different early disease presentations would be appropriate. Ajpolino ( talk) 04:02, 11 November 2020 (UTC)
Per the suggestions above, I tried several times to reword and clarify the part of the causes section with the molecular biology explanation for mycolactone's effect. After several unsuccessful attempts, I decided the problem may be that I'm writing for two totally different audiences there. I cut the molecular detail, since I suppose (agh! Pains me to say!) most people don't care. That said I care how mycolactone works. As an act of protest, I left the molecular explanation in a footnote. Eventually I plan to clean up the article mycolactone which would obviously hold a more detailed explanation. But... what do you think of this compromise? Better? Or am I just moving bad text around... Ajpolino ( talk) 04:09, 9 November 2020 (UTC)
Digging in (ps, I am useless on images and alt text):
What you had: [9]
How M. ulcerans is transmitted to humans remains unclear, but somehow bacteria enter the skin and begin to grow. Ulceration is primarily caused by a bacterial toxin, mycolactone. As the bacteria grow, they release mycolactone, which diffuses into host cells and blocks the action of Sec61, the core translocation protein that serves as the gateway to the endoplasmic reticulum. When Sec61 is blocked, proteins that would normally enter the endoplasmic reticulum are instead translated into the cytosol, causing a pathological stress response that results in cell death by apoptosis. This results in tissue death at the site of infection, causing the open ulcer characteristic of the disease. At the same time, Sec61 inhibition prevents cells from signaling to activate the immune system, resulting in ulcers that lack infiltrating immune cells. Immune cells that do make it to the ulcer are killed by mycolactone, and tissue examinations of the ulcer show a core of growing bacteria surrounded by debris from dead and dying neutrophils.
What is left: [10]
How M. ulcerans is transmitted to humans remains unclear, but somehow bacteria enter the skin and begin to grow. Ulceration is primarily caused by a bacterial toxin called mycolactone. As the bacteria grow, they release mycolactone into the tissue around them. Mycolactone enters host cells and prevents them from secreting proteins, eventually resulting in cell death.A Dead cells slough off, leaving the open wound characteristic of the disease. At the same time, mycolactone prevents dying cells from signaling to activate the immune system. As a result, Buruli ulcers tend to lack infiltrating immune cells. Immune cells that do make it to the ulcer are killed by mycolactone, and tissue examinations of the ulcer show a core of growing bacteria surrounded by debris from dead and dying neutrophils (the most common immune cell).
Note A Specifically, mycolactone blocks the action of Sec61, the core translocation protein that serves as the gateway to the endoplasmic reticulum. When Sec61 is blocked, proteins that would normally enter the endoplasmic reticulum are instead translated into the cytosol, causing a pathological stress response that results in cell death by apoptosis.
Several points:
In either case, I think we have to accept that sometimes not every one can get every section. Bst, SandyGeorgia ( Talk) 17:49, 9 November 2020 (UTC)
Nikkimaria this article is getting very close to FAC ready; when you have time, could I interest you in reviewing the images? Regards, SandyGeorgia ( Talk) 18:14, 10 November 2020 (UTC)
Hi all, thank you for the comments. I think I've addressed everything above? If there's something you're still waiting for me to respond to, or you wanted to follow-up on something, please let me know. Otherwise, I can try reaching out to a few others to get their opinions? I'm in no big rush here. Thanks again! Ajpolino ( talk) 20:28, 16 November 2020 (UTC)
Okay, so these are liable to be a bit rough on the medical side, so please bear with me. I don't believe I've ever collaborated on a review with you before, so I'll go ahead and give a disclaimer that I tend to throw a lot of stuff out with an eye for discussion about smaller points, not that I'm trying to nitpick something to death.
Buruli ulcer has been reported in 33 countries, with 3000-5000 patients reported yearly [ref].) and itself cites a 2018 review that reprints the WHO data since 2002 (going back in time from 2018 to 2002, the annual case numbers are 2708, 2217, 1952, 2043, 2242, 2627, 3213, 4006, 4906, 5082, 5148, 5033, 5376, 4746, 4937, 3346, and 3245). So to say "As of 2019... 3,000 to 5,000... each year" doesn't seem quite right since I think the review author was trying to give some stable range that totals tend to fall within (though of course we can see some of the values fall outside that range). We could say "In 2018, the World Health Organization received 2708 reports of Buruli ulcer". Or be more explicit in mentioning that total report numbers vary but tend to be between 3,000 and 5,000. Or add a "typically" between "Organization and receives". Does one of those (or a different) options strike you as most accurate and interesting to read? Ajpolino ( talk) 04:43, 17 November 2020 (UTC)
Okay, so I think that's all I see. Hog Farm Bacon 03:05, 17 November 2020 (UTC)
As this article has been promoted to FA (congratulations Ajpolino!) I've created the editnotice at Template:Editnotices/Page/Buruli ulcer. Spicy ( talk) 07:48, 30 December 2020 (UTC)
So that image is so, so problematic -- in that it includes a white man, who (assuming) forced a bunch of youth to stand around him. It definitely profiles his very colonial, missionary relationship to the local community -- however the caption doesn't critically engage with those issues -- and its rather unexpected as you read the article, and reinforces a "white non-African saviour to the rescue" kindof narrative in the history section. Could there be some other way to illustrate or engage with that section? Is there really not any description of African or Australian indigenous medicine or story telling about the topic? That whole section feels off with the way the image is contextualizing. Sadads ( talk) 12:33, 24 March 2021 (UTC)
This is the
talk page for discussing improvements to the
Buruli ulcer article. This is not a forum for general discussion of the article's subject. |
Article policies
|
Find medical sources: Source guidelines · PubMed · Cochrane · DOAJ · Gale · OpenMD · ScienceDirect · Springer · Trip · Wiley · TWL |
Archives: 1 |
Wikipedia is not censored. Images or details contained within this article may be graphic or otherwise objectionable to some readers, to ensure a quality article and complete coverage of its subject matter. For more information, please refer to Wikipedia's content disclaimer regarding potentially objectionable content and options to not see an image. |
Buruli ulcer is a featured article; it (or a previous version of it) has been identified as one of the best articles produced by the Wikipedia community. Even so, if you can update or improve it, please do so. | |||||||||||||
This article appeared on Wikipedia's Main Page as Today's featured article on March 24, 2021. | |||||||||||||
| |||||||||||||
Current status: Featured article |
This article is rated FA-class on Wikipedia's
content assessment scale. It is of interest to the following WikiProjects: | ||||||||||||||
|
Ideal sources for Wikipedia's health content are defined in the guideline
Wikipedia:Identifying reliable sources (medicine) and are typically
review articles. Here are links to possibly useful sources of information about Buruli ulcer.
|
Ajpolino, that is all for now; [1] have not read article, pls ping me as you get closer to FAC and I will do a prose review. Not a fan of the word “just” as it is a value judgment ... unless sources use it. SandyGeorgia ( Talk) 18:31, 6 July 2020 (UTC)
Lead says:
Body says:
SandyGeorgia ( Talk) 11:44, 8 July 2020 (UTC)
Lead says 2,000 cases, but infobox and body mention 2 to 5. SandyGeorgia ( Talk) 11:46, 8 July 2020 (UTC)
See top of User:SandyGeorgia for links on however, subsequently, consequently and other prose redundancies. SandyGeorgia ( Talk) 11:59, 8 July 2020 (UTC)
Etcetera SandyGeorgia ( Talk) 01:19, 9 July 2020 (UTC)
WhatamIdoing will inquire about In pregnancy ... several journal articles describe treatment issues. SandyGeorgia ( Talk) 01:22, 9 July 2020 (UTC)
I don't speak HarvRef, but my gadget is reporting an error here:
SandyGeorgia ( Talk) 18:23, 5 September 2020 (UTC)
I noticed there is not much info on social and psychological effects of the disease - [5] looks like it could be a good source for this. [6] this may be useful as well. Spicy ( talk) 13:40, 21 September 2020 (UTC)
Ajpolino, are you back at it ? Don't forget to follow the Spicy trail! SandyGeorgia ( Talk) 22:11, 13 October 2020 (UTC)
Some thoughts while skimming, feel free to disagree with my nitpicking... Thank you! Leaving comments inline so I can keep track a bit better. I hope red doesn't come off as hostile. Just wanted a color that stood out...
resulting in tissue death and immune suppression.- systemic immunosuppression or only at the site of the ulcer? The latter (thankfully). Clarified in lead
mostly in rural sub-Saharan Africa and Australia- are you saying "mostly in ... rural Australia" or "mostly in... Australia"? The former. Clarified in lead
in 1897 Uganda.I find this phrasing a bit awkward. Cleaned up.
by an Australian group at Melbourne University.- I would think that a group at Melbourne University would be Australian by definition Fixed. Not sure how I missed that one. It all sounded so good in my head...
More to come... Spicy ( talk) 02:44, 31 October 2020 (UTC)
In some people, the ulcer may heal on its own or remain small and linger unhealed for years- the phrase "remain small and linger unhealed" seems to imply that the small size is connected to the fact that it doesn't heal, but I'd think a larger ulcer would be less likely to heal on its own? would "remain small but linger unhealed" be better? (I haven't checked the source so not sure if this is accurate) I'm trying to get across three possible outcomes: 1. heal on its own. 2. Remain small but doesn't heal. 3. Gets larger. Switched the wording to "but" per your suggestion. I hope that's clearer?
mycolactone ... diffuses into host cells and blocks the action of Sec61, the core translocation protein that serves as the gateway to the endoplasmic reticulum.[10] When Sec61 is blocked, proteins that would normally enter the endoplasmic reticulum are instead translated into the cytosol, causing a pathological stress response that results in cell death by apoptosis.- this is going to be really hard to understand for anyone who hasn't at least taken an AP biology class. Is it possible to explain this in more plain language while sticking to the sources? At least, Host (biology), Translation (biology) and Protein translocation should be linked. Just marking this to remind myself, I'm thinking about a better way to present this material...
causing the large open ulcer characteristic of disease- the disease?
cases are near stagnant bodies of water- "cases occur" sounds a lot better to me
Supporting this,- I would change this to "supporting this hypothesis" to make it entirely clear what you're referring to
Equipment required to run real-time PCR is prohibitively expensive and often available only at centralized diagnostic laboratories,- is this true for all areas? I would imagine it's not a problem in urban Australia and Japan for example Looking back, the source I used for that statement is clearly referring to the bulk of cases that are diagnosed in low-resource areas. I tried rephrasing this a few ways to reflect that, but then when I read it all back I realized I'm just restating the opening two sentence of the paragraph. So I cut the sentence for now. Hopefully it still flows ok?
An additional method of diagnosis is microscopic examination of ulcer tissue by a trained pathologist. However, this requires more invasive sampling of ulcer tissue, as well as specifically trained personnel- does microscopy from swabs not require specially trained personnel?
For routine diagnosis of BU in the endemic African countries, histopathological analysis of tissue samples is impractical, as it necessitates sophisticated technology as well as specifically trained and highly experienced personnel. Moreover, adequate tissue specimens obtained from the centre of a non-ulcerative lesion or from the edge of an ulcer by invasive sampling techniques are required.I suppose I could cut
as well as specifically trained personnelfrom my sentence without much changing its meaning. Do you have an alternative suggestion? (Sorry dispensed with the red so I didn't make a mess of the red+green). Ajpolino ( talk) 23:17, 10 November 2020 (UTC)
several animals- pedantic, but do you mean "several animals" or "several species of animals"? the latter of course, though I suppose both are true. Clarified.
In some endemic areas, particularly rural communities in African endemic countries, people are aware of Buruli ulcer's association with the environment, yet simultaneously associate it with witchcraft or other supernatural causes- need to be very careful with how you phrase this. The source says
are commonly perceived by the local population as somewhat mysterious ... are often associated with witchcraft or sorcery ... a concept of dual causality is frequently encountered... but the article states this without qualification, leading to the unintentionally racist implication that everyone in those areas believes this. I would imagine that African pathologists don't believe it's caused by witchcraft. Thanks. I moved a "some" and added an "often" to soften the language. Happy to do more clarifying if you feel the paragraph is still misleading as written.
While M. ulcerans may have infected humans throughout history,"throughout history" is vague. The 19th and 20th centuries are history too. Can we be more specific - is there any archeological evidence predating the first description of the disease, for example? Looking at those sources, I'm scratching my head. I'm not sure where I even got "throughout history" from. I've removed it for now, and will take a look for sources this evening. Good catch, and shame on me.
Cook noted several patients with slow-healing ulcers, consistent with Buruli ulcer- phrasing - he couldn't have noted that they were consistent with Buruli ulcer since the concept of the disease didn't exist at the time. I don't think the second part of the sentence is necessary at all because the preceding and following sentences clearly connect Cook's observation to Buruli ulcer.Cut. Thank you.
For much of the modern era- "modern era" is very vague, can we give an approximate date range? Clarified and added a couple sentences of extra treatment history
: "Cu001", isolated from a person in Adzopé, Côte d'Ivoire in 1996; "Mu1615", from a person in Malaysia in the 1960s; and "S1013" from someone in Cameroon in 2010- we have "A person", "a person", then "someone". This is a little jarring.
Forgive my nitpicking. This is a very clearly written and informative article. Spicy ( talk) 04:57, 31 October 2020 (UTC)
Buruli ulcer does not kill, but it is an important cause of morbidity because of scarring and fibrosis, my now-declared favorite review (2018) says only
[Ulcers could remain small, or grow enormous and cause major disability]. With any course, the patients maintained general good health.The background of the Cochrane review calls out a specific study
Vincent 2014a reported that among their 1043 laboratory-confirmed cases of Buruli ulcer in Benin, 229 people (22%) developed permanent functional impairment one year after their treatment, but without seeing other numbers around, I wasn't sure how to contextualize that information in the article... Anyway, will keep an eye out for anything usable... Ajpolino ( talk) 23:48, 14 November 2020 (UTC)
In practice microscopy correctly detects M. ulcerans in just 30–40% of infected people, making it a relatively insensitive diagnostic test.. The source's wording is
Microscopic study of smears made from swabs or FNA specimens that have been stained with Ziehl-Neelsen stain (an acid-fast stain), similar to what is used for tuberculosis, is used in many parts of Africa (20). A study in Ghana showed that this technique has a diagnostic sensitivity of 40% for nodules, which decreases to 30% for ulcers (21).I interpreted that to mean that if you had 20 samples, 10 each true positive/negative, the microscopists would have called 3 or 4 of the true positives as positives, and that the sentence gave no information on how they would rule on the true negative samples. So I meant to get across information about false negatives only. But I could be misinterpreting what the source meant. A second review claims
When compared with [qPCR] the reported sensitivity rates of direct smear microscopy for the detection of M. ulcerans ranged between 26% and 67%. The efficacy of the detection of small numbers of [bacteria] depends strongly on technical skills of the microscopist and on quality of the microscopic equipment(this last bit raises the obvious question of how anyone could use microscopic equipment!?). I used the numbers from the first review because I've landed on the opinion that it is the best review of the bunch, and so I find its numbers most trustworthy. Anyway, laying all this out because this is more in your wheel house than mine, and I'm happy to hear your thoughts! Ajpolino ( talk) 23:17, 14 November 2020 (UTC)
there has been no documentation of human-to-human transmission, and thus BU is not considered a contagious disease[7], and
There is no evidence to support the possibility of human-to-human transmission of BU.[8]. Now that I'm looking back at those two reviews, I've half a mind to switch to their wording... Thoughts? Ajpolino ( talk) 00:33, 1 November 2020 (UTC)
That's it ... a whole lot of this is trivial. I won't ping in anyone else until you've had time to deal with comments from Spicy and me. Or would you prefer to put a call at WT:MED yourself? If so, remember to ping Casliber, Graham Beards, Colin, Jfdwolff, WhatamIdoing ... anyone else familiar with FA standards? Once all the med people are through, there are several non-med editors I can ping in for a non-med jargon review before you head to FAC. Bst, SandyGeorgia ( Talk) 17:39, 31 October 2020 (UTC)
I hadn't thought much about the images as I was working on the text. Now that I do, I'm not sure I've picked a batch that represent the disease well. Today I added images of early signs (lumps and bumps) and images of ulcers. My question for both of you (and anyone else watching)... have I overdone it? Since the pre-ulcer and ulcer can have many different forms, I'd like to illustrate that. But I get that it's not Wikipicturebooks. Thoughts? Ajpolino ( talk) 21:55, 1 November 2020 (UTC)
On the picture, the lesion of a Nigerian 10 years old child on the right thigh and with the typical characteristic of a late stage of the disease: large painless ulceration with presence of necrosis and undermined edges.. As far as adding images, if the collages are ok, then I think I'm happy. If not, perhaps a gallery to show the different categories of ulcer and different early disease presentations would be appropriate. Ajpolino ( talk) 04:02, 11 November 2020 (UTC)
Per the suggestions above, I tried several times to reword and clarify the part of the causes section with the molecular biology explanation for mycolactone's effect. After several unsuccessful attempts, I decided the problem may be that I'm writing for two totally different audiences there. I cut the molecular detail, since I suppose (agh! Pains me to say!) most people don't care. That said I care how mycolactone works. As an act of protest, I left the molecular explanation in a footnote. Eventually I plan to clean up the article mycolactone which would obviously hold a more detailed explanation. But... what do you think of this compromise? Better? Or am I just moving bad text around... Ajpolino ( talk) 04:09, 9 November 2020 (UTC)
Digging in (ps, I am useless on images and alt text):
What you had: [9]
How M. ulcerans is transmitted to humans remains unclear, but somehow bacteria enter the skin and begin to grow. Ulceration is primarily caused by a bacterial toxin, mycolactone. As the bacteria grow, they release mycolactone, which diffuses into host cells and blocks the action of Sec61, the core translocation protein that serves as the gateway to the endoplasmic reticulum. When Sec61 is blocked, proteins that would normally enter the endoplasmic reticulum are instead translated into the cytosol, causing a pathological stress response that results in cell death by apoptosis. This results in tissue death at the site of infection, causing the open ulcer characteristic of the disease. At the same time, Sec61 inhibition prevents cells from signaling to activate the immune system, resulting in ulcers that lack infiltrating immune cells. Immune cells that do make it to the ulcer are killed by mycolactone, and tissue examinations of the ulcer show a core of growing bacteria surrounded by debris from dead and dying neutrophils.
What is left: [10]
How M. ulcerans is transmitted to humans remains unclear, but somehow bacteria enter the skin and begin to grow. Ulceration is primarily caused by a bacterial toxin called mycolactone. As the bacteria grow, they release mycolactone into the tissue around them. Mycolactone enters host cells and prevents them from secreting proteins, eventually resulting in cell death.A Dead cells slough off, leaving the open wound characteristic of the disease. At the same time, mycolactone prevents dying cells from signaling to activate the immune system. As a result, Buruli ulcers tend to lack infiltrating immune cells. Immune cells that do make it to the ulcer are killed by mycolactone, and tissue examinations of the ulcer show a core of growing bacteria surrounded by debris from dead and dying neutrophils (the most common immune cell).
Note A Specifically, mycolactone blocks the action of Sec61, the core translocation protein that serves as the gateway to the endoplasmic reticulum. When Sec61 is blocked, proteins that would normally enter the endoplasmic reticulum are instead translated into the cytosol, causing a pathological stress response that results in cell death by apoptosis.
Several points:
In either case, I think we have to accept that sometimes not every one can get every section. Bst, SandyGeorgia ( Talk) 17:49, 9 November 2020 (UTC)
Nikkimaria this article is getting very close to FAC ready; when you have time, could I interest you in reviewing the images? Regards, SandyGeorgia ( Talk) 18:14, 10 November 2020 (UTC)
Hi all, thank you for the comments. I think I've addressed everything above? If there's something you're still waiting for me to respond to, or you wanted to follow-up on something, please let me know. Otherwise, I can try reaching out to a few others to get their opinions? I'm in no big rush here. Thanks again! Ajpolino ( talk) 20:28, 16 November 2020 (UTC)
Okay, so these are liable to be a bit rough on the medical side, so please bear with me. I don't believe I've ever collaborated on a review with you before, so I'll go ahead and give a disclaimer that I tend to throw a lot of stuff out with an eye for discussion about smaller points, not that I'm trying to nitpick something to death.
Buruli ulcer has been reported in 33 countries, with 3000-5000 patients reported yearly [ref].) and itself cites a 2018 review that reprints the WHO data since 2002 (going back in time from 2018 to 2002, the annual case numbers are 2708, 2217, 1952, 2043, 2242, 2627, 3213, 4006, 4906, 5082, 5148, 5033, 5376, 4746, 4937, 3346, and 3245). So to say "As of 2019... 3,000 to 5,000... each year" doesn't seem quite right since I think the review author was trying to give some stable range that totals tend to fall within (though of course we can see some of the values fall outside that range). We could say "In 2018, the World Health Organization received 2708 reports of Buruli ulcer". Or be more explicit in mentioning that total report numbers vary but tend to be between 3,000 and 5,000. Or add a "typically" between "Organization and receives". Does one of those (or a different) options strike you as most accurate and interesting to read? Ajpolino ( talk) 04:43, 17 November 2020 (UTC)
Okay, so I think that's all I see. Hog Farm Bacon 03:05, 17 November 2020 (UTC)
As this article has been promoted to FA (congratulations Ajpolino!) I've created the editnotice at Template:Editnotices/Page/Buruli ulcer. Spicy ( talk) 07:48, 30 December 2020 (UTC)
So that image is so, so problematic -- in that it includes a white man, who (assuming) forced a bunch of youth to stand around him. It definitely profiles his very colonial, missionary relationship to the local community -- however the caption doesn't critically engage with those issues -- and its rather unexpected as you read the article, and reinforces a "white non-African saviour to the rescue" kindof narrative in the history section. Could there be some other way to illustrate or engage with that section? Is there really not any description of African or Australian indigenous medicine or story telling about the topic? That whole section feels off with the way the image is contextualizing. Sadads ( talk) 12:33, 24 March 2021 (UTC)