Response to ReviewersRevised Manuscript with Track ChangesManuscript

Shaden Kamhawi

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-4304-636XX

Paul Brindley

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-1765-0002

Additional Editor Comments:

Methods section. I suggest including a brief explanation of the heterogeneity of the studies.

Results section. In Table S4 they include the cases of actinomycetoma and eumycetoma. This information should be highlighted in the manuscript. Therefore, using the same variables as in Table 2, I suggest including a Table (Table 3) describing actinomycetoma vs. eumycetoma cases.

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Reviewers' comments:

Key Review Criteria Required for Acceptance?

As you describe the new analyses required for acceptance, please consider the following:

Methods

-Are the objectives of the study clearly articulated with a clear testable hypothesis stated?

-Is the study design appropriate to address the stated objectives?

-Is the population clearly described and appropriate for the hypothesis being tested?

-Is the sample size sufficient to ensure adequate power to address the hypothesis being tested?

-Were correct statistical analysis used to support conclusions?

-Are there concerns about ethical or regulatory requirements being met?

Reviewer #1: Yes, all methodos are ok

Reviewer #2: -The objectives are stated clearly in both the abstract and the introduction.

-Yes, the study design is appropriate to address the stated objectives.

-Yes, the population is clearly described and appropriate for the hypothesis being tested in the context of a systematic review.

- Yes, the sample size is sufficient to ensure adequate power to address the hypothesis being tested in this systematic review and descriptive analysis. This is the largest pooled sample to date for evaluating the global sociodemographic and clinical profile of mycetoma.

-Yes, appropriate statistical methods were used to support the conclusions, given the nature and aim of this systematic review and descriptive epidemiological synthesis. No interventional or comparative hypotheses were tested, so inferential statistics (e.g., p-values, confidence intervals, regression models) were not required.

-There are no major concerns about ethical or regulatory requirements being met in this study

Reviewer #3: The methodology of the study follows the recommended steps in a systematic review, followingISMA guideline with PROSPERO registration which indicate strong methodology

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Results

-Does the analysis presented match the analysis plan?

-Are the results clearly and completely presented?

-Are the figures (Tables, Images) of sufficient quality for clarity?

Reviewer #1: Yes, the results are adequate.

Reviewer #2: -Yes, the analysis presented matches the implied analysis plan for a systematic review, based on the study's objectives and methods section.

-Yes, the results are clearly and completely presented, but there is some room for improvement in clarity and data visualization.

-Yes for the figures and tables

Reviewer #3: The data is well presented, and the figures and tables are high quality.

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Conclusions

-Are the conclusions supported by the data presented?

-Are the limitations of analysis clearly described?

-Do the authors discuss how these data can be helpful to advance our understanding of the topic under study?

-Is public health relevance addressed?

Reviewer #1: Yes, the conclusions are adequate.

Reviewer #2: -The conclusions accurately reflect the scope, limitations, and strength of the findings. They are grounded in a comprehensive analysis of 72 studies and over 29,000 patients, and appropriately cautious where data was limited.

-Overall, the study's discussion of the data shows how it advances the understanding of mycetoma's epidemiology, clinical presentation, and geographic distribution, while also highlighting the need for further research, better data reporting, and improved diagnostic and treatment practices. This aligns with the goal of ultimately reducing the disease burden and improving outcomes for affected individuals.

-Yes, the authors discuss how their data can contribute to advancing our understanding of mycetoma

-the study directly addresses public health relevance by providing insights into disease prevention, treatment, surveillance, and data standardization. The authors propose actionable recommendations to improve public health strategies, from targeted interventions for at-risk populations to broader guidelines for global surveillance and research.

Reviewer #3: The conclusions are supported by the data presented, and the study limitations are clearly described.

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Editorial and Data Presentation Modifications?

Use this section for editorial suggestions as well as relatively minor modifications of existing data that would enhance clarity. If the only modifications needed are minor and/or editorial, you may wish to recommend “Minor Revision” or “Accept”.

Reviewer #1: Accept

Reviewer #2: (No Response)

Reviewer #3: (No Response)

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Summary and General Comments

Use this section to provide overall comments, discuss strengths/weaknesses of the study, novelty, significance, general execution and scholarship. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. If requesting major revision, please articulate the new experiments that are needed.

Reviewer #1: This is a well-conducted, structured, and well-analyzed work. I practically accept it as is. The only suggestion I make is that the authors add a sentence in the discussion section indicating that some of the etiological agents were reported under previous names. For example, Nocardia asteroides is now a complex involving many species, and N. asiteroides sensu stricto is the smallest. In the Americas, the majority of cases are caused by M. psudomycetomatis, not M. mycetomatis as in Africa, and Trematosphaeria grisea could be Nigrograna mackinonii.

Reviewer #2: (No Response)

Reviewer #3: This article outstanding in its discipline since it is the first research to target the Epidemiological Profiling of Patients with mycetoma? It is also the most extensive systematic review on this topic. The methodology follows the recommended steps in the systematic review. The result is well presented and discussed in relation to the literature. The conclusion was well written, covering the objectives of the study. The limitation of the study was well described.

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Reviewer #1: Yes:  Alexandro Bonifaz

Reviewer #2: No

Reviewer #3: Yes:  MOHAMMED YOUSOF BAKHIET

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Attachments

Attachment

Submitted filename: Reviewer Comments.pdf

Dear Dr Salah,

We are pleased to inform you that your manuscript 'Global Sociodemographic, Clinical, and Epidemiological Profiling of Patients with Mycetoma: A systematic review' has been provisionally accepted for publication in PLOS Neglected Tropical Diseases.

Before your manuscript can be formally accepted you will need to complete some formatting changes, which you will receive in a follow up email. A member of our team will be in touch with a set of requests.

Please note that your manuscript will not be scheduled for publication until you have made the required changes, so a swift response is appreciated.

IMPORTANT: The editorial review process is now complete. PLOS will only permit corrections to spelling, formatting or significant scientific errors from this point onwards. Requests for major changes, or any which affect the scientific understanding of your work, will cause delays to the publication date of your manuscript.

Should you, your institution's press office or the journal office choose to press release your paper, you will automatically be opted out of early publication. We ask that you notify us now if you or your institution is planning to press release the article. All press must be co-ordinated with PLOS.

Thank you again for supporting Open Access publishing; we are looking forward to publishing your work in PLOS Neglected Tropical Diseases.

Best regards,

Max Carlos Ramírez-Soto, BSc, MPH, PhD, FRSPH, FECMM

Academic Editor

PLOS Neglected Tropical Diseases

https://orcid.org/0000-0003-0471-6746

Joshua Nosanchuk

Section Editor

PLOS Neglected Tropical Diseases

Shaden Kamhawi

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-4304-636XX

Paul Brindley

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-1765-0002

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