Amblyopia risk factors among pediatric patients in a hospital-based setting using photoscreening

Christiane Al-Haddad; Zeinab El Moussawi; Stephanie Hoyeck; Carl-Joe Mehanna; Nasrine Anais El Salloukh; Karine Ismail; Mona Hnaini; Rose-Mary N. Boustany

doi:10.1371/journal.pone.0254831

Peer Review History

Original SubmissionJanuary 11, 2021
17 Mar 2021 Decision Letter - Ahmed Awadein, Editor PONE-D-21-00998 Refractive Errors among Pediatric Patients in a Hospital-Based Setting Using Photoscreening PLOS ONE Dear Dr. Al-Haddad, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== ACADEMIC EDITOR: The manuscript has many fundamental issues that need meticulous revision. 1- The manuscript needs English editing for grammar and style 2- Some sections such as the introduction section are too long and contain unnecessary data while the results section needs more details 3- The fact that refractive errors were diagnosed with photoscreening rather than a more accurate method like retinoscopy or conventional autorefractors should be addressed. The authors might consider using the term "detection of amblyopia risk factors" rather than "refractive errors" ============================== Please submit your revised manuscript by Apr 16 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Ahmed Awadein, MD, Ph.D, FRCS Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1) Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2) We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: No Reviewer #2: No Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: No Reviewer #3: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: No Reviewer #3: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: No Reviewer #3: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: I have one fundamental objection against methodology of this study: I do not agree that photoscreener can be used for evaluation of refractive error prevalence, and this is also showed by the results of this study. It is however accepted that it is used in screening of amblyopia risk factors. Because of that the whole study, to be accepted for publication, must be completely re-written. Moreover, I do not think that referral rate is so much interesting as long as you did not analyze also all negative cases. However, verification with complete ophthalmic examination and cycloplegia refraction of positive cases is very interesting issue and could a subject for a separate article in the future. Reviewer #2: This study shows the results of hospital-based screening of Lebanese pediatric patients 2-6 years regarding amblyogenic refractive errors and the results of subsequent comprehensive ophthalmic evaluation. There are some concerns regarding methodology and end results. 1. The manuscript needs significant English language editing. 2. The “INTRODUCTION” section is very confusing and contains lots of unnecessary data. Specifically, the second paragraph should be totally rephrased. The whole “INTRODUCTION” section should be 2 to 3 paragraphs describing in brief background and the aim of the study. 3. The authors did not mention the period of time during which the study was conducted. 4. In “RESULTS” section, the authors mentioned that only 59% of their referred cases were examined at their facility, without mentioning where the rest of referred cases (31%) were examined? Reviewer #3: A very nice, respectful and valuable work that is worthy more evaluation with a larger number of patients for a better benefit. 29 prevalence (would be better than rate) 73-76 If you would like to rephrase. 129-133 Table 1 AAPOS ARFs (if you would like to mention ; limit of astigmatism 90/180 Vs oblique one ?, type of anisometropia) 140 Was CRx performed by the same examiner ? 141,142 Source of this rational of cycloplegia ? 174 37/63 were examined at your department. What about the remainder ? 312 "still be treated" Do you mean amblyopia ttt with refractive adaptation only or in general ? ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Reviewer #3: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0254831.r001
Revision 1
21 Apr 2021 Author Response ACADEMIC EDITOR: The manuscript has many fundamental issues that need meticulous revision. 1- The manuscript needs English editing for grammar and style We have revised thoroughly the whole manuscript for grammatical and linguistic errors/ style. 2- Some sections such as the introduction section are too long and contain unnecessary data while the results section needs more details The introduction was made more succinct and only relevant data were kept. The results section was elaborated more on. 3- The fact that refractive errors were diagnosed with photoscreening rather than a more accurate method like retinoscopy or conventional autorefractors should be addressed. The authors might consider using the term "detection of amblyopia risk factors" rather than "refractive errors" Thank you for the comment, the authors agree and have modified the title and manuscript text to use “amblyopia risk factors” rather than “refractive errors.” Reviewer #1: I have one fundamental objection against methodology of this study: I do not agree that photoscreener can be used for evaluation of refractive error prevalence, and this is also showed by the results of this study. It is however accepted that it is used in screening of amblyopia risk factors. Because of that the whole study, to be accepted for publication, must be completely re-written. Moreover, I do not think that referral rate is so much interesting as long as you did not analyze also all negative cases. However, verification with complete ophthalmic examination and cycloplegia refraction of positive cases is very interesting issue and could a subject for a separate article in the future. We thank the reviewer. We have modified accordingly the title to “Amblyopia Risk Factors among Pediatric Patients in a Hospital-Based Setting Using Photoscreening;” additionally, we revised the manuscript text to reflect our aim as detection of amblyopia risk factors in children visiting our medical center rather than prevalence of refractive errors. We agree that reporting the validation of photoscreening positive results by cycloplegic refraction will be an interesting topic in a future study. Reviewer #2: This study shows the results of hospital-based screening of Lebanese pediatric patients 2-6 years regarding amblyogenic refractive errors and the results of subsequent comprehensive ophthalmic evaluation. There are some concerns regarding methodology and end results. 1. The manuscript needs significant English language editing. We have revised the whole manuscript for grammatical and linguistic errors. 2. The “INTRODUCTION” section is very confusing and contains lots of unnecessary data. Specifically, the second paragraph should be totally rephrased. The whole “INTRODUCTION” section should be 2 to 3 paragraphs describing in brief background and the aim of the study. The introduction was made more succinct and relevant points were kept. Specifically paragraph 2 was rephrased and the whole introduction was shortened. 3. The authors did not mention the period of time during which the study was conducted. The study was conducted over a time span of 2 years (2018-2020), this was added to the methods section. 4. In “RESULTS” section, the authors mentioned that only 59% of their referred cases were examined at their facility, without mentioning where the rest of referred cases (31%) were examined? The rest of referred cases were lost to follow up after multiple attempts to schedule an ophthalmology appointment. This was now added to the text for clarification. Reviewer #3: A very nice, respectful and valuable work that is worthy more evaluation with a larger number of patients for a better benefit. We thank the reviewer for their positive feedback and appreciate their comment, indeed we plan on a larger scale “school-based” prevalence study when time permits. 29 prevalence (would be better than rate) Thank you, it was corrected accordingly. 73-76 If you would like to rephrase. The section was rephrased for better clarity to the reader. 129-133 Table 1 AAPOS ARFs (if you would like to mention ; limit of astigmatism 90/180 Vs oblique one ?, type of anisometropia) Although it has been reported that oblique astigmatism constitutes a greater amblyopia risk factor than regular astigmatism, the guidelines published by the AAPOS Vision Screening Committee (JAAPOS 2013;17:4-8, Table 1: AAPOS ARFs), which we have followed in this study, did not differentiate by the axis of astigmatism, but rather used the magnitude in Diopters. Similarly, for anisometropia, only the absolute value in diopters was used. 140 Was CRx performed by the same examiner? Yes the same pediatric ophthalmologist (author C Al-Haddad) examined all referred patients, this is now mentioned explicitly in the methods section. 141,142 Source of this rational of cycloplegia ? Thank you for your comment. In this clinic, we use two sets of dilating drops as a standard especially with darker irides (which constitute a good portion of our population, below references). This was added to our methods section. References : Farhood, Q. K. (2012). Cycloplegic refraction in children with cyclopentolate versus atropine. J Clin Exp Ophthalmol, 3(7), 1-6. Wallace, D. K., Morse, C. L., Melia, M., Sprunger, D. T., Repka, M. X., Lee, K. A., & Christiansen, S. P. (2018). Pediatric eye evaluations preferred practice Pattern®: I. vision screening in the primary care and community setting; II. comprehensive ophthalmic examination. Ophthalmology, 125(1), P184-P227. 174 37/63 were examined at your department. What about the remainder ? The rest of referred cases were lost to follow up after multiple attempts to schedule an ophthalmology appointment. This was now added to the text. 312 "still be treated" Do you mean amblyopia ttt with refractive adaptation only or in general ? This was clarified in text: “within the sensitive period of visual development, while still amenable to patch therapy/ refractive adaptation and at an age where amblyopia has not yet become entrenched” Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0254831.r002
2 Jun 2021 Decision Letter - Ahmed Awadein, Editor PONE-D-21-00998R1 Amblyopia Risk Factors among Pediatric Patients in a Hospital-Based Setting Using Photoscreening PLOS ONE Dear Dr. Al-Haddad, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== ACADEMIC EDITOR: Most of the comments were properly addressed. There are only few comments mentioned below that should be addressed. ============================== Please submit your revised manuscript by Jul 17 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Ahmed Awadein, MD, Ph.D, FRCS Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #3: All comments have been addressed Reviewer #4: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #3: Yes Reviewer #4: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #3: Yes Reviewer #4: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #3: Yes Reviewer #4: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #3: Yes Reviewer #4: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thank you for revising the ms that is now significantly improved. Reviewer #3: (No Response) Reviewer #4: 1- Abstract: Results "The refractive errors among the referred patients were: 41% astigmatism, 51% hyperopia, and 8% myopia, with no amblyopia detected on eye examination.: Needs rephrasing 2- Add reference to Table 1 3- Methods: “for verbal children; anterior segment examination; motility examination for any eye misalignment; cycloplegic manual retinoscopy to detect refractive errors (30 minutes after pupillary dilation with Mydriacyl 1% and Cyclopentolate 1%, applied twice 10 minutes apart, in this clinic, we use two sets as a standard especially with darker irides); The sentence needs grammatical revision. It also starts with small letter 4- Results: "Out of the 37 examined children, 19 had hyperopia, 15 had astigmatism and 3 subjects were myopic." So do this means that none of the patients had both spherical and cylindrical error at the same time? 5- While correlation was done to compare the readings of autorefractor and retinoscopy, the correct statistical analysis would to use an agreement statistics e.g. Bland-Altman plot and Deming regression analysis ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Andrzej Grzybowski, MD, PhD Reviewer #3: Yes:** Ahmed Taha Ismail Reviewer #4: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0254831.r003
Revision 2
28 Jun 2021 Author Response June 28, 2021 Dear Dr Chenette and PLOS ONE Editorial Board, Thank you for your response to our revision on our manuscript entitled "Amblyopia Risk Factors among Pediatric Patients in a Hospital-Based Setting Using Photoscreening". We appreciate the time and effort that has gone into reviewing our manuscript and thank you for the valuable comments. Please find below a point-by-point reply to the reviewer comments. Comments are copied verbatim, followed immediately by our response. Reviewer #4: 1- Abstract: Results "The refractive errors among the referred patients were: 41% astigmatism, 51% hyperopia, and 8% myopia, with no amblyopia detected on eye examination.: Needs rephrasing This sentence was rephrased as follows: The refractive errors observed among the examined patients were distributed as follows: 41% astigmatism, 51% hyperopia, and 8% myopia; amblyopia was not detected. 2- Add reference to Table 1 Reference was added to the table title. 3- Methods: “for verbal children; anterior segment examination; motility examination for any eye misalignment; cycloplegic manual retinoscopy to detect refractive errors (30 minutes after pupillary dilation with Mydriacyl 1% and Cyclopentolate 1%, applied twice 10 minutes apart, in this clinic, we use two sets as a standard especially with darker irides); The sentence needs grammatical revision. It also starts with small letter We agree that this was a long run-on sentence. It was reworded as follows: This entailed age-dependent visual acuity testing: “central steady & maintained” testing for preverbal children and vision charts (Allen pictures and Early Treatment Diabetic Retinopathy Study charts (EDTRS)) for verbal children. Anterior segment examination, motility examination for any eye misalignment, and posterior segment examination using indirect ophthalmoscopy were performed. Cycloplegic manual retinoscopy was done to detect refractive errors (30 minutes after pupillary dilation with Mydriacyl 1% and Cyclopentolate 1%, applied twice 10 minutes apart; in this clinic, we use two sets as a standard especially with darker irides). 4- Results: "Out of the 37 examined children, 19 had hyperopia, 15 had astigmatism and 3 subjects were myopic." So do this means that none of the patients had both spherical and cylindrical error at the same time? Thank you for your comment. As we mentioned in the Methods section: “Significant astigmatism was defined as cylindrical power of 1D or more with the main refractive error being the cylinder. Those reported with hyperopia and myopia had mainly spherical refractive error (>+1D or <-1D, respectively).” Thus, the patients were subdivided based on the predominant refractive error detected when both spherical and cylindrical errors co-existed. 5- While correlation was done to compare the readings of autorefractor and retinoscopy, the correct statistical analysis would to use an agreement statistics e.g. Bland-Altman plot and Deming regression analysis Thank you for your comment. We agree that an agreement statistic would strengthen our study. We thus added a Bland-Altman plot to our paper. Attachments Attachment Submitted filename: Response to Reviewers .docx https://doi.org/10.1371/journal.pone.0254831.r004
5 Jul 2021 Decision Letter - Ahmed Awadein, Editor Amblyopia Risk Factors among Pediatric Patients in a Hospital-Based Setting Using Photoscreening PONE-D-21-00998R2 Dear Dr. Al-Haddad, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Ahmed Awadein, MD, Ph.D, FRCS Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0254831.r005
Formally Accepted
12 Jul 2021 Acceptance Letter - Ahmed Awadein, Editor PONE-D-21-00998R2 Amblyopia Risk Factors among Pediatric Patients in a Hospital-Based Setting Using Photoscreening Dear Dr. Al-Haddad: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Ahmed Awadein Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0254831.r006

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