Metabolic syndrome and its associated factors among epileptic patients at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia; a hospital-based comparative cross-sectional study

Altaseb Beyene Kassaw; Hiwot Tezera Endale; Kibur Hunie Tesfa; Meseret Derbew Molla

doi:10.1371/journal.pone.0279580

Peer Review History

Original SubmissionMarch 19, 2022
24 Aug 2022 Decision Letter - Rick J. Jansen, Editor PONE-D-22-08200Metabolic syndrome and its associated factors among epileptic patients at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia; a hospital-based comparative cross-sectional studyPLOS ONE Dear Dr. kassaw, 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. Please submit your revised manuscript by Oct 08 2022 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. 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Additional Editor Comments: Please make sure to address all reviewer comments fully with specific attention to the comment on reproduction of existing work. Thank you! [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: Partly Reviewer #2: Yes Reviewer #3: No ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: No ****** 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: Yes Reviewer #2: Yes Reviewer #3: No ****** 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: Yes Reviewer #2: No Reviewer #3: No ****** 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: in methology part the selection of apparently healthy individuals is not clear. so it needs revision the selection of apparaently healhty individual criteria must be written on the material and method part. Reviewer #2: Abstract: page 2 line 33, 36 & 39: the association of BMI with MS needs to be described clearly (higher vs lower BMI) Introduction: paragraph one and two can be merged and re-written considering the paper is meant for the scientific community with an understanding of what epilepsy and metabolic syndrome are. The emphasis in the introduction should be on the cross-link between epilepsy and metabolic syndrome. Study participants: Line 110-121: The authors would benefit in adding statement explaining why they chose to use healthy controls. Result and discussion: why did the author prefer to use both the IDF and NCEP-ATP III criteria in the description of the result and discussion? Which one is used in the study setting? The authors should use one of the criteria and present the other as a sensitivity analysis by providing the result as a supplementary file. Discussion: The authors frequently used statements mentioned in the result part in their discussion and focused on comparing their result with others. Instead of comparing the finding of your study with other studies, the focus should be on explaining the consequence of the study finding on the study population. Strength and Limitation of the Study: Line 501 “It also includes healthy controls as a comparative group and treatment-naive epileptic patients.”….did the study include treatment naïve epileptic patients as a control group. As this is not reflected in neither the methods nor result section. Reviewer #3: I have reviewed with great interest the original research article entitled "Metabolic syndrome and its associated factors among epileptic patients at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia; a hospital-based comparative cross-sectional study" which was intended to assess the magnitude of metabolic syndrome among epileptic patients. However, I have the following concerns: A sample size of 102 may not be enough to say the prevalence/magnitude of metabolic syndrome among epileptic patients; rather, it might provide evidence for the presence of metabolic syndrome in epileptic patients in comparison with another 102 healthy controls simply. However, whether the metabolic syndrome is because of the anti-epileptic drugs or due to the epilepsy disease per se should be clearly discussed in this manuscript. Using the nonstandard abbreviations in the abstract section of the manuscript is not recommended. However, the authors used several abbreviations in the abstract section, and the author should write the long form of abbreviations for the first time, e.g., DCSH, MS, AEDs. Since they did not have a list of healthy controls, how could they use a systematic random sampling technique to select patient attendants or caregivers? The author said that they used systematic random sampling techniques to select the control groups, which is impractical without having the frame. The sampling technique and procedures are not well explained for cases and control groups separately. They should review the findings in relation to the sampling method. Some of the major concerns are 1. Data do not supports the conclusions. 2. statistical analysis has been not performed appropriately and rigorously. Apparently it seems forged data. 3. Language is not clear, correct and there are ambiguous sentences as well. Besides, there are some dead sentences are there in the manuscript. 4. The work presented in the manuscript is simply copy of previously published work at another settings. ****** 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. 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Revision 1
28 Sep 2022 Author Response Response to the editor: We thank you for the insightful comments given to our manuscript which obviously further improves the quality of our work. We have been able to incorporate changes to reflect all the comments and suggestions provided. Being specific on the points you raised: #1. We will deposit soon our laboratory protocols in protocols.io., as it has been recommended #2. Regarding financial disclosure, we have not made a change (we didn’t receive any funding for this study). Hence, we have stated “The authors received no specific funding for this work” on the cover letter. #3. On the competing interest section, we have completed the Competing Interests on the online submission form to state any Competing Interests and have stated on the cover letter as “The authors have declared that no competing interests exist”. #4. In Data Availability statement, we have specified the minimal data set underlying the results described in our manuscript (as Supporting information files). #5. ORCID iD for the corresponding author has been linked to Editorial Manager profile. #6. We incorporate the ethics statement in the methods section of our manuscript. #7. We have fully addressed all the reviewer comments and suggestions. Reviewer #1: Response to the comments: Thanks for your kind reminders. We found your comment helpful and has now been written clearly as suggested. An equal number of age and sex-matched apparently healthy volunteer subjects (apparently healthy care givers/ patient attendants who full fill the inclusion criteria) were enrolled in the comparison group. The participants were selected consecutively. [ Page-6, L127-129], on unmarked version of our revised manuscript. Reviewer #2: Response to Comment 1: thank you very much for your suggestion. Although we agree that categorizing BMI as high or low is good to assess its association with MS, continuous independent variables can also be fitted as such and would have high statical power in predicting association, strong prediction contribution to the outcome variable (Jill C. Stoltzfus, 2011). Accordingly, we take BMI as continuous variable and asses its association with MS. The clarified result has presented on “Associated factors of metabolic syndrome among the epileptic groups” section [ Page-20, L341-346, or on Table 7(Page 21) and Table 8 Page 22)]. Response to Comment 2: Thanks for your kind reminders. We found your comment is helpful and have revised accordingly. Response to comment 3: We thanks for the suggestion and incorporated it in our revised manuscript [Page-5, L107-109]. To be clearer, we initially intended to show “whether MS is a problem in epileptic population in the study setting, or to assess whether MS is associated with epilepsy or weather epilepsy and related issues are a risk for MS”. Accordingly, we tried to compare the presence of MS between epileptic and non-epileptic study participants even though the small sample size we enrolled and the study design we used may not sufficiently ascertain. To minimize the effect of confounder, we chose non-epileptic group from healthy individuals. Response comment 4: we are grateful for the comment! Using a single criterion may over estimate or under estimate the magnitude of MS. Hence, we used both the IDF and NCEP-ATP III criteria independently in our setting. Moreover, we did sensitivity analysis and provided the result as a supplementary file (S1). Response to comment 5: We thank you for you’re a very interesting comment. As the Purpose of discussion is to describe, analyzes and interpret/justify findings in relation to the existing literature, theory and practice ((Skelton.J. et al, 2000), (Shona Mc Combes, 2022), (Oner Şanli, et al, 2013)) we were trying to do accordingly. We believe the “consequence of the study finding on the study population” is addressed in a conclusion section [Page-29, Line no. 512-518]. Response to comment 6: Thanks for your kind question. We rather considered current treatment status of epileptic participants as a variable and fitted into logistic regression analysis (Current anti-epileptic drugs (AEDs) use: On mono therapy, On Poly therapy, Not on antiepileptic-agents/ treatment naïve), and tried to show weather the MS is because of the epilepsy by itself or because of the different anti-epileptic drugs [Table 7(Page 21) and Table 8 Page 22)]. Reviewer #3: Response to the comment 1: We are very appreciative for your insightful suggestions and comments. We have gone through your comments carefully and tried our best to address them. Even though the study design we choice (cross-sectional study design) cannot sufficiently ascertain whether the metabolic syndrome is because of the anti-epileptic drugs or due to the epilepsy disease per se (which has been stated as a limitation), the likelihood of MS, given its criteria, has been adjusted for possible confounding variables using a multivariate logistic regression model [Table 7(Page 21) and Table 8 (Page 22)]. Hence, Current anti-epileptic drugs (AEDs) use status (On mono therapy, On Poly therapy, Not on antiepileptic-agents/ treatment naïve) has been adjusted to…. Response to the comment 2: thank you for pointing this out. We agree with this comment and has now been amended in the revised abstract. Response to the comment 3: We thanks for a very interesting doubt you raised. Honestly speaking, volunteer healthy patient attendants were selected consecutively and we are very sorry for a typing fault that has been done in editing of the manuscript. We have now added the corrected content to the manuscript on [Page-6, Line no. 127-129]. Response to the comment 4: Thank you for the comments. We have revised these points according to the suggestions. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0279580.r002
27 Oct 2022 Decision Letter - Rick J. Jansen, Editor PONE-D-22-08200R1Metabolic syndrome and its associated factors among epileptic patients at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia; a hospital-based comparative cross-sectional studyPLOS ONE Dear Dr. kassaw, 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. Please make sure to remove all nonstandard abbreviations form the abstract. Also, please address the comment from the reviewer suggesting this is a mostly reproduced manuscript of a published manuscript. Thank you! Please submit your revised manuscript by Nov 26 2022 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: https://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, Rick J. Jansen, PhD, MS 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. Additional Editor Comments: Please make sure to remove all nonstandard abbreviations form the abstract. Also, please address the comment from the reviewer suggesting this is a mostly reproduced manuscript of a published manuscript. Thank you! [Note: HTML markup is below. Please do not edit.] Reviewers' comments: [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.0279580.r003
Revision 2
21 Nov 2022 Author Response Dear Editor, I would like to say thank you for your comments, support, and invitation for resubmitting our manuscript kind regards. Altaseb Beyene Kassaw Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0279580.r004
12 Dec 2022 Decision Letter - Rick J. Jansen, Editor Metabolic syndrome and its associated factors among epileptic patients at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia; a hospital-based comparative cross-sectional study PONE-D-22-08200R2 Dear Dr. kassaw, 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, Rick J. Jansen, PhD, MS Academic Editor PLOS ONE Additional Editor Comments (optional): The comments have been addressed adequately. Reviewers' comments: https://doi.org/10.1371/journal.pone.0279580.r005
Formally Accepted
19 Dec 2022 Acceptance Letter - Rick J. Jansen, Editor PONE-D-22-08200R2 Metabolic syndrome and its associated factors among epileptic patients at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia; a hospital-based comparative cross-sectional study Dear Dr. Beyene Kassaw: 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. Rick J. Jansen Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0279580.r006

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