Hematological abnormalities and associated factors among metabolic syndrome patients at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia

Amanuel Kelem; Elias Shiferaw; Tiruneh Adane

doi:10.1371/journal.pone.0286163

Peer Review History

Original SubmissionNovember 12, 2022
3 Apr 2023 Decision Letter - Desalegn Admassu Ayana, Editor PONE-D-22-30096Hematological abnormalities and associated factors among metabolic syndrome patients at the University of Gondar comprehensive specialized hospital, Northwest EthiopiaPLOS ONE Dear Dr. Bekele, 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 May 18 2023 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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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. Thank you for stating the following in the Acknowledgments Section of your manuscript: "We are extremely grateful to the University of Gondar for providing the financial means to complete this study.." We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. 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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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.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: The comments given by the first reviewer should be addressed focusing reviewing the title (focusing on anemia) and review of the methodological issues to address the sampling and the instrument data quality issue, [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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: 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: Yes Reviewer #2: 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: Yes Reviewer #2: 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: Comments on: Hematological abnormalities and associated factors among metabolic syndrome patients at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia Line 1. Title page it is good to add common hematological abnormalities ….as the authors investigated limited hematology related measurements among many Abstract section: Methods part: Authors did not mentioned who are patients of metabolic syndrome ? how they are diagnosed . Introduction part Line 124, it is better to limit common hematological abnormalities rather than all types. Methods part : Line 157 : authors did not indicate total number of MetS patients, please indicate that Second sampling methods says systematic random sampling : It is good to explain the selection processes with actual numbers !! Line 246 : Authors did not mention the time when was FBS, TG, and HDL-C testes were done if there are time variation it could have impact on the interpretation of the results unless it is stated clearly including the limitation of secondary data . Moreover try to consider method variation, do all samples analyzed with similar instruments / methods? Line 276-277 : authors stated that “The automated hematology analyzer's performance was evaluated by running quality control reagents” I think here we need to check with known quality control materials it is not mentioned in your QA work. On table 3 , please describe the stage of the parasites for Girdia lamblia and Entamoeba histolytica/diaper Line 363-364 : authors mentioned altitudes and smoking adjustment Hemoglobin value is described but how the adjustment was made is not mentioned in the methods section. It is good to state that to replicate the work. Try to avoid repeating results in text, tables and figures The discussion looks a bit longer try to reduce by avoiding redundant information Under limitation part it is wise to mention the biochemical parameters are taken as a secondary data not done in parallel with the hematological parameters it could have impact on the findings. Moreover, try to indicate anemia and other hematological abnormalities are happened before Mets or during Mets follow up ? Reviewer #2: The manuscript addresses one of the important public health issues, the prevalence of undiagnosed hematological disorders among MetS study participants. The findings will give additional input to improve the quality of life among MetS-developed individuals. Also encouraged other researchers to conduct similar studies to consolidate the findings in Ethiopia, and /or worldwide. Thus, if the manuscript is published, it will have a good response to advance the medical science world. ****** 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: Yes: Dr. Mistire Wolde, PhD; Associate Professor ******** [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. 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Revision 1
13 Apr 2023 Author Response Date: April 13,2023 To: Plos One Journal Subject: Sending a rebuttal letter Dear Sir/madam, Greetings! These is a rebuttal letter that responds to each point raised by the academic editor and reviewer(s). For the Academic Editor 1. We ensure that our manuscript meets PLOS ONE's style requirements, including those for file naming. 2. We ensure that we removed any funding-related text from the manuscript and we agreed with the current Funding Statement which reads as follows: "The study was funded by the University of Gondar. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." Though we have no update on our current funding statement, we included the above statement within our cover letter. 3. We included captions for our Supporting Information files at the end of our manuscript, and we updated any in-text citations to match accordingly. 4. We reviewed our reference list and we ensured that it is complete and correct. For Reviewer 1 • You have recommended to add other common hematological abnormalities ….but as we are in resource limited country Ethiopia, we had financial, reagent as well as equipment constraints to add other hematology related measurements. But in the future if we got this supports we may certainly measure other hematology related parameters among metabolic syndrome patients, and we just put recommendations forward to other researchers to conduct more extensive studies. • Abstract section: we try to mention who are patients of metabolic syndrome and how they are diagnosed, but the word limit for the abstract will exceed more than 300 words and this will be against the submission guidelines of the journal. • Introduction part Line 124, we believe that including many types of hematological abnormalities will make the study more sound, rather than including only the common ones. • Sampling methods says systematic random sampling: It is good to explain the selection processes with actual numbers !! Answer: we explain the selection process with actual numbers, which can be read as follows: “A systematic random sampling technique was applied to select study participants at a regular interval (K) of two”. • Line 246 : Authors did not mention the time when was FBS, TG, and HDL-C testes were done if there are time variation it could have impact on the interpretation of the results unless it is stated clearly including the limitation of secondary data . Moreover try to consider method variation, do all samples analyzed with similar instruments / methods? Answer: it says that “Biochemical profiles such as FBS, TG, and HDL-C results on the date of data collection”.so these parameters were collected on the date of the data collection. For every answer: Mets patients these tests are inevitable tests when they come for checkup and we just collect these updated and timely results on the date of the data collection. Regarding the method variation, all biochemical tests were done with the same chemistry machine and since we only take the data from the patients’ charts we believe that we don’t need to mention the way these biochemical profiles were done. • Line 276-277 : authors stated that “The automated hematology analyzer's performance was evaluated by running quality control reagents” I think here we need to check with known quality control materials it is not mentioned in your QA work. Answer: It is obvious that quality control reagents are known quality control materials, and we mentioned that “The automated hematology analyzer's performance was evaluated by running quality control reagents (known quality control materials)” • On table 3, please describe the stage of the parasites for Girdia lamblia and Entamoeba histolytica/diaper All were trophozoite stages of e.histolytica and g.lamblia • Line 363-364 : authors mentioned altitudes and smoking adjustment Hemoglobin value is described but how the adjustment was made is not mentioned in the methods section. It is good to state that to replicate the work. Answer: We just put these on references as well as on the supporting informations. Try to indicate anemia and other hematological abnormalities are happened before Mets or during Mets follow up? Answer: Because of its cross-sectional nature, this study was unable to identify any causal relationships, and unable to indicate anemia and other hematological abnormalities are happened before Mets or during Mets follow up. Sincerely! Amanuel Kelem: Department of Medical Laboratory Sciences, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia. E-mail: amanuelkelem@gmail.com. Tel.: +251-9-11712112 Elias Shiferaw: Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. E-mail: eliasshiferaw2008@gmail.com. Tel.: +251-9-27607075 Tiruneh Adane: Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. E-mail: tirunehadane01@gmail.com. Tel.: +251-9-18754325 Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0286163.r002
10 May 2023 Decision Letter - Desalegn Admassu Ayana, Editor Hematological abnormalities and associated factors among metabolic syndrome patients at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia PONE-D-22-30096R1 Dear Mr. Bekele, 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, Desalegn Admassu Ayana, Ph.D Academic Editor PLOS ONE Additional Editor Comments (optional): 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 ******** 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 ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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 ****** 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 ****** 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: Authors addressed almost all comments. However, the explanation they mentioned for quality control materials and quality control reagents has to be clarified. In hematological measurements, you need to run QC materials low, high and normal to check the instrument is working. You need to mention weather you used such QC materials in your lab analysis. Similarly, authors collected TG, COL, FBS, and other data which is secondary not a primary data and nothing is mentioned the time of testing. Which means that some patients may had new data ( tested with in one week of data collection others could be months back , even year/s this could influence your interpretation. You may mention under limitation part too. ****** 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: No ******** https://doi.org/10.1371/journal.pone.0286163.r003
Formally Accepted
17 May 2023 Acceptance Letter - Desalegn Admassu Ayana, Editor PONE-D-22-30096R1 Hematological abnormalities and associated factors among metabolic syndrome patients at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia Dear Dr. Bekele: 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. Desalegn Admassu Ayana Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0286163.r004

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