Dear Dr. Aldiban,

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 Jul 24 2026 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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We look forward to receiving your revised manuscript.

Kind regards,

Dhan Bahadur Shrestha, MBBS

Academic Editor

PLOS One

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4. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

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

Reviewer #1: Yes

Reviewer #2: No

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

**********

Reviewer #1: The study tries to addresses an important and underexplored occupational health question. This is a multicentric study and sample size is large.

However there are several issues in design and methodology of this study which need improvement before it is suitable for publication.

I have put my comments in the pdf file of the manuscript and uploaded it here. Please go through it.

Few countries have disproprotionately large number of respondents, so it may not be appropriate to generalise it to MENA counties.

Aims and objective and the methodology should be very clear. The study specific proforma/questionarre is not clear.

Some language/grammer policing is needed.

Reviewer #2: I enjoyed reading this manuscript, which reports a large, multinational cross-sectional study examining the prevalence, characteristics, and determinants of chest pain among physicians in the MENA region.

The study is novel, addresses an important occupational health topic, and leverages a large sample (N=6,224) across 12 countries, providing substantial statistical power. The use of standardized instruments and multivariable regression modeling is appropriate, and the statistical analyses—including both binary and multinomial logistic regression, assessment of multicollinearity, and sensitivity analyses—appear rigorous and well-justified. Tables and figures are clear, and the results are internally consistent with the conclusions.

The findings—that chest pain is highly prevalent in this population, with psychological factors (panic disorder, anxiety), sleep deprivation, obesity, and nicotine use among key determinants—are supported by the data presented. The discussion appropriately contextualizes these findings within existing literature, highlights potential occupational health implications, and acknowledges the multifactorial nature of chest pain, including non-cardiac associations.

Strengths of the manuscript include the large, multinational sample, standardized assessment tools, and detailed statistical modeling.

There is some country-clustering- Egypt, Iraq, Yemen and Jordan constitute 67.3% of the entire sample. However, this limitation is unlikely to materially alter the main conclusions, given the consistency and magnitude of the observed associations.

Limitations are clearly acknowledged, including the cross-sectional design, reliance on self-reported chest pain (RAQ), potential selection and recall bias, and uneven country representation.

Minor concerns remain:

1) The Data Availability Statement does not fully comply with PLOS ONE requirements. Raw data underlying summary statistics, including individual-level responses, should be made publicly available in a repository or as supplementary material, or clear restrictions should be explicitly justified.

2) In Conclusion, the phrase: "are major drivers alongside traditional cardiovascular risk factors" may imply causation. Since this is a cross-sectional study, consider: "were strongly associated with chest pain alongside traditional cardiovascular risk factors."

In summary, this is a technically sound, well-analyzed, and clearly presented study with important implications for occupational health among physicians in the MENA region.

**********

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:  Vijay Ketan Reddy

**********

[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.]

To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures

You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation.

NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

Attachments

Attachment

Submitted filename: PONE-D-26-19587 comments.pdf

Dear Dr. Aldiban,

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 Sep 05 2026 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.

• A 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.

As the corresponding author, your ORCID iD is verified in the submission system and will appear in the published article. PLOS supports the use of ORCID, and we encourage all coauthors to register for an ORCID iD and use it as well. Please encourage your coauthors to verify their ORCID iD within the submission system before final acceptance, as unverified ORCID iDs will not appear in the published article. Only  the individual author can complete the verification step; PLOS staff cannot  verify ORCID iDs on behalf of authors.

We look forward to receiving your revised manuscript.

Kind regards,

Dhan Bahadur Shrestha, MBBS

Academic Editor

PLOS One

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

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

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: I Don't Know

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

**********

Reviewer #1: This is a highly relevant multinational study with a large sample size. The findings carry important clinical implications, as they link both psychological and physical factors to the development of chest pain.

Area for improvement: The abbreviation ENDS was used on multiple occasions without prior definition. It is standard practice to provide the full term alongside the abbreviation when you use it for the first time in the text.

Also, you can add the implication of the finding of your study in the manuscript.

Best wishes

Reviewer #2: Thank you for addressing the issues raised in peer review. I believe this is a great article - While treating patients, physicians underestimate the impact of their profession, lifestyle and mental health on their personal overall health and large cross-sectional studies like these generate new questions to be answered and will help guide research in the right direction.

**********

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:  VIJAY KETAN REDDY

**********

[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.]

To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures

You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation.

NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

Prevalence, characteristics, and determinants of chest pain among physicians in the Middle East and North Africa: A multinational cross-sectional study

PONE-D-26-19587R2

Dear Dr. Aldiban,

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.

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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,

Dhan Bahadur Shrestha, MBBS

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments: