Review for 10.1186/s12876-024-03337-1 (2024)

Title: Lead poisoning as a differential diagnosis in pediatric patients with chronic abdominal
pain: A case-control study in Tehran#Iran
Version: 7 Date: 05 Mar 2024
Reviewer:  Leila Barati
Reviewer's report:
Dear Authors;
Thank you for your efforts about this manuscript. The subject of manuscript is one of the issues
involved in children. I reviewed the manuscript and have some comments. I hope my comments
lead to improvement of the manuscript.
Abstract:
In method: The name of the city of the study should be added.
In Result: The Mean and SD of age of patients in both groups, the gender of them, BMI should
be mentioned.
Background:
1- The authors should cite studies that have specifically focused on Lead level in chronic
abdominal pain in children, highlighting gaps in knowledge that the current study aims to
address.
2- Discussing findings from similar studies conducted in different geographical or cultural
contexts could enhance the rationale for the current study, particularly if it explores a region or
population not well covered in the existing literature.
3- Clarifying the expected contribution of the study to existing knowledge and its potential
implications for clinical practice, public health policy, or preventive Strategies would strengthen
the introduction's impact.
Methods:
The description of the study as a "case- control study" at " Children's Medical Center  Hospital
in Tehran " is clear but lacks specific details that would enable reproducibility and contextual
understanding. For example, mentioning the hospital's capacity, the typical patient population
it serves, and why it was chosen for this study could provide valuable context.
Results:
1- It is recommended that “Female” and “Male” are used instead of “Men and Women”.
2- The age of case group was 8.80±2.7 and the control group was 9.23±3.9, these differences
specifically in children may influence on the weight of groups, so although there was no
statistical difference between age in two groups, the Mean and SD of ages had some differences
that may lead to bias in reporting about statistical differences between weight of groups.
3- Considering that the age range is 2.5-16 years old, it is suggested to define the age sub groups
and evaluate the average and statistical analysis of weight in similar age groups.
4- It is suggested that average lead levels be presented based on different age subgroups.
Tables:
1- Were BMI of both groups exactly equal?
Discussion:
1- The Discussion makes several references to existing studies but often does not directly
compare the current findings with those of previous research. For a more robust analysis, it
would be beneficial to explicitly compare and contrast the results of this study with those
of similar studies, including any discrepancies in findings or interpretations. This approach
could help to highlight the study's unique contributions to the field and suggest reasons for any
differences observed, such as variations in population demographics, geographic locations, or
methodologies.
2- While the manuscript mentions the novelty of its focus on lead level and abdominal pain
among children, it could further elaborate on how this study fills specific gaps in the existing
literature.
3- It has been mentioned in the discussion that Zamani's and Hosseini's studies had higher lead
levels, but this amount, which was 20% in Hosseini's study, and about  Zamani's study was not
determined, and the reason for this difference in lead levels in these studies was not discussed.
4- The manuscript could more explicitly outline directions for future research, building on
the study's findings. Suggesting specific areas where further investigation is needed, such
as longitudinal studies to track long-term outcomes of lead poisoning, the effectiveness of
prevention and education programs, or comparative studies across different regions or healthcare
systems, would be valuable.
References:
1- Reference 13 and 17 are the same.
Thank You!