Review for 10.1186/s12876-025-04074-9 (2025)

Title: Prevalence and Associated Risk Factors of Helicobacter pylori Infection among Medical
Students at Shendi University, Sudan
Version: 0 Date: 09 May 2025
Reviewer's report:
Dear authors you are doing well and  that’s look great work. A few issues, however, need to
be addressed;
Several grammatical errors and awkward phrases diminish clarity.
Revise the abstract using formal academic language and correct grammar. For example:
Make sure Helicobacter pylori is italicized throughout the text, as per scientific conventions.
Change "the aim to investigate" to "This study aimed to investigate".
Change "From this results we can conclude" to "These results suggest".
Express numbers consistently (e.g., “18(36.0%)” should be “18 (36.0%)” with a space).
Ensure verb tenses are consistent, especially in the Methods and Results sections (e.g., use past
tense for completed actions: “was conducted,” “were collected”).
Be consistent in reporting p-values. Use standard formatting (e.g., "p = 0.010" not “p=0.010”),
and correct use of significant figures. Also, "0.000" should be written as "p < 0.001".
Revise sentence structure to improve clarity and readability. For example, the sentence “From
this results we can conclude high prevalence…” should be revised to “These results indicate a
relatively high prevalence…”
Helicobacter pylori must be italicized throughout the text and only abbreviated to H. pylori after
the first mention.
Consider revising: “...infection remains a global health challenge, with a higher prevalence...”
# “...remains a global health concern, particularly prevalent in developing countries.”
To enhance introduction section add the following reference: Al-Ouqaili, MTS., Hussein RA.,
Majeed, HY., Al-Marzooq, F. 2023. Study of vacuolating cytotoxin A (vacA) genotypes of
ulcerogenic and non-ulcerogenic strains of Helicobacter pylori and its association with gastric
disease. Saudi Journal of Biological Sciences, Volume 30, Issue 12. http://doi.org/10.1016/
j.sjbs.2023.103867
Phrases like “risk of MALT lymphoma (7)” may benefit from a slightly more precise phrasing,
such as “a lifetime risk of developing gastric MALT lymphoma.”
To enhance introduction section add the following reference: Hussein RA, Al-Ouqaili MTS,
Majeed YH. (2021). Detection of Helicobacter Pylori infection by invasive and non-invasive
techniques in patients with gastrointestinal diseases from Iraq: A validation study. PLoS
One. 23;16(8):e0256393. doi: 10.1371/journal.pone.0256393. PMID: 34424925; PMCID:
PMC8382163.
Ensure consistent punctuation inside parentheses and with in-text citations (e.g., spacing around
citation numbers).
Break the introduction into 4–5 clear paragraphs, each covering a single thematic area (e.g.,
global burden, biology, transmission/risk factors, student-based studies, local context and aim).
This will significantly improve readability and logical flow.
The transition from international studies to the local context of Sudan (last paragraph) could be
improved. Consider starting the final paragraph with a more explicit knowledge gap in Sudan
before stating the objectives.
The section numbering is inconsistent (e.g., “.2”, “.11.2.4”, missing numbers) and may confuse
readers. Use consistent numbering throughout (e.g., 1.1, 1.2... or simply remove sub-levels
unless absolutely necessary). Align formatting for clarity.
Add exclusion criteria such as recent antibiotic or proton pump inhibitor use, which can affect
test accuracy.
Add a sentence in the Sampling Procedure subsection explaining how the 50 students were
selected.
Specify statistical tests (e.g., chi-square, t-test) used to analyze associations between variables
and H. pylori infection.
Mention the brand and manufacturer of the ICT fecal antigen test used (e.g., “The test kit used
was XYZ brand, manufactured by ABC Ltd.”), including sensitivity/specificity if known.
Added a placeholder for the approval reference number of the ethical approval.
Enhanced the explanation of informed consent to include the right to withdraw without
consequence. Maintained formal and clear language, ensuring the ethical rigor of the study is
evident.
While many variables are analyzed, the narrative should better distinguish between statistically
significant and non-significant findings. Consider explicitly stating when a variable has no
statistically significant association to avoid any reader confusion or misinterpretation.
Use consistent formatting for p-values (e.g., P = 0.010, not P = 0.01 or 0.000). For extremely
small values, use P < 0.001 instead of P = 0.000.
For categorical data, consider reporting odds ratios (OR) or relative risks (RR) with 95%
confidence intervals (CI) alongside p-values. This provides more meaningful insights than p-
values alone, especially in cross-sectional studies.
Some subgroups (e.g., smokers, those who did not wash hands) had very small numbers (as low
as n=1–4). Statistical outcomes from such small groups should be interpreted with caution and
possibly marked with a footnote in tables.
Consider adding an introductory paragraph to the discussion that briefly summarizes the
main findings and explains the purpose of the section. This helps establish context for the
interpretation that follows.
To enhance discussion section add the following reference: Hussein, RA, Al-Ouqaili MTS,
Majeed YH. (2022). Detection of clarithromycin resistance and 23SrRNA point mutations
in clinical isolates of Helicobacter pylori isolates: Phenotypic and molecular methods, Saudi
Journal of Biological Sciences, 29 (1).
For variables that showed no statistically significant association (e.g., water source, hygiene,
eating habits), consider discussing possible reasons (e.g., small sample size, uniform behaviors
across the cohort, or unmeasured confounders). Avoid dismissing them entirely.
To enhance discussion section add the following reference: Hussein RA, Al-Ouqaili MTS,
Majeed YH. Association between alcohol consumption, cigarette smoking, and Helicobacter
pylori infection in Iraqi patients submitted to gastrointestinal endoscopy. Journal of Emergency
Medicine, Trauma & Acute Care. 2022(6):12 https://doi.org/10.5339/jemtac.2022.aimco.12.
Conclusion should be objective with further perspective or should add at least a few sentences
about future study/future perspective of it