Review for 10.1186/s12876-023-03091-w (2023)

Title: Mean Platelet Volume and Total White Blood Cells as Diagnostic Biomarkers for Acute
Appendicitis at Omdurman Military Hospital: A Cross-Sectional Study - 2021
Version: 3 Date: 09 Jun 2023
Reviewer's report:
Dear Editor and Authors;
1. Power Analysis of the sample size (110 patients) should be done. Power analysis explanations
and the power value of the study should be given in the study setting section.
2. a. “This study aims to study the MPV as a diagnostic biomarker in diagnosing AA in
Omdurman Military Hospital.” TWBCs should also be added to the sentence. Because in the
continuation of the study, not only the MPV but also the TWBCs value was discussed.
b. Also in the 1.Introduction section, “This study is aimed to (a) compare the MPV and TWBC
in patients with or without histological evidence of inflamed appendix (b) determine the positive
predictive value, negative predictive value, sensitivity, and specificity of MPV as a diagnostic
biomarker in the diagnosis of AA.” As stated in the sentence, the aims must be stated correctly
in the Background section under the Abstract title.
c. In the 1.Introduction section, “This study is aimed to (b) determine the positive predictive
value, negative predictive value, sensitivity, and specificity of MPV as a diagnostic biomarker in
the diagnosis of AA.” TWBCs value should be added next to the MPV in the sentence. Because
Results and Conclusion are also included in TWBCs.
3. In the Materials and methods section under the title of Abstract, “Analytical cross-sectional
study was conducted at Omdurman Military Hospital from December 2020 - December 2021.”
while there is a sentence; “This study was conducted at the emergency department of Omdurman
Military Hospital in Omdurman, Khartoum, Sudan, from September 2020 to December 2021,
using a cross-sectional design.” has a sentence. Is it December 2020? September 2020?
4. In the Materials and methods section under the Abstract title, “Data variables covered
socio-demographic characteristics, clinical presentations, intraoperative appendix macroscopic
findings, pre-operative MPV and TWBCs and post-operative histopathological findings.” The
long version of TWBCs should be written in the sentence. Afterwards, the abbreviation TWBCs
should be used, there is no need to write the long version.
5. In the Results section under the Abstract title, “Sixty-three patients (57.3%) had low (<7.5)
MPV, whereas 47 (42.7%) had normal parameters.” In the sentence, values should be written
instead of parameters.
6. In general; When giving values for MPV, TWBCs numeric variables, their units should be
included. For example; In the Results section under the Abstract title, “Sixty-three patients
(57.3%) had low (<7.5) MPV, 47 (42.7%) had normal parameters.” In the sentence, the unit
should be added next to <7.5. All text should be checked and written in its entirety.
7. Under the Abstract title, there is the WBCs statement in the Conclusion section. TWBCs? or
WBCs? There must be a unity.
8. In the 2.Materials and methods section, under Patients explanations, “Descriptive statistics
were used; Mean ± SD for continuous variables and proportions for categorical variables.”
When Mean±SD is written in the sentence, the open version of SD should be written and its
abbreviation () should be given next to it. Frequency and percent should be written instead of
proportions.
9. 2. Under Patients explanations in the Materials and methods section, “The chi-square test
was then performed to investigate associations, and the P value was considered significant
if <0.05.” According to the sentence, if the relationship is examined in the study, the
correlation coefficients should be given. If differences between groups are investigated, the word
"associations" should be changed.
10. 2. Ethics Committee Approval date and Number should be added under the Ethical
consideration explanations in the Materials and methods section.
11. 3.Socio-demographic characteristics in the Results section. and 3.3 Medications and
Imaging. contained in the headings. . mark should be deleted. Under the socio-demographic
characteristics descriptions, “This study included 110 patients, primarily males 75 (68.2%). Half
(50%) of the patients were in the age group 10-19 years).” The ) sign at the end of the sentence
should be deleted. In addition, the mean ± standard deviation values of the age variable should
be given.
12. In the 3.Results section, under the Signs and symptoms descriptions — spelling should be
checked.
13. In the 3.Results section, under the Medications and Imaging explanations, those who are not
given drugs should be stated in the form of numbers and rates. If both Abdominal Ultrasound
and Abdominal CT are performed, the number and rate should be specified.
14. In the 3.Results section, under the Outcome descriptions, the first sentence should start with
a capital letter. (n=87, 82%) should be written in a sentence, not in parentheses.
15. In Table 1 and Table 2, Variables should be written in the column header, not Parameter. In
Table 1, mean±SD values should not be written under the Frequency column. By adding a row
below the table, mean±SD values should be written under the mean±SD column heading.
“The mean TWBCs among the patients were 12.3± 3.6, with 54.5% having a high TWBC
count (>11). However, MPV was found to have a mean of 7.6± 0.8 fL, with 63 (57.3%) having
low (<7.5 fL) readings (Table 1).” with “When comparing patients with histological evidence
of inflamed appendix and those who have none regarding MPV and TWBCs, most of the
patients with an inflamed appendix have high TWBCS (n= 59/87, 68%) and low MPV (62/87,
71.2%) than those with the non-inflamed appendix, which is statistically significant, P value
<0.05 (Table 2).” There should be integrity when giving number and percentage values in table
interpretations such as It should be like n(%) ie 63 (57.3%). (n= 59/87, 68%), (62/87, 71.2%)
should not be like 54.5%.
16. Regarding Table 2, besides the n values in the cells, the % (row percent) values in () should
be given. Isn't the total n=110? P value should be written like p-value.
17. P values should be written directly in the tables. If symbolizing with *, each * should
symbolize only one thing and their explanations should be given under the table. There is
………. statistically significant difference (p-value<0.01) in the table interpretations. or it should
be written as (p-value<0.05). According to the p-value.
18. In Table 2 and Table 3, besides the p-value values, (#2) values should be added under the
column titled Chi-Square.
19. In Table 4, <24 hour , >24 hour, Total groups should be given in n values ().
20. Comments for the values given in each column in Table 4 should be added. A concurrent
high (such as above about 0.80) of Performance measures for a new diagnostic test (MPV,
TWBCs) will indicate that it is a good diagnostic test. Therefore, the values should be interpreted
completely and correctly. In addition, the cut-off points of the MPV and TWBCs variables
should be given, and the sensitivity and selectivity values of the cut-off points should be
interpreted together.
21. 4. p-value values should not be written in the Discussion section. When writing “3.7 days
and four ± 3.5 days” under the title of MPV in acute appendicitis, it should be written with the
number “four”.
22. 4. In the Discussion section, under the title of TWBC in acute appendicitis, there is the first
leucocyte count statement. leucocyte count , WBCs or TWBCs whichever is used should be
common usage.
23. Likewise, WBCs are written in the 5th Conclusion section. leucocyte count , WBCs or
TWBCs whichever is used should be common usage. Mostly TWBCs were written in the article.
24. Conclusion should be reviewed again. More explanation should be added, not a summary.
25. Reference writings should be checked, especially the sources 3, 4, 5, 11, 13, 14, 17, 18.
26. Finally; TWBCs as well as MPV were evaluated in the study content. Therefore, Mean
platelets volume and Total white blood cells should be together in the title.