Reviewer ’s report  
 
Title:  Tubo -ovarian Abscess with Sepsis in a Nonagenarian Woman: A Case Report and 
Literature Review  
 
Version: 0 Date: 04 Dec 2018 
 
Reviewer:  Gagandeep K  Walia  
 
Reviewer’s report:  
 
The current case report titled, "An Unusual Cause of Sepsis i n Post -menopausal Women" 
highlights that tubo -ovarian abscess, a complication of pelvic inflammatory diseases (PID), can 
be a potential cause of infection even in post -menopausal women and thus should not be 
neglected by clinicians in older women patients since PID can be life threatening if not treated on 
time.   
 
1. This case is an important finding of PID among elderly women, but before suggesting it as a 
potential cause, it needs to be confirmed whether this abscess in the presented case was due to 
PID o r due to local spread of an inflammatory disease of the bowel or adnexal surgery.   
 
2. The authors need to elaborate the discussion section to further highlight why pelvic 
examination should be included while identifying the cause of infection. The authors  should also 
highlight that their patient did not present high fever or leukocytosis and thus clinicians should 
be alert while diagnosing the infection.  
 
3. Authors need to elaborate how the immune system of their patient was compromised due to 
uremia and how that could have led to PID.  
 
4. The discussion section need to be re -organized as the current flow is sometimes confusing and 
interferes with the existing knowledge, gaps and recommendations.  
 
5. The background and conclusion sections of the abstract nee d to be revised by giving a stronger 
justification for the clinical importance of PID among elderly women.  
 
Are the methods appropriate and well  described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is re commended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
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1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financia lly from the publication of this 
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3. Do you hold o r are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do yo u have any other financial competing interests?  
 
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below. If your reply is yes to any, please give details below.  
 
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