Reviewer's report
Title:Clinical pattern and spectrum of endometrial pathologies in patients with
abnormal uterine bleeding in Pakistan: need to adopt a more conservative
approach
Version:1Date:15 January 2014
Reviewer: Remigius Izunwa
Reviewer's report:
Title Revisions
The authors should complete the title ("need to adopt conservative approach to
treatment")
Grammar revisions:
1. The authors need to modify the fourth sentence on the background section of
the abstract, as the use of the word "abstain" has a serious negative connotation
on the doctor's current practice. Suggestion - " This would provide guidelines for
appropriate choice of treatment modalities, thereby reducing unnecessary
hysterectomies, and promoting minimally invasive, uterus-sparing therapeutic
strategies, ".
2. Insert "and" after 34% in the result section of the abstract.
3. Modify the third statement in the background section of the main text.
Suggestion; "Risk factors" of AUB or Conditions that can manifest with AUB
include;
4. Remove the "Although" or remove the "but" in the first line of the third
paragraph under the background section. The two cannot go together.
5. Correct the grammar in the last sentence of the second paragraph. Suggestion
; "while type 2 endometrial carcinoma was noted in one case".
6. Correct the grammar in the last sentence of the third paragraph under
background section. Suggestion; On the other hand, the frequencies of
endometrial hyperplasia and carcinoma were quite low, being 13.2% and 4%
respectively (table 2).
7. Correct the grammar in the first sentence under discussion. Suggestion;
"poses a considerable".
8. Correct the grammar in the last sentence of the first paragraph under
discussion. Suggestion; AUB is of concern because it may have serious
medical "and social" consequences, as bleeding may cause "anaemia", undue
disruption of women’s daily activities "and sexual life".
9. Remove "Although" from the last sentence of the second paragraph under
discussion.
10. Correct the grammar in the first sentence of the fourth paragraph under
discussion. Suggestion; "In a study conducted in the northern areas of Pakistan
to determine the spectrum of AUB, 128 cases of AUB were evaluated, and the
results showed that the highest frequency of the problem was in the reproductive
age group (52%), followed by 43% and 7% in the peri and postmenopausal age
groups respectively".
11. Correct the first statement in the fifth paragraph under discussion.
Suggestion; "Sarwar A et al reported 50 cases of AUB in Islamabad, in which
only 25 cases were evaluated histologically".
12. General grammar check with emphasis on the the use of “coma” and
“fullstops”
Background section revisions:
13. The authors need to discuss the complications of hysterectomy like bowel,
bladder and ureteric injuries, haemorrhage, sepsis, thrombo-embolism, and
anaesthetic complications to strengthen their point and discuss the rates of these
complications.
14. The authors should discuss the efficacy of minimally invasive procedures in
the management of AUB.
15. A local reference is necessary on the rate of hysterectomy and the
indications for AUB in the study population.
Revisions on the methodology;
16. Authors should comment on the generalizabilty of the result to the study
population as this was a one centre, hospital based study.
17. The authors should comment on how many pathologists that examined the
uterus after hysterectomy and comment on the similarity of their experience.
Revision on the conclusion
18. Modify the conclusion. There seem to be an overstatement in the conclusion.
Hysterectomy for AUB is not always done with oophorectomy, and it is
oophorectomy that is associated with cardiovascular complications and not
hysterectomy.
Other comments to be factored into your background section discussion
19. Fertility saving treatment may not be absolutely necessary for a woman with
AUB who has completed her family or is over the age of 45 years.
20. Accurate diagnosis of specific causes of AUD is necessary for proper choice
of the best treatment modalities. This is not always possible pre-operatively.
21. Skills and experience may be limiting factors to the use of minimally invasive
techniques and gynaecologists should perform procedures that they were
properly trained in, and gradually upgrade their skills to accommodate new
treatment modalities.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests