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:2 December 2013
Reviewer: Cyril Dim
Reviewer's report:
Comments to Authors (Major compulsory revisions)
I commend authors for the efforts put in this study. My comments /
recommendations are as follows:
General comments:
The study is relevant. However, knowing that age is an important determinant for
the outcomes of interest, authors would have added more to knowledge if they
had designed a comparative study or at least carried out a comparative analysis
– either of these would obviously need a larger sample size.
Authors should note syntax and spelling errors in the manuscript. English editing
may be necessary.
Specific comments:
In addition to these comments, authors should note the comments posted on the
manuscript as sticky notes
Abstract:
This is too long. Authors should summarize further especially the “conclusion”
Authors used “radical hysterectomy” here and in other sections, and I wonder
whether that was the message they wished to pass across. Radical hysterectomy
has a definition and indications in Gyneacology. Authors should note and revise
Introduction:
Authors should enrich this introduction with
• Paragraph 1, lines 2-4: report(s) from their locality on the prevalence of AUB
(e.g. per gynae. clinic attendee)
• Paragraph 3, lines 1 & 2: Authors noted that AUB was the commonest
indication for hysterectomy in developing countries. Developing countries include
a large geographical area so, I view this statement as an over generalization.
Consider using “a common indication” instead of the most frequent indication”.
Readers would wish to know the practice in your setting with references (if
available).
• Paragraph 3, line 3: List common morbidities of hysterectomy with appropriate
references.
• Para 4, lines 2-3: “…..which dilatation and curettage is considered …….”.
Provide a reference for this statement.
Methods:
This section is scanty and needs substantial upgrading so as to encourage
reproducibility of the study.
Sampling: Were the study participants selected consecutively or a sample of
patients. If the latter, what method was used?
What was your primary outcome measure(s)? Was the sample size adequate to
measure it (then), and how did you determine your sample size?
Timing of informed consent: “Informed consent was taking at time of the
procedure”. Consider replacing with “Informed consent was obtained prior to the
procedure”
Who carried out the D & C? What training does s/he have? Is he blinded to
study’s objectives? Summarize what was done and how the specimen was
handled. For instance, “D and C was carried out by 2 gynaecologists using
standard method (insert reference). For each participant, her specimen was
immediately stored in Formalin solution (state the solution used and
concentration), labeled, and transferred to the histopathology laboratory”
I am worried about Quality control for the histology reports: Who reported the
histology slides? Were they blinded to study objectives? How did you ensure
quality control so as to reduce measurement bias during the reporting? If no
measure was put in place, authors should discuss this limitation and the possible
effect on the results.
Authors should describe the study center and study area for the benefit of the
readers.
Key terminologies were used in this study such as polymenorrhea, etc. Authors
should state the definition they used for each term with reference(s).
Results:
Para 2, lines 1-3: When more than 1 denominator is involved in a report, it may
be better to indicate them for better clarity. E.g. " Among the 82 (34.0%) cases
with normal menstrual pattern, secretory endometrium was the commonest
pattern (59.8%, 49/82), followed by proliferative endometrial pattern (40.2%,
33/82).
Para 4: Consider re-writing thus: (In all, out of the 241 participants, 236 (97.9%)
had benign ......."
Other basic characteristics of study participants should be stated since this was a
prospective study e.g. marital status, educational status, parity.
Use “Figures” instead of “Charts”
Use “Participants” instead of “Cases”
Other comments are attached as sticky notes on the manuscript.
Discussion
Para 3, line 1: “We found that age was an important …….” Authors cannot make
this claim from their results based on simple descriptive analysis! Whatever the
results show is only suggestive - authors should state this clearly.
Authors may consider re-writing the discussion section. They are encouraged to
discuss their results and not to present a literature review. They should compare
important findings with relevant local and international reports; as well as discuss
the relevance of important study findings.
Study strength and limitations should be discussed as well as new research
interests based on their study.
Conclusion should be concise and based on the results. Also, authors can make
policy-relevant recommendation(s) based on their results.
Tables and Figures
Table1:
Often it is necessary to add a row at the end of tables to indicate "Total" of
sub-categories presented.
Consider presenting your percentages using one decimal place.
Figures (Charts):
Delete figures 1, 3, 5, and 6. Describe their contents in the text of the results if
they have not been captured.
Level of interest: An article whose findings are important to those with closely
related research interests
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