Title: A Large-Scale Study on the Prevalence of Intestinal Parasites in Patients Referred to
Medical Laboratories in Urmia, Northwest Iran
Version: 4 Date: 17 Aug 2023
Reviewer:  Aki Ronkainen
Reviewer's report:
The reviewer is delighted that the authors have addressed the main concerns regarding the
manuscript. Concerning the revised manuscript, the reviewer would like to suggest a few
corrections.
Page 1, Lines 19-20 (Abstract): Please transfer the percent (%) symbol after the numbers.
Page 1, Lines 26-29 (Abstract): Suggestion to enhance readability: Results: 209 intestinal
parasites were identified in 184 out of 2845 (6.5%) patients of which 136 out of 2174 males
(6.3%) and 48 out of 671 females (7.2%) were positive. Some patients had tested positive for
multiple protozoa.
Page 2, Lines 3-4 (Abstract): "granted are indices for water and food hygienic status in the area"
Please clarify and rephrase.
Page 2, Line 25 (Introduction): the multiple infection -> co-infection with multiple parasites
The reviewer is pleased with revised description of materials and methods, especially adding
the section "Limitations of the study".
Page 3, Line 13 (Materials and Methods): Please clarify the sentence. Were the samples
suspended in formalin and PVA after  sample collection by the patients or when they arrived
in the laboratory? Meaning, were the samples transported without preservative? Were the wet
mount preparations made from unfixed samples?
As for the limitations of the study, it should be mentioned and emphasised that the samples
WERE NOT treated with ethyl-acetate concentration. This is important as this procedure
enhances identification of intestinal parasites. For instance, the eggs of Ascaris lumbricoides
and Taenia spp. may be missed in the presence of debris present in wet mount preparations. This
should also be clearly stated in the discussion.
Page 5 Line 3 (Results): Blastocystis spp. Please correct spp. to non-italics.
In the result section, please use arabic numbers for numbers more than 10 in stead of writing them
(e.g. page 9 line 1, twenty-one -> 21) to enhance readability. Furthermore, place the percentages
after the numbers (e.g. 21 (11,41%) out of 184 patients -> 21 out of 184 patients (11,41 %)).
Page 10 Line 2 (Discussion): Chilomastixmesnili -> Chilomastix mesnili
Page 10 Line 4-5 (Discussion): which diagnosis is not a stool examination, but the cellulose tape
(adhesive cellophane tape) [12] that did not perform in the present study. -> which is regularly
analysed either from  adhesive cellophane tape or swab sample that were not performed in this
study.
Page 10 Line 11 (Discussion): The reference 17 used in comparison states, although somewhat
ambiguously, the use of formalin-ether concentration. It should be stated that the methodology
differed from this study.
Page 10 Line 22-24 (Discussion): This dramatic reduction in the prevalence of intestinal
parasites is LIKELY the result of the recent improvement in hygienic status, sanitation, and
health education in society.
Title: A Large-Scale Study on the Prevalence of Intestinal Parasites in Patients Referred to
Medical Laboratories in Urmia, Northwest Iran
Version: 4 Date: 17 Aug 2023
Reviewer:  Aki Ronkainen
Reviewer's report:
The reviewer is delighted that the authors have addressed the main concerns regarding the
manuscript. Concerning the revised manuscript, the reviewer would like to suggest a few
corrections.
Page 1, Lines 19-20 (Abstract): Please transfer the percent (%) symbol after the numbers.
Page 1, Lines 26-29 (Abstract): Suggestion to enhance readability: Results: 209 intestinal
parasites were identified in 184 out of 2845 (6.5%) patients of which 136 out of 2174 males
(6.3%) and 48 out of 671 females (7.2%) were positive. Some patients had tested positive for
multiple protozoa.
Page 2, Lines 3-4 (Abstract): "granted are indices for water and food hygienic status in the area"
Please clarify and rephrase.
Page 2, Line 25 (Introduction): the multiple infection -> co-infection with multiple parasites
The reviewer is pleased with revised description of materials and methods, especially adding
the section "Limitations of the study".
Page 3, Line 13 (Materials and Methods): Please clarify the sentence. Were the samples
suspended in formalin and PVA after  sample collection by the patients or when they arrived
in the laboratory? Meaning, were the samples transported without preservative? Were the wet
mount preparations made from unfixed samples?
As for the limitations of the study, it should be mentioned and emphasised that the samples
WERE NOT treated with ethyl-acetate concentration. This is important as this procedure
enhances identification of intestinal parasites. For instance, the eggs of Ascaris lumbricoides
and Taenia spp. may be missed in the presence of debris present in wet mount preparations. This
should also be clearly stated in the discussion.
Page 5 Line 3 (Results): Blastocystis spp. Please correct spp. to non-italics.
In the result section, please use arabic numbers for numbers more than 10 in stead of writing them
(e.g. page 9 line 1, twenty-one -> 21) to enhance readability. Furthermore, place the percentages
after the numbers (e.g. 21 (11,41%) out of 184 patients -> 21 out of 184 patients (11,41 %)).
Page 10 Line 2 (Discussion): Chilomastixmesnili -> Chilomastix mesnili
Page 10 Line 4-5 (Discussion): which diagnosis is not a stool examination, but the cellulose tape
(adhesive cellophane tape) [12] that did not perform in the present study. -> which is regularly
analysed either from  adhesive cellophane tape or swab sample that were not performed in this
study.
Page 10 Line 11 (Discussion): The reference 17 used in comparison states, although somewhat
ambiguously, the use of formalin-ether concentration. It should be stated that the methodology
differed from this study.
Page 10 Line 22-24 (Discussion): This dramatic reduction in the prevalence of intestinal
parasites is LIKELY the result of the recent improvement in hygienic status, sanitation, and
health education in society.
Please review this paper.
user
Title: A Large-Scale Study on the Prevalence of Intestinal Parasites in Patients Referred to
Medical Laboratories in Urmia, Northwest Iran
Version: 4 Date: 17 Aug 2023
Reviewer:  Aki Ronkainen
Reviewer's report:
The reviewer is delighted that the authors have addressed the main concerns regarding the
manuscript. Concerning the revised manuscript, the reviewer would like to suggest a few
corrections.
Page 1, Lines 19-20 (Abstract): Please transfer the percent (%) symbol after the numbers.
Page 1, Lines 26-29 (Abstract): Suggestion to enhance readability: Results: 209 intestinal
parasites were identified in 184 out of 2845 (6.5%) patients of which 136 out of 2174 males
(6.3%) and 48 out of 671 females (7.2%) were positive. Some patients had tested positive for
multiple protozoa.
Page 2, Lines 3-4 (Abstract): "granted are indices for water and food hygienic status in the area"
Please clarify and rephrase.
Page 2, Line 25 (Introduction): the multiple infection -> co-infection with multiple parasites
The reviewer is pleased with revised description of materials and methods, especially adding
the section "Limitations of the study".
Page 3, Line 13 (Materials and Methods): Please clarify the sentence. Were the samples
suspended in formalin and PVA after  sample collection by the patients or when they arrived
in the laboratory? Meaning, were the samples transported without preservative? Were the wet
mount preparations made from unfixed samples?
As for the limitations of the study, it should be mentioned and emphasised that the samples
WERE NOT treated with ethyl-acetate concentration. This is important as this procedure
enhances identification of intestinal parasites. For instance, the eggs of Ascaris lumbricoides
and Taenia spp. may be missed in the presence of debris present in wet mount preparations. This
should also be clearly stated in the discussion.
Page 5 Line 3 (Results): Blastocystis spp. Please correct spp. to non-italics.
In the result section, please use arabic numbers for numbers more than 10 in stead of writing them
(e.g. page 9 line 1, twenty-one -> 21) to enhance readability. Furthermore, place the percentages
after the numbers (e.g. 21 (11,41%) out of 184 patients -> 21 out of 184 patients (11,41 %)).
Page 10 Line 2 (Discussion): Chilomastixmesnili -> Chilomastix mesnili
Page 10 Line 4-5 (Discussion): which diagnosis is not a stool examination, but the cellulose tape
(adhesive cellophane tape) [12] that did not perform in the present study. -> which is regularly
analysed either from  adhesive cellophane tape or swab sample that were not performed in this
study.
Page 10 Line 11 (Discussion): The reference 17 used in comparison states, although somewhat
ambiguously, the use of formalin-ether concentration. It should be stated that the methodology
differed from this study.
Page 10 Line 22-24 (Discussion): This dramatic reduction in the prevalence of intestinal
parasites is LIKELY the result of the recent improvement in hygienic status, sanitation, and
health education in society.
assistant