Title: A Large-Scale Study on the Prevalence of Intestinal Parasites in Patients Referred to
Medical Laboratories in Urmia, Northwest Iran
Version: 2 Date: 07 Jul 2023
Reviewer:  Aki Ronkainen
Reviewer's report:
The authors have  conducted a study titled "A Large-Scale Study on the Prevalence of Intestinal
Parasites in Patients Referred to Medical Laboratories in Urmia, North West of Iran". The
reviewer is impressed with the  scale of  study as well as the study aim.
The reviewer is concerned with insufficient description of the materials and methods. The
description does not include a thorough description of sampling and sample analysis. What type
of container and fixative (if any) was used preserve the specimens? How were the wet mount
preparations made? All this is crucial when interpreting the results. Please  revise the manuscript
by including a step-by-step description of the sample collection and analysis.
As for the results, the authors should pay attention when addressing pathogenic and apathogenic
parasites. For example, when addressing  species such as Blastocystis spp., Endolimax nana,
Entamoeba coli, Iodamoeba butschlii, and Chilomastix mesnili, the use of term "infection"
is a overstatement as these organisms are usually considered apathogens. The author would
recommend using the term colonization with respect to these organisms. In the discussion, there
is line "Interestingly, it is reported from 10 patients with diarrhea which is resolved after treating
E. coli infection [19]. ", suggesting that E. coli is a pathogen. However, the authors refer to a
study from 1991, and does not reflect the current view on the organism's status as pathogen.
The reviewer is suprised that the study does not report any helmints besides Enterobius
vermicularis that may occasionally be found in stool samples. The reviewer suggest that the
word "interestingly" to be omitted from the discussion. Furthermore, the authors do not report
any Entamoeba histolytica/dispar or Entamoeba hartmanni cases. All this underlines the need to
update the materials and methods for the readers to scrutinize the results.
The reviewer does not agree as such with the conclusions "According to the results of the present
study, the prevalence of intestinal parasitic infections in West Azerbaijan province, northwest
of Iran, is not considered very high, yet seems significant. Most intestinal protozoa are still
prevalent in the area, granted in low prevalence. Moreover, in terms of helminthic infections,
no soil-transmitted helminth was detected thus, West Azerbaijan is in decent condition. " These
claims require some comparisons.  To state that something is not high, what is the reference?
How is the low-prevalence defined?
Title: A Large-Scale Study on the Prevalence of Intestinal Parasites in Patients Referred to
Medical Laboratories in Urmia, Northwest Iran
Version: 2 Date: 07 Jul 2023
Reviewer:  Aki Ronkainen
Reviewer's report:
The authors have  conducted a study titled "A Large-Scale Study on the Prevalence of Intestinal
Parasites in Patients Referred to Medical Laboratories in Urmia, North West of Iran". The
reviewer is impressed with the  scale of  study as well as the study aim.
The reviewer is concerned with insufficient description of the materials and methods. The
description does not include a thorough description of sampling and sample analysis. What type
of container and fixative (if any) was used preserve the specimens? How were the wet mount
preparations made? All this is crucial when interpreting the results. Please  revise the manuscript
by including a step-by-step description of the sample collection and analysis.
As for the results, the authors should pay attention when addressing pathogenic and apathogenic
parasites. For example, when addressing  species such as Blastocystis spp., Endolimax nana,
Entamoeba coli, Iodamoeba butschlii, and Chilomastix mesnili, the use of term "infection"
is a overstatement as these organisms are usually considered apathogens. The author would
recommend using the term colonization with respect to these organisms. In the discussion, there
is line "Interestingly, it is reported from 10 patients with diarrhea which is resolved after treating
E. coli infection [19]. ", suggesting that E. coli is a pathogen. However, the authors refer to a
study from 1991, and does not reflect the current view on the organism's status as pathogen.
The reviewer is suprised that the study does not report any helmints besides Enterobius
vermicularis that may occasionally be found in stool samples. The reviewer suggest that the
word "interestingly" to be omitted from the discussion. Furthermore, the authors do not report
any Entamoeba histolytica/dispar or Entamoeba hartmanni cases. All this underlines the need to
update the materials and methods for the readers to scrutinize the results.
The reviewer does not agree as such with the conclusions "According to the results of the present
study, the prevalence of intestinal parasitic infections in West Azerbaijan province, northwest
of Iran, is not considered very high, yet seems significant. Most intestinal protozoa are still
prevalent in the area, granted in low prevalence. Moreover, in terms of helminthic infections,
no soil-transmitted helminth was detected thus, West Azerbaijan is in decent condition. " These
claims require some comparisons.  To state that something is not high, what is the reference?
How is the low-prevalence defined?
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: 2 Date: 07 Jul 2023
Reviewer:  Aki Ronkainen
Reviewer's report:
The authors have  conducted a study titled "A Large-Scale Study on the Prevalence of Intestinal
Parasites in Patients Referred to Medical Laboratories in Urmia, North West of Iran". The
reviewer is impressed with the  scale of  study as well as the study aim.
The reviewer is concerned with insufficient description of the materials and methods. The
description does not include a thorough description of sampling and sample analysis. What type
of container and fixative (if any) was used preserve the specimens? How were the wet mount
preparations made? All this is crucial when interpreting the results. Please  revise the manuscript
by including a step-by-step description of the sample collection and analysis.
As for the results, the authors should pay attention when addressing pathogenic and apathogenic
parasites. For example, when addressing  species such as Blastocystis spp., Endolimax nana,
Entamoeba coli, Iodamoeba butschlii, and Chilomastix mesnili, the use of term "infection"
is a overstatement as these organisms are usually considered apathogens. The author would
recommend using the term colonization with respect to these organisms. In the discussion, there
is line "Interestingly, it is reported from 10 patients with diarrhea which is resolved after treating
E. coli infection [19]. ", suggesting that E. coli is a pathogen. However, the authors refer to a
study from 1991, and does not reflect the current view on the organism's status as pathogen.
The reviewer is suprised that the study does not report any helmints besides Enterobius
vermicularis that may occasionally be found in stool samples. The reviewer suggest that the
word "interestingly" to be omitted from the discussion. Furthermore, the authors do not report
any Entamoeba histolytica/dispar or Entamoeba hartmanni cases. All this underlines the need to
update the materials and methods for the readers to scrutinize the results.
The reviewer does not agree as such with the conclusions "According to the results of the present
study, the prevalence of intestinal parasitic infections in West Azerbaijan province, northwest
of Iran, is not considered very high, yet seems significant. Most intestinal protozoa are still
prevalent in the area, granted in low prevalence. Moreover, in terms of helminthic infections,
no soil-transmitted helminth was detected thus, West Azerbaijan is in decent condition. " These
claims require some comparisons.  To state that something is not high, what is the reference?
How is the low-prevalence defined?
assistant