Title: Lead poisoning as a differential diagnosis in pediatric patients with chronic abdominal
pain: A case-control study in Tehran#Iran
Version: 5 Date: 09 Dec 2023
Reviewer's report:
Dear authors,
Thanks for your submission.
According the big mistakes I am not able to accept this manuscript for publishing in valuable
journal.
I hope authors revise it and submit it in another journal.
*Background
Chronic abdominal pain is a potential complication of lead poisoning, which is often challenging
to diagnose.
Complication is unfavorable result of a disease, health condition, or treatment. Complications
may adversely affect the prognosis, or outcome, of a disease.
It is not proper word in this sentence.
In fact abdominal pain is one of lead poisoning symptom.
*Although the Centers for Disease Control and Prevention (CDC) have established a blood lead
cut-off of 5 µg/dL as the point at which medical interventions should be considered for children
aged 1–5 years, no specific reference value for a safe blood lead level has been determined to
prevent adverse effects(2, 11, 12)
According https://www.cdc.gov/nceh/lead/data/blood-lead-reference-value.htm#:~:text=CDC
%20uses%20a%20blood%20lead,higher%20than%20most%20children's%20levels:
Recently CDC have established a blood lead cut-off of 3.5 µg/dL as the point at which medical
interventions should be considered for children aged 1–5 years.
*Authors did not pay attention to proper references.
It is repeated several times in discussion part
It is a huge mistake for valuable journal.
1-
Other studies indicate that one in every twenty adolescents in the United States has hazardous
blood lead levels(21).
Reference number 21 is a case report. It is not related to this sentence.
This paper is the real reference :
Markowitz G, Rosner D. Cater to the children: the role of the lead industry in a public health
tragedy, 1900–1955. Am J Public Health. 2000;90:36–46. [PMC free article] [PubMed] [Google
Scholar]
2-Previous studies demonstrated children in South and Central America had blood lead levels
higher than 10 g/dL in 33–34% of cases (20)
Ref 20 is about “Data for children aged 1 to 5 years from the National Health and Nutrition
Examination Survey III Phase I, 1988-1991, and Phase II, 1991-1994 were compared to data
from the survey period 1999-2004.”
Blood lead levels were distributed as follows: 14.0% were <1.0 microg/dL, 55.0% were 1.0 to
<2.5 microg/dL, 23.6% were 2.5 to <5 microg/dL, 4.5% were 5 to <7.5 microg/dL, 1.5% were
7.5 to <10 microg/dL, and 1.4% were >/=10 microg/dL. Multivariable analysis indicated that
residence in older housing, poverty, age, and being non-Hispanic black are still major risk factors
for higher lead levels. Blood lead testing of Medicaid-enrolled children increased to 41.9% from
19.2% in 1988-1991. Only 43.0% of children with elevated blood lead levels had previously
been tested.
I read this article but I couldn’t find this sentence.
3-Faranoush et al. evaluated children in the city of Semnan and found that blood lead levels in
78.8% of the children is above 10 µg/dl (23).
Authors must mention the date of the findings.(this is referred to 2003).
In our study, overall, 77% of study participants and 85% of children with abdominal pain had
serum lead # 5 µg/dL. As there are different sources of lead exposure include paints, water, soil,
toys, air pollution, old metal pipes, alternative medicines, and also food (1, 6)
it isn’t suitable  for this sentence.
4-lead poisoning is of great concern in children who live in Tehran and may lead to deleterious
complications (9)
Reference 9 is a editorial paper, how authors found this sentence.
Chronic lead poisoning in Iran; a silent disease
5-Air pollution is a major cause of lead poisoning, according to earlier research conducted in
Iran (26)
It is not related to reference 26.
Only sentence in reference 26 that is mentioned “air pollution “ word is referred to “Hosseini A,
Fayaz A, Hassanian-Moghaddam H, et al. Blood lead concentrations among pediatric patients
with abdominal pain: A prospective cross-sectional study. BMC Gastroenterol. 2021;21:493.
doi: 10.1186/s12876-021-02023-w.”
In ref 26 just pointed to living in industrial zone with p value more than 0.05.
6-Since, a country scale study in 2020, the mean of lead blood levels was remarkably high
between participants(10).
Population of this study (ref 10)were lead poisoned patients and it is not related to general
population.
#The results showed the prevalence of lead poisoning in the study children was extremely high.
The patient’s medical history, physical examination, laboratory tests, and results of endoscopy
and radiography were used to distinguish organic and non-organic chronic abdominal pain.
Organic abdominal pain is secondary to known physiological or anatomical dysfunctions.
Authors should mention a diagram,show how many patients access,how many of abdominal
pain patient were organic ,how many excluded due to parents didn’t fill the consent forms.
Diagram shows all inclusion and exclusion patients number and causes.
*English writing is poor:
1-M.KH, M.Y and N.E participated in grafting of manuscript.(drafting)
2-may help detect the effects of lead exposure on growth in the children.(on children growth)
3-most of the sentences have grammatical errors.
*Some references are old:(42-43-38-31-23-24-19)
Title: Lead poisoning as a differential diagnosis in pediatric patients with chronic abdominal
pain: A case-control study in Tehran#Iran
Version: 5 Date: 09 Dec 2023
Reviewer's report:
Dear authors,
Thanks for your submission.
According the big mistakes I am not able to accept this manuscript for publishing in valuable
journal.
I hope authors revise it and submit it in another journal.
*Background
Chronic abdominal pain is a potential complication of lead poisoning, which is often challenging
to diagnose.
Complication is unfavorable result of a disease, health condition, or treatment. Complications
may adversely affect the prognosis, or outcome, of a disease.
It is not proper word in this sentence.
In fact abdominal pain is one of lead poisoning symptom.
*Although the Centers for Disease Control and Prevention (CDC) have established a blood lead
cut-off of 5 µg/dL as the point at which medical interventions should be considered for children
aged 1–5 years, no specific reference value for a safe blood lead level has been determined to
prevent adverse effects(2, 11, 12)
According https://www.cdc.gov/nceh/lead/data/blood-lead-reference-value.htm#:~:text=CDC
%20uses%20a%20blood%20lead,higher%20than%20most%20children's%20levels:
Recently CDC have established a blood lead cut-off of 3.5 µg/dL as the point at which medical
interventions should be considered for children aged 1–5 years.
*Authors did not pay attention to proper references.
It is repeated several times in discussion part
It is a huge mistake for valuable journal.
1-
Other studies indicate that one in every twenty adolescents in the United States has hazardous
blood lead levels(21).
Reference number 21 is a case report. It is not related to this sentence.
This paper is the real reference :
Markowitz G, Rosner D. Cater to the children: the role of the lead industry in a public health
tragedy, 1900–1955. Am J Public Health. 2000;90:36–46. [PMC free article] [PubMed] [Google
Scholar]
2-Previous studies demonstrated children in South and Central America had blood lead levels
higher than 10 g/dL in 33–34% of cases (20)
Ref 20 is about “Data for children aged 1 to 5 years from the National Health and Nutrition
Examination Survey III Phase I, 1988-1991, and Phase II, 1991-1994 were compared to data
from the survey period 1999-2004.”
Blood lead levels were distributed as follows: 14.0% were <1.0 microg/dL, 55.0% were 1.0 to
<2.5 microg/dL, 23.6% were 2.5 to <5 microg/dL, 4.5% were 5 to <7.5 microg/dL, 1.5% were
7.5 to <10 microg/dL, and 1.4% were >/=10 microg/dL. Multivariable analysis indicated that
residence in older housing, poverty, age, and being non-Hispanic black are still major risk factors
for higher lead levels. Blood lead testing of Medicaid-enrolled children increased to 41.9% from
19.2% in 1988-1991. Only 43.0% of children with elevated blood lead levels had previously
been tested.
I read this article but I couldn’t find this sentence.
3-Faranoush et al. evaluated children in the city of Semnan and found that blood lead levels in
78.8% of the children is above 10 µg/dl (23).
Authors must mention the date of the findings.(this is referred to 2003).
In our study, overall, 77% of study participants and 85% of children with abdominal pain had
serum lead # 5 µg/dL. As there are different sources of lead exposure include paints, water, soil,
toys, air pollution, old metal pipes, alternative medicines, and also food (1, 6)
it isn’t suitable  for this sentence.
4-lead poisoning is of great concern in children who live in Tehran and may lead to deleterious
complications (9)
Reference 9 is a editorial paper, how authors found this sentence.
Chronic lead poisoning in Iran; a silent disease
5-Air pollution is a major cause of lead poisoning, according to earlier research conducted in
Iran (26)
It is not related to reference 26.
Only sentence in reference 26 that is mentioned “air pollution “ word is referred to “Hosseini A,
Fayaz A, Hassanian-Moghaddam H, et al. Blood lead concentrations among pediatric patients
with abdominal pain: A prospective cross-sectional study. BMC Gastroenterol. 2021;21:493.
doi: 10.1186/s12876-021-02023-w.”
In ref 26 just pointed to living in industrial zone with p value more than 0.05.
6-Since, a country scale study in 2020, the mean of lead blood levels was remarkably high
between participants(10).
Population of this study (ref 10)were lead poisoned patients and it is not related to general
population.
#The results showed the prevalence of lead poisoning in the study children was extremely high.
The patient’s medical history, physical examination, laboratory tests, and results of endoscopy
and radiography were used to distinguish organic and non-organic chronic abdominal pain.
Organic abdominal pain is secondary to known physiological or anatomical dysfunctions.
Authors should mention a diagram,show how many patients access,how many of abdominal
pain patient were organic ,how many excluded due to parents didn’t fill the consent forms.
Diagram shows all inclusion and exclusion patients number and causes.
*English writing is poor:
1-M.KH, M.Y and N.E participated in grafting of manuscript.(drafting)
2-may help detect the effects of lead exposure on growth in the children.(on children growth)
3-most of the sentences have grammatical errors.
*Some references are old:(42-43-38-31-23-24-19)
Please review this paper.
user
Title: Lead poisoning as a differential diagnosis in pediatric patients with chronic abdominal
pain: A case-control study in Tehran#Iran
Version: 5 Date: 09 Dec 2023
Reviewer's report:
Dear authors,
Thanks for your submission.
According the big mistakes I am not able to accept this manuscript for publishing in valuable
journal.
I hope authors revise it and submit it in another journal.
*Background
Chronic abdominal pain is a potential complication of lead poisoning, which is often challenging
to diagnose.
Complication is unfavorable result of a disease, health condition, or treatment. Complications
may adversely affect the prognosis, or outcome, of a disease.
It is not proper word in this sentence.
In fact abdominal pain is one of lead poisoning symptom.
*Although the Centers for Disease Control and Prevention (CDC) have established a blood lead
cut-off of 5 µg/dL as the point at which medical interventions should be considered for children
aged 1–5 years, no specific reference value for a safe blood lead level has been determined to
prevent adverse effects(2, 11, 12)
According https://www.cdc.gov/nceh/lead/data/blood-lead-reference-value.htm#:~:text=CDC
%20uses%20a%20blood%20lead,higher%20than%20most%20children's%20levels:
Recently CDC have established a blood lead cut-off of 3.5 µg/dL as the point at which medical
interventions should be considered for children aged 1–5 years.
*Authors did not pay attention to proper references.
It is repeated several times in discussion part
It is a huge mistake for valuable journal.
1-
Other studies indicate that one in every twenty adolescents in the United States has hazardous
blood lead levels(21).
Reference number 21 is a case report. It is not related to this sentence.
This paper is the real reference :
Markowitz G, Rosner D. Cater to the children: the role of the lead industry in a public health
tragedy, 1900–1955. Am J Public Health. 2000;90:36–46. [PMC free article] [PubMed] [Google
Scholar]
2-Previous studies demonstrated children in South and Central America had blood lead levels
higher than 10 g/dL in 33–34% of cases (20)
Ref 20 is about “Data for children aged 1 to 5 years from the National Health and Nutrition
Examination Survey III Phase I, 1988-1991, and Phase II, 1991-1994 were compared to data
from the survey period 1999-2004.”
Blood lead levels were distributed as follows: 14.0% were <1.0 microg/dL, 55.0% were 1.0 to
<2.5 microg/dL, 23.6% were 2.5 to <5 microg/dL, 4.5% were 5 to <7.5 microg/dL, 1.5% were
7.5 to <10 microg/dL, and 1.4% were >/=10 microg/dL. Multivariable analysis indicated that
residence in older housing, poverty, age, and being non-Hispanic black are still major risk factors
for higher lead levels. Blood lead testing of Medicaid-enrolled children increased to 41.9% from
19.2% in 1988-1991. Only 43.0% of children with elevated blood lead levels had previously
been tested.
I read this article but I couldn’t find this sentence.
3-Faranoush et al. evaluated children in the city of Semnan and found that blood lead levels in
78.8% of the children is above 10 µg/dl (23).
Authors must mention the date of the findings.(this is referred to 2003).
In our study, overall, 77% of study participants and 85% of children with abdominal pain had
serum lead # 5 µg/dL. As there are different sources of lead exposure include paints, water, soil,
toys, air pollution, old metal pipes, alternative medicines, and also food (1, 6)
it isn’t suitable  for this sentence.
4-lead poisoning is of great concern in children who live in Tehran and may lead to deleterious
complications (9)
Reference 9 is a editorial paper, how authors found this sentence.
Chronic lead poisoning in Iran; a silent disease
5-Air pollution is a major cause of lead poisoning, according to earlier research conducted in
Iran (26)
It is not related to reference 26.
Only sentence in reference 26 that is mentioned “air pollution “ word is referred to “Hosseini A,
Fayaz A, Hassanian-Moghaddam H, et al. Blood lead concentrations among pediatric patients
with abdominal pain: A prospective cross-sectional study. BMC Gastroenterol. 2021;21:493.
doi: 10.1186/s12876-021-02023-w.”
In ref 26 just pointed to living in industrial zone with p value more than 0.05.
6-Since, a country scale study in 2020, the mean of lead blood levels was remarkably high
between participants(10).
Population of this study (ref 10)were lead poisoned patients and it is not related to general
population.
#The results showed the prevalence of lead poisoning in the study children was extremely high.
The patient’s medical history, physical examination, laboratory tests, and results of endoscopy
and radiography were used to distinguish organic and non-organic chronic abdominal pain.
Organic abdominal pain is secondary to known physiological or anatomical dysfunctions.
Authors should mention a diagram,show how many patients access,how many of abdominal
pain patient were organic ,how many excluded due to parents didn’t fill the consent forms.
Diagram shows all inclusion and exclusion patients number and causes.
*English writing is poor:
1-M.KH, M.Y and N.E participated in grafting of manuscript.(drafting)
2-may help detect the effects of lead exposure on growth in the children.(on children growth)
3-most of the sentences have grammatical errors.
*Some references are old:(42-43-38-31-23-24-19)
assistant