Reviewer’s report
Title: 
Gastrointestinal symptoms as the first manifestation of antiphospholipid
syndrome
Version: 
0 
Date: 
03 Feb 2021
Reviewer's report:
The manuscript entitled "Gastrointestinal symptoms as the first manifestation of
antiphospholipid syndrome" describes a clinical autoimmune condition involving
auto antibodies to phospholipids that cause systemic effects that can present
differently in those afflicted. This manuscript describes a case study of a patient
that presented with severe, intractable intestinal pain. After visits to several
hospital departments, it was found that she was positive for autoantibodies that
characterize antiphospholipid syndrome. The authors intent is to inform medical
professionals of this condition and to consider this condition when severe
intractable gastrointestinal symptoms present.
The manuscript is largely well written with minor typos:
Title Page Abstract:
...history of two miscarriages [add s]
Abstract:
line 3 
condition, which produces [add s]
line 15 
miscarriages [add s]
Background:
Line 26 
reduce missed diagnosis. [delete remaining words]
Case Presentation:
Line 4 relieved her symptoms [add s]…
Line8 
However, the symptoms [add s]…
Line 13 
and splenic vein (Fig 1.1)
Line 25 multiple thrombi [plural]
Page 5 
The authors say that after months of discharge with treatment, the patient was
eventually hospitalized with recurrent abdominal pain. Can the authors speculate
on why they think the therapy became ineffective. Was it noncompliance?
Discussion and Conclusion:
Is APS more prominent in women similar to other autoimmune diseases?
Based on the biochemical tests, the patient apparently did not have liver
involvement, yet it is the most common manifestation in APS. Is this correct?
Line 48 
Hamilton [remove all caps] et al, reported a [a instead of the] case...
Page 6
It is implied that the patient eventually progressed to CAPS criteria? Is this
correct? It would be helpful if the authors could provide a timeline of the disease
progesssion.
Line 18 
For [add] patients with …
Line 20 
...or INR 3-4 is [add] suggested for...
Line 46 Surgery [instead of Surgically] should be performed...
Line 55 
other clinical studies are [add] lacking to show whether...\
Page 7:
Line 3 
There is no [delete any] case...
Line 4 
reported. [delete comma]
Line 9 
Text says that thrombectomy is feasible with 72 hours of venous
thrombosis yet the prior text says that there is no case of venous trombotomy that
has been reported. These sentences appear to contradict.
Line 46 
signs of abdominal involvement should be considered in patients with
APS. Can the authors comment on other demographics that are associated with
this disease? Women? Age? etc.
Figures
Fig 1.1 and 1.2 have misplaced hyphens in words in the text of the legend.
The dark arrows in all of the figures are difficult to see. Make them light colored
(white)
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find the details of processing in Publons’ privacy policy
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No
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interest.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Gastrointestinal symptoms as the first manifestation of antiphospholipid
syndrome
Version: 
0 
Date: 
03 Feb 2021
Reviewer's report:
The manuscript entitled "Gastrointestinal symptoms as the first manifestation of
antiphospholipid syndrome" describes a clinical autoimmune condition involving
auto antibodies to phospholipids that cause systemic effects that can present
differently in those afflicted. This manuscript describes a case study of a patient
that presented with severe, intractable intestinal pain. After visits to several
hospital departments, it was found that she was positive for autoantibodies that
characterize antiphospholipid syndrome. The authors intent is to inform medical
professionals of this condition and to consider this condition when severe
intractable gastrointestinal symptoms present.
The manuscript is largely well written with minor typos:
Title Page Abstract:
...history of two miscarriages [add s]
Abstract:
line 3 
condition, which produces [add s]
line 15 
miscarriages [add s]
Background:
Line 26 
reduce missed diagnosis. [delete remaining words]
Case Presentation:
Line 4 relieved her symptoms [add s]…
Line8 
However, the symptoms [add s]…
Line 13 
and splenic vein (Fig 1.1)
Line 25 multiple thrombi [plural]
Page 5 
The authors say that after months of discharge with treatment, the patient was
eventually hospitalized with recurrent abdominal pain. Can the authors speculate
on why they think the therapy became ineffective. Was it noncompliance?
Discussion and Conclusion:
Is APS more prominent in women similar to other autoimmune diseases?
Based on the biochemical tests, the patient apparently did not have liver
involvement, yet it is the most common manifestation in APS. Is this correct?
Line 48 
Hamilton [remove all caps] et al, reported a [a instead of the] case...
Page 6
It is implied that the patient eventually progressed to CAPS criteria? Is this
correct? It would be helpful if the authors could provide a timeline of the disease
progesssion.
Line 18 
For [add] patients with …
Line 20 
...or INR 3-4 is [add] suggested for...
Line 46 Surgery [instead of Surgically] should be performed...
Line 55 
other clinical studies are [add] lacking to show whether...\
Page 7:
Line 3 
There is no [delete any] case...
Line 4 
reported. [delete comma]
Line 9 
Text says that thrombectomy is feasible with 72 hours of venous
thrombosis yet the prior text says that there is no case of venous trombotomy that
has been reported. These sentences appear to contradict.
Line 46 
signs of abdominal involvement should be considered in patients with
APS. Can the authors comment on other demographics that are associated with
this disease? Women? Age? etc.
Figures
Fig 1.1 and 1.2 have misplaced hyphens in words in the text of the legend.
The dark arrows in all of the figures are difficult to see. Make them light colored
(white)
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interest.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Gastrointestinal symptoms as the first manifestation of antiphospholipid
syndrome
Version: 
0 
Date: 
03 Feb 2021
Reviewer's report:
The manuscript entitled "Gastrointestinal symptoms as the first manifestation of
antiphospholipid syndrome" describes a clinical autoimmune condition involving
auto antibodies to phospholipids that cause systemic effects that can present
differently in those afflicted. This manuscript describes a case study of a patient
that presented with severe, intractable intestinal pain. After visits to several
hospital departments, it was found that she was positive for autoantibodies that
characterize antiphospholipid syndrome. The authors intent is to inform medical
professionals of this condition and to consider this condition when severe
intractable gastrointestinal symptoms present.
The manuscript is largely well written with minor typos:
Title Page Abstract:
...history of two miscarriages [add s]
Abstract:
line 3 
condition, which produces [add s]
line 15 
miscarriages [add s]
Background:
Line 26 
reduce missed diagnosis. [delete remaining words]
Case Presentation:
Line 4 relieved her symptoms [add s]…
Line8 
However, the symptoms [add s]…
Line 13 
and splenic vein (Fig 1.1)
Line 25 multiple thrombi [plural]
Page 5 
The authors say that after months of discharge with treatment, the patient was
eventually hospitalized with recurrent abdominal pain. Can the authors speculate
on why they think the therapy became ineffective. Was it noncompliance?
Discussion and Conclusion:
Is APS more prominent in women similar to other autoimmune diseases?
Based on the biochemical tests, the patient apparently did not have liver
involvement, yet it is the most common manifestation in APS. Is this correct?
Line 48 
Hamilton [remove all caps] et al, reported a [a instead of the] case...
Page 6
It is implied that the patient eventually progressed to CAPS criteria? Is this
correct? It would be helpful if the authors could provide a timeline of the disease
progesssion.
Line 18 
For [add] patients with …
Line 20 
...or INR 3-4 is [add] suggested for...
Line 46 Surgery [instead of Surgically] should be performed...
Line 55 
other clinical studies are [add] lacking to show whether...\
Page 7:
Line 3 
There is no [delete any] case...
Line 4 
reported. [delete comma]
Line 9 
Text says that thrombectomy is feasible with 72 hours of venous
thrombosis yet the prior text says that there is no case of venous trombotomy that
has been reported. These sentences appear to contradict.
Line 46 
signs of abdominal involvement should be considered in patients with
APS. Can the authors comment on other demographics that are associated with
this disease? Women? Age? etc.
Figures
Fig 1.1 and 1.2 have misplaced hyphens in words in the text of the legend.
The dark arrows in all of the figures are difficult to see. Make them light colored
(white)
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interest.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant