Reviewer's report
Title:Macro-AST: Misleading Finding in an Adolescent with MCAD-deficiency
Version: 1Date:26 May 2012
Reviewer: James Leonard
Reviewer's report:
This paper is a short case report.
MCAD deficiency is the most common disorder of fatty acid oxidation and its
management has proved to be straightforward. Complications without symptoms
appear to be rare.
In this paper an adolescent with MCAD was found to have a raised AST. There
are really two points. A raised AST activity may be of no importance and
investigation of asymptomatic patients with MCAD deficiency is rarely indicated.
Abstract - Background: The simple distinction between catabolism and anabolism
is somewhat misleading. There are continuous cycles of anabolism following
meals and catabolism during periods of fasting such as during the night. Patients
with MCAD only become unwell with more prolonged fasting or when is it
combined with another metabolic stress such as an infection.
Abstract - Case presentation: line 6 for ‘rather an unspecific finding’ read ‘rather a
non-specific …’
Abstract - Conclusion: The lesson is not so much that the patient needs to be
seen in a metabolic clinic but rather that the general practitioner needs more
information: best from a specialist.
Case presentation:
An important point is that the patient remained well so that attending a
specialised clinic did not seem necessary. It should be remembered that a
specialist appointment usually means time off school and time off work for the
parents as well as travel costs. What is needed is ready access to information.
Telephone clinics and readily available specialist advice save time and money.
This should be the future, not more clinics.
Conclusion paragraph 1 line 7: ‘during anabolism’ see earlier comment. This
phrase should read ‘when well’
Paragraph 3 line 3: If the acyl carnitines were responsible for macro-AST all
patients with MCAD would have raised AST but they do not.
Level of interest: An article of limited interest
Quality of written English: Acceptable
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
Reviewer's report
Title:Macro-AST: Misleading Finding in an Adolescent with MCAD-deficiency
Version: 1Date:26 May 2012
Reviewer: James Leonard
Reviewer's report:
This paper is a short case report.
MCAD deficiency is the most common disorder of fatty acid oxidation and its
management has proved to be straightforward. Complications without symptoms
appear to be rare.
In this paper an adolescent with MCAD was found to have a raised AST. There
are really two points. A raised AST activity may be of no importance and
investigation of asymptomatic patients with MCAD deficiency is rarely indicated.
Abstract - Background: The simple distinction between catabolism and anabolism
is somewhat misleading. There are continuous cycles of anabolism following
meals and catabolism during periods of fasting such as during the night. Patients
with MCAD only become unwell with more prolonged fasting or when is it
combined with another metabolic stress such as an infection.
Abstract - Case presentation: line 6 for ‘rather an unspecific finding’ read ‘rather a
non-specific …’
Abstract - Conclusion: The lesson is not so much that the patient needs to be
seen in a metabolic clinic but rather that the general practitioner needs more
information: best from a specialist.
Case presentation:
An important point is that the patient remained well so that attending a
specialised clinic did not seem necessary. It should be remembered that a
specialist appointment usually means time off school and time off work for the
parents as well as travel costs. What is needed is ready access to information.
Telephone clinics and readily available specialist advice save time and money.
This should be the future, not more clinics.
Conclusion paragraph 1 line 7: ‘during anabolism’ see earlier comment. This
phrase should read ‘when well’
Paragraph 3 line 3: If the acyl carnitines were responsible for macro-AST all
patients with MCAD would have raised AST but they do not.
Level of interest: An article of limited interest
Quality of written English: Acceptable
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
Please review this paper.
user
Reviewer's report
Title:Macro-AST: Misleading Finding in an Adolescent with MCAD-deficiency
Version: 1Date:26 May 2012
Reviewer: James Leonard
Reviewer's report:
This paper is a short case report.
MCAD deficiency is the most common disorder of fatty acid oxidation and its
management has proved to be straightforward. Complications without symptoms
appear to be rare.
In this paper an adolescent with MCAD was found to have a raised AST. There
are really two points. A raised AST activity may be of no importance and
investigation of asymptomatic patients with MCAD deficiency is rarely indicated.
Abstract - Background: The simple distinction between catabolism and anabolism
is somewhat misleading. There are continuous cycles of anabolism following
meals and catabolism during periods of fasting such as during the night. Patients
with MCAD only become unwell with more prolonged fasting or when is it
combined with another metabolic stress such as an infection.
Abstract - Case presentation: line 6 for ‘rather an unspecific finding’ read ‘rather a
non-specific …’
Abstract - Conclusion: The lesson is not so much that the patient needs to be
seen in a metabolic clinic but rather that the general practitioner needs more
information: best from a specialist.
Case presentation:
An important point is that the patient remained well so that attending a
specialised clinic did not seem necessary. It should be remembered that a
specialist appointment usually means time off school and time off work for the
parents as well as travel costs. What is needed is ready access to information.
Telephone clinics and readily available specialist advice save time and money.
This should be the future, not more clinics.
Conclusion paragraph 1 line 7: ‘during anabolism’ see earlier comment. This
phrase should read ‘when well’
Paragraph 3 line 3: If the acyl carnitines were responsible for macro-AST all
patients with MCAD would have raised AST but they do not.
Level of interest: An article of limited interest
Quality of written English: Acceptable
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
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