Metabolic and Anthropometric Influences on Nerve Conduction Parameters in Patients with Peripheral Neuropathy: A Retrospective Chart Analysis
Round 1
Reviewer 1 Report
In this study, the authors performed a retrospective analysis aimed at evaluating the relationship between nerve conduction study (NCS) outcomes and anthropometric and metabolic factors. The research objectives are well defined, and the design of the study is appropriate. The study methodology in general is nicely described and clear. The results are also well described and interesting. The main limitations of this study are appropriately reported. Their implications in terms of interpretation of the data are also included and well discussed by the authors in the text.
The discussion section is informative and includes the comparison with the results from peer-reviewed articles relevant to the topic.
The conclusions drawn by the authors are supported by the data they present.
I believe this is a nice work, and I have only a few minor suggestions which I hope could improve the quality of the manuscript, which is already good.
My specific comments are reported below:
- “Besides this, few other metabolic markers have been investigated for their effects on the NCS outcomes.”
It would be great to report a few examples, accompanied by the references. - “Compellingly, in the lower limbs, urea significantly accounted for more sensorimotor variability (beta coefficient between -0.221 and -0.398; Table 5) than both age and HbA1c contributions in upper limbs was much less in both domains (beta coefficient between -0.0419 and -0.107; Table 5).”
It looks like some words are missing in this sentence, but the meaning is still clear. - “In this present study, HbA1c and age were demonstrated to correlate and impact nerve conduction amplitude and velocity significantly. Urea, ESR and TSH were also shown to inversely correlate with both nerve conduction parameters, albeit to a lesser extent. BMI was not found to correlate with nerve conduction parameters. These relationships were identified through both univariate and multivariate linear analyses.”
This last sentence may need to be rephrased, since the contributions of ESR, Urea (except SLLMV and SLLSMV), and TSH were not significant in multivariate analysis. - “When conducted bilaterally, the average velocity, amplitude and latencies of both sides was calculated”.
It would be interesting to report in how many cases the exam was conducted bilaterally. - It would be great to report a table with an overview of the basic descriptive statistics of the nerves measured. This table would be very informative to researchers studying nerve conductions.
- From table 2, it looks like most if not all of these patients are either prediabetic or diabetic. If this is confirmed, I would specify this detail in the methods section, in order to facilitate the interpretation of these results, which cannot be necessarily extended to a non-diabetic population.
- For clarity, please report the unit of measurement for urea, TSH, and ESR in table 2.
- Another factor that would be interesting to evaluate and to include in table 2 with the corresponding descriptive statistics could be the time interval (absolute value) between the blood analysis and NCS as well as between HbA1c and NCS.
- “Our study’s results discerned a weak, inverse linear correlation to nerve conduction outcomes, though some models did not reach statistical significance.”. This sentence needs to be rephrased, since only a few univariate models reached the statistical significance, whereas in most of the models TSH was not statistically significant.
Author Response
Please see the attachment
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Review: Metabolic and Anthropometric Influences on Nerve Conduction Parameters in Patients with Peripheral Neuropathy: A Retrospective Chart Analysis
COMMENTS TO AUTHORS:
The authors report data from a study about the relationship between metabolic and anthropometric parameters and diabetic peripheral neuropathy.
I wonder why the following metabolic variables had been selected by authors only: HbA1c, erythrocyte sedimentation rate (ESR), thyroid-stimulating hormone (TSH) and urea. Measurement of Vit b12, duration of DM and data about comorbidities and diabetic complications (retinopathy, neuropathy) are missing. I think, that authors should report those data.
Furthermore, authors should discuss the reasons for presenting the measurements of neurophysiological parameters as sum and not for each nerve separately. I suggest, that correlations should be done for each separately and the results should be reported.
No novelty at all for the study.
I think that, the methodology and design are not appropriate. The manuscript is generally clearly written and the discussion / conclusions are acceptable.
Overall, the data could be of interest, if the above mentioned data could be added to the manuscript.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
Authors should clarify if there were NCV measurements below 30 m/s, because measurements are imprecise in that range.
Author Response
The Editor, Neurology International
Response to Reviewer 2's comment
Dear Sir/Madam,
Thank you for the suggestion. We are hereby responding to the comment on the NCS measurements. This was clarified in the results section, line 127-128 showing all our patients' NCS measurements were >30 m/s (>40 m/s to be specific) and none was <30 m/s.
Sincerely yours,
Usman Malabu
On behalf of co-authors.
Author Response File: Author Response.pdf
