Analysis of Clinical Symptoms and Biochemical Parameters in Odontogenic Cellulitis of the Head and Neck Region in Children

Round 1

Reviewer 1 Report

Comments -

1. 2020 to 2021 on patients .....please update until Dec 2022

2. Differences in the study group (SS) 20 and clinical group (CS).....explain first then present. Sudden appearance in the abstract made things difficult to understand.

3. Subject number and age should be added in the abstract.

4. Gap statement is missing in the introduction 

5. Power sample size calculation missing.

6. Poor sample size - please add more

7. prospective study - how? Blood re-drawn to check the improvement after treatment?

8. We assessed the presence of 69 intraoral and extraoral swelling and the presence of trismus during the physical examination...... cross sectional or retrospective study of secondary data....please consult with statistician.

9. Significance and novelty missing.

10. Limitation of the study needs to be added.

8. 

 

Author Response

Dear Editor and Reviewers

 

I would like to thank you and the reviewers for the careful evaluations of our manuscript entitled “Analysis of clinical symptoms and biochemical parameters in odontogenic cellulitis of the head and neck region in children”(Submission. No. children-2139326). The comments gave us an opportunity to further improve the quality of our manuscript. We have revised our manuscript in accordance with the comments provided. Responses to each comment are attached below in a point-to-point fashion, and all responses are highlighted in the manuscript. We hope that this revised version is now acceptable for publication in Children.

Sincerely yours,

Adrianna Słotwińska-Pawlaczyk, DDM

Prof. Dr Bogusława Orzechowska-Wylęgała

Katarzyna Latusek, DDM

Prof. Dr Anna Roszkowska

 

Response to Reviewer 1 Comments

 

Point 1: 1. 2020 to 2021 on patients .....please update until Dec 2022

Response 1: Thank you for your comment. The article is part of the PhD thesis. The research period is limited to 2020-2021 due to the time limits for publication of research results and defense of the thesis imposed by the Doctoral Program. In addition, we obtained a grant from the Medical University of Silesia, which obliges us to carry out the research and publish the results within a strict deadline.

 

 

Point 2:  Differences in the study group (SS) 20 and clinical group (CS).....explain first then present. Sudden appearance in the abstract made things difficult to understand.

Response 2: Thank you for highlighting this point. Definitions of SS and CS are explained in abstract and in materials and methods paragraph.

 

Point 3: Subject number and age should be added in the abstract.

Response 3: Thank you for this suggestion. Subject number and age have been added in the abstract.

 

Point 4:  Gap statement is missing in the introduction 

Response 4: Thank you for raising this important point and allowing us to clarify this point. Explanation is added to the introduction: “Abetter understanding of the problem of odontogenic cellulitis and periodic updating of knowledge in the field of epidmeiology, etiology, symptomatology and treatment by general dentists, pedodontists and paediatricians can help make an accurate diagnosis earlier and implementing effective treatment faster.”

 

 

Point 5: Power sample size calculation missing

Response 5: Thank you for your assessment of our manuscript. The post-hoc power is used to assess the power of a statistical test for retrospective studies. Post-hoc power results for biochemical parameters are as follows: CRP-100%, WBC- 100%, NLR- 81,9%, D-Dimer- 56,3%, Prealbumin-100%, Hospitalization time- 99,9%

 

 

Point 6: Poor sample size - please add more

Response 6: Thank you for your thoughtful suggestion. The article is part of the PhD thesis. The research period is limited to 2020-2021 due to the time limits for publication of research results and defense of the thesis imposed by the Doctoral Program. In addition, we obtained a grant from the Medical University of Silesia, which obliges us to carry out the research and publish the results within a strict deadline.

 

Point 7: prospective study - how? Blood re-drawn to check the improvement after treatment?

Response 7: Correction of the type of studies from prospective to retrospective

 

Point 8: We assessed the presence of 69 intraoral and extraoral swelling and the presence of trismus during the physical examination...... cross sectional or retrospective study of secondary data....please consult with statistician.

Response 8: Correction of the type of studies to retrospective.

 

Point 9: Significance and novelty missing.

Response 9: Thank you for raising this important point. Most of the articles found in the PubMed database that describe odontogenic cellulitis are based on adult patients. We have not found studies that evaluate NLR ratio, Prealbumin, D-Dimers or correlation between biochemical parameters and clinical symptoms in pediatric patients suffering from odntogenic cellulitis.

 

Point 10:  Limitation of the study needs to be added.

Response 10: Thank you for your comment and the opportunity to clarify this point. The limitation of the present study is retrospective nature limited the possibility to draw more characteristic conclusions. The limitation of this study is that the number of patients is not very large. The severity of infection and the length of hospital stay are influenced by many complex factors. We evaluated several parameters and therefore further studies with larger groups of patients and additional measurements of biochemical parameters at regular intervals should be carried out to be able to use markers of inflammation to predict the course of infection.

 

 

 

 

 

 

 

Author Response File: Author Response.doc

Reviewer 2 Report

In the abstract (lines 25-26), mentioned that “Differences in SS group and CS group were clinically significant.” This term is ambiguous or incorrect, because only in manuscript discussion section, not in the results, is statistical but not clinical the significance mentioned.

Line 27 of the abstract mentions that "CRP can be indicators of infection regression", however, the manuscript does not describe any results related to infection regression.

In the introduction section, the information on cellulitis is insufficient. It is not defined what is cellulitis, their pathogenesis is ambiguous; it does not mention or describe local or systemic factors for its development. Additionally, there is not sufficient background or context about of the markers studied to justify their analysis.

 

In materials and methods, a prospective study is postulated, however, in the development of the manuscript, no evidence of observation of cause, course or intervention is shown. The presented design resembles more of a Retrospective or case-control study, since the CS-Control study group does not really present a real odontogenic infectious process.

The term CS must be unified, in the abstract mentioning it as a clinical group and in materials and methods as a control study.

Within the statistical analysis, it is proposed to perform a Student t test or the Mann-Whitney test to analyze differences between SS and CS, however, this result is not reported in the results apart, it is mentioned in the discussion, which is confusing.

In different tables the decimal punctuation is incorrect, it is advisable to use a point instead of a comma.

In conclusions (lines 239-240) it is stated that prealbumin and D-dimer can measure the response to treatment, however, this data was not reported in this manuscript.

Author Response

Dear Editor and Reviewers

 

I would like to thank you and the reviewers for the careful evaluations of our manuscript entitled “Analysis of clinical symptoms and biochemical parameters in odontogenic cellulitis of the head and neck region in children”(Submission. No. children-2139326). The comments gave us an opportunity to further improve the quality of our manuscript. We have revised our manuscript in accordance with the comments provided. Responses to each comment are attached below in a point-to-point fashion, and all responses are highlighted in the manuscript. We hope that this revised version is now acceptable for publication in Children.

Sincerely yours,

Adrianna Słotwińska-Pawlaczyk, DDM

Prof. Dr Bogusława Orzechowska-Wylęgała

Katarzyna Latusek, DDM

Prof. Dr Anna Roszkowska

 

Response to Reviewer 2 Comments

Point 1: In the abstract (lines 25-26), mentioned that “Differences in SS group and CS group were clinically significant.” This term is ambiguous or incorrect, because only in manuscript discussion section, not in the results, is statistical but not clinical the significance mentioned.

Response 1: Thank you for your thoughtful suggestion. We have corrected the senstense to: Differences in biochemical test results in the SS and CS were statistical significant (p<0,05).

 

 

Point 2: Line 27 of the abstract mentions that "CRP can be indicators of infection regression", however, the manuscript does not describe any results related to infection regression.

Response 2: Thank you for highlighting this point to our attention, we very much appreciate and agree with this suggestion and have therefore corrected this sentence to: Statistically significant positive relationship was found between CRP and extraoral swelling. NLR ratio correlates significantly with extraoral swelling and the length of hospitalization. NLR and CRP ratio can be considered a prognostic marker of the course of infection and hospitalization time.

 

Point 3: In the introduction section, the information on cellulitis is insufficient. It is not defined what is cellulitis, their pathogenesis is ambiguous; it does not mention or describe local or systemic factors for its development. Additionally, there is not sufficient background or context about of the markers studied to justify their analysis.

Response 3: Thank you for your comment and the opportunity to clarify this point. The introduction has been expanded with additional information such as: definition of cellulitis, its pathogenesis, factors for its development and description of analyzed biochemical markers.

 

Point 4: In materials and methods, a prospective study is postulated, however, in the development of the manuscript, no evidence of observation of cause, course or intervention is shown. The presented design resembles more of a Retrospective or case-control study, since the CS-Control study group does not really present a real odontogenic infectious process.

Response 4: Thank you for your thoughtful suggestion. We agree with this tip and have corrected the type of studies from prospective to retrospective.

 

Point 5: The term CS must be unified, in the abstract mentioning it as a clinical group and in materials and methods as a control study.

Response 5: Thank you for the opportunity to clarify this issue, as we agree that readers might be confused. Definitions of SS and CS are corrected and explained in abstract and materials and methods paragraph.

 

Point 6: Within the statistical analysis, it is proposed to perform a Student t test or the Mann-Whitney test to analyze differences between SS and CS, however, this result is not reported in the results apart, it is mentioned in the discussion, which is confusing.

Response 6: Thank you for raising this point and encouraging us to further clarify our methodology. The Student's t-test was used to analyze the results of biochemical tests: CRP, WBC, NLR, D-Dimer and Preralbumin. The Mann-Whitney test was used to assess time of hospitalization. This data has been updated in the text.

 

Point 7: In different tables the decimal punctuation is incorrect, it is advisable to use a point instead of a comma.

Response 7: Thank you for highlighting this point, we appreciate the suggestion and agree that uniformity in the decimal punctuation in tables has an important influence on clarity of the article. Decimal punctuation has been corrected. Dots have been used instead of commas as recommended.

 

Point 8: In conclusions (lines 239-240) it is stated that prealbumin and D-dimer can measure the response to treatment, however, this data was not reported in this manuscript.

Response 8: Thank you for your comment and the opportunity to clarify this point. We have decided to correct this sentence to: Serum prealbumin and D-dimer may be a measure of disease severity of odontogenic cellulitis of the head and neck region in children. It is necessary to conduct another study in which it will be possible to assess the regression of parameters after the implementation of the treatment.

 

 

 

 

 

 

 

 

Author Response File: Author Response.doc

Round 2

Reviewer 1 Report

All okay.

Author Response

Dear Editor and Reviewers

I would like to once again thank you and the reviewers for the evaluations of our manuscript entitled “Analysis of clinical symptoms and biochemical parameters in odontogenic cellulitis of the head and neck region in children”(Submission. No. children-2139326). We hope that this revised version is now acceptable for publication in Children.

Sincerely yours,

Adrianna Słotwińska-Pawlaczyk, DDM

Prof. Dr Bogusława Orzechowska-Wylęgała

Katarzyna Latusek, DDM

Prof. Dr Anna Roszkowska

Author Response File: Author Response.doc

Reviewer 2 Report

An important improvement was observed in the manuscript, even small format errors are observed, such as the presence of decimal commas instead of decimal points (Page 1, line 23; page 3, table 1; page 6, table 6;  page 9, line 211); as well as the presence of a phrase in Polish instead of English (Page 9 line 210-211). In addition, the font size must be homogenized (Page 2).

Author Response

Dear Editor and Reviewers

I would like to once again thank you and the reviewers for the evaluations of our manuscript entitled “Analysis of clinical symptoms and biochemical parameters in odontogenic cellulitis of the head and neck region in children”(Submission. No. children-2139326). We have revised our manuscript in accordance with the comments provided. We hope that this revised version is now acceptable for publication in Children.

Sincerely yours,

Adrianna Słotwińska-Pawlaczyk, DDM

Prof. Dr Bogusława Orzechowska-Wylęgała

Katarzyna Latusek, DDM

Prof. Dr Anna Roszkowska

Author Response File: Author Response.doc