Submited on: 25 Jan 2013 03:31:43 PM GMT
Published on: 25 Jan 2013 07:15:38 PM GMT
 
Perforated Duodenal Ulcers
Posted by Dr. William J Maloney on 14 Mar 2013 09:39:21 PM GMT

  • What are the main claims of the paper and how important are they?

    Twenty seven patients diagnosed with a perforated duodenal ulcer were studied.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Yes


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    Yes


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    No


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    No


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Yes- this would be a very nice seminar for residents in a hospital setting.


  • Other Comments:

    The authors state that the increased use of H. pylori eradication therapy and proton pump inhibitors have caused a decrease in the number of definitive surgeries needed for acid peptic disease. The authors state that surgeries for duodenal ulcer perforations have not been decreased. They go on to state that early diagnosis and timely management is important in reducing morbidity and mortality.

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    Clinical associate professor

  • How to cite:  Maloney W J.Perforated Duodenal Ulcers[Review of the article 'Perforated Duodenal Ulcer Emerging Pattern ' by Nirhale D].WebmedCentral 2013;4(3):WMCRW002609
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Sir, Thank you very much for your review.I liked your comment regarding my original article.Please let me know if any changes have to be made in my article. .
Responded by Dr. Murtaza A Calcuttawala on 26 Apr 2013 10:11:08 AM
Perforated duodenal ulcer
Posted by Anonymous Reviewer on 28 Jan 2013 09:03:12 PM GMT

  • What are the main claims of the paper and how important are they?

    They have claimed that the pattern of duodenla ulcers has changed, and that they have delinieated a protocol for its management. Changing patterns are important to analyse as new standardised protocols.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    No, they are not

    1. Am Surg. 1990 Apr;56(4):270-4. Changing patterns in perforated peptic ulcer disease. Gunshefski L, Flancbaum L, Brolin RE, Frankel A. Department of Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick.

    2. Dig Dis. 1992;10(1):10-6. Perforated peptic ulcer--the changing scene. Cocks JR. Department of General Surgery, Box Hill Hospital, Melbourne, Australia.

    There are multiples such studies.


  • Are the claims properly placed in the context of the previous literature?

    No, there is no good comparison with historical data from the same cultural/social/ regional area. 


  • Do the results support the claims? If not, what other evidence is required?

    It needs a historical control group that is similar in composition not international cohorts especially if there are regional factors involved like smoking habits etc


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    It is a retrospective rview with poorly defined parameters and no control group or histroical control to compare the changing pattern with. Although reproducible, it is not a useful addition to literature. Also with such a unique cohort of younger patients, the results of no mortality are remarkable.


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    They need more data on the prevealnce of peptic ulcer disease, both current and historical, also  more data regarding the changes in health care from now and previously to reallly compare the change in disease pattern in that region. 27 patient over 2 years is a small number.

     

    Knowing 3 rd world referral patterns, social and culutral problems and the lack of care to the large population, this study has a selection bias. This may also be responsible for the better than average outcomes that they have. 


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    As explained above, this study is biased, underpowered with really no good data for comparison and hence to state that there is a new emerging pattern. 


  • Other Comments:

    None

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    Laparascopic , foregut, HPB and Gi surgery.

  • How to cite:  Anonymous.Perforated duodenal ulcer[Review of the article 'Perforated Duodenal Ulcer Emerging Pattern ' by Nirhale D].WebmedCentral 2013;4(1):WMCRW002467
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Sir, Thank you very much for your review.Please let me know if any changes are to be made in my original article.
Responded by Dr. Murtaza A Calcuttawala on 26 Apr 2013 10:18:09 AM
Perforated Duodenal Ulcer Emerging Pattern
Posted by Dr. Prasan K Hota on 27 Jan 2013 07:10:47 AM GMT

  • What are the main claims of the paper and how important are they?

    Perforated Peptic ulcer is a common surgical emergency in India. Emergency Laparotomy with closure of perforation & peritoneal toileting is the main stay of the management.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    The findings & the treatment protocol mentioned in this study are usually practised. Types of antibiotics, culture of the peritoneal fluid & sensitivity of the antibiotics pattern, & duration & number of abdominal drains if any used should have been mentioned.


  • Are the claims properly placed in the context of the previous literature?

    The claims mentioned in the article do match the previous literature. However, complications like post op infections, MODS etc if any should have been mentioned.


  • Do the results support the claims? If not, what other evidence is required?

    Results of this study support the claims.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    The study does not reflect any randomized controlled trial.


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Details of methodology are sketchy.


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    Clinical informations like board like rigidity over right upper abdomen & epigastrium( which is a classical feture of peptic perforation), oblteration of liver dullness, radilogical evidence of gas under diaphragm in terms of percentage of cases, antibiotic protocol, culture patternof organisms etc should have been given to bring some importance to the study.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    This is a common study without any new information.


  • Other Comments:

    As peptic perforation is a common surgical emergency, this type of study gives new ideas for a better patient management. this type of studies should be considered for publication with findings mentioed above.

  • Competing interests:
    No
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    In my long carrier as a surgeon, I have managed considerable number of peptic perforation cases. Proper protocol for clinical & investigative data along with treatment protocol are required for correct diagnosis & positive outcome of the cases.

  • How to cite:  Hota P K.Perforated Duodenal Ulcer Emerging Pattern[Review of the article 'Perforated Duodenal Ulcer Emerging Pattern ' by Nirhale D].WebmedCentral 2013;4(1):WMCRW002465
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Perforated Duodenal Ulcer Emerging Pattern
Posted by Dr. Dnyanesh M Belekar on 26 Jan 2013 12:39:19 PM GMT

  • What are the main claims of the paper and how important are they?

    To study emerging pattern in perforated duodenal ulcer patients


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Yes


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    yes


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    1. There is no mention about role of minimal access surgery in treatment of these perforations. at many centres across the world these conditions are managed by laparoscopic surgeries as the emerging trend in its treatment.
    2. there is no mention of role of conservative approach in management of these patients who are hemodynamically very stable & come very early.
    3. one unusual finding is that, there was no fever in any of these patients.
    4. two patients who presented in shock were managed in similar fashion or any additional measures were taken & what was the post operative course in these two is not clear.
    5. what exactly is the emerging pattern in such patients is not clear.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    No


  • Other Comments:

    In my experience, the emerging patterns in these patients are as below-

    1. I have seen the main emerging pattern in these patients is the obvious decline in number of patients presented with these complaints over last 15 years due to newer & better medicines available today.
    2. we don't have to do gastro-jejunostomies & vagotomies in these patients anymore.
    3. morbiditiy & mortality has been reduced significantly due to excellent & better patient care.
    4. laparoscopy has changed patient care dramatically.

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    We have treated this common clinical situation quite routinely & efficiently over last 15 years.

  • How to cite:  Belekar D M.Perforated Duodenal Ulcer Emerging Pattern[Review of the article 'Perforated Duodenal Ulcer Emerging Pattern ' by Nirhale D].WebmedCentral 2013;4(1):WMCRW002462
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