Submited on: 13 Apr 2011 01:36:31 PM GMT
Published on: 15 Apr 2011 08:30:42 AM GMT
 

1 Is the subject of the article within the scope of the subject category? Yes
2 Are the interpretations / conclusions sound and justified by the data? Partly
3 Is this a new and original contribution? Yes
4 Does this paper exemplify an awareness of other research on the topic? No
5 Are structure and length satisfactory? Yes
6 Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience? No
7 Can you suggest any reductions in the paper, or deletions of parts? Yes
8 Is the quality of the diction satisfactory? Yes
9 Are the illustrations and tables necessary and acceptable? Yes
10 Are the references adequate and are they all necessary? Yes
11 Are the keywords and abstract or summary informative? Yes
  • Other Comments:

    The associations discussed are relevant to the pathway of thiamine losses and processed sugar.

     

    There are differences associated between R & L arms, in fact, where the blood pressure cuff is placed on site of the arm surfaces will produce significant differences. Because blood pressure has a mind-emotion connection it may fluctuate often in idiopathic fashion.

     

    Measures of the average R compared to L (BP) averages are very difficult to associate with nutrient deficiency alone since so many other associations are potentially operant.  Numerically associations by age, nutrient intake, gender, Body Mass Index, and diagnosed blood sugar abnormals would add to the conclusions proposed.

     

    To qualify the relationship between blood pressures taken, the method might be reclassified as a 1st step of other object measures to determine nutrient deficiency.

  • 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:

    Misner, B.  Food alone may not provide sufficient micronutrients for preventing deficiency.  Journal of the International Society of Sports Nutrition.  3(1):51-55, 2006.

  • How to cite:  Misner B .Exaggerated Autonomic Asymmetry:The First Clue to Nutrient Deficiency Dysautonomia [Review of the article 'Exaggerated Autonomic Asymmetry: A Clue to Nutrient Deficiency Dysautonomia ' by Obrenovich M].WebmedCentral 2011;2(9):WMCRW00930
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1 Is the subject of the article within the scope of the subject category? Yes
2 Are the interpretations / conclusions sound and justified by the data? No
3 Is this a new and original contribution? Yes
4 Does this paper exemplify an awareness of other research on the topic? Yes
5 Are structure and length satisfactory? No
6 Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience? Yes
7 Can you suggest any reductions in the paper, or deletions of parts? Yes
8 Is the quality of the diction satisfactory? Yes
9 Are the illustrations and tables necessary and acceptable? Yes
10 Are the references adequate and are they all necessary? Yes
11 Are the keywords and abstract or summary informative? Yes
  • Other Comments:

    The research objective was not clearly defined.

     

    I gather from the description that the author wishes to study the differential pulse pressure between the left and right arm whether there is any association with thiamine difficiency. 

     

    It appears that the author wished to carry out a cross sectional case-control study. Firstly the we need to be explicit in defining the case (thiamine deficiency).   What are the criterias for thiamine deficiency in terms of TKA level/TPPE.  Once we have clearly defined this criteria, then we have to assess how many cases are available? Since we are trying to compare pulse pressure between two arms in the same individual and that measurement is a numerical value then the appropriate statistical test to use is paired t-test.  Provided we could fulfil the assumption of normality.  If we only have 17 patients then we have to consider using non-parametric test, in this instance wilcoxon test.  In this study the author has indicated that there were 17 patients in the thiamine deficiency arm. I suppose this decision was made on clinical grounds.  At the end only 10 patients had raised TPPE.  If we are going to use this as the criteria of thiamine deficiency, then only 10 cases are positive whereas the rest are not! 

     

    Measurement of pulse pressure need to be standardised.  Each patient should contribute the same weightage to the calculation. We can't have one patient (patient 1, 14 and 16) contributing to three readings, whereas others only single reading.  This will lead to bias.  We can choose to take three reading for each patient and then take the average. 

    If we use paired t-test, we could only evaluate each arm individually.  Null hypothesis: (1) There is no difference in the pulse pressure between the right and left arm in patients with thiamine deficiency.  (2) There is no difference in the pulse pressure between the right and left arm in patients with thiamine sufficiency.

     

    If we want to compare both arms, thiamine deficiency and sufficiency, the Khi-square test or its non-parametric equivalent is to be used provided we know before hand what is the allowable 'normal' difference in the pulse pressure between the right and left arm.  Then we could categorize each difference as either normal or abnormal.  In this way we could then build a 2x2 table and evaluate this with Khi-square.  IMHO I don't think the normal value has been characterised.

     

    Hence at this juncture this study do not have the statistical strength to scientifically answer the question regarding differences on pulse pressure between arms and its association with thiamine deficiency.   Nevertheless it is an interesting topic to cover.

  • 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:

    Clinician with interest in thiamine deficiency

  • How to cite:  Dzarr A .Amended methodogy required to answer this research question[Review of the article 'Exaggerated Autonomic Asymmetry: A Clue to Nutrient Deficiency Dysautonomia ' by Obrenovich M].WebmedCentral 2011;2(4):WMCRW00683
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I agree that the numbers are not good enough for good statistical significance. My main object as a physician in private practice was to draw attention to the asymmetry of blood pressures because I havae never seen anythinbg on it in the literature. It DOES need further study and I believe that the difference in pulse pressures for those patient with abnormal thiamine homeostasis is important to reproduce in a major study. It ooks to me as though we are missing an important clue in our dealing with hypertension/hypotension. Derrick Lonsdale M.D.
Responded by Dr. Derrick Lonsdale on 05 May 2011 11:36:37 AM