Submited on: 01 Oct 2010 12:52:14 AM GMT
Published on: 01 Oct 2010 06:30:25 AM GMT
 

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

    Comments:

    1. 1.      Dr. Balga reported that patients with insulin overdose could potentially suffer from ventricular fibrillation (Vf) wit takotsubo cardiomyopathy. Actually, hypokalemia can induce Vf, especially in those with impaired LV function, including takotsubo cardiomyopathy, and hypokalemia can be resulted from insulin treatment. Therefore, it will be illogical to state insulin-overdose may trigger Vf. Although the author discussed this in the discussion, yet the title and abstract will make the readers confused. In my opinion, the title, abstract, and conclusion should be revised more clearly.
    2. 2.      The statement of “lethal complications as VF with TC were produced after insulin –overdose and glucose treatment” should be revised. It is not logically.
    3. 3.      Please submit the coronary angiography pictures and the followed-up cardiac function data at discharge. I can not find out any data showing the heart function was normal after discharge. Among patients with takotsubo cardiomyopathy, the cardiac function will be recovered without any sequela.
    4. 4.      Should every insulin-overdose patients need bedside echocardiography? I do not think so. Although they are at risk of hypokalemia and the potential fetal arrhythmia, yet in my opinion, it will be overstated that every such patient needs bedside echocardiography. In fact, many hypokalemia patients will not have Vf.
    5. 5.      There are some minor mistakes in this literature:

    1)      Some spelling errors: eg. letal

    2)      The reference numbers should be re-ordered. I can not find the “reference 1”, but there were two “reference 2”. The cited references in the session “introduction” were 10-12, and 13-15, but should they be “1-2”, and “3-5”?

    3)      12-lead ECG DPI is not enough. By the current figure 4, ST seemed to be not elevated in lead III. Please re-submit a more clear figure.

     

  • Competing interests:
    nonw
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    Yes
  • References:
    Liu YW, Chen JY, Tsai WC, Chen JH. Atypical presentation of "takotsubo cardiomyopathy" without ST segment elevation: a case report. Cases J. 2008;1:309.
  • Experience and credentials in the specific area of science:

    I stated my experience in the manuscript : Atypical presentation of "takotsubo cardiomyopathy" without ST segment elevation: a case report. Cases J. 2008;1:309.

  • How to cite:  Liu Y .Insulin-overdose, A Potential Trigger Of Ventricular Fibrillation With Takotsubo Cardiomyopathy ? [Review of the article 'Insulin-overdose- A Potential Trigger of Ventricular Fibrillation with Takotsubo Cardiomyopathy? ' by Balga I].WebmedCentral 2010;1(12):WMCRW00194
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  • Other Comments: This article reports a very interesting case of a successfully managed prehospital cardiac arrest following treatment for non-intentional insulin overdose in presence of possible takotsubo cardiomyopathy [TC]. The author comments rightly on the electrolyte disturbance associated with the insulin overdose and the need for an extended monitoring. The message regarding routine unavailability of stat potassium out-of-hospital and its potential implication is also highly relevant. I would perhaps advise more caution about some of the wording in the text. There is much debate regarding the diagnosis, aetiology and management of TC. Reports are on a rise. Despite it (and despite this particular case), most smoker diabetic males who suffer ventricular fibrillation (whether or not in association with hypoglycaemia) do not have TC. As such, thinking about TC by a paramedic and/or A&E team remains less important than considering a myocardial infarction and electrolyte disturbance. TC remains a diagnosis of exclusion. Has a possibility of phaeochromocytoma please been ruled out on the follow-up? This case illustrates well that severe insulin overdose can be deadly and may have an unpredicted development requiring monitoring. In summary, this is a highly interesting case-report with a clinically relevant message. P.S. It would be helpful if The WebmedCentral Team could help out the English-non native speakers contributors with the texts:)
  • Competing interests:
    none
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    Yes
  • References:
    Pernicova I, Garg S, Bourantas CV, Alamgir F, Hoye A. Takotsubo cardiomyopathy: a review of the literature. Angiology 2010;61:166-73.
  • Experience and credentials in the specific area of science:
    Author of a review article on Takotsubo cardiomyopathy. Currently lecturer at the Division of Cardiovascular & Diabetes Research at the Leeds Institute of Genetics, Health and Therapeutics. University of Leeds. U.K.
  • How to cite:  Pernicova I .Insulin overdose, a potential trigger of ventricular fibrillation with takotsubo cardiomyopathy?[Review of the article 'Insulin-overdose- A Potential Trigger of Ventricular Fibrillation with Takotsubo Cardiomyopathy? ' by Balga I].WebmedCentral 2010;1(10):WMCRW0081
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  • Other Comments: This article reports a nice new example of a clinical scenario accompanied by Takotsubo acute and transient cardiomyopathy. Insulin overdose was apparently the precipitating event, but not the real cause. Of 1 000 000 cases of insulin overdose only an occasional case (1-5, maybe) will be complicated by a similar presentation, while the others do not, and they recover without complications. What is the difference? We believe that the baseline cause of Takotsubo syndrome is endothelial dysfunction: transient and severe. That triggers, in our theory, severe diffuse coronary spasm of most or some of the coronary tree, with acute ischemia. This would lead to persistent left ventricular dysfunction, usually but not only at the apex, of variable duration. (see reference of mine, above, for the "first ever" cases of experimental reproduction of Takotsubo in humans, broght about by acetylcholine challenge, in the cath lab, with echocardiographic demonstration of reversible apical ballooning). So, in many different baseline clinical states, with or without adrenergic challenge) a patient would develop a transient excessive spsticity of the coronay arteries, that leads to sustained ischemia and residual stunning of the affected myocardium. Insulin overdose would realize the same (triggering of takotsubo) only in predisposed patients, with endothelial dysfunction, that can only be demonstarted with acetylcholine testing. An this is the novel message of our paper, we are commenting.
  • Competing interests:
    No
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    Yes
  • References:
    Angelini P: Transient left ventricular apical ballooning: a unifying theory at the edge of Prinzmetal angina. J Cathet Cardiovasc Interv 2008;71:342-352
  • Experience and credentials in the specific area of science:
    Author of multiple articles on the Takotsubo syndrome. Involved in research on the pathophysioloy mechanism of Takotsubo. main article: Angelini P: Transient left ventricular apical ballooning: a unifying theory at the edge of Prinzmetal angina. J Cathet Cardiovasc Interv 2008;71:342-352
  • How to cite:  Angelini P E.Insulin overdose, a potential trigger of ventricular fibrillation with takotsubo cardiomyopathy[Review of the article 'Insulin-overdose- A Potential Trigger of Ventricular Fibrillation with Takotsubo Cardiomyopathy? ' by Balga I].WebmedCentral 2010;1(10):WMCRW0048
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