Acute hemorrhagic necrotizing encephalopathy associated with COVID-19 in a patient with liver cirrhosis
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COVID-19 emerging as a global pandemic is a complex disease presenting with multiorgan involvement.AHNE is a rarely reported phenomenon post COVID-19 infection but is a rapidly progressing, fatal, haemorrhagic necrosis of the CNS parenchyma. Here,we present a very interesting case of a cirrhotic male patient with acute hemorraghic necrotizing encephalopathy with COVID-19 infection. Diagnosis of AHNE requires a multimodality approach and high index of suspicion in a patient suffering from SARS CoV-2.Timely intervention and diagnosis may lead to a favourable outcome in the diagnosed cases.Future detailed studies in this direction may give an insight on this rare but important disease entity.
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The reviewers have highlighted minor concerns with the work presented. Please ensure that you address their comments. This manuscript still requires close editing to correct typographical issues throughout to enable smooth reading.
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Comments to Author
The article continues to be dotted with typos that make it impossible to read it smoothly. Since the Authors did not provide evidence of the finding of SARS-CoV-2 in the central nervous system, I suggest toning down in the text the direct correlation between SARS-CoV-2 infection and hemorrhagic necrotizing encephalopathy. Finally, I believe that clinical data should be anonymized and it is not clear to me why it has been reported in the text that confidentiality cannot be guaranteed. This aspect is against the rules of respect for privacy.
Please rate the quality of the presentation and structure of the manuscript
Poor
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, …
Comments to Author
The article continues to be dotted with typos that make it impossible to read it smoothly. Since the Authors did not provide evidence of the finding of SARS-CoV-2 in the central nervous system, I suggest toning down in the text the direct correlation between SARS-CoV-2 infection and hemorrhagic necrotizing encephalopathy. Finally, I believe that clinical data should be anonymized and it is not clear to me why it has been reported in the text that confidentiality cannot be guaranteed. This aspect is against the rules of respect for privacy.
Please rate the quality of the presentation and structure of the manuscript
Poor
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
No: It is not clear to me why it has been reported in the text that data confidentiality cannot be guaranteed
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The reviewers have highlighted major concerns with the work presented. Please ensure that you address their comments.
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Comments to Author
It is an important paper as the condition is very rare. However, the Authors should address the following points: Besides some typographical errors, my main question is how the Authors took informed consent from such a moribund patient who ultimately died (line 172-175). The patient was suffering from mental disorientation from the very beginning and in this condition informed consent should be taken from the patient's relatives or the patient's legally authorized person. The SARS-CoV-2 should be mentioned in one and preferably in this form throughout the manuscript. Mention SARS-CoV-2 as such, not as the SARS-CoV-2 virus (line 51). Mention IL-1B as IL-1β (line 54).
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are …
Comments to Author
It is an important paper as the condition is very rare. However, the Authors should address the following points: Besides some typographical errors, my main question is how the Authors took informed consent from such a moribund patient who ultimately died (line 172-175). The patient was suffering from mental disorientation from the very beginning and in this condition informed consent should be taken from the patient's relatives or the patient's legally authorized person. The SARS-CoV-2 should be mentioned in one and preferably in this form throughout the manuscript. Mention SARS-CoV-2 as such, not as the SARS-CoV-2 virus (line 51). Mention IL-1B as IL-1β (line 54).
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
Although the topic covered is innovative and interesting, there are several aspects to improve: MAJOR CRITICAL ISSUES - Obtaining informed consent from the patient is not clear, given the critical health conditions and subsequent death. Ethics committee approval is not mentioned; - COVID-19 refers to the disease, therefore it is incorrect to mention "COVID-19 infection" (see lines 22, 25, 74, etc.); - the virological investigations carried out were limited. Specifically, the presence of the SARS-CoV-2 virus in the central nervous system has not been demonstrated. MINOR CRITICALITIES - There are frequent typos of text that make it difficult to read; - there are unexplained acronyms (see "AHNE" on lines 22 and 25, "HIV" on line 47, "BBB" on line 61, etc.).
Please rate the quality of the …
Comments to Author
Although the topic covered is innovative and interesting, there are several aspects to improve: MAJOR CRITICAL ISSUES - Obtaining informed consent from the patient is not clear, given the critical health conditions and subsequent death. Ethics committee approval is not mentioned; - COVID-19 refers to the disease, therefore it is incorrect to mention "COVID-19 infection" (see lines 22, 25, 74, etc.); - the virological investigations carried out were limited. Specifically, the presence of the SARS-CoV-2 virus in the central nervous system has not been demonstrated. MINOR CRITICALITIES - There are frequent typos of text that make it difficult to read; - there are unexplained acronyms (see "AHNE" on lines 22 and 25, "HIV" on line 47, "BBB" on line 61, etc.).
Please rate the quality of the presentation and structure of the manuscript
Poor
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
No: It is not clear how the informed consent of the patient was obtained given the serious health conditions and the consequent approval of the Ethics Committee
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For revision please focus on the following areas. Grammatical corrections are needed throughout the paper. Addition of references throughout the manuscript is required, as similarity scores to other publications were notably high. If quoting other publications directly, please include quotations around quoted phrases and sentences.
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