Vulvovaginal Candidiasis in Pregnancy—Between Sensitivity and Resistance to Antimycotics

Round 1

Reviewer 1 Report

The paper by Maftei et al., entitled "Vulvovaginal candidiasis in pregnancy - between sensitivity and 2 resistance to antimycotics" investigated the sensitivity different species of Candida spp. to antifungal drugs isolated in vulvovaginitis during the pregnancy

The topic of this study is inside the scope of the journal, however the content is similar to other studies in the literature. The manuscript needs numerous modifications before it can be considered for publication. More details are required to improve manuscript quality.

It would be better fit the text to a short communication, directing particular attention to the results and discussion section.

The introduction section should be rewritten: the purpose is not clear enough. The authors should indicate the objectives of the work, avoiding a detailed literature on the mechanisms of action of drugs. The mechanism of action of the various drugs must be eliminated because it is superfluous (lines 62-99) and known by the readers.

The materials and methods section may be shortened focusing on the most important methods by reviewing the paragraph separation. It is unclear how the authors identified the yeasts. In The laboratory works section they used SAB broth, but in Mycologic culture section, the next step is not clear. Why the authors used the Candifast kit? Please clarify

The results section lacks adequate statistical analysis. More details related to statistical analysis, are required to improve manuscript quality

 

Author Response

Response to Reviewer 1 Comments

 

Thank you for the time given to the review and we respond promptly to the comments, because we consider that all observations are objective and well founded.

 

Point 1: The introduction section should be rewritten: the purpose is not clear enough. The authors should indicate the objectives of the work, avoiding a detailed literature on the mechanisms of action of drugs. The mechanism of action of the various drugs must be eliminated because it is superfluous (lines 62-99) and known by the readers.

Response 1: I have indicated the objectives of the work. Because the other two reviewers agreed with the intruduction chapter as it is presented in the article, we have not eliminated lines 62-99.

Point 2: The materials and methods section may be shortened focusing on the most important methods by reviewing the paragraph separation. It is unclear how the authors identified the yeasts. In The laboratory works section they used SAB broth, but in Mycologic culture section, the next step is not clear. Why the authors used the Candifast kit? Please clarify

Response 2: The materials and methods section was shortened. We used the Candifast kit, because the report of price-quality is good and this kit gives viable results reliable.

Point 3: The results section lacks adequate statistical analysis. More details related to statistical analysis, are required to improve manuscript quality.

Response 3: I have added supplementary statistical analysis.

 

 

For all suggestions for corrections which were introduced in the attached pdf file, I have modified the text where it was suggested. All changes have been marked in red.

 

Reviewer 2 Report

The authors studied the sensitivity of treatments of vulvovaginitis during pregnancy and the risk of resistance to antimicotics. In general, the work is technically sound. The following are suggestions for the authors to address to improve the overall quality of the manuscript.

Introduction

Ø  Include the PRC of clotriamazole and miconazole in the table 1.

Ø  The chemical structure of the product of 14alfa demethylase in figure 1 is better to be changed

Materials and Methods, Results

Ø  The both sections are well structured and informatively illustrated.

Discussion

Ø  In the Abstract there is a sentence: Starting from the idea that clotrimazole is the most recommended antifungal in candidal vaginitis in pregnancy,…; In the Discussion and throughout the article it is not mentioned again. It is written that - Miconazole is the preferred antifungal drug, whatever the species of vaginal candidiasis. I think clarifications should be made to avoid confusion.

Author Response

Response to Reviewer 2 Comments

 

Thank you for the time given to the review and we respond promptly to the comments, because we consider that all observations are objective and well founded.

Introduction

Point 1: Include the PRC of clotriamazole and miconazole in the table 1.

Response 1: I have included.

Point 2: The chemical structure of the product of 14alfa demethylase in figure 1 is better to be changed

Response 2: Since the figure is taken from the literature, it is more difficult to modify.

Discussion

Point 3: In the Abstract there is a sentence: Starting from the idea that clotrimazole is the most recommended antifungal in candidal vaginitis in pregnancy,…; In the Discussion and throughout the article it is not mentioned again. It is written that - Miconazole is the preferred antifungal drug, whatever the species of vaginal candidiasis. I think clarifications should be made to avoid confusion.

Response 3: I checked and modified.

 

For all suggestions for corrections which were introduced in the attached pdf file, I have modified the text where it was suggested. All changes have been marked in red.

 

Reviewer 3 Report

The manuscript:  Vulvovaginal candidiasis in pregnancy - between sensitivity and resistance to antimycotics

Nicoleta-Maricica Maftei, Manuela Arbune, Costinela Valerica Georgescu, Alina Mihaela Elisei, Alina Viorica Iancu, Alin Laurentiu Tatu

Title: corresponds to the content of the article

Introduction: enough; represent the essence of the problem; does not require change

Methodology: meets the requirements of the journal and the branch of knowledge; does not require modification;

But:

On lines 30 and 31 in the "Abstract" section it is written that "In this retrospective study (from January to June 2019), 663 pregnant women were evaluated, 30 of whom were hospitalized for various pregnancy-related symptoms." However, in the section "Materials and methods" on lines 103-104 it is written that "... 663 pregnant women with the clinical diagnosis of genital candidiasis" were observed. Maybe it's just a typo. It is unlikely that all 630 women were with genital candidiasis. Moreover, 140 women with candidiasis are considered further.

Statistics: meets the requirements of international standards

Results:

- Lines 168-169 indicate that "... vaginal candidiasis was mainly associated with the 1st quarter of pregnancy 168 (53.57%) and less in the last quarter (17.14%). In obstetrics, it is customary to divide by trimesters of pregnancy, not by quarters. Moreover, Figure 2 shows the frequency of candidiasis by trimester of pregnancy.

Question: Did the frequency of detection of different types of yeast-like fungi differ in different trimesters of pregnancy? If so, it would be nice to give a picture of the frequency of detection of different types of candida in different trimesters.

Literature: sufficient for the article and does not require additions

Article design: meets the requirements of the journal

Conclusion: The article can be published after some revision and correction.

Author Response

Response to Reviewer 3 Comments

 

Thank you for the time given to the review and we respond promptly to the comments, because we consider that all observations are objective and well founded.

 

Point 1: On lines 30 and 31 in the "Abstract" section it is written that "In this retrospective study (from January to June 2019), 663 pregnant women were evaluated, 30 of whom were hospitalized for various pregnancy-related symptoms." However, in the section "Materials and methods" on lines 103-104 it is written that "... 663 pregnant women with the clinical diagnosis of genital candidiasis" were observed. Maybe it's just a typo. It is unlikely that all 630 women were with genital candidiasis. Moreover, 140 women with candidiasis are considered further.

Response 1: We checked and corrected.

Point 2: Lines 168-169 indicate that "... vaginal candidiasis was mainly associated with the 1st quarter of pregnancy 168 (53.57%) and less in the last quarter (17.14%). In obstetrics, it is customary to divide by trimesters of pregnancy, not by quarters. Moreover, Figure 2 shows the frequency of candidiasis by trimester of pregnancy.

Response 2: We checked and corrected.

Point 3: Question: Did the frequency of detection of different types of yeast-like fungi differ in different trimesters of pregnancy? If so, it would be nice to give a picture of the frequency of detection of different types of candida in different trimesters.

Response 3: After the analysis was carried out, we found that there are no differences between the different types of yeast-like fungi in different trimesters of pregnancy and for this reason we considered that it is not necessary to enter these data.

 

 

For all suggestions for corrections which were introduced in the attached pdf file, I have modified the text where it was suggested. All changes have been marked in red.

Round 2

Reviewer 1 Report

The manuscript may be accepted for publication in the journal.

However, I ask the authors to check the table because C albicans always appears in the second column. It will be a mistake