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This revised version is suitable for publication in PeerJ.
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Thank you for thoroughly addressing the concerns I raised in your previous submission. The changes made have improved the clarity and overall quality of the manuscript.
No more comments from my side. The revised manuscript addresses all the points as per the suggestions.
No more comments from my side. The revised manuscript addresses all the points as per the suggestions.
No more comments from my side. The revised manuscript addresses all the points as per the suggestions.
The revised manuscript is now suitable for a larger audience.
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- This pilot study explores the impact of diabetes and respiratory diseases on the clinical outcomes of COVID-19 patients in Almaty, Kazakhstan. The authors have collected valuable preliminary data that highlights a significant public health issue, particularly in a region with limited epidemiological literature. The manuscript is generally well-structured.
- Raw data files:
The sheet named "Лист7" appears to be a coded version of the dataset, which is more appropriate for analysis. However, a data dictionary or legend explaining each column header (e.g., gr1, gr2, gr280) and the meanings of coded numerical values is necessary for transparency and reproducibility.
The sheet named "Sheet1" seems to contain raw, uncoded data in Russian or Kazakh. This version is difficult to interpret and verify without translation or standardisation.
- Sampling process: The manuscript would benefit from a participant flow diagram that illustrates the number of potentially eligible patients, those screened, excluded (with reasons), and the final sample included in the analysis.
- Inclusion/Exclusion criteria: The criterion stating that “patients had to have at least one documented comorbid condition (e.g., diabetes, pneumonia, or chronic bronchitis)” introduces an important limitation. The study does not include a control group of COVID-19 patients without these conditions.
As a result, it is not possible to evaluate the relative risk of these comorbidities compared to patients without comorbidities. Rather than comparing with a non-comorbid baseline, the study compares outcomes across different comorbidity subgroups. This should be clearly acknowledged and discussed as a major limitation.
- Clarification of study period: Lines 120–121 state: “The study was conducted from September to December 2023...” This is unclear because the study uses retrospective EMR data. Please clarify whether the data were collected during this period or if they reflect acute COVID-19 cases that occurred between September and December 2023.
- Potential confounding factors: The manuscript does not address several potential confounders that may influence COVID-19 outcomes.
These include:
Smoking status: may worsen respiratory symptoms and affect disease severity.
COVID-19 vaccination status: partial, full, or booster vaccination could reduce severity and mortality.
History of previous COVID-19 infection: Reinfections may have different clinical courses compared to primary infections.
BMI or obesity: a known risk factor for poor COVID-19 outcomes.
- Additional comorbidities: Were conditions beyond diabetes and chronic bronchitis collected?
For example, diabetes often coexists with hypertension, dyslipidaemia, or cardiovascular disease, which may confound clinical outcomes. Immunocompromised states or COPD are also relevant and should be mentioned if not assessed.
- The rationale for focusing specifically on pneumonia and chronic bronchitis should be clarified. Are these the most common respiratory comorbidities observed in the dataset or in Kazakhstan?
Why were other respiratory conditions, such as COPD or asthma, not considered?
- The potential effect of COVID-19 vaccination on outcomes should be addressed in the Discussion.
Even if vaccination status was not available. This limitation should be acknowledged, as it may significantly influence disease severity.
- The manuscript could be strengthened by discussing variations in clinical management and treatment received during hospitalisation. For instance, access to medications such as remdesivir, molnupiravir, nirmatrelvir/ritonavir, or corticosteroids could affect outcomes and should be described if available.
The manuscript by Tazhibayeva et al. entitled "Diabetes and respiratory diseases as comorbid conditions in COVID-19 patients, Kazakhstan: a pilot investigation" represents a pilot study on diabetes and respiratory diseases in COVID-19 patients, impact, and critical findings in such cases. The study is focused on the country of Kazakhstan. There are some points to be considered for the better improvement of the present form of the manuscript.
*The title should be "Diabetes and respiratory diseases as comorbid conditions in
COVID-19 patients from Kazakhstan: a pilot investigation, or any other suitable title
*Lines 61-63 are not very clear. Please rewrite in a better way
* In the sentence from lines 61-64, need citation
* in Table 1 entitled "Table 1. Whole sample demographic and clinical characteristics, and bivariable associations with 2 clinical outcomes were found to have wrong calculations, especially for the percentage. Please check carefully all tables mentioned in the manuscript. In spite of the whole sample, the right total sample, or other suitable word. Similarly, in the manuscript whole sample is written, but not clear in what sense it is mentioned.
*In Table 1, "18-44 years and 45-60 were mentioned in the characteristics and the respective no and percentages mentioned, but the count what is in between 44-45 is not clear.
* table 2 Table 2. "Adjusted odds ratios (AOR) and 95% confidence intervals (CI) for demographic and clinical predictors of COVID-19 outcomes (N = 292)" ref is not clear and not mentioned in the legend
* Table 3: The mentioned whole sample and ref are not clear
The sample size mentioned in the experiment is low, but they mentioned this point in the limitations of the study.
The outcome is important in terms of the cases of COVID-19 that are in the group of comorbidities.
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