Comment on “Gut fungal profile in new onset treatment-naïve ulcerative colitis in Saudi children”

Dear Editor, The original article “Gut fungal profile in new onset treatment-naïve ulcerative colitis in Saudi children”, published in The Saudi Journal of Gastroenterology, is a meaningful contribution.[1] The study aimed to describe the gut fungal profile in pediatric patients of ulcerative colitis (UC) in Saudi Arabia.[1] I agree with the study’s rationale that we have limited data to suggest the role of fungi in the causation of UC, and the present study is an effort in this direction to generate more evidence. I take this opportunity to share multiple observations and suggestions that could improve the scientific rigor and the external validity of the reported study findings. The general rule of writing the methodology section is that it has to be self-explanatory and reproducible, but this has not been followed uniformly.[2] To begin with, the study design is cross-sectional, but it has not been explicitly mentioned in the methodology.[2] It has been stated that children with a confirmed diagnosis of UC were included as study participants, but it has not been defined how the diagnosis of UC was established (namely, endoscopic, histopathological, or clinical).[1] In continuation, the authors have not mentioned other potential inclusion/exclusion criteria (such as age range, dietary habits, and history of other gastrointestinal disorders). The authors have not mentioned how they arrived at a sample size of 40 (20 in each group) as ideally, sample size must be scientifically derived and justification has to be given.[3] It is worth noting that neither in the study title nor in the objectives of the study, it has been stated that this was a comparative study, including healthy controls.[1] In continuation, the authors should have given justification for choosing school children as control groups rather than matching participants for age and sex-matched healthy siblings or hospital-based controls.[1] Furthermore, the methodology does not provide details about who collected the samples, how the contamination was avoided, adherence to a standardized protocol, storage of samples during transport, duration between collection and freezing (crucial for microbial DNA integrity), and the extraction kit that was used for DNA extraction.[1] Moreover, sequencing details are not complete as targeted fungal regions or sequencing depths need to be mentioned.[1] In this study, fecal samples were obtained from healthy controls but do not add anything about parental consent, assent from children, or ethical clearance for obtaining these samples.[1,2] The discussion section is written to “discuss” study results and cite reasons for similar or contrasting findings after comparing them with other studies, and the authors have done justice to that for most of the points.[4] Moreover, it was nice to note that the authors mentioned self-identified limitations, an important aspect of writing a research paper.[1,4] To summarize, the study adds vital information about the role of fungal infections in the causation of UC among the pediatric age group, but the findings of the study would be more valid if the authors had elaborated inclusion and exclusion criteria, justified sample size, added reasons for selection of control groups, and methodology that was followed for analysis of different samples. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.