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EDITORíS CHOICE


Bombay Hospital Journal has now become the leading medical journal in Mumbai, in which scientific articles are being published. For the last few years, the load of the articles has increased. Readers will notice that we select only one or two articles from every medical institution, college or hospital, so that all of them are represented.

We have a committee of specialists, who review the articles to assess their suitability for publication, and each one of these specialists, is a leading doctor and an authority in his field, who is doing an honorary job for our Journal. I am extremely thankful and grateful to them. But for them, the standard of the Journal would not have risen. Thus, a number of articles, not upto the mark are rejected and returned.


Yes, you must have also noticed that "case reports" have become more in number than the original articles, a trend set by the British Medical Journal.


Yet, we should not forget that this Journal is an institutional Journal. Thus at times, articles written by our senior colleagues, which may have been rejected by the review panel, need to be published because they reflect the experience of their large private practice and are useful in a Journal, which is mainly aimed at family physicians. However, this does not mean that the Editor agrees with the views of the writers. In this issue, you will find two articles, namely,


1. Protozoal colitis as the aetiology of the gastroesophageal reflux disease.


2. Disease pattern of medical outpatients of Bombay Hospital written by our senior staff from the hospital, along with the help of a technical officer.


Ideally, in modern times, such articles may well be hosted on the internet, where the articles don't pass through any peer review and where every body has the access and the right to air their views or experiences. Articles, such as the ones mentioned above, are a thing of the past, before modern investigations were available. For example, the diagnosis of GORD itself in modern days, is extremely difficult, even with the help of endoscopy - in absence of acid perfusion test, pH studies and manometric studies.


Similarly, the clinical diagnosis of protozoal colitis, or one done by stool examination, is an entity of the past. In modern days, unless a sigmoidoscopy shows ulcers, which on biopsy reveal entamoeba, the diagnosis of amoebiasis is not acceptable. By the way, Dr. Arun Chitale, who has seen thousands of colonic biopsies, has hardly ever seen the presence of protozoa, thus confirming that clinicians are over-diagnosing or over - over-diagnosing and labelling all patients of irritable colon (who behave exactly like amoebiasis patients) as amoebic in aetiology.


Regarding the other protozoa, which is giardia lamblia, unless during gastroscopy, small intestinal juice is aspirated from the duodenum and this parasite is demonstrated, its diagnosis is very difficult, especially in absence of blood IgM levels, which are not available until now in any laboratory. We have to also remember that response to metronidazole has lost its value, confirming its amoebic aetiology because not only does it also work in H. pylorie infection, but also in another half a dozen conditions of GI tract.

In routine stool examination of hotel and canteen employees, most of the entamoeba seen in stools are entamoeba dispar, which are benign and resemble entamoeba histolytica.


Similarly, in modern days hypertension cannot be diagnosed in OPD because ambulatory blood monitoring studies show that 30% of such patients have white collar hypertension, which is not a true hypertension. Malaria cannot be diagnosed by the presence of malarial parasites in a statistical study because this patient may be a carrier. We cannot evaluate an incidence of 'arthritis', when we have got 'rheumatologists' in our institution, and the label of 'arthritis' is used only by laymen.


In fact, the retrospective analysis, in patients who are not investigated with modern technology has lost its significance except for adding to the number of publications of the author.


Thus, let it not be misunderstood that at the peak of its fame, the Journal is publishing the above type of articles. However even in future, we might carry such articles in the Journal because the authors are giants, who have helped in bringing up this Institution and their experiences must be noted somewhere.

 



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