CCMI: Nivel I – Parte 1b (EM)

1. Sinopsis de diagnósticos, definiciones y comentarios:


Caso clínico 1: Varón de 14 años con síndrome nefrítico por glomérulo-nefritis aguda pos-estreptocócica. A los 5 días del ingreso se evidenciaron algunos cilindros hemáticos en un examen de orina, lo que es común en estos casos donde también puede haber: hematuria macroscópica, y proteinuria masiva -en menos del 20% de casos-. El anticuerpo anti-estreptolisina a menudo no esta presente en la infección cutánea, como en este caso. Luego de una semana de establecido el cuadro clínico suele empezar espontáneamente la resolución de la retención de agua y de la hipertensión. Por ello el tratamiento es de apoyo: reposo hasta que los signos de glomérulo-nefritis y de congestión disminuyan; la diuresis por si sola mejora la hipertensión leve a moderada; se puede utilizar penicilina o eritromicina si se demuestra infección estreptocócica. Algunos casos pueden evolucionar hacia glomérulo-nefritis rápidamente progresiva, y otros a insuficiencia renal terminal; pero en varias décadas. En general, cuando se conserva por lo menos un 25% de la función renal el valor de la creatinina sérica puede no incrementarse [1].


Caso clínico 2: Mujer de 37 años con criptococosis pulmonar y meningo-encefalica. Además: desnutrición crónica energética (DCE) grado II. El C. neoformans fue aislado en el cultivo del LCR. La criptococosis pulmonar con frecuencia es asintomática; sin embargo en la radiografía de pulmones suelen observarse infiltrados densos bien circunscritos que se resuelven espontáneamente. La meningo-encefalitis sin tratamiento suele ser mortal (hay edema cerebral en casos agudos e hidrocefalia en los crónicos). El 75% de los pacientes tienen un proceso predisponente (linfomas, terapia esteroidea, etc.). Este caso es un ejemplo de que en nuestro medio la nutrición juega ese papel. El índice de Quetelet (P/T²) fue 16.4, próximo al rango de la DCE grado III (Quetelet < 16). La DCE afecta tanto la inmunidad celular como la humoral, favoreciendo las infecciones que, a su vez, empeoran la desnutrición. Con el régimen de anfotericina y flucitosina 50 -70% de los enfermos con esta micosis se curan; el tratamiento duraría hasta hacer negativo el LCR [2].


Caso clínico 3: Mujer de 26 años con hipertiroidismo complicado con agranulocitosis por metimazol. Otros diagnósticos: candidiasis orofaringea, neumonía probablemente por gram-negativos. La agranulocitosis es una de las complicaciones más graves de los anti-tiroideos, ocurre en 0.5% de los expuestos en los 3 primeros meses del tratamiento, se manifiesta con fiebre o faringitis, y es reversible [3]. Esta reacción adversa obliga a suspender definitivamente el uso de los anti-tiroideos [4]. Tiempo prolongado de uso y remisión promedio de solo 50% son otras desventajas del producto. Sin embargo, debería ser preferible porque no hay riesgo de hipotiroidismo como cuando se usa I¹³¹ y cirugía, y si persiste el hipertiroidismo puede recurrirse a otras formas de tratamiento; no agrava el exoftalmos [5] (Comentario: actualmente yo prefiero optar por terapia con I¹³¹, es mucho más práctico). Pacientes con neutropenia puedes desarrollar una neumonía sin alteraciones radiológicas claras, como en este caso. En tal situación se debería obtener una muestra por broncospcopia para el diagnostico [6]. Como el riesgo para infecciones graves es mayor cuando el número de neutrofilos es menor de 500/mm3 es importante la prevención con las siguientes medidas: lavado escrupuloso de las manos antes del contacto con el paciente, evitar exámenes rectales, excluir de la dieta frutas secas y verduras por la facilidad de contaminación con coliformes. No han mostrado utilidad: aislamiento invertido, uso de camisolines y mascaras orales no absorbibles. Ante una temperatura mayor a 38°C debe administrarse antibióticos en función de los gérmenes más comunes en el ambiente hospitalario donde está el paciente [7].


Caso clínico 4: Mujer de 34 años con disfagia orgánica por acalasia idiopática. Tres años antes del ingreso le habían diagnosticado en otro centro estrechez del esfínter esofágico interior (EEI) con esofagografía baritada y endoscopia; pero no se le realizó la dilatación respectiva por inasistencia de la paciente. Este tratamiento se lleva a cabo con un balón que desgarra algunas fibras musculares para disminuir la presión del EEI. La eficacia del procedimiento es del 85% y puede inducir el desarrollo de esofagitis de reflujo y estenosis péptica [8].


Caso clínico 5: Varón de 17 años con lesiones mielicéricas  en cara y conjuntivitis derecha por impétigo estrepto-dérmico. El tratamiento comprende: soluciones antisépticas como agua Dalibur (sulfato de Zn y de Cu al 1/1000) diluido al tercio y beta-lactámicos o macrólidos [9].

2. Referencias:

1.   Glassock RJ y Brenner BM. Glomeruonefritis aguda por-estreptocócica. En: Harrison: Principios de Medicina Interna.  12° ed. McGraw-Hill Interamericana, 1991. pp: 1352 - 4.

2.   Bennet JE. Criptococosis. En: Harrison: Principios de Medicina Interna.  12° ed. McGraw-Hill Interamericana, 1991. pp: 870 - 2.

3.   Saltman RJ y Goldberg AC. Hipertiroidismo. En: Manual Washington de Terapéutica Médica. 7° ed. Masson SA y Lippincott, Williams & Wilkins, 1990. pp: 493 - 500.

4.   Moses AM y Ingbar SH. Hipertiroidismo: Tratamiento. En: Harrison: Principios de Medicina Interna.  12° ed. McGraw-Hill Interamericana, 1991. pp: 1980 - 2.

5.   Valdivia H. Manejo del Hipertiroidismo. En: Actualización en Medicina Interna. Universidad Nacional Mayor de San Marcos, 1990. pp: 103 - 6.

6.   Hammond WP. Infecciones en el huésped inmunocomprometido. Med. Contemporánea, N°36, pp: 3 - 17.

7.   Bailes JS y Le Maistre CF. Neutropenia. En: Stein JH: Manual de Medicina Interna. Panamericana, 1991, pp: 467 - 9.

8.   Goyal RK. Acalasia. En: Harrison: Principios de Medicina Interna.  12° ed. McGraw-Hill Interamericana, 1991. pp: 1413 - 7.

9.   Magnin PH et al. Piodermitis. Terapéutica dermatológica, 1989. pp: 106 - 11.

            

pd: me disculpo por los inconvenientes ya que algunas referencias no están completas.

CCMI: Nivel I – Parte 1a (EM)

_______________________________________________________ Caso clínico 1, 1993:

ANAMNESIS: JAC. Varón de 14 años natural de Ayacucho y residente en Lima 3 meses, quien estaba enfermo 08 días cuando ingresó a un hospital local. La enfermedad había empezado con edema blando en los tobillos, aumento de temperatura local, pero sin fóvea ni cambio con el reposo. Siete días antes el paciente había amanecido con edema en la cara que no cambiaba durante el transcurso del día. Concomitantemente presentaba cefalea frontal intensa, nauseas e hiporexia. Seis días antes el edema se había generalizado y, cinco días antes se había agregado fiebre y orinas de color oscuro.

Cuatro semanas antes del ingreso el paciente había presentado en las extremidades lesiones maculo-papulares, rojizas y pruriginosas que supuraron y algunas todavía  persistían al ingreso.

EXAMEN FISICO: TA: 170/85 mmHg, FP: 64x’, Temperatura: 37,5°C, Peso: 54kg, Talla: 1,53 m. Alerta, no lucía grave, pero con disnea en la posición de decúbito. Algunas pústulas y edema 2+/4+ en pies y piernas, así como heridas pequeñas en fase de cicatrización en los antebrazos. Exploración regional: no IY, impulso ventricular palpable en el quinto e.i.c.i./LMC, RC rítmicos, de mediana intensidad, SS: II/VI en ápex. Amplexación N; submatidez, VV y MV disminuidos en bases  de ACP. PPL y PRU superior y medio en ambos lados positivos. El resto fue irrelevante. La diuresis del primer día de hospitalización fue 500 cc.

EXAMENES AUXILIARES: Exámenes de sangre: Hemograma: Hto: 34%, leuc: 5300/mm3, abast: 4%, linf: 16%, VSG: 13 mm/h; bioquímica: glucosa: 88 mg/dl, urea: 18 mg/dl, creatina: 0.87 mg/dl, prot.t: 4,8 gr/dl, alb: 2,9 gr/dl. Examen de orina: pH: 5, densidad: 1006, aspecto turbio, color amarillo, proteínas ++, glucosa: -, GR: +++, sedimento: GR: 40-50/c, leuc: 6-8/c, células epiteliales escasas, cilindros hialinos: 1, gérmenes no se observan.

________________________________________________________ Caso clínico 2, 1993:

ANAMNESIS: FAF. Mujer de 37 años natural de  Ancash y residente en Lima siete años cuando fue hospitalizada por una enfermedad que tenía 2 meses y que consistió en rinorrea transparente, cansancio fácil, malestar general y diaforesis profusa. Dos semanas antes se había agregado dolor en el HTD que aumentaba con la tos. Su peso había disminuido 7 kg.

Hacía 2 años que le habían ligado las trompas de Falopio y hacía 10 meses que un neurólogo le había diagnosticado migraña sin aura. Negó haber tenido TBC-P. Antecedentes obstétricos: menarquía a los 13 años, RC 3/30, FUR hacia 2 años, G: 8-P: 8008. Su madre era hipertensa.

EXAMEN FISICO: TA: 120/80 mmHg. FP: 110x’, FR 26x’. Temperatura: 38°C, Peso: 40 kg, Talla: 1,56 m. Alerta, no grave, mucosa oral húmeda, palidez, cicatriz de quemadura en el brazo izquierdo y pupilas CIRLA de 2 mm de diámetro. Exploración regional: VV disminuidas, submatidez, crepitos, soplo tubario y broncofonía aumentada en el tercio superior del HTD; roncantes difusos en el HTI. Folstein: 29 puntos. El resto fue irrelevante.

EXAMENES AUXILIARES: Examen de sangre: Hto: 25%, EIA - VIH negativo. Examen de esputo: BAAR negativo. Radiografía de tórax (antero-posterior y lateral): radio-opacidad en los dos tercios superiores del HTD y en la región hiliobasal izquierda.

EVOLUCION: A los seis días del ingreso presentó cefalea  intensa, a los siete días nauseas, a los ocho días vómitos explosivos con rigidez meníngea. El estudio del LCR mostró entonces: turbidez, pandy +++, alb: 1,01 gr/dl, leuc: 50/mm3, GR: 20/c.

________________________________________________________ Caso clínico 3, 1993:

ANAMNESIS: NVT. Mujer de 26 años de edad natural y procedente de Lima (SMP), quien fue admitida en la emergencia de un hospital local por una enfermedad de 3 días que empezó con disnea a medianos esfuerzos. Dos días antes del ingreso se agregaron odinofagia que le impedía alimentarse e incluso deglutir saliva, y fiebre continua que disminuyeron luego de recibir 1 gr de amoxicilina cada ocho horas. Un día antes del ingreso se agregaron cefalea frontal pulsátil, palpitaciones y temblor de manos, por lo que tomó ergotamina por decisión propia, sin obtener respuesta.

Cuatro años antes le habían diagnosticado hipertiroidismo (T4 libre incrementado y bocio difuso hipercaptante por gammagrafía). La paciente siguió entonces tratamiento con metimazol y propranolol; pero de  forma irregular que, 45 días antes del ingreso, se reanudó por indicación médica al verificarse un incremento del T4 libre aun sin traducción clínica. La dosis de metimazol en esta ocasión fue 15 mg día. Antecedentes obstétricos: menarquía: a los 12 años, RC 3/30-60 días, FUR hacia un dia, G: 1-P: 1001.

EXAMEN FISICO: TA: 120/60 mmHg, FP: 120x’, FR: 28x’, Temperatura: 38,2°C. Alerta, no lucía grave, en regular estado de nutrición, mucosa oral húmeda, TCSC escaso, sin edema, ojos: pupilas CIRLA, no exoftalmos ni retracción palpebral; cavidad oral: queilosis bilateral, lengua depapilada con tremor y enantemas eritematosos de bordes irregulares y distribución difusa, algunas placas blanquecinas en carrillos y congestión en la oro faringe; región submaxilar: ganglios de pequeño tamaño sin dolorabilidad. Tiroides: No bocio ni soplo, consistencia algo aumentada. En el resto del examen solo se pudo evidenciar temblor de manos y puño percusión lumbar derecha positiva.

EXAMENES AUXILIARES: Exámenes de sangre: Hemograma: Hb: 10,4 g/dl, leuc (al ingreso): 2100/mm3, linf: 100%, leuc (al día siguiente): 900/mm3, segmentados: 40%; química: AGA: pCO2: 19 mmHg, HCO3: 18,2, pH: 7,52, pO2:142 mmHg. Sat. O2: 99,2%. Examen de orina: normal. Radiografía de tórax: radio-opacidad de patrón reticulonodular bibasal y de menor magnitud en el tercio medio e hilio de ACP.

________________________________________________________ Caso clínico 4, 1993:

ANAMNESIS: LCJ. Mujer de 34 años de edad natural de Ayacucho y residente en Lima, con un tiempo de enfermedad de nueve años. La enfermedad empezó con dolor opresivo en la región esternal inferior que se presentaba al ingerir alimentos que fueron sólidos al inicio y líquidos al  ingreso. En los últimos dos años había presentado a veces -mientras dormía- regurgitación de material acido y de mal olor aproximadamente dos horas después de la ingesta. La regurgitación disminuía cuando se sentaba y se acompañaba a veces de vómitos biliosos en abundancia. Un año antes del  ingreso había perdido el conocimiento durante 30’ (un médico le diagnosticó anemia), y nueve meses antes sus deposiciones se habían espaciado a una cada 15 días. Su peso había disminuido 16 kg en los últimos tres años.

A los siete años de edad había tenido sarampión, a los 9 años  tos ferina, a los 12 años luxación de columna lumbar y fractura nasal luego de que cayera de un caballo, a los 17 años otitis derecha e ¿infección renal?. A los 9 años de edad la operaron de catarata en ambos ojos. Antecedentes obstétricos: menarquía a los 13 años, RC 7/28, FUR hacia aprox. seis semanas, G: 6-P: 5015.

EXAMEN FISICO: TA: 130/70 mmHg, FP: 60x’, FR: 18x’, Temperatura:36,6°C, Peso: 39kg, Talla: 1,55m. Alerta, no lucía grave, mucosa oral seca, palidez moderada en conjuntivas palpebrales, TCSC escaso, cifoscoliosis dextro-cóncava y dolorabilidad mediana en la columna lumbar. El resto del examen fue irrelevante.

EXAMENES AUXILIARES: Hemograma: Hto: 34%, Hb: 10 gr/dl, leuc: 5900/mm3, linf: 20%, examen de orina: normal.

______________________________________________________ Caso clínico 5, 1994:

ANAMNESIS: JPM. Varón de 17 años de edad natural de Ayacucho y residente en El Callao, con una enfermedad de 6 días al ingreso. El cuadro había empezado con pápulas pruriginosas en la región frontal izquierda que, al dia siguiente, evolucionaron a vesículas y pústulas por lo que se automedicó colirio. Tres días antes del ingreso la región indicada presentaba signos de flogosis que se extendieron al arco superciliar y parpado izquierdos cubriendo el ojo correspondiente. Ante tal cuadro fue llevado a la emergencia de un hospital local. Negó traumas y mordeduras de insectos.

EXAMEN FISICO: TA: 100/70mmHg, FP: 84x’, FR: 22x’, Temperatura: 36,8°C, Alerta, no lucía grave, en regular estado de nutrición, mucosa lingual húmeda, heridas con costras mielicericas y secreción seropurulenta en las regiones frontal, arco superciliar, parpado, malar y el pabellón auricular izquierdos, así como inyección conjuntival con secreción purulenta en el ojo izquierdo. Mucosa oro-faríngea congestiva. El resto fue irrelevante.

EXAMENES AUXILIARES: Examen de sangre: Hto: 43%, leuc: 14,600/mm3, abast: 9%; GUC: normal. Examen de orina: normal.

Revistas Extranjeras 2 (EM)

Hepatology

http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1527-3350

The premier publication in the field of liver disease, Hepatology publishes original, peer-reviewed articles concerning all aspects of liver structure, function and disease. Each month, the distinguished Editorial Board monitors and selects only the best articles on subjects such as immunology, chronic hepatitis, viral hepatitis, cirrhosis, genetic and metabolic liver diseases and their complications, liver cancer, and drug metabolism.

Epidemiologic Reviews (ER)

http://epirev.oxfordjournals.org/

ER is a leading review journal in public health. Published once a year, issues collect review articles on a particular subject. Recent issues have focused on The Obesity Epidemic, Epidemiologic Research on Health Disparities, and Epidemiologic Approaches to Global Health.

Evidence-Based Complementary and Alternative Medicine (eCAM)

http://www.hindawi.com/journals/ecam/

eCAM is an international, peer-reviewed journal that seeks to understand the sources and to encourage rigorous research in this new, yet ancient world of complementary and alternative medicine.

Evidence-Based Complementary and Alternative Medicine was founded in 2004 by Professor Edwin L. Cooper who served as the Editor-in-Chief of the journal between 2004 and 2010.

The most recent Impact Factor for Evidence-Based Complementary and Alternative Medicine is 2.064 according to 2009 Journal Citation Reports released by Thomson Reuters (ISI) in 2010.

Age and Ageing (AA)

http://ageing.oxfordjournals.org/

AA is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.

Obstetrics & Gynecology (OG)

http://journals.lww.com/greenjournal/pages/default.aspx

OG is the official publication of the American College of Obstetricians and Gynecologists (the College). Popularly known as "The Green Journal," Obstetrics & Gynecology has been published since 1953. Then as is now, the goal of the journal is to promote excellence in the clinical practice of obstetrics and gynecology and closely related fields.

Journal of the American Society of Nefrology (JASN)

http://jasn.asnjournals.org/

Annals of the Rheumatic Diseases (ARD)

http://ard.bmj.com/

ARD is an international peer-reviewed journal committed to promoting the highest standards of scientific exchange and education. It covers all aspects of rheumatology, which includes the spectrum of musculoskeletal conditions, arthritic disease, and connective tissue disorders. ARD publishes basic, clinical, and translational scientific research. Concise scientific communication is encouraged and peer-reviewed proceedings of international meetings are featured.

The American Journal of Public Health (AJPH)

http://ajph.aphapublications.org/

AJPH is dedicated to publication of original work in research, research methods, and program evaluation in the field of public health. The Journal also regularly publishes editorials and commentaries and serves as a forum for health policy analysis. The mission of the Journal is to advance public health research, policy, practice, and education. Each month, national and international public health professionals turn to AJPH for the most current, authoritative, in-depth information in the field.

The goals of both the online and the print versions of the Journal, published monthly by the American Public Health Association, are

• To publish the best scientific research in the field of public health
• To serve as a forum for diverse viewpoints on major public health issues and policies
• To promote diverse public health practice models
• To increase public and professional understanding of public health problems and their solutions through delivery channels relevant to different audiences and their needs
• To work in concert with the 3 main priorities of the American Public Health Association, namely to develop universal coverage, eliminate health disparities, and rebuild the public health infrastructure.

AJPH, first published in 1911, is the official Journal of the American Public Health Association, 800 I St., NW, Washington, DC 20001-3710; (202) 777-APHA(2742). APHA is a professional society founded in 1872 to represent all disciplines and specialties in public health.

The Bulletin of the World Health Organization (BWHO)

http://www.ncbi.nlm.nih.gov/pmc/journals/522/

BWHO is an international journal of public health with a special focus on developing countries. Since it was first published in 1948, the Bulletin has become one of the world’s leading public health journals. In keeping with its mission statement, the peer-reviewed monthly maintains an open-access policy so that the full contents of the journal and its archives are available online free of charge. As the flagship periodical of the World Health Organization (WHO), the Bulletin draws on WHO experts as editorial advisers, reviewers and authors as well as on external collaborators. Anyone can submit a paper to the Bulletin, and no author charges are levied. All peer-reviewed articles are indexed, including in ISI Web of Science and MEDLINE.

The American Journal of Respiratory and Critical Care Medicine (AJRCCM)

http://ajrccm.atsjournals.org/

AJCCM focuses on human biology and disease, as well as animal studies that contribute to the understanding of pathophysiology and treatment of diseases that affect the respiratory system and critically ill patients.  Papers that are solely or predominantly based in cell and molecular biology are published in the companion journal, the American Journal of Respiratory Cell and Molecular Biology. The Journal also seeks to publish outstanding review articles on areas of interest in several forms. The State-of-the-Art review is a treatise usually covering a broad field that brings bench research to the bedside. Shorter reviews are published as Clinical Commentaries or Pulmonary Perspectives. These are generally focused in a more limited area and advance a concerted opinion about care for a specific process. Case Reports of exceptional merit are also published in the Journal.
A recent trend and future direction of the journal has been to include debates of a topical nature on issues of importance in pulmonary and critical care medicine and to the membership of the American Thoracic Society. Other recent changes have included encompassing works from the field of critical care medicine and the extension of the editorial governing of journal policy to colleagues outside of the United States of America. The focus and direction of the Journal is to establish an international forum for state-of-the-art respiratory and critical care medicine.



Blood

http://bloodjournal.hematologylibrary.org/

Blood is a weekly medical journal published by the American Society of Hematology. It was founded by Dr. William Dameshek, the researcher credited with describing the concept of myeloproliferative diseases and participating in the first studies of nitrogen mustard in various blood malignancies, in 1946, and has since been in continuous publication.

With 1,364 articles published annually, an impact factor of 10.555, and an Immediacy Index of 2.209, Blood is the most cited peer-reviewed publication in the field. It provides an international forum for the publication of original articles describing basic laboratory, translational, and clinical investigations in hematology. The journal covers all aspects of hematology, including disorders of leukocytes, both benign and malignant, erythrocytes, platelets, hemostatic mechanisms, vascular biology, immunology, and hematologic oncology. All articles undergo a rigorous peer review and are selected on the basis of the originality of the findings, the superior quality of the work described, and the clarity of presentation. Blood is indexed and abstracted by Index Medicus, Excerpta Medica, Current Contents/Life Sciences, Current Contents/Clinical Medicine, Science Citation Index, SCISEARCH, Automatic Subject Citation Alert, ISI/BIOMED, and BIOSIS.

The American Journal of Psychiatry (AJP)

http://ajp.psychiatryonline.org/

APJ is committed to keeping the field of psychiatry vibrant and relevant by publishing the latest advances in the diagnosis and treatment of mental illness. The findings presented in this journal explore the full spectrum of issues related to mental health diagnoses and treatment. Original articles include new developments in diagnosis, treatment, neuroscience, and patient populations.

Journal of Rehabilitation Medicine (JRM)

http://www.medicaljournals.se/jrm/content/

JRM Medicine is the international peer-review journal published in English, with at least 10 issues published per year.

Original articles, reviews, case reports, short communications, special reports and letters to the editor are published, as also are editorials and book reviews. The journal strives to provide its readers with a variety of topics, including: functional assessment and intervention studies, clinical studies in various patient groups, methodology in physical and rehabilitation medicine, epidemiological studies on disabling conditions and reports on vocational and sociomedical aspects of rehabilitation.

The journal is read by a wide group of healthcare professionals including specialists in rehabilitation medicine, neurology, clinical neurophysiology, general medicine, psychologists, physiotherapists, occupational therapists and social workers.

Contributions from all parts of the world and from different professions in rehabilitation are welcome.

Revistas Extranjeras 1 (EM)

Esta serie incluye revistas que tienen el mayor factor de impacto en cada disciplina médica. La fuente para la selección fue el portal: http://www.freemedicaljournals.com.  No encontré a The Lancet en dicho portal tras varios intentos; pero la incluí por su importancia. En cada caso se presenta el nombre de la revista, su web page y la descripción que hace la revista sobre si misma.

New England Journal of Medicine (NEJM)

http://www.nejm.org/

The NEJM is dedicated to bringing physicians the best research and key information at the intersection of biomedical science and clinical practice, and to presenting the information in an understandable and clinically useful format. A career companion for physicians, NEJM keeps practicing physicians informed on developments that are important to their patients and keeps them connected to both clinical science and the values of being a good physician.

NEJM employs a highly rigorous peer-review and editing process to evaluate manuscripts for scientific accuracy, novelty, and importance. The editors have set policies to ensure that authors disclose all relevant financial associations and that those financial associations do not influence published content. These factors contribute to NEJM’s reputation as the "gold standard" for quality biomedical research and for the best practices in clinical medicine.

NEJM is the most widely read, cited, and influential general medical periodical in the world. As it evolves to meet the changing needs of its readers in the 21st century, it is committed to maintaining that reputation and integrity, while using innovative formats and technologies for new features and faster delivery and access.

Read more:  http://www.nejm.org/page/about-nejm/history-and-mission

The Lancet

http://www.thelancet.com/

The Lancet publishes medical news, original research, and reviews on all aspects of clinical medicine and public health. TheLancet.com will shortly see the launch of Article Collections, collating articles in sub-specialties published across The Lancet journals. Please register on this site and opt in to receive emails to receive notification of the launch of The Lancet Article Collections.

Read more: http://www.thelancet.com/lancet-about

PLoS Medicine (PM)

http://www.plosmedicine.org/home.action

PM is the leading open-access medical journal, providing an innovative and influential venue for research and comment on the major challenges to human health worldwide. We specifically seek to publish papers which have relevance across a range of settings and that address the major environmental, social, and political determinants of health, as well as the biological.

British Medical Journal (BMJ)

http://www.bmj.com/

The BMJ is an international peer reviewed medical journal and a fully “online first” publication. Our publishing model—”continuous publication”— means that all articles appear on bmj.com before being included in an issue of the print journal. The website is updated daily with the BMJ’s latest original research, education, news, and comment articles, as well as podcasts, videos, and blogs.
All the BMJ’s original research is published in full on bmj.com, with open access and no limits on word counts. The BMJ’s vision is to be the world’s most influential and widely read medical journal. Our mission is to lead the debate on health and to engage, inform, and stimulate doctors, researchers, and other health professionals in ways that will improve outcomes for patients. We aim to help doctors to make better decisions. The BMJ team is based mainly in London, although we also have editors elsewhere in Europe and in the US.

Read more: http://resources.bmj.com/bmj/about-bmj

Clinical Infectious Diseases (CID)

http://cid.oxfordjournals.org/

CID, one of the most heavily cited journals in the fields of infectious diseases and microbiology, publishes articles on diverse topics in infectious diseases, with a focus on clinical practice. Every issue includes special sections focusing on key topics such as HIV/AIDS, antimicrobial resistance, aging and infectious diseases, and biological weapons. Many articles are published with commentaries by prominent researchers, and current trends and best practices are regularly covered in review articles and practice guidelines. CID also publishes numerous supplements devoted to single topics in the field.

Journal of Infectious Diseases (JID)

http://jid.oxfordjournals.org/

Founded in 1904, The JID is the premier publication in the Western Hemisphere for original research on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune mechanisms. Articles in JID include research results from microbiology, immunology, epidemiology, and related disciplines.

AIDS

http://journals.lww.com/aidsonline/pages/default.aspx

Publishing the very latest ground breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of significant advances. The Editors, themselves noted international experts who know the demands of your work, are committed to making AIDS the most distinguished and innovative journal in the field.

Articles older than 12 months, back to 1997, are freely accessible on this website. We understand the importance of a journal as a source of valuable information, and have allowed access to all the fields of research published in AIDS over this time period. This extends access options made through HINARI that provides at greatly reduced cost on-line subscriptions to institutions within countries whose resources would otherwise prevent them from subscribing and accessing journal content.

Circulation

http://circ.ahajournals.org/

Endocrine reviews (ER)

http://edrv.endojournals.org/

ER publishes bimonthly comprehensive, authoritative, and timely review articles balancing both experimental and clinical endocrinology themes and crystallizing the most significant clinical experience and current research in endocrinology and related areas such as cell biology, immunology, pharmacology, genetics, molecular biology, neuroscience, reproductive medicine, and pediatric endocrinology. In the 2009 Journal Citation Report, Endocrine Reviews has the highest Impact Factor ranking of the 105 journals in the category of Endocrinology and Metabolism: 19.761.


Diabetes

http://diabetes.diabetesjournals.org/

Diabetes publishes original research about the physiology and pathophysiology of diabetes mellitus. Submitted manuscripts can report any aspect of laboratory, animal, or human research. Emphasis is on investigative reports focusing on areas such as the pathogenesis of diabetes and its complications, normal and pathologic pancreatic islet function and intermediary metabolism, pharmacological mechanisms of drug and hormone action, and biochemical and molecular aspects of normal and abnormal biological processes. Studies in the areas of diabetes education or the application of accepted therapeutic and diagnostic approaches to patients with diabetes mellitus are not published.

Clinical Microbiology Reviews (CMR)

http://cmr.asm.org/

CMR analyzes the latest developments in clinical microbiology and immunology. Key topics include pathogenic mechanisms, individual and groups of microbial pathogens, clinical and laboratory aspects of newly recognized and reemerging infectious diseases, antimicrobial agents and their applications, and diagnostic laboratory technologies. Clinical and medical microbiologists, immunologists, epidemiologists, pathologists, public health workers, and infectious disease specialists all turn to the journal to discover not only the current state of knowledge in the field, but also balanced, thought-provoking perspectives on controversial issues of the day.

Brain: a Journal of Neurology

http://brain.oxfordjournals.org/

Brain provides researchers and clinicians with the finest original contributions in neurology. Leading studies in neurological science are balanced with practical clinical articles. Its citation rating is one of the highest for neurology journals, and it consistently publishes papers that become classics in the field. The Editorial Board reflects both the journal's truly international readership and wide coverage.

Brain is using the latest technology to speed up the publication process and add greater functionality to the published papers. Papers are now submitted online, and manuscripts are posted online weeks in advance of their appearance in the printed issue. This means you can read the best research without delay, and your papers can start being cited even more rapidly than before.

CA: A Cancer Journal for Clinicians (CA:ACJC)

http://www.cacancerjournal.com/view/0/index.html

CA: ACJC is a peer-reviewed journal of the American Cancer Society providing cancer care professionals with up-to-date information on all aspects of cancer diagnosis, treatment, and prevention.
Published six times per year, CA is the most widely circulated oncology journal in the world, with a circulation of approximately 76,000, including primary care physicians; medical, surgical, and radiation oncologists; nurses; other health care and public health professionals; and students in various health care fields. Although CA is an oncology journal, it is not a journal only for oncologists. It reaches a very wide and diverse group of professionals, and provides an unparalleled opportunity to present information to these professionals about cancer prevention, early detection, treatment of all forms, palliation, advocacy issues, quality-of-life topics, and more.

Journal of Investigative Dermatology (JID)

http://www.nature.com/jid/index.html

JID publishes papers describing original research on all aspects of cutaneous biology and skin disease. Topics include biochemistry, biophysics, carcinogenesis, cell regulation, development, skin structure, extracellular matrix, genetics, immunology, melanocyte biology, microbiology, molecular and cell biology, pathology, physiology, pharmacology, photobiology, percutaneous absorption, clinical research, epidemiology and other population-based research. Original Articles, Communications, Review Articles, and Letters to the Editor are standard features. Perspectives and Commentaries are invited by the Editorial Board.

Academic Emergency Medicine (AEM)

http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1553-2712

AEM is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second largest peer-reviewed scientific journal in the specialty of emergency medicine.

The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to enhance the goals and objectives of the Society for Academic Emergency Medicine (SAEM). Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, in addition to clinical news, case studies and more.

Each issue contains information relevant to the investigations, educational advancements, and practice of Emergency Medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal. AEM is governed by an Editorial Board led by Editor-in-Chief, David C. Cone, MD.