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Objectives To describe the trends of research design in publications from high-impact medical journals. Methods A cross-sectional, descriptive study was conducted by searching the 2011 electronic publications of the journals: New England Journal of Medicine, Journal of the American Medical Association, The Lancet, British Medical Journal, and Annals of Internal Medicine. Studies were classified as primary and secondary. The journal impact factor was taken from the Journal Citation Report website. Descriptive statistics were used to analyze and interpret the data. Results We analyzed 1130 publications: 804 primary and 326 secondary studies, which represented 71.2% and 28.8% of the total publications, respectively. Among the primary studies, randomized clinical trials (30.4%) were the most prevalent, followed by cohort studies (21.9%) and case reports (9.0%). Conclusions These findings can have implications in Evidence-Based Medicine programs. Literature review should focus on reviewing secondary articles first, then experimental studies and finally, observational studies.

La isquemia del segmento anterior es una complicación seria que puede presentarse después de la cirugía de estrabismo, particularmente después de desinsertar tres o cuatro músculos extraoculares, con la sección de sus respectivas arterias ciliares anteriores. Sin embargo, susceptibilidad individual y una cantidad considerable de factores de riesgo juegan también un papel importante en el desarrollo de esta condición que pone en peligro la vista. Una evaluación minuciosa es fundamental para cada paciente. Por lo tanto, conocer la irrigación del segmento anterior junto con los mecanismos que producen la isquemia de esta región del ojo es de suma importancia para evaluar a los pacientes, para planear y decidir qué procedimiento quirúrgico es el mejor para cada caso en particular, y para prevenir la ocurrencia de esta complicación. La revisión de la anatomía descriptiva y su posterior correlación con el cuadro clínico de esta entidad facilita el entendimiento de la patogénesis de la isquemia y crea conciencia acerca de la necesidad de instituir medidas preventivas. Anterior segment ischemia is a serious complication that may occur after strabismus surgery, particularly after the deinsertion of three or four extraocular muscles, with transection of their anterior ciliary arteries. However, individual susceptibility and a considerable amount of risk factors also play an important role in the development of this condition, which endangers sight. A thorough evaluation is essential for each patient. Therefore, knowing the irrigation of the anterior segment along with the mechanisms that produce ischemia of the eye region is very important to assess patients, plan and decide which surgical procedure is best for each particular case, and to prevent the occurrence of this complication. Review of the descriptive anatomy and its subsequent combination with the clinical picture of this entity facilitates understanding of the pathogenesis of ischemia and raises awareness about the need to institute preventive measures.

We have evaluated the efficacy of dapagliflozin in patients with type 1 diabetes mellitus (DM1) without adequate control. We expected that adding dapagliflozin to this population on top of their base treatment would lower their HbA1c levels.We conducted a pragmatic, open, 24-week study of treatment with 10 mg of oral dapagliflozin in patients with DM1 and chronic hyperglycemia. We evaluated glycemic control, lipid profile, weight, and insulin dose. Safety was assessed by adverse event reporting.Fasting glucose levels decreased from 176.42 ± 45.33 mg/dL to 139.67 ± 44.42 mg/dL (p = 0.05); although no significant valued was reached, postprandial glucose showed a decreased tendency from 230.25 ± 52.06 mg/dL to 193.83 ± 45.43 mg/dL (p = 0.08). The hemoglobin A1C (HbA1C) level decreased from 9.18 ± 1.02 (77 ± 11.1 mmol/mol) to 8.05 ± 1.09 % (64 ± 11.9 mmol/mol) (p = 0.0156); total cholesterol decreased from 299 ± 12 to 199 ± 7 mg/dL (p = 0.02); triglycerides decreased from 184 ± 15 to 160 ± 11 mg/dL (p = 0.0002), HDL-C decreased from 40 ± 17 to 42 ± 9 mg/dL (p = 0.54); and LDL-C decreased from 187 ± 19 to 170 ± 21 mg/dL (p = 0.049). No adverse events were reported.The beneficial effects of SGLT2 inhibitors on metabolic control and their safety after a 24-week open study demonstrate their potential indication as an adjunctive treatment with insulin in patients with DM1; however, long-term clinical trials should be considered.

Diabetes in pregnant women is associated with an increased risk for maternal and neonatal morbidities and remains a significant medical challenge. Fortunately, the prognosis has changed dramatically, related to an increased clinical awareness of the potential risks for the mother and the infant, better health care and intensive treatment strategies to maintain the closest to normal metabolic milieu. Diabetes and pregnancy may be divided into pregestational diabetes (women previously diagnosed with type 1 or type 2 diabetes) and gestational diabetes defined as any glucose intolerance detected during pregnancy that has evolved from a diagnosis associated with the metabolic risk of type 2 diabetes to a clinical condition associated with higher risks for maternal and perinatal morbidity. Early diagnosis of gestational diabetes is an important step to improve outcomes and systematic or selective screening with the OGTT should be established. Associated with the global epidemic in diabetes, pregnancy associated with diabetes is saturating high-risk obstetric clinics and neonatal intensive care units, becoming a heavy burden to the health care systems around the world.

A thyroid nodule (TN) is a discrete lesion in the thyroid gland radiologically distinct from the adjacent parenchyma, with a prevalence variable depending on the diagnostic method used and the study population. Thyroid disorders have been identified in more than 50% of patients with systemic lupus erythematosus (SLE); however, the prevalence of TN has not been frequently studied. We identified a prevalence of 27% TN in 55 SLE patients > 16 years of age. One-third of TN were >1 cm with radiological features of malignancy. The mean age of patients with TN was 39 ± 11 years, 93% women, and SLE duration 10 ± 6 years. Among patients, we reported family history of cancer in three cases (20%), thyroid disease in one (7%), and autoimmune disease in six (40%). Regarding treatment, 50% of patients with TN were treated with azathioprine vs. 23% of patients without TN ( p = 0.02), with an OR of 3.94 (95% CI 1.12–13.84, p = 0.03). As a conclusion a high prevalence of TN in SLE patients was found. Prevalence of TN correlated only with history of azathioprine use. We don’t know the long-term implications of our findings; however, a functional and morphological evaluation of the thyroid gland is warranted in all patients with SLE.

Introduction In the patient with acromegaly, pituitary surgery is the therapeutic standard. Despite undergoing surgery, a significant number of patients with acromegaly continue to have uncontrolled growth hormone secretion. These patients require other treatments such as external irradiation and/or drug therapy. Case presentation We present the clinical and laboratory responses to six months of treatment with rosiglitazone in four cases. In all four cases, the patients had persistent growth hormone overproduction despite previous surgical treatment and other conventional therapy. Case 1 is a 57-year-old Caucasian woman, case 2 is a 51-year-old Hispanic man, case 3 is a 32-year-old Hispanic woman, and case 4 is a 36-year-old Hispanic man. In three of these patients, basal and nadir growth hormone and insulin-like growth factor 1 levels were significantly decreased (P < 0.05 and P < 0.01, respectively). Conclusion Rosiglitazone could be a treatment option in select patients with acromegaly.