Chronic circadian shift leads to adipose tissue inflammation and fibrosis.

The circadian clock exerts temporal coordination of metabolic pathways. Clock disruption is intimately linked with the development of obesity and insulin resistance, and our previous studies found that the essential clock transcription activator, Brain and Muscle Arnt-like 1 (Bmal1), is a key regulator of adipogenesis. However, the metabolic consequences of chronic shiftwork on adipose tissues have not been clearly defined. Here, using an environmental lighting-induced clock disruption that mimics rotating shiftwork schedule, we show that chronic clock dysregulation for 6 months in mice resulted in striking adipocyte hypertrophy with adipose tissue inflammation and fibrosis. Both visceral and subcutaneous depots display enlarged adipocyte with prominent crown-like structures indicative of macrophage infiltration together with evidence of extracellular matrix remodeling. Global transcriptomic analyses of these fat depots revealed that shiftwork resulted in up-regulations of inflammatory, adipogenic and angiogenic pathways with disruption of normal time-of-the-day-dependent regulation. These changes in adipose tissues are associated with impaired insulin signaling in mice subjected to shiftwork, together with suppression of the mTOR signaling pathway. Taken together, our study identified the significant adipose depot dysfunctions induced by chronic shiftwork regimen that may underlie the link between circadian misalignment and insulin resistance.

Validación de un instrumento para evaluar el autocuidado de pacientes adultos con diabetes mellitus tipo 2 / Validation of an instrument to evaluate self-care of adult patients with type 2 diabetes mellitus

Múltiples estudios han evaluado el autocuidado de pacientes con diabetes mellitus, sin embargo, no existe suficiente literatura donde aparezcan instrumentos de recolección de datos validados por juicio de expertos. Objetivo: Elaborar y validar el contenido de un instrumento para evaluar el autocuidado y cuantificar cómo influyen el nivel de actividad física y el régimen de alimentación en la salud de los usuarios. Así como, analizar el estado emocional del paciente adulto con diabetes tipo 2 identificando los riesgos que intervienen en su comportamiento para un mejor autocuidado. a social laboral y personal, segmentadas en 26 preguntas que analizan aspectos de estas personas Metodología: Se realizó una investigación prospectiva, cuantitativa, de corte transversal de tipo analítico descriptivo. Utilizando a una prueba piloto donde con 16 pacientes como población probabilística. El instrumento empleado fue validado por juicio de expertos este contiene aspectos de tres categorías correspondientes. Resultados: la calificación otorgada por los expertos obtuvo 97,6 puntos de confiabilidad, se valora como Muy confiable al ubicarse por encima de 90% en la escala empleada. Como resultado del juicio de expertos al promediar las respuestas se alcanzó 97,6 puntos de "Confiabilidad", por lo tanto, se considera como un instrumento "Muy Confiable". Es decir, que se ubica este resultado en el rango entre 100 y 80 puntos. En cuanto al resultado de la prueba de consistencia interna a través del coeficiente de alfa de Cronbach fue de 0.77, se propuso eliminar un ítem de la primera versión y se elevó la confiabilidad de la escala a 0.80. Además, el tiempo promedio para llenar la encuesta no superó los 10 minutos, alcanzándose un promedio de 8 min 45 segundos durante la aplicación, esto conlleva a una lógica de reproducibilidad y ritmo aceptable en la sucesión de los temas, demostrando no ser complejo para los pacientes. Conclusión: Quedó elaborado un instrumento validado por juicio de expertos, el cual alcanzó 97,6 puntos de "Confiabilidad. El estudio cuantitativo realizado demostró que es bajo el nivel de actividad física y, además, muestran desordenes en su régimen de alimentación. Al analizar el estado emocional de los pacientes adultos con diabetes mellitus tipo 2 se identificaron diversos riesgos para sobrellevar la compleja naturaleza de esta enfermedad(AU)

Multiple studies have evaluated the self-care of patients with diabetes mellitus; however, there is not enough literature where data collection instruments validated by expert judgment appear. Objective: To elaborate and validate the content of an instrument to evaluate self-care and quantify how the level of physical activity and the diet influence the health of users. As well as, to analyze the emotional state of the adult patient with type 2 diabetes, identifying the risks that intervene in their behavior for better self-care. Methodology: It is a prospective, quantitative, cross-sectional, analytical descriptive investigation. Using a pilot test with 16 patients as a probabilistic population. Expert judgment validated the instrument; it contains aspects of three corresponding categories. Results: the qualification granted by the experts obtained 97.6 points of reliability; it is valued as Very reliable as it is above 90% on the scale used. As a result, of the expert judgment, when the responses averaged, 97.6 points of "Reliability" reached; therefore, it considered a "Very Reliable" instrument. That is, this result is located in the range between 100 and 80 points. Regarding the result of the internal consistency test through Cronbach's alpha coefficient, it was 0.77, it proposes to eliminate an item from the first version and the reliability of the scale raised to 0.80. In addition, the average time to complete the survey did not exceed 10 minutes, reaching an average of 8 min 45 seconds during the application, this leads to a logic of reproducibility and acceptable rhythm in the succession of the subjects, proving not to be complex for the patients. Conclusion: Developed an instrument validated by expert judgment, which reached 97.6 points of "Reliability. The quantitative study carried out showed that the level of physical activity is low and, in addition, they show disorders in their eating regimen. The analysis of emotional state of adult patients with type 2 diabetes mellitus, identified various risks for coping with the complex nature of this disease(AU)

Loperamide Mimicking Brugada Pattern.

Brugada syndrome is an inherited arrhythmia that increases a patient's risk of sudden cardiac death. Certain pharmacologic agents may induce a transient Brugada pattern on surface electrocardiogram (EKG). One of these is loperamide, an over-the-counter agent commonly used to manage diarrhea. We report the case of a patient who experienced EKG changes that mimicked Brugada pattern after excessive intake of loperamide.

[Percutaneous nephrolithotomy (PCNL): Conditions for a safe performance.] / Nefrolitotricia percutanea (NLP): condiciones de una ejecución segura.

OBJECTIVE: To describe the PCNL technique addressing those conditions that enable us to perform the procedure with maximum patient's safety without losing focus on the objective of lithiasis resolution. METHODS: Based on our experience, accumulated with time, and the constant update of the endourological techniques we treat those issues in relation to PCNL from the efficiency, efficacy and effectiveness perspective. To consider them involves the successful performance of the technique, with complications prevention and taking cost-efficiency into account. The first one is in close connection to selection of the most adequate technique for each case, training and team work to achieve excellence. With meticulous preoperative preparation and procedure performance, on every single step of the operation, we will ensure an effective technique, avoiding complications. Efficiency comes from the two first and involves, in addition to perform a successful and safe procedure, that the procedure should be cost effective from the management point of view. CONCLUSIONS: PCNL offers the possibility of endoscopic extraction of renal lithiasis, regardless of its volume, density or site, but its success, safety and efficiency are closely linked to the possibility of establishment of an appropriate tract that enables manipulation and total extraction of the calculus.

[Retroperitoneal endoscopic nephrectomy]. / Nefrectomía endoscópica retroperitoneal.

OBJECTIVES: Nephrectomy is probably the most widely accepted procedure for the application of laparoscopic techniques in urology. The great advantages of laparoscopy over conventional approaches have justified its indication for different renal extirpative procedures: atrophy, renal carcinoma, transitional cell carcinoma, polycystic kidney disease, living kidney donation for transplantation and partial nephrectomies. The objective of this article is to describe the techniques and advantages of laparoscopic nephrectomy through a retroperitoneoscopic approach, demonstrating that it is an effective option for the majority of cases in which extraction of the kidney is required. METHODS: Between January 1991 and January 2001 107 patients with different renal conditions were treated at the Instituto Docente de Urología (IDU) using transperitoneal (36 patients) or retroperitoneal (71 patients) laparoscopic access. Indications for laparoscopic approach included atrophy, living donation, renal carcinoma, urothelial tumour, polycystic kidney disease and partial nephrectomy. RESULTS: Nephrectomy trough a transperitoneal approach was completed in 33 (91.6%) of 36 patients, being necessary to convert to conventional surgery in the remaining 3 cases (8.3%). Retroperitoneoscopic approach was successful in all cases (100%). CONCLUSIONS: The retroperitoneoscopic approach is a simple procedure that allows its implementation in the majority of patients in which there is an indication for nephrectomy. Retroperitoneoscopy provides a rapid recovery, minimal analgesic needs, and a short hospital stay. Finally, retroperitoneoscopic approach represents a logical evolution for conventional flank incisions, providing familiarity with surgical field landmarks and management to those urologists that incorporate this new technical modality.