Factors associated with elevated serum alanine aminotransferase in patients with type 1 diabetes mellitus.

AIM: Metabolic syndrome and type 2 diabetes are associated with insulin resistance and hepatic steatosis, which are common causes of alanine aminotransferase (ALT) elevation. This study aims to identify variables associated with altered ALT in type 1 diabetic (DM1) subjects. METHODS: A cross-sectional study conducted in the outpatient endocrinology clinic of a university hospital. Patients with DM1 were seen between December 2012 and September 2013; clinical variables were collected from medical records. RESULTS: Fifty-six patients were included aged 27 ± 10.1 years; 60.7% were men. The study subjects exhibited an average ALT of 36.7 ± 10.3 U/L (median = 35 U/L) and their average Body Mass Index (BMI) was 23.8 ± 3.8 kg/m2. When comparing individuals with elevated ALT > 35 U/L (N. = 27) with those ALT ≤ 35 U/L (N. = 29), we found that individuals with ALT values > 35 U/L showed a higher proportion of men (77.8% vs. 44.8%, P = 0.012) and a higher mean age (30.2 ± 12.3 vs. 24.6 ± 6.9 years, P = 0.046). When new ALT reference values were applied (19 U/L for women and 30 U/L for men), five individuals had normal ALT values. Individuals with elevated ALT had higher BMI (24.3 vs. 20.9; P = 0.036), fasting glucose (194.8 ± 101.2 vs. 123.6 ± 42.0 mg/dL; P = 0.013) and higher HbA1c (9.9 ± 2.8 vs. 7.8 ± 0.7%; P < 0.001) levels. In Pearson correlation analysis, ALT values ​correlated with HbA1c (r = 0.285; P = 0.033). CONCLUSION: In patients with DM1, elevated ALT values ​​are associated with BMI, fasting glucose and HbA1c.

Pain: clinical validation with postoperative heart surgery patients.

PROBLEM: To estimate the content validity of the nursing diagnosis of pain in postoperative heart surgery patients. METHODS: Observation of and interviews with postoperative heart surgery patients (N = 80), 40 experiencing pain and 40 without pain. FINDINGS: The group experiencing pain had statistically different results from the group without pain, with a higher frequency in the following 19 defining characteristics: verbal report of pain, discomfort, fear of reinjury, sleep disturbance, guarding behavior, distraction behavior, irritability, restlessness, facial mask of pain, increased heart rate, immobility, anxiety, loss of appetite, self-focus, withdrawal, impaired thought process, unusual posture, increased blood pressure, and changes in respiratory patterns. CONCLUSIONS: These defining characteristics support the idea that pain is a complex phenomenon of clinical interest to nursing that needs better understanding. Studies using the same defining characteristics in other sample groups of patients with acute and chronic pain might be useful in the refinement of this nursing diagnosis.