Cytokines profile and its correlation with endothelial damage and oxidative stress in patients with type 1 diabetes mellitus and nephropathy.

The aim of the present study was to investigate the association between the presence of albuminuria and cytokines profile with biomarkers of endothelial damage and oxidative stress in patients with type 1 diabetes mellitus (DM1). The sample was composed by 35 healthy individuals, 63 DM1 patients with normoalbuminuria (<30 mg of albumin/g of creatinine) and 62 DM1 patients with micro- and macroalbuminuria (≥30 mg of albumin/g of creatinine). Plasma and urinary cytokines (TNF-α, IL-6 and IL-10) and thrombomodulin levels were determined by ELISA. Oxidative status was evaluated using the TBARS and MTT assays. Diabetic patients were characterized by elevated levels of urinary cytokines TNF-α, IL-6 and IL-10. Those with macroalbuminuria presented significantly higher TNF-α and IL-10 urinary levels when compared to other groups. Urinary and plasmatic levels of TNF-α were positively correlated with plasma levels of cystatin C, creatinine, urea and albuminuria, while they were negatively correlated with estimated glomerular filtration rate. Urinary IL-10 levels proved positive correlation with fasting glucose, HbA1c, thrombomodulin and TBARS, while IL-6 plasma levels were positively correlated with HbA1c and albuminuria. Only urinary TNF-α levels were associated with the presence and severity of macroalbuminuria, after logistic regression analysis. This finding suggests that measurement of urinary TNF-α level may be helpful to evaluate progression to nephropathy in DM1 patients.

Visita em Unidades de Terapia Intensiva: concepção dos familiares quanto à humanização do atendimento / Visit on Intensive Care Units: The Families´ Understanding on Care Humanization

A Unidade de Terapia Intensiva (UTI) é considerada um ambiente hostil e invasivo. Portanto, o envolvimentoda família com o paciente é importante para o processo de humanização, pois a presença da família junto aoente querido contribui com o tratamento e para a sua recuperação. Objetivo: Verificar a concepção dosfamiliares quanto a visita em UTI. Método: Estudo descritivo exploratório realizado na UTI da Emergência deum hospital do noroeste paulista, realizado por meio de entrevista, utilizando-se um formulário com questõesfechadas e abertas relacionadas às orientações recebidas sobre a unidade, aprovação do horário de visitas,atendimento da equipe multiprofissional, reconhecimento do enfermeiro na equipe, sentimentos e importânciados familiares na recuperação do cliente. Foram entrevistados 41 familiares, nos meses de julho a outubro de2005, durante o horário de visita. Os dados foram analisados em freqüência e porcentagens e apresentadosem tabelas. Resultados: A família sente necessidade de atenção e da companhia de um profissional para obterinformações sobre como seu familiar passou o dia, as intercorrências e outros acontecimentos que permeiama rotina dessas pessoas e da unidade, e desejam mais um horário para visitas. Considerações: Uma assistênciahumanizada necessita de um enfermeiro mais atuante, dando orientações completas e freqüentes aos familiares.Sobretudo, é o profissional com maior capacidade e conhecimento para atuar junto à família, considerandoseu contato ininterrupto com o paciente e, assim, pode amenizar a ansiedade vivida, enfatizando a importânciada presença da família na recuperação do seu ente querido.

Introduction: The hospital Intensive Care Unit (ICU) is considered a hostile and invasive environment. Thus,the patient family involvement is important for the humanization process, once the presence of the patients’family improve the care and recovery of their loved ones. Objectives: To identify the ICU patients’ familyneeds and to observe primary health care to the families of these patients. Method: An exploratory descriptivestudy was performed at an emergency intensive care unit of a hospital at a Northwestern State of São Paulo.Individual structured interviews were used with a questionnaire with core open-ended questions to allow therespondents to explain their own viewpoints and experiences as completely as possible. Family data onwhether a family received information about the unit; approval of visit hours; whether they were receivingsupport from the multidisciplinary team; whether they were told of the specific role of each ICU caregiver;and the feelings and the importance of the family on the patient’s recovery. From July to October 2005, a totalof 41 family members completed the questionnaire during the visit hours. Results: The family needs attentionand help from a health professional to be provided with the appropriate, clear, and compassionate informationon the diagnosis, prognosis, or treatment of the patient, and more visit hours allowed per day. Conclusion: Ahumanized assistance requires a more active nurse, who provides the family members usual and completeinformation. Taking into account the interaction between health professionals and family members; thenurses are the most qualified caregiver to provide all the information to the family members. Moreover, theyare usually in touch with the patient, and can also diminish the family anxiety; emphasizing the importance ofthe family´s presence on the recovery of their loved ones.