Top PDF Model for end-stage liver disease (MELD) score as a predictor and monitor of mortality in patients with Vibrio vulnificus necrotizing skin and soft tissue infections.

Model for end-stage liver disease (MELD) score as a predictor and monitor of mortality in patients with Vibrio vulnificus necrotizing skin and soft tissue infections.

Model for end-stage liver disease (MELD) score as a predictor and monitor of mortality in patients with Vibrio vulnificus necrotizing skin and soft tissue infections.

nine 9mg/dL)] + 6.4 [9]. Serum bilirubin concentration is a well established marker of the he- patic synthetic function, although it represents excretory function. Prothrombin time and the INR reflect coagulopathy associated with synthetic dysfunction in patients with advanced liver dysfunction. Because renal dysfunction in patients with liver disease is an ominous sign for mortality, serum creatinine concentration is heavily weighted in the MELD score equation. In interpreting the MELD score in hospitalized patients, Wiesner et al. [30] had reported that the 3-month mortality was more than 19.6% in patients with MELD score  20. In contrast, the current study on patients with VNSSTIs revealed that the case-fatality rate was as high as 66.7% for patients with MELD score  20 on admission, whereas for total patients the case-fa- tality rate was only 12.8%. Botta et al. [9] had used the MEGX test, a tool for the real-time as- sessment of hepatic function, to confirm the fact that an increase in MELD score is associated with a decrease in residual liver function. In critically ill patients after polytrauma or sepsis, several studies had further shown that a decrease in MEGX test values (i.e., hepatic functional impairment) is associated with an enhanced systemic inflammatory response and an enhanced risk for the development of MODS and a poor outcome [31]. We, therefore, recommend that an earlier and better identification of V. vulnificus-infected patients with liver dysfunction is warranted and may be the way to evaluate new therapeutic strategies and further improve the prognosis of sepsis.
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Transplante combinado fígadorim : experiência de um hospital unisitário brasileiro

Transplante combinado fígadorim : experiência de um hospital unisitário brasileiro

ABSTRACT – Background: Combined liver–kidney transplant is a routine procedure in many transplant centers. The increase in its number coincided with the introduction in 2002 of the MELD (Model for End-stage Liver Disease) score for allocation of livers, prioritizing patients with renal dysfunction. Aim: To analyze the experience with combined liver-kidney transplantation in a liver transplant center in Brazil. Method: A retrospective review was conducted. All transplants were performed using grafts from deceased donors. Results: Sixteen combined liver-kidney transplantations were performed in the same period, which corresponds to 2.7% and 2.5% of the kidney and liver transplants, respectively. Fourteen patients were male (87.5 %) and two were female (12.5%). The average patients and donors age was 57.3±9.1 and 32.7±13.1, respectively. The MELD score mean was 23.6±3.67. The main cause of liver dysfunction were chronic hepatitis C virus (n=9). As for renal dysfunction, diabetic nephropathy (n=4) was the most frequent. There were six deaths, two of them by severe dysfunction of the liver graft and four by infectious causes. The 1, 3 and 5 years survival rate in patients undergoing liver-kidney transplantations was 68.8%, 57.3% and 57.3%, respectively. Conclusion: The survival rates achieved in this series are considered satisfactory and show that this procedure has an acceptable morbidity and survival. Correspondência:
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Transplante combinado fígado-rim: experiência de um hospital universitário brasileiro.

Transplante combinado fígado-rim: experiência de um hospital universitário brasileiro.

ABSTRACT – Background: Combined liver–kidney transplant is a routine procedure in many transplant centers. The increase in its number coincided with the introduction in 2002 of the MELD (Model for End-stage Liver Disease) score for allocation of livers, prioritizing patients with renal dysfunction. Aim: To analyze the experience with combined liver-kidney transplantation in a liver transplant center in Brazil. Method: A retrospective review was conducted. All transplants were performed using grafts from deceased donors. Results: Sixteen combined liver-kidney transplantations were performed in the same period, which corresponds to 2.7% and 2.5% of the kidney and liver transplants, respectively. Fourteen patients were male (87.5 %) and two were female (12.5%). The average patients and donors age was 57.3±9.1 and 32.7±13.1, respectively. The MELD score mean was 23.6±3.67. The main cause of liver dysfunction were chronic hepatitis C virus (n=9). As for renal dysfunction, diabetic nephropathy (n=4) was the most frequent. There were six deaths, two of them by severe dysfunction of the liver graft and four by infectious causes. The 1, 3 and 5 years survival rate in patients undergoing liver-kidney transplantations was 68.8%, 57.3% and 57.3%, respectively. Conclusion: The survival rates achieved in this series are considered satisfactory and show that this procedure has an acceptable morbidity and survival. Correspondência:
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Arq. Gastroenterol.  vol.45 número1

Arq. Gastroenterol. vol.45 número1

ABSTRACT – Background - Hepatopulmonary syndrome is reported to occur in 4% to 32% of the patients with chronic liver disease and is associated with poor liver function and shortened patient survival before and after liver transplantation. Aims - To assess the frequency of hepatopulmonary syndrome in Brazilian patients with decompensated chronic liver disease and to investigate its impact on patient survival. Methods - One hundred and thirty patients (101 males, mean age 61 ± 12 years) with decompensated chronic liver disease were evaluated for the presence of hepatopulmonary syndrome. The diagnosis of hepatopulmonary syndrome was considered in the presence of alveolar arterial oxygen gradient of more than 15 mm Hg and of pulmonary vascular dilatation assessed by contrast enhanced echocardiography. Results - Hepatopulmonary syndrome was observed in 21 (16%) patients. The presence of hepatopulmonary syndrome was significantly associated with severity of liver disease assessed by the MELD (Model for End-Stage Liver Disease) score, but not with in hospital mortality after admission due to decompensated chronic liver disease. Conclusions - Hepatopulmonary syndrome occurs in 16% of patients with chronic liver disease and is associated with disease severity according to the MELD score. Short term mortality following decompensation of chronic liver disease was not associated with hepatopulmonary syndrome.
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en 0103 507X rbti 20170019

en 0103 507X rbti 20170019

he strengths of this study are that it revealed an SSTI epidemiology and etiology that was very diferent from that which has been traditionally described. NF, which was previously more common in trauma and war wounds, appears to be more strongly associated with iatrogenic skin infections and immunosuppression at present, and some patients appeared to develop severe infections in the absence of traditional risk factors. S. aureus was not the most commonly isolated microorganism. Additionally, while microorganisms with MDR were present even in the absence of traditional risk factors, prior use of antimicrobials was signiicantly associated with MDR isolation. Furthermore, we identiied a high rate of positivity in surgical samples, which helped in establishing the etiology of infection. Although the identiication of this inding was not the aim of this study, it may afect the manner in which clinicians select antimicrobials for the treatment of NF; however, whether it will afect patient outcomes remains unclear.
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Variation of hemodialysis related arterial stiffness in patients with end stage renal disease

Variation of hemodialysis related arterial stiffness in patients with end stage renal disease

The present study showed an increase in arterial stiffness after dialysis, in direct relationship with volume and electrolyte changes. Lack of blood pressure variation could be explained by blood pressure lowering treatment administered during dialysis. None of the patients had significant falls in blood pressure or cramps which would indicate ultrafiltration above dry weight, and the vasoconstriction response was inhibited with medication.

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Cardiovascular Disease and Chronic Inflammation in End Stage Kidney Disease

Cardiovascular Disease and Chronic Inflammation in End Stage Kidney Disease

Background: Chronic Kidney Disease (CKD) is one of the most severe diseases worldwide. In patients affected by CKD, a progressive destruction of the nephrons is observed not only in structural but also in functional level. Atherosclerosis is a progressive disease of large and medium-sized arteries. It is characterized by the deposition of lipids and fibrous elements and is a common complication of the uremic syndrome because of the coexistence of a wide range of risk factors. High blood pressure, anaemia, insulin resistance, inflammation, high oxidative stress are some of the most common factors that cause cardiovascular disease and atherogenesis in patients suffering from End Stage Kidney Disease (ESRD). At the same time, the inflammatory process constitutes a common element in the apparition and development of CKD. A wide range of possible causes can justify the development of inflammation under uremic conditions. Such causes are oxidative stress, oxidation, coexistent pathological conditions as well as factors that are due to renal clearance techniques.
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Rev. Col. Bras. Cir.  vol.44 número3

Rev. Col. Bras. Cir. vol.44 número3

Objective: to evaluate the benefit of parathyroidectomy in patients on hemodialysis, regarding nutritional and biochemical statuses, body composition and the health-related quality of life. Methods: this is a longitudinal study involving 28 hemodialysis adult patients with severe secondary hyperparathyroidism evaluated before and one year after surgery. Inclusion criteria: parathyroid hormone levels exceeding ten times the upper normal range and end-stage renal disease in hemodialysis program. We used the body mass index to classify the nutritional status and the biodynamics analyzer to evaluate the body composition. Biochemical analysis included markers of lipid and bone metabo- lism. We assessed quality of life with the SF36 (Short Form Health Survey) questionnaire. All individuals underwent total parathyroidectomy with a forearm implant. Results: there were significant gains in body weight (61.7 vs 66.0 kg, p<0.001), body cell mass (22.0 vs 24.5 kg/ m 2 , p=0.05) and quality of life (p=0.001) after surgery. With respect to bone metabolism, intact PTH, calcium, phosphorus and alkaline
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Rev. Bras. Psiquiatr.  vol.38 número4

Rev. Bras. Psiquiatr. vol.38 número4

There is evidence that ESRD patients have compro- mised QoL, which deteriorates further as the DS burden increases. 23,24 HD therapy is critical for survival in ESRD, with patients unavoidably requiring at least one full-day session, three days a week. Devoting such a long time entirely to health maintenance certainly affects QoL. At inclusion, QoL scores differed between the DS and no DS groups; over time, QoL improved in the DS group, with increases in all WHOQOL scores, while patients in the no DS group had sustained or declining scores, which nevertheless remained higher than those of the DS group. These effects imply that QoL in patients undergoing HD may vary over time and in association with DS. All WHOQOL domains correlated with BDI scores, demon- strating consistency between the questionnaires. 25
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End-Stage Renal Disease in Familial Amyloidosis ATTR Val30Met: A

End-Stage Renal Disease in Familial Amyloidosis ATTR Val30Met: A

The reported patients were selected from a cohort of 22 subjects with FAP, all carrying the TTR Val30Met mutation and receiving dialysis during 1999. The two patients had family history of FAP, TTR amyloidosis in renal biopsy specimens shown by congophilic deposits with green birefringence under polarized light, and posi- tive immunolabelling by anti-TTR monoclonal antibodies. Our conditions for combined liver-kidney transplantation were as fol- lows: (1) ability to walk without aid or no more than one crutch to walk; (2) absence of permanent bladder catheter, (3) absence of neurogenic or decubitus nonhealing ulcers; (4) absence of dialysis- related syncope or persistent vomiting due to autonomic neurop- athy; and (5) general conditions suitable for kidney and liver transplantation.
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Methylenetetrahydrofolate reductase gene, homocysteine and coronary artery disease: the A1298C polymorphism does matter. Inferences from a case study (Madeira, Portugal)

Methylenetetrahydrofolate reductase gene, homocysteine and coronary artery disease: the A1298C polymorphism does matter. Inferences from a case study (Madeira, Portugal)

Mechanisms by which hyperhomocysteinemia pro- motes the development of CAD are still not fully understood. Supposed mechanisms of Hcy induced atherosclerosis include impaired production of endothelium-derived nitric oxide, stimulated prolif- eration of smooth muscle cells, endothelial cell growth inhibition and effects on platelets and coa- gulation [36,37]. Increased production of free radicals may also be involved in Hcy-mediated damage [38]. Several studies have also shown that elevated levels of this aminoacid may induce DNA damage [39,40]. Hyperhomocysteinemia may result from either gene- tic or nutritional causes. If a genetic variant in- fluences the plasma level of a potential causal risk factor, a similar association would be expected bet- ween the variant and disease, as between the plasma level and disease. The most common genetic defects of Hcy metabolism are two mutations in the gene encoding for the enzyme MTHFR: MTHFR C677T, originating a thermolabile form of the enzyme and MTHFR A1298C. Our results show that the thermo- labile MTHFR variant has a marked impact on plasma Hcy level which is significantly higher in the presence of the T allele and TT genotype. We also found the same pattern of influence with the A allele and AA genotype of the 1298 polymorphism. Thus, the presence of haplotype 677C/1298C resulted in sig- nificantly lower mean levels of Hcy, while the indi- viduals with haplotype 677T/1298A showed a significant increase in plasmatic Hcy. Homozygosity for the C677T MTHFR mutation has been extensively associated with intermediate and mild hyperhomo- cysteinemia [11,41,42], while most studies have failed to find an association between the MTHFR A1298C and Hcy levels [43,44].
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Severity of Ascites Is Associated with Increased Mortality in Patients with Cirrhosis Secondary to Biliary Atresia

Severity of Ascites Is Associated with Increased Mortality in Patients with Cirrhosis Secondary to Biliary Atresia

Cumulative probability of survival by groups was calcu- lated using the Kaplan–Meier method, and curves were com- pared using the log-rank test. A p value of less than 0.05 was considered significant. Univariate analysis was performed to identify variables related to decreased survival for both time endpoints using the Cox regression method. Variables analyzed included: age at inclusion, Pediatric End-Stage Liver Disease (PELD) score [18], nutritional status as deter- mined by height/age z-score, prothrombin time as assessed by INR, total bilirubin, serum albumin, and serum sodium. For statistical analysis, age was categorized as 0–1 years versus ≥ 1 year. Malnutrition was defined as a height/age z-score < − 2. The distribution of continuous numeric vari- ables was assessed using the Shapiro–Wilk test. Continuous variables with normal distribution were expressed as mean and standard deviation and compared using the T-test and/ or ANOVA as appropriate. Continuous variables without normal distribution were expressed as median and interquar- tile interval (percentiles 25 and 75) and compared using the Kruskal–Wallis and Mann–Whitney tests.
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The Impact of E-Commerce Securi ty, and National Environment  on Consumer adoption of Intern et Banking in Malaysia and  Singapore

The Impact of E-Commerce Securi ty, and National Environment on Consumer adoption of Intern et Banking in Malaysia and Singapore

The Malaysia government is proactive in supporting and promoting ICT usage just like its Singapore counterpart. Internet usage has been found to be relatively mature in a consumer satisfactory survey conducted by the Malaysia Communications and Multimedia Commission (MCMC) (2004a). Four out of ten Internet users access e- government services for registration and information purposes. Further more, the World Bank has classified Malaysia as an upper-middle-income country (ITU, MCMC, 2004a). Malaysia’s Personal Computer (PC) penetration rate stood at 16.6 percent (ITU, 2004a). The cost of dial-up Internet access has been kept relatively low with subscribers being able to connect to a dial-up point of presence at local call rates (see table 2). Commercial broadband services were first launched by Time dotcom (TIME) in June 2001. At the end of 2003, there were a total of 110,247 subscribers. According to ITU 2004a, this translates to subscriber penetration rate of 0.44 percent or a household broadband penetration rate of 1.98 percent. Around 98 percent of all broadband connections are over direct exchange line (DSL).
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Mechanisms of endothelial dysfunction in resistance arteries from patients with end-stage renal disease.

Mechanisms of endothelial dysfunction in resistance arteries from patients with end-stage renal disease.

Impaired endothelial influence on pinacidil-induced responses may further support our data about reduced basal release of endothelium-derived factors in ESRD. Indeed, NOS/COX inhibitors induced smaller constriction in uremic vs. control arteries. As basal vascular tone is to a large extend NO-dependent [29], our data implies a reduction in basal production of NO in ESRD. In contrast, a previous study reported increased basal NO production in the forearm of hemodialysis patients [30]. The inconsistent results may be caused by different methodology, and selection of patients. Recently, we demonstrated the lack of NO contribution to shear stress responses in subcutaneous uremic arteries [11]. In the current study, differences in sensitivity between BK and ACh, depending from NOS/COX inhibition in controls but not in ESRD, indicated on distinct NO contribution to agonist-induced relaxation between the two groups. Moreover, the negative correlation between serum ADMA levels and relaxation to ACh and BK in ESRD but not in controls further supports the impaired contribution of NO to agonists- induced responses in uremia.
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Hepcidin-25 in diabetic chronic kidney disease is predictive for mortality and progression to end stage renal disease.

Hepcidin-25 in diabetic chronic kidney disease is predictive for mortality and progression to end stage renal disease.

As described previously [23], a cohort of 243 adult patients with type 2 diabetes of any CKD stage was enrolled between 2003 and 2005 from four nephrology outpatient clinics in the Würzburg area, Germany. Main exclusion criteria comprised renal replacement therapy (RRT, dialysis or kidney transplantation) at baseline, and any type of anemia therapy (red blood cell transfusions within three weeks before enrollment, medical therapy with iron, vitamin B12, fo- late, or erythropoietin stimulating agents [ESA]). Information was collected on medical history, physical examination and routine clinical measures, while details on medical history were based on personal interview as well as by detailed investigation of the patients’ charts. Biomate- rials were processed immediately and stored at -80°C. Between 2008 and 2009, patients were followed by telephone interview with their nephrologist and/or primary care physician (PCP) regarding survival status, initiation of RRT and the patient’s last available serum creatinine measurement. The latter value was determined prior to death (however, in a considerably sta- ble condition as judged by the patient’s PCP/nephrologist) or most closely to the date of the telephone interview. During the same time of baseline examination, a group of n = 29 type 1 di- abetic patients was enrolled in the study according to the procedures described above, while longitudinal information was collected up to 2012. The study was approved by the Ethics Com- mittee of the University of Würzburg. All patients provided written informed consent.
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Alcohol consumption and risk of fatty liver disease: a meta-analysis

Alcohol consumption and risk of fatty liver disease: a meta-analysis

In the two previous meta-analysis conducted by Corrao et al. (1998) and Rehm et al. (2010), they included 15 and 17 epidemiological studies, respectively, mainly from the USA and Europe, and assessed the association between alcohol consumption and liver cirrhosis, demonstrating that heavy alcohol consumption significantly increases risk of liver cirrhosis. Corrao et al. also found that the same amount of average alcohol consumption was related to a higher risk of liver cirrhosis in women than in men. In the present meta-analysis, we evaluated the association of alcohol consumption with risk of FLD by including the 16 observational studies mainly from Asia, especially Japan. Our results, which have been described above, are inconsistent with the findings in the two previous meta-analysis. The different results between our study and the two previous meta-analysis may be explained in part by the differences in different stages of FLD development, and ethnicity and genetic factors. The two meta-analysis by Corrao et al. and Rehm et al. assessed the association of alcohol consumption with frank liver cirrhosis, namely end-stage liver disease of ALD development, whereas our meta-analysis evaluated the correlation between alcohol consumption and risk of the relative early stages of ALD development, namely fatty liver (simple steatosis) and steatohepatitis. On the other hand, Kwon et al. reported that aldehyde dehydrogenase 2 (ALDH2) deficiency can ameliorate alcoholic fatty liver in mice (Kwon et al., 2014). Approximately 40–50% of East Asians carry an inactive ALDH2 gene (ALDH2*2 allele) (Singh et al., 1989), but it is very rarely that ALDH2*2 allele is found in European (Peterson, Goldman & Long, 1999). The above data appear to partly explain the reason why even excessive alcohol consumption also seemed to have a protective effect on FLD in Japanese men.
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Exercise Capacity Impairment Can Predict Postoperative Pulmonary Complications after Li art cbamagalhães

Exercise Capacity Impairment Can Predict Postoperative Pulmonary Complications after Li art cbamagalhães

encephalopathy), vascular, or musculoskeletal conditions limiting their ability to walk and were therefore excluded. All subjects list- ed for LT, with priority for graft allocation, who attended the out- patient LT clinic, were submitted to a preoperative evaluation, in- cluding clinical history, physical examination, spirometry, mea- surement of respiratory muscle strength, 6MWT, and 6MST. As the tests were performed concomitantly, on average 7 days before surgery, they were indeed very up-to-date. Cases with ascites lead- ing to significant functional capacity impairment were routinely drained, and tests were carried out afterwards. After LT, the pa- tients were transferred to an intensive care unit (ICU). Ventilatory strategy included a tidal volume of 6 mL/kg of the ideal body weight. As mechanical ventilation with high positive end-expira- tory pressure has been reported to impair liver outflow [17] , we started with 5 cm H 2 O and adjusted from 5 to 10 cm H 2 O according
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Aberrant functional connectome in neurologically asymptomatic patients with end-stage renal disease.

Aberrant functional connectome in neurologically asymptomatic patients with end-stage renal disease.

We further examined the small-world parameters of each functional module motived by the fact that different modules possess unique organizations [64, 65]. Four modules were identified in the HC group, largely consistent with those in a previous study [66]. In the modular frame- work, all the modules were aberrantly organized in ESRD in a similar manner to that of whole- brain networks. These findings indicate that as a general change in ESRD, disrupted balances between local specialization and global integration are involved in all functional systems. This is consistent with previous findings that ESRD is associated with diffused gray matter atrophy [67] and white matter damage [19, 20] over the cerebral mantle. Before any overt neurological manifestation, patients with ESRD are often accompanied with various cognitive deficits, such as attention, processing speed [68], executive function [13], motor function [69] and memory [70]. We speculate that the generality of cognitive disturbances in ESRD may (at least partly) be attributable to widespread disruptions in network organization. Notably, the patients in this study were cognitively intact globally (MMSE > = 28). Therefore, altered network organization may be an early predictive sign of cognitive dysfunction in the disease. Future studies are re- quired to determine the dynamic reconfiguration of network organization with the progress of the disease.
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The Korean Clinical Research Center for End-Stage Renal Disease Study Validates the Association of Hemoglobin and Erythropoiesis-Stimulating Agent Dose with Mortality in Hemodialysis Patients.

The Korean Clinical Research Center for End-Stage Renal Disease Study Validates the Association of Hemoglobin and Erythropoiesis-Stimulating Agent Dose with Mortality in Hemodialysis Patients.

We also investigated whether the survival benefit differs by patient characteristics, including patient age or the presence of diabetes. In subgroup analysis stratified by age or diabetes status, HR for mortality was significantly increased in Hb category < 9 g/dL in both older and youn- ger groups, whereas in Hb category 9–10 g/dL, the increased risk for mortality was statistically significant only in the younger group. However, the interaction of age and Hb level on mortal- ity risk tended to be significant only at Hb level 9–10 g/dL. This result suggests that the older group might tolerate lower Hb better than the younger group, especially at Hb level 9–10 g/dL. Similar to our findings, the Japan Dialysis Outcomes and Practice Patterns Study (J-DOPPS) cohort demonstrated that the population aged over 75 years had poorer prognosis only at Hb < 9 g/dL [14]. The marginal significance of interaction in our study might be related to the smaller number of patients compared to the Japanese study.
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Frequency of Helicobacter pylori infection in patients with liver cirrhosis

Frequency of Helicobacter pylori infection in patients with liver cirrhosis

Pre va len ci ja in fek ci je s H. pylo ri kod op šte po- pu la ci je ve o ma je pro u ča va na. We na uče sta lost je 45- 83%, s tim da je vi ša u so ci o e ko nom ski ni že raz vi- je nim ze mqa ma, te da se pre va len ci ja ove in fek ci je po ve ća va sa sta ro šću [6]. Ciq ve li kog bro ja is tra- ži va wa bio je da se utvr di pre va len ci ja ove in fek- ci je kod oso ba obo le lih od ci ro ze je tre. Re zul ta ti su, me đu tim, bi li kon tro verz ni [7-10]. Me đu obo le- li ma od ci ro ze pre va len ci ja in fek ci je s H. pylo ri je iz me đu 10% i 49%, a ri zik od raz vo ja ove in fek ci je čak 5-8 pu ta ve ći u po re đe wu s op štom po pu la ci jom [11]. Re zul ta ti auto ra iz Špa ni je po ka zu ju pre va len- ci ju in fek ci je od 45,5% kod bo le sni ka s ci ro zom je- tre. Po red to ga, po ka za li su da pre va len ci ja ove in- fek ci je ne za vi si od sta ro snog do ba i po la bo le sni- ka, ni ti od po re kla ci ro ze [12]. Utvr đe ne su obr nu- ta re la ci ja pre ma Čajld–Pju o vom ste pe no va wu i ten- den ci ja sma we wa pre va len ci je in fek ci je pre ma po- sto ja wu port no si stem ske en ce fa lo pa ti je [13], što je po tvr đe no i na šim is tra ži va wem. U po re đe wu s op štom po pu la ci jom, kod bo le sni ka s ci ro zom je tre i ul ku som že lu ca za be le že no je vi še kom pli ka ci- ja, po put kr va re wa, pro du že nog le če wa i ve ćeg ste- pe na re ci di va ul ku sa [11]. Sto pa smrt no sti kod kr- va re wa iz pep tič kog ul ku sa je 20%, što je vi še ne go kod bo le sni ka bez ci ro ze je tre. Pa to lo ški me ha ni- zmi od go vor ni za ta kvo sta we su i da qe ne ja sni, ma- da se sma tra da va žnu ulo gu ima ju al te ra ci je u lu če- wu že lu dač ne ki se li ne, hi per hi sta mi ne mi ja, ošte- ćen pro tok kr vi kroz mu ko zu že lu ca i pro me ne od- bram be nih me ha ni za ma mu ko ze, kao po sle di ce port- ne hi per ten zi je i we nih efe ka ta na mu ko zu že lu ca. Uti caj in fek ci je s H. pylo ri na ta ko iz me we ne pa to- fi zi o lo ške me ha ni zme kod bo le sni ka s ci ro zom je, me đu tim, ne po znat. Dru ga is tra ži va wa su po ka za la da kod oso ba obo le lih od ci ro ze je tre po sto ji iden- ti čan epi de mi o lo ški obra zac za in fek ci ju s H. pylo- ri kao i u op štoj po pu la ci ji [14, 15].
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