Acute Liver Failure due to Wilson Disease: Eight Years of the National Liver Transplant Program in Uruguay.

INTRODUCTION AND AIM: Wilson's disease (WD) is an uncommon cause of acute liver failure (ALF). Our aim was to describe clinical features, diagnostic findings, treatments, and outcomes of patients with ALF due to WD. MATERIAL AND METHODS: Retrospective medical record reviews of all patients with ALF due to WD in eight years in Uruguay. RESULTS: WD was the cause of six (15%) of thirty-nine ALF cases. All patients were females, with a mean age of 18 years. Four patients presented with hyperacute liver failure and two with acute failure. Jaundice was the main complaint of all patients. Mean total bilirubin (TB), alkaline phosphatase (AP), AST, and ALT were 27.5 mg/dL, 45.5 lU/l, 156 IU/L, and 51 IU/L, respectively. Ceruloplasmin levels were low in four patients, urinary cooper was high in four, and two had Kayser-Fleischer rings. All patients had Coombs-negative hemolytic anemia, acute kidney injury, histochemical identifiable copper, and advanced fibrosis on liver histology. The average MELD score was 36. All patients were treated with d-penicillamine and listed for urgent liver transplantation (LT). Prometheus® was performed in one patient. Three patients died: two without LT and one after LT. Three patients survived: one without LT (New Wilson Index<11) and two with LT. The referral time to the program and the total time (referral plus waiting list time) were longer for non-survivors than for survivors (14 vs. 3 days and 23 vs. 8 respectively). CONCLUSION: All cases had typical clinical, analytical and histopathology characteristics. Early referral was determinant of prognosis.

Errores de medicamentos LASA en anestesiología en Uruguay / LASA medication errors in anesthesiology in Uruguay

El error en la administración de fármacos es una causa frecuente de incidentes críticos en el perioperatorio. Se definen como medicamentos LASA (del inglés, look alike, sound alike) a aquellos medicamentos que se parecen físicamente o que sus nombres suenan parecido. Objetivo: conocer la situación de probable riesgo a la que se exponen los pacientes en Uruguay durante las cirugías con anestesia a causa de errores de medicación LASA (subgrupo LA). Material y método: se documentaron fotográficamente las ampollas involucradas en las confusiones con medicamentos LASA de uso anestésico que causaron o pudieron causar la muerte del paciente al inyectarse accidentalmente. La identificación de las ampollas confundidas se realizó mediante una encuesta anónima a una muestra representativa de los anestesiólogos de Uruguay (n=70). Se analizaron dos tipos de confusiones: las casi inyecciones y las inyecciones accidentales. Resultados: el atracurio es el fármaco que se confunde con mayor frecuencia; los 10 fármacos más confundidos (27,0% de los 37 analizados) están implicados en 80,6% de las confusiones y en 88,4% de las inyecciones accidentales. Se fotografiaron las ampollas LASA para esos 10 fármacos y 48 de los 56 pares de fármacos confundidos. Conclusión: en Uruguay existen ampollas LASA de uso anestésico que generan riesgo potencial y real de confusiones, dado su aspecto similar, al 86,2% de los anestesiólogos. El 88,4% de esos accidentes podrían disminuirse si se identifican claramente las ampollas de 10 fármacos.

Medication errors are a frequent cause of critical incidents in the preoperative and postoperative stages. LASA drugs (look alike, sound alike) are defined as those which physically resemble others, or whose names sound similar. Objective: to learn about the probable risk Uruguayan patients are exposed to when undergoing surgeries with anesthesia, due to LASA medication errors (LA subgroup). Method: pictures of ampoules involved in LASA medication errors for anesthetic use that cause or could have caused the patients' death when accidentally injected were taken. Identification of the confused ampoules was made by means of an anonymous survey in a representative sample of Uruguayan anesthesiologists (n=70). Two kinds of confusions were analysed: accidental injections and cases where injections were almost given. Results: atracurio is the most frequently confused drug; the 10 most regularly confused drugs (27.0% out of the 37 analysed) are involved in 80.6% of confusions and in 88.4% of accidental injections. Pictures were taken of LASA ampoules for these 10 drugs and 48 of the 56 pairs of drugs confused. Conclusion: there are LASA ampoules for anesthetic purposes in Uruguay that represent a potential and real risk of being confused, due to their being similar to others, by 86.2% of anesthesiologists. 88,4% of these accidents could be reduced if the ampoules of these 10 drugs were clearly identified.

O erro na administração de fármacos é uma causa frequente de acidentes críticos no período peri operatório. Os medicamentos chamados LASA (abreviatura em inglês, Look Alike, Sound Alike) são aqueles cujo aspecto, nome fonético ou ortográfico são semelhantes. Objetivo: conhecer a situação de provável risco a que estão expostos os pacientes durante as cirurgias com anestesia devido a erros por medicamentos LASA (subgrupo LA) no Uruguai. Material e método: fez-se um registro fotográfico das ampolas que foram usadas nos episódios de confusão com medicamentos LASA de uso anestésico que causaram ou puderam causar a morte do paciente por ser injetados acidentalmente. A identificação das ampolas confundidas foi feita através de um questionário anónimo submetido a uma amostra representativa de anestesistas no Uruguai (n=70). Foram analisados dois tipos de erros: as quase injeções e as injeções acidentais. Resultados: o atracúrio é o fármaco que é confundido com mais frequência; os 10 fármacos mais confundidos (27,0% dos 37 analisados) estão presentes em 80,6% das confusões e em 88,4% das injeções acidentais. As ampolas LASA desses 10 fármacos e 48 dos 56 pares de fármacos confundidos foram fotografados. Conclusão: no Uruguai existem ampolas LASA de uso anestésico que geram risco potencial e real de confusões, devido ao aspecto similar, para 86,2% dos anestesistas. 88,4% desses acidentes poderiam ser reduzidos se as ampolas desses 10 fármacos fossem claramente identificadas.

Biting activity and breeding sites of Anopheles species in the municipality Villavicencio, Meta, Colombia.

Villavicencio, the capital city of the Department of Meta, Colombia, is at high risk for the urbanization of malaria because of the region's ecological conditions, as well as the permanent presence of infected human populations arriving from rural areas. From August to November 2002 and in April 2003, anopheline collections were undertaken in the area. Isofamilies were obtained from 331 wild females, which were then recorded according to their abundance as follows: Anopheles marajoara, Anopheles rangeli, Anopheles braziliensis, Anopheles darlingi, and Anopheles apicimacula. Anopoheles darlingi showed the highest biting activity (3.0) between 1800 and 1900 h. Forty-five breeding places were sampled, 64% of which were fish ponds, 6.7% flooded meadows, and 6.7% drainpipes, with these being the most representative locations. All sampled breeding sites were positive for anophelines. Anopheles marajoara could play an important role as an auxiliary vector in Villavicencio's urban area. Control measures should be aimed at weeding the marginal areas around fish ponds and at evaluating the use of impregnated bed-nets.