Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Pott’s disease or tuberculous spondylodiscitis accounts for less than 1% of tuberculosis cases. However, the indolent clinical course of this condition leads to a generally delayed diagnosis and to the destruction of the vertebral structures. The resulting spinal deformity requires surgical treatment, which is complex and demands a prolonged hospital stay. In this report, we present the case of a 52-year-old male patient who was diagnosed with lumbar spondylodiscitis by clinical and imaging studies, without response to an empiric antibiotic treatment. Transforaminal percutaneous approach, a minimally invasive technique, allowed the diagnosis of tuberculous spondylodiscitis and a symptomatic improvement of the patient.

Ayahuasca belongs to the group of plant-based or vegetal hallucinogens sharing their alterating effects on the state of consciousness and causing perceptual alterations. Traditionally used as a concoction in ceremonial rites aimed to achieve experiences of spiritual or curative content, its use has expanded throughout centuries, reaching our current cultural context, where it is used by small groups guided by purposes of personal growth. The experience usually lasts a few hours and the effects are usually self-limited. We describe the case of a patient who developed a manic episode with psychotic symptoms after experimental consumption of ayahuasca. In addition, a systematic review of published cases of sustained psychotic symptoms after the consumption of ayahuasca is carried out. There are few experimental studies of the relationship between ayahuasca and psychotic experiences, although a good safety profile has been determined in single administrations to healthy subjects. In the present study, the results suggest that the appearance of psychotic episodes associated with ayahuasca consumption is an infrequent phenomenon and seem to be related to vulnerability characteristics such as personal or family history of severe mental disorder or the concomitant use of other drugs, particularly cannabis.

Objective: To identify changes of prescription patterns in long term psychiatric inpatients in 1995 and 2009. Material and Methods: Cross sectional comparative study of two one-day-census, (06/15/1995 and 12/14/2009) at the Hospital Neuropsiquiátrico Alejandro Korn, Argentina. Records of prescribed psychotropic agents to all patients in long stay wards were examined. Results: The number of hospitalized patients decreased 33% from 1995 (n=1048) to 2009 (n=698), with increases in male gender (44% a 57%) and hospitalizations lasting more than 20 years (29% a 40%). Schizophrenia remained as the most prevalent diagnosis followed by learning disabilities/mental retardation (45% and 27% in 1995, respectively, 44% and 33% in 2009). The average antipsychotic dosis in schizophrenia was almost the same, the equivalent of around 760 mg of chlorpromazine. Patients on antipsychotic doses above an equivalent of 1200 mg decreased from 28% to 23,9%. Around 80% of those with learning disabilities were prescribed antipsychotics on both census. Antipsychotic polypharmacy increased 6,7% in schizophrenia (61%) and decreased 12,6% in learning disabilities (45%), and 6,5% in all inpatients (49%). Haloperidol and levomepromazine were still the more frequently prescribed antipsychotics while the use of anticholinergic agents diminished in a 21%. Regarding sedatives, the use of benzodiazepines and promethazine increased (15% and 19% respectively), while around 35% in both census was still receiving levomepromazine. Discussion: The introduction of atypical antipsychotic was not followed by great improvements in the rational use of psychotropics drugs, except for less antipsychotic polypharmacy in learning disabilities and of anticholinergics in the general population. Conclusion: The increase in antipsychotic polypharmacy in schizophrenia and the continuous use of benzodiazepines highlight the need to bring the usual practice closer to the evidence provided by clinical research.

Objective: To explore the perceived parental rearing behavior in adolescents diagnosed with an eating disorder, and to identify eventual differences with altered eating and self-injurious behaviors. Material and methods: A total of 45 adolescents diagnosed with some eating disorder (11 diagnosed with anorexia nervosa, 23 with bulimia nervosa and 11 with binge eating disorder), recruited from the outpatient and hospitalization areas of the Juan N Navarro Children’s Psychiatric Hospital, were included. Results: It was found that the greater the memories of favoritism (r = 0.41, p-value = 0.005) or rejection (r = 0.36, p-value = 0.016) by the father, the higher the scores on the Eating Attitude Scale. Differences were also found in the mother’s warmth dimension, between the adolescents who presented self-injuries (mean = 39.6, de = 11.3) and those who did not present them (mean = 47.4, de = 8.8) (t =-2.6, value p = 0.015). Conclusions: Adolescents with a diagnosis of eating disorders presented differences in their perception of parental rearing, a factor that may decisively influence the manifestation of other psychopathological behaviors.

Subarachnoid hemorrhage is a very rare complication of thrombolytic therapy. We report the case of a 76-year- old mestizo woman with a pacemaker, admitted to the emergency room due to compromised consciousness, walking difficulties and dysarthria. She reported a history of poorly controlled hypertension, hypothyroidism, and numerous surgical interventions. Based on a non-contrast Multislice Computed Tomography (MSCT) of the brain and the clinical manifestations, a diagnosis of ischemic stroke was established. Thrombolytic therapy with alteplase was immediately started and another non-contrast MSCT brain scan, performed three hours later, identified a subarachnoid hemorrhage as a treatment complication. Twenty-four hours later, a CT angiography confirmed an ischaemic stroke with hemorrhagic transformation, without the presence of a ruptured aneurysm. The patient was admitted to ICU, remaining in observation with permanent control of vital signs, and discharged after 20 days. the patient was discharged. The identification and reporting of this unusual complication contribute to a better understanding and diagnosis of the case.

Objectives: Description of epidemiological features of suicides in Peru between the years 2017-2021. Material and Methods: Descriptive-comparative study based on the review of the national computerized registry of SINADEF deaths between the years 2017-2021; the final sample included a total of 2579 suicides. Results: Male gender reached 69.5%, average age 34.87 years, 79.5% were single, and 26.6% had complete secondary education. The departments with highest frequency of suicides were Lima (20.3%), Arequipa (19.2%), Cusco (9.5%) and Junín (7.8%). According to ICD-10, the main cause of death was cerebral edema (22.71%), and place of death at home (63.4%). Suicide modalities included hanging (56.6%), poisoning (29.2%), firearm (4%), precipitation (3.1%), and knife (1.7%). It was possible to establish significant differences with a p<0.05 value in: type of suicide and gender, 74% of hangings among males; type of suicide and natural region: hanging in the coast (60%); type of suicide and age range: hanging 10-19 years (27.7%) and poisoning 20-29 years (26.5%). A majority (70.7%) died at home by hanging, followed by poisoning in health facilities (56.9%), and by precipitation (16.8%) on public roads. Conclusions: The most frequent type of suicide was by hanging in young-adult males, and poisoning among females.

Objective: To determine the relationship between year levels of medical studies and depressive and anxious symptoms during the first months of the COVID-19 pandemic in a sample of medical students in Lima, controlling specifically the variables sex and presence of underlying medical conditions. Material and Methods: An online survey collected information from 250 medical students, covering general data, previous medical history and symptoms of depression (PHQ-9) and anxiety (GAD-7). Data were managed using multivariate analysis of covariance. Results: Differences were found between years of study and the combined values of PHQ-9 and GAD-7 (Wilks’ Λ = 0.86; p = 1.68 x 10-4; η2p = 0.08). Underlying medical conditions also showed significant differences for the combined values of PHQ-9 and GAD-7 (Wilks’ Λ = 0.94, p = 4.43 x 10-4, η2p = 0.06). The univariate test for year of study showed differences for PHQ-9 (F6.241 = 4.12, p = 0.001, η2p = 0.09) and GAD-7 (F6.241 = 2.81, p = 0.01, η2p = 0.07). The post hoc analysis showed statistically significant differences in the first years of study. Conclusions: These results suggest that medical students of the first years show higher levels of depression and anxiety symptoms than participants from more advanced years of the medical career. Likewise, the occurrence of previous medical conditions also explained high levels of depression and anxiety.