Child and adolescent psychiatry training in Brazil, Argentina, Uruguay and Chile: current panorama and future challenges.

Mental disorders affect approximately 10-15% of children and adolescents worldwide. In South America these numbers are probably higher due to poverty and adverse life events that frequently affect this region. The availability of qualified services and well-trained professionals to care for those children are by far insufficient. The aim of this study was to assess and describe child and adolescent psychiatry (CAP) training in Brazil, Argentina, Uruguay, and Chile, to support the development and strengthen training standards. The coordinators of CAP residency programs in Brazil, Argentina, Uruguay, and Chile were invited to answer an online questionnaire about the characteristics of their training programs. Twelve programs from Brazil, three programs from Chile, two from Argentina, and one from Uruguay completed the questionnaires. In the last three countries, CAP is recognized as an independent specialty, while in Brazil it is considered a subspecialty of psychiatry. None of the countries have a national guideline for CAP residency training. Recently, there has been an increase in the number of professionals interested in pursuing a formal CAP training. This is the first study aiming to evaluate the current scenario of CAP training in South America. The results point to a great potential in the evaluated programs, but also to the need for homogeneous criteria for CAP training and evaluation of residents. A more efficient communication among programs would be an enriching strategy for their development, which may be facilitated by the results of this study.

[Suicide attempts among Chilean adolescents]. / Prevalencia de intento de suicidio adolescente y factores de riesgo asociados en una comuna rural de la provincia de Concepción.

BACKGROUND: Suicide mortality rates are increasing among teenagers. AIM: To study the prevalence and predictive factors of suicide attempts among Chilean adolescents. MATERIAL AND METHODS: A random sample of 195 teenagers aged 16 ± 1 years (53% males) answered an anonymous survey about their demographic features, substance abuse, the Osaka suicidal ideation questionnaire, Smilksten familial Apgar. Beck hopelessness scale, Beck depression scale and Coppersmith self-esteem inventory. RESULTS: Twenty five percent of respondents had attempted suicide at least in one occasion during their lives. These attempts were significantly associated with female gender, absent parents, family dysfunction, drug abuse, smoking, low self-esteem, hopelessness, depression and recent suicidal ideation. A logistic regression analysis accepted female gender, smoking and recent suicidal ideation as significant independent predictors of suicide attempt. CONCLUSIONS: Suicide attempted is common among teenagers and its predictors are female sex, smoking and previous suicidal ideation.

Prevalencia de intento de suicidio adolescente y factores de riesgo asociados en una comuna rural de la provincia de Concepción / Suicide attempts among Chilean adolescents

Background: Suicide mortality rates are increasing among teenagers. Aim: To study the prevalence and predictive factors of suicide attempts among Chilean adolescents. Material and Methods: A random sample of 195 teenagers aged 16 ± 1 years (53% males) answered an anonymous survey about their demographic features, substance abuse, the Osaka suicidal ideation questionnaire, Smilksten familial Apgar. Beck hopelessness scale, Beck depression scale and Coppersmith self-esteem inventory. Results: Twenty five percent of respondents had attempted suicide at least in one occasion during their lives. These attempts were significantly associated with female gender, absent parents, family dysfunction, drug abuse, smoking, low self-esteem, hopelessness, depression and recent suicidal ideation. A logistic regression analysis accepted female gender, smoking and recent suicidal ideation as significant independent predictors of suicide attempt. Conclusions: Suicide attempted is common among teenagers and its predictors are female sex, smoking and previous suicidal ideation.

Propiedades psicométricas de la escala de síntomas de TEPT para niños (CPSS) en población chilena afectada por el terremoto y tsunami del 27-F de 2010 / Psychometric properties of the children's posttraumatic symptoms scale in the earthquake and tsunamis chileans' victims

Existen pocos instrumentos para la evaluación de sintomatología postraumática en niños/as y adolescentes en Latinoamérica. El presente estudio analiza las propiedades psicométricas de la child PTSD Symptom Scale CPSS (Foa, Johnson, Feeny y Treadwell, 2001), en niños y niñas víctimas de un desastre natural. Se realizan los análisis psicométricos habituales, incluyendo un análisis factorial exploratorio y uno confirmatorio. Se analiza la convergencia de la escala CPSS con el diagnóstico de TEPT a través de la entrevista estructurada DISC-IV Una estructura de tres factores de primer orden fue la que mostró mejor ajuste en el análisis confirmatorio. La escala mostró alta consistencia interna. Un puntaje de 24 o más puntos permite obtener una sensibilidad de 82 por ciento y especificidad de 88 por ciento respecto del diagnóstico de TEPT con el DISC-IV Estas positivas cualidades psicométricas indican la utilidad de la escala para ser usada en chile con niños/ as y adolescentes expuestos a desastres naturales.

There are not many instruments about evaluation of post Traumatic symptomatology in Latin-American children and adolescents. The current study analyzes the psychometric properties of the child PTSD Symptom Scale CPSS (Foa, Johnson, Feeny y Treadwell, 2001), among young victims of a natural disaster. Regular psychometric analyses were carried out, including an exploratory and confirmatory factor analysis of the instrument. The structured interview DISC-IV was used as a criterion test. An structure of three first order factors showed the best fit. The scale presented high internal consistency. A score of 24 or more points allowed a sensitivity of 82 percent and a specificity of 88 percent according to DISC-IV. These positive psychometric qualities indicate the utility of this scale to be used in chilean children and adolescents.

Estudio comparativo de dos escalas de depresión en relación al intento de suicidio en adolescentes no consultantes / Comparative study of two scales of depression in relating to suicide attempt in no consultant adolecents

Introduction: 80 percent of young people who attempt suicide and 90 percent of those who consume it have a history of psychiatric disorders. The more involved psychopathologies are the mood disorders, especially depression. Objective: Characterize the behavior of 2 depression scales applied to adolescents in relation to suicidal attempts. Method: Cross-sectional analytical study. 195 adolescents were surveyed in the "Liceo Nueva Zelandia' of Santa Juana (Sampling error = 0.0445) media random sampling provided by sex and grade, including the application of Beck's Depression Inventory (BDI), Child Depression Inventory (CDI) and a history of attempted suicide. X², T-Student, Mann-Whitney U, Spearman linear correlation and binary logistic regression were used. Results: When analyzing the mean scores obtained by both groups, both scales show significant differences statistically (p < 0.001). The scales present a strong to moderate linear correlation (p < 0.001). Only BDI is significant in the logistic regression model (p = 0.001). Discussion: Although these scales evaluated the depression construct similarly, the CDI would be redundant to associate it with the suicide attempt. It would be necessary to implement the factorial studies of the composition of the BDI to identify components associated with attempted suicide...

Introducción: El 80 por ciento de los jóvenes que intentan suicidarse y el 90 por ciento de quienes lo consuman tienen historia de desordenes psiquiátricos. Las psicopatologías más involucradas son los trastornos del ánimo, especialmente la Depresión. Objetivo: Caracterizar el comportamiento de 2 escalas para Depresión aplicada en adolescentes relacionado al intento de suicidio. Método: Estudio analítico de corte transversal. Se encuestó a 195 adolescentes del Liceo Nueva Zelandia de Santa Juana (Error de muestreo = 0,0445) mediante muestreo aleatorio proporcionado por sexo y curso, incluyendo Escala de Depresión de Beck (BDI), Cuestionario de Depresión Infantil (CDI) y antecedentes de intento de suicidio. Se utilizaron estadísticos descriptivos, X², T-student, U Mann-Whitney, correlación lineal de Spearman y Regresión logística binaria. Resultados: Al analizar los promedios de los puntajes obtenidos por los grupos intentadores y no intentadores en ambas escalas presentan diferencias estadísticamente significativas (p < 0,001). Las escalas presentan una correlación lineal moderada a fuerte (p < 0,001). Sólo la BDI es significativa en el modelo de regresión logística (p = 0,001). Discusión: Si bien ambas escalas evalúan el constructo de depresión de manera similar, la CDI sería redundante al asociarla al intento de suicidio. Sería necesario poner en práctica los estudios factoriales de la composición de la BDI para identificar los componentes asociados al intento de suicidio...

[Prevalence of psychiatric disorders among Chilean children and adolescents]. / Salud mental infanto-juvenil en Chile y brechas de atención sanitarias.

BACKGROUND: Psychiatric disorders that appear during childhood or adolescence should be a public health priority. AIM: To report the results of a national representative survey in the Latin American region examining the prevalence of DSM-IV psychiatric disorders in children and adolescents. MATERIAL AND METHODS: Subjects aged 4 to 18 years were selected using a stratified multistage design. The Diagnostic Interview Schedule for Children Version IV (DISC-IV) was used to obtain 12-month DSM-IV diagnoses, and was supplemented with questionnaires examining family risk factors, socioeconomic status and service use. RESULTS: A sample of 1558 children and adolescents (51% males) was evaluated. Fifty three percent of the sample were children aged 4 to 11 years and the rest were adolescents aged 12 to 18 years. The prevalence rate for any psychiatric disorder without impairment was 38.3% (33.5% for boys and 43.3% for girls). The prevalence rate was higher among children as compared to adolescents (42.9% and 33.2%, respectively). A third of participants receiving a diagnosis sought some form of assistance. Nearly a quarter of those using services, did not have a psychiatric diagnosis in the past year. Comorbidity was found in 27% of those with a disorder, but only 7% had three or more diagnoses. CONCLUSIONS: The prevalence of psychiatric disorders in Chile is high among children and adolescents. This study highlights the increasing need to re-evaluate mental health services provided to children and adolescents in our country.

Prevalence of child and adolescent mental disorders in Chile: a community epidemiological study.

BACKGROUND: In Latin America, there is limited research on the prevalence of mental disorders in children and adolescents. This Chilean survey is the first national representative survey in the Latin American region to examine the prevalence of diagnostic and statistical manual-IV (DSM-IV) psychiatric disorders in the region in children and adolescents. METHODS: Subjects aged 4-18 were selected using a stratified multistage design. The diagnostic interview schedule for children version IV (DISC-IV) was used to obtain 12-month DSM-IV diagnoses of affective, anxiety, conduct and substance use disorders, and supplemented with questionnaires examining family risk factors, family income, and service utilization. The parent or the primary caretaker was interviewed for children, aged 4-11, using the DISC-IV; however, adolescents, aged 12-18, were directly interviewed. RESULTS: A sample of 1558 children and adolescents was evaluated. Using the most stringent DISC-IV impairment algorithm, the prevalence rate for any psychiatric disorders was 22.5% (19.3% for boys and 25.8% for girls). The prevalence rate was higher among the children, aged 4-11, in comparison with adolescents, aged 12-18 (27.8% and 16.5%, respectively). Less than half of the subjects in need of services sought some form of assistance. Nearly a quarter of those using services did not present with a psychiatric diagnosis in the past year. Comorbidity was found in 24.8% of those with a disorder, but only 6.3% had three or more diagnoses. CONCLUSIONS: The prevalence of psychiatric disorders in Chile is high among children and adolescents. This study highlights the increasing need to reevaluate mental health services provided to children and adolescents in Latin America.

Salud mental infanto-juvenil en Chile y brechas de atención sanitarias / Prevalence of psychiatric disorders among Chilean children and adolescents

Background: Psychiatric disorders that appear during childhood or adolescence should be a public health priority. Aim: To report the results of a national representative survey in the Latin American region examinig the prevalence of DSM-IV psychiatric disorders in children and adolescents. Material and Methods: Subjects aged 4 to 18 years were selected using a stratified multistage design. The Diagnostic Interview Schedule for Children Version IV (DISC-IV) was used to obtain 12-month DSM-IV diagnoses, and was supplemented with questionnaires examining family riskfactors, socioeconomic status and service use. Results: A sample of1558 children and adolescents (51% males) was evaluated. Fifty three percent of the sample were children aged 4 to 11 years and the rest were adolescents aged 12 to 18 years. The prevalence rate for any psychiatric disorder without impairment was 38.3% (33.5% for boys and 43.3% for girls). The prevalence rate was higher among children as compared to adolescents (42.9% and 33.2%, respectively). A third of participants receiving a diagnosis sought some form of assistance. Nearly a quarter of those using services, did not have a psychiatric diagnosis in the past year. Comorbidity was found in 27% of those with a disorder, but only 7% had three or more diagnoses. Conclusions: The prevalence of psychiatric disorders in Chile is high among children and adolescents. This study highlights the increasing need to re-evaluate mental health services provided to children and adolescents in our country.

[Prevalence of mental health disorders among children and adolescents living in southern Chile]. / Epidemiología de trastornos mentales infanto juveniles en la Provincia de Cautín.

BACKGROUND: The knowledge about prevalence of psychiatric disorders in all age groups is fundamental to plan an adequate mental health care. AIM: To determine the prevalence of DSM-IV psychiatric disorders in a representative sample of children and adolescents living in the province of Cautin, Chile. MATERIAL AND METHODS: Subjects aged between 4 and 18 years were selected in an aleatory stratified multistage fashion. As part of a national sample, four counties in Cautín were selected, then blocks, homes and the child or adolescent to be interviewed. Psychology graduate students applied the Spanish computer version of DISC-IV, as well as a questionnaire on family risk factors, socioeconomic index and service use. RESULTS: A sample of 272 children and adolescents was evaluated, obtaining 93,4% of participation. Using the most stringent impairment algorithm, the prevalence rate for any psychiatric disorder was 16.8%, being 16.5% in boys and 17.1% in girls and mainly explained by anxiety and affective disorders. Prevalence was practically the same in the group aged 4 to 11 years than in those aged 12 to 18 years (16.7% and 16.8% respectively). Prevalence of anxiety disorders was the highest, but less associated with impairment. On the other hand, all children and adolescents with affective disorders were impaired. CONCLUSIONS: The prevalence of psychiatric disorders in Cautín is high in children and adolescents.

Epidemiología de trastornos mentales infanto juveniles en la Provincia de Cautín / Prevalence of mental health disorders among children and adolescents living in southern Chile

Background: The knowledge about prevalence of psychiatric disorders in all age groups is fundamental to plan an adequate mental health care. Aim: To determine the prevalence of DSM-IV psychiatric disorders in a representative sample of children and adolescents living in the province of Cautin, Chile. Material and Methods: Subjects aged between 4 and 18 years were selected in an aleatory stratified multistage fashion. As part of a national sample, four counties in Cautín were selected, then blocks, homes and the child or adolescent to be interviewed. Psychology graduate students applied the Spanish computer version of DISC-IV, as well as a questionnaire on family risk factors, socioeconomic index and service use. Results: A sample of 272 children and adolescents was evaluated, obtaining 93,4 percent of participation. Using the most stringent impairment algorithm, the prevalence rate for any psychiatric disorder was 16.8 percent, being 16.5 percent in boys and 17.1 percent in girls and mainly explained by anxiety and affective disorders. Prevalence was practically the same in the group aged 4 to 11 years than in those aged 12 to 18 years (16.7 percent and 16.8 percent respectively). Prevalence of anxiety disorders was the highest, but less associated with impairment. On the other hand, all children and adolescents with affective disorders were impaired. Conclusions: The prevalence of psychiatric disorders in Cautín is high in children and adolescents.

Edad óptima para el despistaje endoscópico de cáncer gástrico en pacientes con dispepsia sin síntomas de alarma / Age optimal for endoscopic screening for gastric cancer in patients with dyspepsia symptoms without alarm

Objetivo: Determinar la edad óptima de despistaje de cáncer gástrico en pacientes con dispepsia sin síntomas de alarma. MÉTODO: Estudio analítico, descriptivo y retrospectivo (2001-2005). Se analizó 285 casos de pacientes con dispepsia y cáncer gástrico en el Hospital Nacional Arzobispo Loayza, calculándose la frecuencia acumulativa por edad y grupo etáreo, así como también por estudio de percentiles, para determinar la edad óptima de despistaje endoscópico. Ambos grupos, con y sin signos de alarma fueron analizados con frecuencias relativas y absolutas, Chi-cuadrado y test de Student según la variable categórica o contínua respectivamente. Se consideró valores significativos de p<0.05. RESULTADOS: De 32,388 endoscopías realizadas en pacientes por motivo de dispepsia, se encontró 285 casos confirmados de cáncer gástrico, 45 de ellos sin signos de alarma. No hubo diferencia en la frecuencia acumulativa <35 y <40 años, con una pérdida de casos de cáncer gástrico de 0.29 y 0.30 por 1000 endoscopías, respectivamente. Al tomarse 40 años como edad óptima de despistaje, se perderían 4 casos (8.9 por ciento, aproximadamente 1 caso por año), de los cuales uno sería cáncer gástrico precoz. El percentil 5 fue 30.3 años y el 10 fue 39,4 años. Si se hubiera tomado una edad de 45 años se habrían perdido 6 casos (15 por ciento) y 12 (27 por ciento), si la edad se elevaba a 55 años. No hubo diferencia estadísticamente significativa entre el sexo, edad y duración de la dispepsia. Por el contrario, sí existió relación con el tipo de dispepsia (ulcerosa), tipo de lesión, localización, histología y el estadío del cáncer gástrico para ambos grupos. CONCLUSIÓN: Se recomienda que la edad óptima para el despistaje endoscópico de cáncer gástrico en pacientes con dispepsia sin síntomas de alarma, sea a partir de los 40 años de edad para ambos sexos.

Objective: To determine the optimal age for screening endoscopy on patients withdyspepsia without alarm symptoms to avoid missing gastric cancer. Methods: A Cross sectional study was performed (2001-2005). 285 cases of patientswith dyspepsia and gastric cancer were found at Arzobispo Loayza National Hospital. Cumulative age frequencies and percentiles were used to determine the optimal age for screening endoscopy. Both groups, with and without alarm symptoms were comparedusing the chi-square test for categorical data. Continuous data was expressed as mean (SD) and was compared with the t- test. Significant values of p were specified as mayor 0.05. Results: A total of 32,388 upper endoscopic procedures in dyspeptic patients were performed and 285 cases of gastric cancer were diagnosed, 45 cases of them not featuring any alarm symptoms were found. There were no differences in cumulative frequency between the mayor 35 and mayor 40 years old, with a frequency of 0.29 and 0.20 per 1000 endoscopies, respectively. If the age of 40 had been taken as the optimal age for screening, 4 cases of gastric cancer (8.9 per cent) would have been missed (one case per year approximately),one case would have been an early gastric cancer. The 5th percentile was 30.3 years old and the 10th was 39.4. If the age of 45 had been taken as the optimal age for screening, 6 (15 per cent) cases of gastric cancer would have been missed and 12 (27 per cent) cases if the age was 55 years old. There was no statistical difference between gender, age and duration of dyspepsia. On the other hand, relations between type of dyspepsia (ulcerative), type of lesion, position, histology and stage of gastric cancer for both groups were found. Conclusion: It´s recommended that the optimal age for endoscopic screening for gastric cancer in dyspeptic patients without alarm symptoms for both genders, should be over 40 years old.

[Optimal age for gastric cancer screening in patients with dyspepsia without alarm symptoms]. / Edad óptima para el despistaje endoscópico de cáncer gástrico en pacientes con dispepsia sin síntomas de alarma.

OBJECTIVE: To determine the optimal age for screening endoscopy on patients with dyspepsia without alarm symptoms to avoid missing gastric cancer. METHODS: A Cross sectional study was performed (2001-2005). 285 cases of patients with dyspepsia and gastric cancer were found at Arzobispo Loayza National Hospital. Cumulative age frequencies and percentiles were used to determine the optimal age for screening endoscopy. Both groups, with and without alarm symptoms were compared using the chi-square test for categorical data. Continuous data was expressed as mean (SD) and was compared with the t- test. Significant values of p were specified as <0.05. RESULTS: A total of 32,388 upper endoscopic procedures in dyspeptic patients were performed and 285 cases of gastric cancer were diagnosed, 45 cases of them not featuring any alarm symptoms were found. There were no differences in cumulative frequency between the <35 and <40 years old, with a frequency of 0.29 and 0.20 per 1000 endoscopies, respectively. If the age of 40 had been taken as the optimal age for screening, 4 cases of gastric cancer (8.9%) would have been missed (one case per year approximately), one case would have been an early gastric cancer. The 5th percentile was 30.3 years old and the 10th was 39.4. If the age of 45 had been taken as the optimal age for screening, 6 (15%) cases of gastric cancer would have been missed and 12 (27%) cases if the age was 55 years old. There was no statistical difference between gender, age and duration of dyspepsia. On the other hand, relations between type of dyspepsia (ulcerative), type of lesion, position, histology and stage of gastric cancer for both groups were found. CONCLUSION: It's recommended that the optimal age for endoscopic screening for gastric cancer in dyspeptic patients without alarm symptoms for both genders, should be over 40 years old.

Trastorno por estrés postraumático en la niñez / Posttraumatic stress disorder in childhood

Children are exposed to trauma, and when they experience severe trauma as violence, sexual abuse, accidents or natural disasters they may develop Posttraumatic Stress Disorder (PTSD). Different issues about this disorder in children are reviewed. Its definition, current diagnostic criteria (DSM-IV-TR and ICD-10), prevalence and course, clinical presentation including clinical cases, mediating factors, etiology and treatments that include individual psychotherapy, group and family therapy and pharmacotherapy are discussed.

Los niños están expuestos a traumas psíquicos, y cuando sufren experiencias psicológicas severas como violencia física, abuso sexual, accidentes o desastres naturales pueden desarrollar Trastorno por Estrés Postraumático (TEPT). Se revisan diferentes aspectos de este trastorno en niños. Se estudia en este artículo su definición, criterios diagnósticos actuales (DSM-IV-TR y CIE-10), curso y prevalencia, presentación clínica incluyendo viñetas de casos clínicos, factores mediadores, etiología y tratamientos que van desde la psicoterapia individual, la terapia familiar y grupal hasta la farmacoterapia.

[HEPATIC AMYLOIDIOSIS: REPORT OF ONE CASE] / Amiloidosis hepática como diagnóstico en la amiloidosis sitémica. Reporte de un caso.

We present a case of a 62-year old patient with systemic amyloidosis. The conclusive diagnosis was made by liver biopsy. The most important features of the disease, diagnosis, treatment, and prognosis were reviewed. We emphasize the importance of clinical acumen for diagnosis.

Amiloidosis hepática como diagnóstico en la amiloidosis sistémica: reporte de un caso / Hepatic amyloidosis: report of one case

Presentamos el caso de un paciente de 62 años con amiloidosis sistémica. El diagnóstico definitivo se confirmó por biopsia hepática. Se hace una revisión de las características más importantes, diagnóstico, tratamiento y pronóstico de esta enfermedad, resaltando la importancia de la sospecha clínica para llegar al diagnóstico.

Paracoccidiodomicosis colónica: reporte de un caso / Colonic paracoccidioimycosis: a report on one case

Presentamos el caso de un paciente de 36 años con paracoccodiodomicosis colónica. Se revisan aspectos epidemiológicos, clínicos, de laboratorio, radiológicos, anatomopatológicos y de tratamiento de esta inusual patología.

Psiquiatría de enlace en los servicios pediátricos del Hospital Regional de Concepción / Liaison psychiatry in the pediatric services of Hospital Regional de Concepción

Se presenta un estudio de dos períodos de un año cada uno, del total de actividades de interconsultas de psiquiatría de enlaces en los servicios pediátricos del Hospital Regional de Concepción. Se efectúa un análisis descriptivo para cada año y para el total de actividades, y un análisis comparativo entre ambos años para determinar las modificaciones experimentadas a través del tiempo

[COLONIC PARACOCCIDIOIMYCOSIS: A REPORT ON ONE CASE] / Paracoccidiodomicosis colónica: Reporte de un caso.

We present a 36-year-old patient with colonic paracoccidiodomycosis. The epidemiological, clinical, laboratory, radiological, pathological features and treatment of this unusual disease were reviewed.

La Laparoscopía como método diagnóstico clínico en un centro hospitalario del Perú / Laparoscopy as diagnosis and clinics method in a hospital center of Peru

La laparoscopía o peritoneoscopía es un procedimiento endoscópico invasivo, que permite visualizar la cavidad abdominal por una pequeña incisión de la pared, obteniéndose la observación de los órganos intra-abdominales y por lo tanto se puede objetivar patología de estos órganos. Ayuda a definir diagnósticos y clasificar o establecer estadíos de enfermedades. En el presente estudio realizado en 141 pacientes con afecciones hepáticas detectadas por laparoscopía y biopsia en el Hospital General Nacional Arzobispo Loayza de Lima-Perú, se comprueba la eficacia diagnóstica de la laparoscopía en enfermedades hepato-biliares con cirrosis, neoplasias, etc., y también para precisar la etiología de enfermedades peritoneales. Se enfatiza que su importancia radica en la toma de biopsias bajo control visual

Enfermedad hepática veno-oclusiva asociada a la ingestión de humanrripa (senecio tephrosioides) / Hepatic veno-oclusive disease associated to ingetion of huamanrripa (senecio tephrosioides)

Se reporta un caso de enfermedad veno-oclusiva del hígado (EHVO) en una mujer de 38 años de edad que había consumido ocasionalmente "huamanrripa" (Senecio tephrosioides) durante algunos años como antitusígeno. Fue hospitalizada por presentar dolor abdominal difuso, ictericia y anasarca durante 10 semanas. El estudio histológico de la biopsia hepática mostró marcada congestión a predominio centrolobulillar, focos de necrosis y en algunas áreas, inversión de la arquitectura del lobulillo hepático. En los siguientes 13 meses ha sido hospitalizada en 4 ocasiones por complicaciones de hipertensión portal. Este es el primer caso reportado de enfermedad hepática veno-oclusiva asociada a la ingesta de S. tephrosioides. Es muy probable que esta planta usada en la medicina tradicional peruana contenga alcaloides pirrolizidina, sustancias hepato- y nefrotóxicas que estan presentes en otras especies del género Senecio. Debido a la popularidad actual de las medicinas alternativas se espera un aumento en la incidencia de EHVO