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Santiago Sáez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Cesáreo" "apellidos" => "Fernández Alonso" "email" => array:1 [ 0 => "cesareofa@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Carmen" "apellidos" => "Megía Morales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Andrés E." "apellidos" => "Santiago Sáez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Legal, Hospital Clínico San Carlos, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sumisión química por «ayahuasca»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hospital emergency departments (HEDs) provide care for victims of suspected chemical submission (CS). Toxicological analyses (TAs) carried out in highly qualified laboratories, such as the Spanish National Institute of Toxicology and Forensic Sciences (INTCF, <span class="elsevierStyleItalic">Instituto Nacional de Toxicología y Ciencias Forenses</span>), makes it possible to identify substances that are not conventionally detected in these HEDs.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">An increase in the consumption of plant substances associated with various practices has been reported in the last decade.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Burundanga is one such concoction that is made with scopolamine-rich plants of the Solanaceae family and used in cases of CS.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In this paper we present the case of a 46-year-old Spanish man, with no remarkable medicosurgical history nor usual pharmacological treatment, who consulted the Emergency Department of Clinical Hospital San Carlos on a particular afternoon in December 2019, upon landing in Madrid after returning from a trip to Peru. He claimed that strangers had given him an unknown substance with the aim of overriding his will to steal his money and belongings. He stated that 48 hours earlier, he had been given a “bitter greenish colored” drink that had a hallucinogenic effect associated with nausea and vomiting, and that 24 hours earlier he had consumed an “odorless and tasteless drink” that caused him amnesia, confusion, blurred vision, as well as dry skin and mouth. He suspected that he had been administered burundanga and ayahuasca against his will. He reported that he had traveled alone to the Peruvian city of Pucallpa for “business purposes”. A general physical examination and blood tests revealed no significant alterations. In accordance with the standard procedure for dealing with a potential case of CS, biological samples (blood and urine) were collected and sent to the INTCF of Madrid, Spain, for TAs. The patient was informed of the results of these tests a few months later. Neither the enzyme immunoassay nor the chromatography assay detected substances at toxicologically significant levels in his blood sample; however, his urine sample was positive for bufotenin, harmine, harmalol, and harmaline.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Bufotenin is an alkaloid derived from serotonin that has hallucinogenic effects. Harmine, harmaline, and harmalol are monoamine oxidase inhibitors (MAOIs) that prevent the metabolism of bufotenin, thus promoting the hallucinogenic effects of this compound, and are present in certain plants, such as the <span class="elsevierStyleItalic">Banisteriopsis caapi</span> vine. Given that no reference standard was available to identify these substances, based on the available literature, they were identified by using high-resolution mass spectrometry techniques, as well as drug samples received at the INTCF Drug Service. No other drugs of abuse, psychotropic drugs, or frequently used drugs were detected in the TAs performed.</p><p id="par0025" class="elsevierStylePara elsevierViewall">To our knowledge, this is one of the first reported cases of suspected ayahuasca CS identified by means of a TA in Spain. The only previous case reported in our country was that of a 36-year-old man who visited a HED in Barcelona due to presenting with behavioral alterations secondary to the recreational use of ayahuasca.<span class="elsevierStyleSup">4</span> However, this substance was not detected in the TAs performed, and his symptoms were attributed to the consumption of other toxic substances. The main active substance in ayahuasca is N,N-dimethyltryptamine (DMT), which is found in the leaves of the <span class="elsevierStyleItalic">Psychotria viridis</span> plant. Decoction of this plant together with the aforementioned <span class="elsevierStyleItalic">Banisteriopsis caapi</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> plant allows for extracting DMT and certain substances that enhance the action of DMT, such as MAOIs (mainly harmine, harmaline, and harmalol). In the case presented in this paper, DMT could not be identified, probably owing to the time elapsed since the substance’s ingestion. It should be noted that, although DMT is included in the international narcotics control lists, the substances found in the TAs described herein are not. On the other hand, although some of the concoctions consumed by the patient described in this paper could have contained burundanga, due to the narrow detection window of this compound, it could not be identified because, according to the patient, approximately 72 hours had elapsed since the supposed intake of this substance.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Ayahuasca is little known in our clinical setting. The name of this substance derives from the Quechua language and means soul <span class="elsevierStyleItalic">(aya)</span> of the vine or root <span class="elsevierStyleItalic">(huasca)</span>. In American countries that include the Amazon basin, this substance is known to be traditionally used in the field of medical practices or religious rituals led by shamans.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a> However, in recent years there has been a proliferation of “ayahuasca tourist routes” that attract people in search of “different sensory experiences” that can be dangerous and can end in cases of CS associated with crimes against personal property (theft) or sexual freedom, and even lead to death.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Collaboration between professionals from HEDs and those pertaining to the medico-legal field, as is the case in procedures applied in the event of a suspected CS,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–5</span></a> allows to give visibility to current social realities that can remain distanced from scientific evidence.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernández Alonso C, Megía Morales C, Santiago Sáez AE. Sumisión química por «ayahuasca». Med Clin (Barc). 2021;157:e325–e326.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identificación de la droga de abuso flakka (α-PVP) como sospecha de sumisión química no probada en Urgencias de un hospital terciario" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Fernández Alonso" 1 => "O. Quintela Jorge" 2 => "A.S. Santiago Sáez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2016" "volumen" => "147" "paginaInicial" => "224" "paginaFinal" => "228" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Drogas emergentes (III): plantas y hongos alucinógenos" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Burillo-Putze" 1 => "E. López Briz" 2 => "B. Climent Díaz" 3 => "P. Munné Mas" 4 => "S. Nogue Xarau" 5 => "M.A. Pinillos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4321/s1137-66272013000300015" "Revista" => array:6 [ "tituloSerie" => "An Sist Sanit Navar" "fecha" => "2013" "volumen" => "36" "paginaInicial" => "505" "paginaFinal" => "518" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24406363" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primera confirmación en España del uso de la burundanga en una sumisión química atendida en urgencias" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I. Gomila Muñiz" 1 => "J. Puiguriguer Ferrando" 2 => "L. Quesada Redondo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2016" "volumen" => "147" "paginaInicial" => "421" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intoxicación por ayahuasca" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B. De Pablo Márquez" 1 => "B. Dietl Gómez-Luengo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2017" "volumen" => "149" "paginaInicial" => "136" "paginaFinal" => "137" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La importancia del factor tiempo en el análisis toxicológico de casos de sospecha de sumisión química en un servicio de urgencias hospitalario" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Fernández Alonso" 1 => "O. Quintela Jorge" 2 => "B. Bravo Serrano" 3 => "A.E. Santiago-Sáez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Emergencias" "fecha" => "2019" "volumen" => "31" "paginaInicial" => "65" "paginaFinal" => "66" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30656879" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015700000010/v2_202201010925/S2387020621005623/v2_202201010925/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015700000010/v2_202201010925/S2387020621005623/v2_202201010925/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621005623?idApp=UINPBA00004N" ]
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Vol. 157. Issue 10.
Pages e325-e326 (November 2021)
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Vol. 157. Issue 10.
Pages e325-e326 (November 2021)
Letter to the Editor
Chemical submission by “ayahuasca”
Sumisión química por «ayahuasca»
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