Abstract. Clusia minor L. is traditionally used to treat many disorders that including pain and inflammation such as sores and warts. Four extracts from the leaves of the plant were prepared: hexane (A), ethyl acetate (B), methanol (C) and ethanol (E). GC/MS analysis of extracts B and C led to the identification of thirty-three and twenty-seven compounds, respectively. The presence of vitamin E and lupeol was relevant in both extracts. All extracts showed effective radical scavenger properties in the 2,2-diphenyl-2-picryl-hydrazyl (DPPH) assay, being extract E the most promissory (IC50 = 10.25 µg/mL). Extracts A, C and E, administered topically (0.5-4 mg per ear), significantly reduced ear edema induced by croton oil at 4 mg per ear, meanwhile, extract B was able to significantly reduce the inflammation at the dose of 2 mg per ear. The cytotoxic activity of the extracts was evaluated against four cell lines. Extract B showed the most cytotoxicity effect, with IC50 values in the range of 32.01-203.5 µg/mL. In addition, no acute oral toxicity after mice exposure to the four extracts was observed. The results suggest Clusia minor L. may be an excellent potential source of new bioactive agents for the development of new medicinal agents.

Resumen. La especie Clusia minor L. se usa tradicionalmente para tratar algunos trastornos que incluyen dolor e inflamación, como son las llagas y verrugas. Se prepararon cuatro extractos a partir de las hojas de la planta: hexano (A), acetato de etilo (B), metanol (C) y etanol (E). El análisis por CG/EM de los extractos B y C permitieron la identificación de 33 y 27 compuestos, respectivamente. La presencia de vitamina E y lupeol fue relevante en ambos extractos. Todos los extractos mostraron capacidad secuestradora del radical 2,2-difenil-2-picril-hidrazilo (DPPH), siendo el extracto E el más prometedor (IC50 = 10,25 μg/ml). Los extractos A, C y E, administrados tópicamente (0,5-4 mg por oreja), redujeron significativamente el edema de oreja inducido por aceite de crotón a 4 mg por oreja; mientras que el extracto B lo logró a la dosis de 2 mg por oreja. También fue evaluada la actividad citotóxica de los extractos contra cuatro líneas celulares. El extracto B mostró el mayor efecto de citotoxicidad, con valores de IC50 en el rango de 32,01-203,5 μg/mL. Además, no se observó toxicidad aguda por vía oral después de la exposición de los ratones a los extractos. Los resultados sugieren que esta especie puede ser una fuente potencial de nuevos agentes bioactivos para desarrollar agentes medicinales.

Through history, diagnosis and management of sex development disorders has been very difficult due to the significant impact on affected children, their families and care takers, representing a great challenge to healthcare professionals. Nowadays, there is significant debate regarding these children's care and outcome. This discussion is not only a medical issue, but it also includes legal and ethical matters. The Bioethics Committee of the "Hospital de Niños Ricardo Gutiérrez" has been considering this conflict and discussing its different aspects. Here we share our beliefs and opinions taking into account that they should not be considered the only and whole truth. There is an open debate in which all involved people should participate.

Los trastornos del desarrollo sexual, por sus dificultades diagnósticas, terapéuticas y el gran impacto sobre el paciente, su familia y aun para los integrantes del equipo tratante, han sido históricamente un desafío para todos los involucrados. En los últimos tiempos, se ha abierto un debate en relación con la conducta para tomar respecto del tratamiento y futuro de estos niños. Este debate excede el ámbito médico tradicional y se extiende al social y al jurídico. Por ello, luego de un análisis del tema, el Comité de Bioética del Hospital de Niños Ricardo Gutiérrez quiere acercar sus reflexiones, que de ninguna manera deben ser tomadas como la única verdad, por lo que queda abierto el debate para la participación de todos los intervinientes.

OBJETIVOS: Estimar a prevalência de burnout entre residentes pediátricos e avaliar o impacto de uma intervenção breve voltada para o controle da doença. MÉTODOS: Foi realizado um estudo controlado randomizado em 74 residentes de pediatria. Todos preencheram o Inventário de Burnout de Maslach, e foram coletadas informações demográficas (idade, sexo, filhos, coabitantes e ano de residência). O grupo experimental (n = 37) participou de oficinas de autocuidado durante 2 meses, e o grupo controle (n = 37) não recebeu nenhuma intervenção. Após a intervenção, os participantes preencheram novamente o Inventário de Burnout de Maslach. Todos os potenciais preditores de burnout foram incluídos em um modelo de regressão logística. A eficácia da intervenção foi avaliada pelo teste qui-quadrado. Os valores p < 0,05 foram considerados significativos. RESULTADOS: A prevalência de burnout entre residentes pediátricos foi de 66%. Após controle para idade, gênero, filhos e coabitantes, a prevalência de burnout foi maior entre residentes do terceiro ano (razão de chances = 11,8; intervalo de confiança de 95% 2,3-59,3; p = 0,003). Não foram encontradas diferenças significativas na prevalência de burnout no grupo experimental entre os períodos inicial e pós-intervenção (p = 0,8) ou entre os dois grupos após a intervenção (p = 0,8). A única diferença observada foi uma melhora quanto à "despersonalização", no grupo experimental (p = 0,031). CONCLUSÕES: A prevalência de burnout entre residentes pediátricos foi de 66%, sendo maior entre os residentes do terceiro ano. Uma intervenção breve não foi eficaz na redução da prevalência de burnout, apesar da melhora no quesito "despersonalização".

OBJECTIVES: To estimate burnout prevalence among pediatric residents and to evaluate the impact of a brief intervention aimed at controlling burnout. METHODS: A randomized controlled trial was conducted on 74 pediatric residents. The Maslach Burnout Inventory was administered to all subjects, and demographic information was gathered (age, gender, children, cohabitants, and residency year). The experimental group (n = 37) participated in self-care workshops over the course of 2 months, and the control group (n = 37) did not receive any intervention. After the intervention, the Maslach Burnout Inventory was administered again to all participants. All potential predictors of burnout were included in a logistic regression model. The efficacy of the intervention was evaluated by the chi-square test. P values < 0.05 were considered significant. RESULTS: The burnout prevalence among pediatric residents was 66%. After controlling for age, gender, children, and cohabitants, the prevalence of burnout was significantly higher among third-year residents (odds ratio = 11.8; 95% confidence interval 2.3-59.3; p = 0.003). There were no significant differences regarding burnout prevalence in the experimental group between the baseline and post-intervention periods (p = 0.8) or between the two groups after intervention (p = 0.8). The only difference observed was an improvement regarding "depersonalization" in the experimental group (p = 0.031). CONCLUSIONS: The burnout prevalence among pediatric residents was 66% and was higher among third-year residents. A brief intervention was not effective in reducing burnout prevalence, despite the achievement of an improvement in "depersonalization."

Introduction. Bacterial meningitis is a severe disease. Though it is early diagnosed and proper antimicrobial therapy is indicated, neurological complications and long term morbility still occur. Objective. To update acute neurological complications incidence in bacterial meningitis. To describe the relationship between laboratory tests, patient age, neurological complications and death. Population, material and methods. Patients aged one month to fifteen years old with diagnosis of meningitis admitted at Dr. Pedro de Elizalde Hospital, between January 2003 and November 2005 were analyzed. The variables applied were patients' age, cerebroespinal fluid (CSF) laboratory values obtained by lumbar puncture at hospital admission: CSF white blood cells, CSF glucose, CSF proteins, agent identification by CSF latex agglutination test, CSF culture and peripheral blood culture. Multivariate analyses was conducted using logistic regression modele. Chi squared test was used for univariate analyses. Numeric variables were analyzed by Wilcoxon test. Results. 81 patients with bacterial meningitis were included, 18.51% presented neurological complications, 3.7% died. High CSF proteins (p= 0.011; β=5,68; CI 95%= 1,5-21,52),), younger age (p= 0.022; β=0,61; CI 95%= 0,40-0,93) and positive blood culture (p= 0.003; β=13,22: CI 95%= 2,35-74) were associated to worse evolution. Streptococcus pneumoniae had greater percentage of neurologic complications (p= 0.028; β=15). Conclusion. Positive peripheral blood culture, high CSF proteins and younger age present a significative statistical association with the development of acute complications of bacterial meningitis.

Introducción. A pesar del diagnóstico precoz y del tratamiento antibiótico adecuado, la meningitis bacteriana se asocia a una alta tasa de complicaciones neurológicas y morbilidad a largo plazo. Objetivos. Estimar la incidencia de complicaciones neurológicas agudas en las meningitis bacterianas. Valorar la correlación entre valores de laboratorio, la edad del paciente y complicaciones neurológicas. Población, materiales y métodos. Estudio retrospectivo. Se incluyeron pacientes de un mes a quince años de edad con diagnóstico de meningitis que ingresaron al Hospital "Dr. Pedro de Elizalde" entre enero de 2003 y noviembre de 2005. Las variables estudiadas fueron: edad de los pacientes, características citoquímicas del líquido cefalorraquídeo (LCR) obtenido por punción lumbar al ingreso: celularidad, proteinorraquia y glucorraquia, agente etiológico por aglutinación en látex en LCR, cultivo de LCR y de sangre periférica. En los análisis unifactoriales se utilizó la prueba de X², para las variables numéricas se empleó la prueba de Wilcoxon. La información se evaluó mediante un análisis multifactorial, con un modelo de regresión logística. Resultados. Se incluyeron 81 pacientes con meningitis bacteriana. Presentaron complicaciones neurológicas 18,51%, fallecieron 3,7%. La hiperproteinorraquia (p= 0,011; β=5,68; IC 95%= 1,5-21,52), la menor edad del paciente (p= 0,022; β=0,61; IC 95%= 0,40-0,93) y los hemocultivos positivos (p= 0,003; β=13,22: IC 95%= 2,35-74) se asociaron a mala evolución. El S. pneumoniae se asoció con más complicaciones (p= 0,028; β=15). Conclusión. Los hemocultivos positivos, el aumento de la proteinorraquia y la menor edad de los pacientes exhiben una asociación estadísticamente significativa con la aparición de complicaciones agudas en la meningitis bacteriana.