Resumen Introducción El enfoque de la salud basado en los derechos humanos (ESBDH) en la educación médica exige una formación eficiente y en condiciones favorables para la formación de médicos, sin embargo, se han documentado quejas por errores médicos en donde se involucran a estudiantes de medicina, afectando la protección del derecho a la salud en usuarios y médicos en formación. Objetivo Identificar los factores atribuibles a la ocurrencia de errores médicos (diagnóstico-terapéuticos) auto percibidos por falta de supervisión académica o falta de competencias clínicas en residentes médicos, adscritos a unidades hospitalarias del estado de Veracruz, México. Método Se utilizaron datos generados por el Observatorio de Educación Médica y Derechos Humanos (OBEME) de la Universidad Veracruzana, considerando los derechos a la educación, a la salud y al trabajo de residentes médicos de especialidad clínica del ciclo académico 2019-2020. Se desarrolló un estudio epidemiológico de prevalencias analítico y se estimó la Tasa de Error Médico (TEM). Resultados Se determinaron factores asociados en la ocurrencia e incremento de la TEM en 764 médicos residentes: la falta de supervisión de las actividades, número de horas semanales trabajadas, tipo de adscripción hospitalaria, tipo de especialidad y edad. Las condiciones del derecho al trabajo digno incrementaron el riesgo en hasta siete veces cuando tomaron decisiones médicas sin supervisión, así como el incremento de riesgo ante un trato discriminatorio. El error médico se presenta de manera diferenciada para hombres y mujeres en algunos de los factores analizados. Conclusiones El error médico disminuye cuando es mayor la garantía del respeto a los derechos analizados. Con base en el ESBDH se establece que, para disminuir el error médico cometido por médicos residentes, es fundamental respetar sus derechos. Finalmente, se sugiere la incorporación de la perspectiva de género en el análisis e intervención para mejoras de la educación médica.

Abstract Introduction The Human Rights-Based Approach to Health (HRBAH) in medical education requires efficient training and favorable conditions in order to train doctors. However, complaints about medical errors involving residents have been documented, so protecting the right to health of users and residents has been affected. Objective This paper aims to identify the factors related to self-perceived medical errors (diagnostic-therapeutic), risk and protection factors that occur due to lack of academic monitoring or because specialty medical residents, assigned to medical units in the state of Veracruz, Mexico, during the 2019-2020 academic year, lack of clinical skills. Method We used data collected by the Observatory of Medical Education and Human Rights of Universidad Veracruzana, in which the right to education, the right to health and the right to work in medical students, particularly those from both clinical specialty and 2019-2020 academic year, are considered. We conducted an analytic prevalence epidemiological study, for which we elaborated the Rate of Medical Errors (RME). Results The following factor were determined with the occurrence and increase of RME in 764 medical residents: lack of supervision of activities, number of weekly hours worked, type of hospital affiliation, type of specialty and the age, was observed. The conditions for the right to decent work increased the risk up to seven times when medical decisions were made without the supervision of the person in charge, as well as the increased risk for discriminatory treatment. Medical error is presented differently for men and women in some of the factors analyzed. Conclusion Medical errors decrease when the guarantee of the rights analyzed is greater. From the HRBAH perspective, it is essential to respect the right to education, work, and a decent life of medical residents in order to reduce medical errors. Finally, the incorporation of the gender perspective in the analysis and intervention for improvements in medical education is suggested.

Resumen Introducción: El enfoque de la salud basado en derechos humanos (ESBDH) postula que los programas de salud pueden violentar los derechos humanos (DDHH) de las personas, y en él se considera determinante el respeto a estos para la mejora de la salud de la población, por lo que es relevante la construcción de instrumentos que permitan conocer el disfrute de los DDHH en médicos residentes. Objetivo: Construir y analizar la estructura interna de un instrumento para conocer la opinión de médicos residentes sobre el disfrute de su derecho a la educación y al trabajo digno. Método: Se construyó un instrumento con base en la definición de derecho a la educación y al trabajo digno del Pacto Internacional de Derechos Económicos, Sociales y Culturales. Se aplicó a 605 médicos residentes. Se realizó un análisis factorial a través del método de mínimos cuadrados no ponderados con rotación oblicua Promin, y posteriormente se analizó la fiabilidad. Resultados: La estructura final se conformó por 17 ítems distribuidos en 2 factores: perjuicios percibidos al disfrute de los DDHH y beneficios percibidos al disfrute de los DDHH. Se obtuvieron indicadores favorables en la fiabilidad de las puntuaciones (α > .70) y del constructo (ω > .70). Conclusiones: El instrumento propuesto presenta adecuada evidencia de validez con relación a su estructura interna y fiabilidad, y resulta útil para conocer el disfrute de los DDHH de los médicos residentes.

Abstract Introduction: The Human Rights-based Health Approach (HRHA) claims that health programs can violate the human rights of people. This approach considers that respecting human rights plays a key role to improve the health of the population. Therefore, elaborating tools instruments is relevant to know whether or not medical residents are fully enjoying their resident physicians. Objective: Develop and analyze the internal structure of a research instrument to seek the views of resident physicians on enjoying their right to education and decent work. Methods: A research instrument was developed according to the definition of the right to education and decent work provided by the International Covenant on Economic, Social and Cultural Rights. The instrument was conducted among 605 resident physicians. A factorial analysis was performed using the unweighted least squares with the Promin oblique rotation. Then, reliability was analyzed. Results: The 17-item final structure was divided into two factors: perceived obstacles to the full enjoyment of human rights and perceived benefits to the full enjoyment of human rights. Favorable indicators were obtained in reliability of scores (α> .70) and the construct (ω> .70). Conclusion: The proposed research instrument offers appropriate evidence of validity regarding its internal structure and reliability. Also, it is useful to seek the enjoyment of human rights by resident physicians.

Abstract Introduction The Human Rights-Based Approach to Health (ESBDH) postulates that poor training and unfavorable working conditions of human resources for health not only hinders the protection of the right to health, but can be, paradoxically, an important source of violations to it. Can specialist medical training programs violate their right to education and decent work? Objective Know the opinion of resident physicians on the fact that their right to education and decent work must be respected. Method A cross-sectional and descriptive study was conducted in a non-random sample of 605 resident doctors from a public university located in Mexico to. A 32-item (Cronbach's alpha = 0.931)Likert questionnaire was carried out anonymously, confidentially and voluntarily to assess the residents' opinions on their rights to education and decent work being respected. Simple frequencies are presented and, in a nutshell, the overall score regarding respect for the law and the percentage of favorable and unfavorable events and the score obtained for each item. Results The average age of the participants was 29.5 years (± 2.9), 58% men, 78.5% single and 79% with no children. 80% of respondents worked more than 80 hours a week. 65% of residents were first and second year. Most of residents (87%) considered there was a medium or greater level of respect for their rights. The overall score of respect was 57%. The percentage of favorable events was 55% and unfavorable events or rights violation was that of 36%. Conclusions In the light of the human rights-based approach to health, the current training system for medical specialists should be reviewed.

Resumen Introducción El enfoque de la salud basada en derechos humanos (ESBDH) postula que la formación deficiente y las condiciones laborales desfavorables de los recursos humanos para la salud no solo dificulta la protección del derecho a la salud, sino que puede ser, paradójicamente, una fuente importante de violaciones al mismo ¿Los programas de formación de médicos especialistas pueden violentar su derecho a la educación y al trabajo digno? Objetivo Conocer la opinión de los médicos residentes sobre el respeto a su derecho a la educación y al trabajo digno. Método Estudio transversal, descriptivo, realizado en una universidad pública de México a una muestra no aleatoria de 605 médicos residentes. Se aplicó de manera anónima, confidencial y voluntaria un cuestionario tipo Likert para valorar la opinión de los residentes sobre el respeto a sus derechos a la educación y al trabajo digno; integrado por 32 ítems (Alfa de Cronbach = 0.931). Se presentan frecuencias simples y, como medidas de resumen, la evaluación global del respeto al derecho, el porcentaje de manifestación de sucesos favorables y desfavorables y el puntaje obtenido por cada ítem. Resultados La edad media de los participantes fue de 29.5 años (± 2.9), 58% hombres, 78.5% solteros y 79% sin hijos. 80% de los encuestados trabajó más de 80 horas a la semana. 65% de los residentes eran de primer y segundo años. La mayoría de los residentes (87%) considera que hubo un respeto medio o mayor a sus derechos. La evaluación global del respeto fue 57%. El porcentaje de manifestación de sucesos favorables fue de 55% y los sucesos desfavorables o violatorios a los derechos tuvieron una manifestación de 36%. Conclusiones A la luz del enfoque de la salud basado en derechos humanos debe revisarse el actual sistema de formación de médicos especialistas.

OBJETIVOS: Sepse neonatal corresponde a uma síndrome complexa, causada por resposta inflamatória sistêmica descontrolada, associada a um foco infeccioso que pode determinar disfunção ou falência de um ou mais órgãos ou mesmo a morte. Apresenta incidência elevada em neonatos prematuros, sendo importante correlacionarmos fatores prognósticos para otimizar nosso diagnóstico precoce e resposta a terapêutica nestes pacientes. Este estudo teve por objetivo determinar a relação entre marcadores inflamatórios e parâmetros oxidativos com fatores prognósticos em sepse neonatal precoce. MÉTODOS: Foi realizado um estudo observacional, prospectivo e foram coletados os dados de 120 pacientes, da maternidade de hospital universitário. Foram incluídos na pesquisa neonatos prematuros (< 37 semanas de gestação) com pelo menos um outro fator de risco para sepse neonatal. Foram determinados os níveis de interleucina (IL)-6, IL-10, substâncias reativas ao ácido tiobarbitúrico e de proteínas carboniladas em sangue do cordão umbilical e sua relação com gravidade de sepse. RESULTADOS: Os níveis das substâncias reativas ao ácido tiobarbitúrico e IL-6, mas não IL-10 e proteínas carboniladas, apresentaram correlação significativa com o escore de gravidade SNAPPE-II (r=0,385, p=0,017 e r=0,435 / p=0,02, respectivamente). Não houve relação dos marcadores com a mortalidade dos pacientes. CONCLUSÃO: Substâncias reativas ao ácido tiobarbitúrico e IL-6 têm uma correlação de média a moderada com o escore de gravidade SNAPPE-II, mas não com mortalidade.

OBJECTIVES: Neonatal sepsis is a complex syndrome involving an uncontrolled systemic inflammatory response associated with an infection. It may result in the dysfunction or failure of one or more organs or even death. Given its high incidence in premature neonates, the identification of prognostic factors to optimize the early diagnosis and therapeutic interventions are highly desirable. This objective study determine the relationship between inflammatory markers and oxidative parameters as prognostic factors in early neonatal sepsis. METHODS: We conducted a prospective observational study by collecting data from 120 patients in the maternity unit of a university hospital. Preterm (<37 weeks of pregnancy) infants with at least one additional risk factor for neonatal sepsis were included. The levels of interleukin (IL)-6, IL-10, thiobarbituric acid reactive species (TBARS) and protein carbonyls and their association with sepsis severity were determined in the cord blood. RESULTS: Levels of IL-6 and TBARS, but not IL-10 and protein carbonyls, demonstrated a mild to moderate correlation with the SNAPPE-II severity score (r=0.435, p=0.02 and r = 0.385, p = 0.017, respectively). No correlations were found between these markers and mortality. CONCLUSION: TBARS and IL-6 have a mild to moderate correlation with SNAPPE-II, but none of the studied markers were able to predict mortality in our sample.

La glomerulonefritis rápidamente progresiva (GNRP) es una entidad poco frecuente; el diagnostico precoz es importante con fines terapéuticos y pronósticos. El objetivo del presente trabajo es reportar la casuística de GNRP en el Servicio de Nefrología del Hospital de Niños “Jorge Lizarraga” entre enero 2004 y enero 2009. Método: Estudio retrospectivo y descriptivo con la revisión de las historias clínicas de 8 pacientes, con edades entre 3-13 años. Resultados: Seis pacientes correspondieron al sexo femenino. La edad promedio fue de 11±3.5 años. La mayoría presentó un foco infeccioso previo con mayor frecuencia en piel (6 casos), y en faringe un caso. Las manifestaciones clínicas y los hallazgos de laboratorio se caracterizaron por: edema, hipertensión, hematuria, retención azoada progresiva, proteinuria e hipocomplementemia. Se realizó biopsia renal en todos los casos, observándose glomerulonefritis proliferativa endo y extracapilar en 6 casos y glomerulonefritis membranoproliferativa en 2 casos. La terapéutica se basó en tratar la infección y el fallo renal agudo. Se aplicaron pulsos de metilprednisolona a todos los pacientes y 6 pacientes ameritaron diálisis peritoneal. Seis pacientes sobrevivieron (2 egresaron con función renal normal y 4 progresaron a enfermedad renal crónica) y 2 pacientes fallecieron. Conclusiones: La GNRP es una condición que se presenta esporádicamente; su evolución depende de la severidad del compromiso renal, extensión de las lesiones histopatológicas y precocidad en la terapéutica farmacológica y dialítica. La mayoría de los pacientes sobrevive, un porcentaje importante progresa a enfermedad renal crónica, lo cual eventualmente amerita terapia substitutiva con diálisis y trasplante renal.

Rapidly progressive glomerulonephritis (RPGN) is a rare entity; early diagnosis is important for adequate and prompt treatment. The objective of this paper is to report the casuistic of RPGN in the Department of Nephrology of the Hospital de Niños “Jorge Lizarraga” between January 2004 and January 2009. Method: Retrospective and descriptive study collecting data of the medical records of 8 patients, ages 3-13 years. Results: Six patients were females and the average for age was 11±3.5 years. The majority presented a previous infection (skin in 6 and pharynx in 1). Clinical manifestations and laboratory findings were: edema, hypertension, hematuria, progressive azotemic retention, proteinuria and hypocomplementemia. Renal biopsy was performed in all patients with the following results: endo and extracapillary proliferative glomerulonephritis in 6 cases and membranoproliferative glomerulonephritis in 2. Therapeutic measures were aimed to the treatment of infection acute renal failure. Methylprednisolone boluses were indicated in all patients, 6 patients were submitted to peritoneal dialysis. Six patients survived (2 with normal renal function and 4 with progression to chronic kidney disease), and 2 died. Conclusions: RPGN is a condition that occurs sporadically; its evolution depends of the severity of renal involvement, the extension of histological lesions and the precocity with which pharmacological and dialytic treatment are installed. Most patients survive but a significant number progress to chronic kidney disease.

Introducción: El análisis de los resultados de casuísticas de biopsias renales es importante con fines diagnósticos, terapéuticos y de pronóstico. Objetivo: Evaluar la serie de biopsias renales en el Hospital de Niños de Valencia, Venezuela, durante el período 1978-2007. Métodos: Fueron analizadas 421 biopsias renales practicadas en 395 pacientes, de 2 meses a 20 años, 57% varones. El material fue procesado por microscopía óptica, inmunofluorescencia y microscopía electrónica en 98 % de los casos. Resultados: Se obtuvo muestra adecuada (más de 10 glomérulos) en 93% de los casos (n=392). Indicaciones clínicas: síndrome nefrótico 199 (50%), síndrome nefrítico atípico 53 (13%), otros: (hematuria/proteinuria, proteinuria, trasplante, enfermedades sistémicas 143 (37%). Resultados Histopatológicos: A.- Glomerulonefrítis primaria (GNP) 302 casos (77%) , B.- Nefropatías secundarias (NS) 68 casos (17%), C.- Riñones trasplantados 28 casos (7%). -Diagnósticos en GNP: 1) Lesión de cambios mínimos 140 (46%), 2) Glomeruloesclerosis segmentaria y focal 79 (26%), 3) GN proliferativa y/o mesangial 67 (22%), 4) GN Membranosa 16 (5%). -Diagnósticos en NS: Nefritis lúpica: 20 casos (32.25%), Nefropatía IgA: 22 casos (35.50%); Otras: 20 casos (32.25%). -Diagnósticos en riñones trasplantados: rechazo agudo 50%, necrosis tubular aguda 25%, rechazo crónico 20%, enfermedad recurrente en trasplante 5%. Complicaciones: Hematuria transitoria: 21 casos (5%), hematoma perirenal: 3(<1%), perforación intestinal: 2 (<0.5%), hemorragia importante: 2 (<0.5%), nefrectomía: 1(0.2%). Conclusiones: La presente es una de las primeras casuísticas de biopsias renales reportadas en Latinoamérica y una de las más grandes en el mundo y, de acuerdo a nuestros resultados, es un procedimiento seguro con gran utilidad diagnóstica, pocas complicaciones, sin mortalidad.

Introduction: Evaluation and analysis of the results of renal biopsy are important for diagnostic, therapeutic and prognostic matters. Objective: to evaluate a series of renal biopsies performed during the period 1978-2007 in the Hospital de Niños de Valencia, Venezuela. All patients had history of either primary or secondary nephropathies. Methods: 421 biopsies were done in 377 patients, ages 2 months-20 years; 57% boys. 26 patients were re-biopsed. Percutaneous needle biopsy (PNB) was performed in all the patients, except in one who underwent open biopsy because of a solitary kidney. Renal tissue was processed for optical, inmunofluorescence and electronic microscopy in 98% of cases. The biopsy technique, clinical syndromes at presentation, hystopathological pattern, effectiveness and complications are described. Results: Adequate sample was obtained in 392 cases (93%) (more than 10 glomeruli) and inadequate or failed biopsy in 29 (7%). Clinical syndromes at presentation were: nephrotic syndrome: 199 cases (50%), atypical acute nephritic syndrome: 53 (13%), others: hematuria and proteinuria, isolated proteinuria, kidney transplant biopsy or systemic diseases: 143 (37%). The hystopathological pattern obtained was as follows: A.- Primary glomerulonephritis (PG): 302 cases, 77%, B.- Secondary nephropathies: 68 cases, 17%, C.- Kidney transplant biopsies: 28 cases, 5 %. Primary Glomerulonephritis diagnosis: minimal change disease: 140 cases, 46%, Focal Segmental Glomerulosclerosis: 79 (26%), diffuse proliferative glomerulonephritis / mesangial: 67 (22%), membranous glomerulonephritis: 16 (5%). Secondary nephropathies: lupus nephritis: 20 cases (32.25%), IgA Nephropathy: 22 cases (35.50%), others: 20 cases (32.25%). Transplant biopsies: rejection 50%, acute tubular necrosis 25%, chronic rejection 20%, and recurrent disease 5%. Complications: transient hematuria: 21 (5%), perirenal hematoma: 3 (<1%), gut perforation (<0.2%), bleeding which required blood transfusion: 2 (<0.5%) and nephrectomy because of incontrollable bleeding 1 (0.2%). Conclusions: this series of renal biopsies is one of the first reported in Latin-America and one of the largest in the world. According to our results, renal biopsy is a reliable and safe procedure in pediatric nephrology. Our casuistic shows that it is useful for the diagnosis, prognosis and follow up of patients with various nephropathies, excellent effectiveness and low number of complications, with no mortality.