The objective of this systematic literature review was to identify the main diseases that affect physicians worldwide, through an electronic survey in the Virtual Health Library (BVS) database based on the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (Prisma) methodology. We analyzed 57 of the 374 scientific papers published on this subject between 2005 and 2015 in English, Portuguese, and Spanish. The findings showed that mental affections prevailed, highlighting the occupational exhaustion (burnout syndrome). Among the physical ailments, musculoskeletal affections prevailed.KEYWORDS Occupational diseases. Burnout, professional. Occupational health.
RESUMO O objetivo desta revisão sistemática da literatura foi de identificar as principais doenças que acometem os médicos em todo o mundo, mediante uma pesquisa eletrônica na base de dados Biblioteca Virtual em Saúde (BVS) baseada na metodologia Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma
Acidification in proximal tubule of the isolated rat kidney, perfused in vitro, was studied by stopped-flow microperfusion techniques, using Sb microelectrodes to measure luminal pH. The kidney was perfused with mammalian Ringer's solution at pH 7.4 buffered by 20 mmol/l phosphate and containing 7.5 g/100 ml bovine albumin, equilibrated with air. Final urine pH was 6.88 +/- 0.5. Steady-state pH in proximal segments was 6.81 +/- 0.03 (n = 80), and acidification half-time (t/2) 7.25 +/- 0.33 (80) s, giving a net secretory H+ ion flux of 0.51 +/- 0.05 nmol . cm-2 . s-1. This flux was about 70% of "in vivo" (blood perfused kidneys). During luminal perfusion with solutions at pH 6.2, back-flux of H+ was 0.82 +/- 0.08 nmol . cm-2 . s-1, with an alkalinization t/2 of 6.33 +/- 0.34 (34) s. The difference between acidification and alkalization t/2 was not significant. This is compatible with a pump-leak system of H+ transport. This is compatible with a pump-leak system of H+ transport. The back flux of H from the lumen was markedly reduced in low Na+ perfused kidneys in the presence of 10(-4) mol/l amiloride in the lumen, indicating that this process is mediated by the luminal Na/H exchanger. Observations in the presence of high K levels suggest that it may have also a charged component. 10(-4) mol/l acetazolamide added to the kidney perfusate reduced acidification to 0.5% of control, and 10(-6) mol/l SITS to 25% of control. Thus, despite the low pCO2 (0.1-0.4 kPa, or 1-3 mm Hg), the CO2/HCO-3 buffer system still plays an important role in tubular acidification in this preparation.
The effect of temperature on proximal tubular acidification was studied in isolated rat kidney, perfused with 20 mM phosphate Ringer's containing 7.5 g/100 ml bovine albumin, equilibrated with air. Tubular pH was measured with Sb microelectrodes during stopped-flow microperfusion. The temperature of the kidney was varied between 10 and 46 degrees C. At 10 degrees C the proximal tubule was still able to maintain pH gradients of about 0.7 pH units. However, half-times (t/2) of both acidification and alkalinization were markedly increased, from 6-7 s at 37 degrees C to 27-30 s at 10 degrees C. In consequence, net H+-ion flux into the tubule was reduced to 26% of that at 37 degrees C. In this system, in the absence of exogenous HCO-3 and CO2, t/2 of acidification and alkalinization were very similar at 37 degrees C and below. Above 37 degrees C alkalinization t/2 fell markedly to 1.43 +/- 0.09 (11) s at 46 degrees C, while acidification t/2 stayed at about 7 s. H+-ion back-fluxes increased progressively from 10-46 degrees C, while secretory JH reached a maximal value at 37 degrees C and fell at higher temperatures. Apparent activation energies calculated from rate coefficients were 8.48 kcal . mol-1 for acidification, and 9.30 for alkalinization, and those calculated from JH were 6.30 and 9.55 respectively. These data indicate that both H-ion secretion and back-flux are carrier-mediated, probably flowing through the Na/H exchanger in the luminal membrane, since their activation energies are of the same order of magnitude and markedly higher than those for protons in solution.
Mulher de 33 anos de idade procurou atendimento médico em razão de piora da falta de ar há duas semanas.A paciente sofreu, aos 31 anos de idade, infarto do miocárdio. Depois do infarto, evoluiu com dispnéia desencadeada por esforços moderados que progrediu até ser desencadeada por mínimos esforços e ocorrer mesmo em repouso. A paciente era tabagista.O cateterismo cardíaco realizado dois meses após o infarto revelou pressões na aorta 120/80 mmHg e no ventrículo esquerdo (VE) 120/20 mmHg. A cineangiocoronariografi a revelou lesão de 60% na origem do ramo interventricular anterior da artéria coronária esquerda. A ventriculografi a revelou aumento de VE com acinesia ântero-lateral e apical, e insufi ciência mitral moderada.O exame físico no primeiro atendimento no Hospital, há um ano, revelou freqüência cardíaca de 70 bpm, pressão arterial 110/70 mmHg. O exame dos pulmões foi normal. O exame do coração revelou segunda bulha hiperfonética em área pulmonar e sopro sistólico ++/4 em área mitral. O exame do abdome foi normal e não havia edema de membros.O eletrocardiograma de há um ano revelou ritmo sinusal, freqüência 79 bpm, duração de QRS de 129 mseg, SÂQRS -30° para trás, ondas Q em I, aVL, V 3 e V 4 , ondas S profundas em V 2 e V 3 e persistência de supradesnível de segmento ST em derivações precordiais. Os diagnósticos eletrocardiográfi cos foram de sobrecarga atrial esquerda, distúrbio intraventricular da condução do estímulo do tipo bloqueio de ramo esquerdo, bloqueio da divisão ânterosuperior do ramo esquerdo e áreas eletricamente inativas em paredes lateral e anterior (Fig. 1).A radiografia de tórax revelou aumento da área cardíaca, sem sinais de congestão pulmonar.Os exames laboratoriais naquela ocasião revelaram 12,6 g/dl de hemoglobina, hematócrito 37%, colesterol Fig. 1 -Eletrocardiograma -Sobrecarga atrial esquerda, distúrbio de condução intraventricular do estímulo, bloqueio da divisão ântero-superior do ramo esquerdo e área eletricamente inativa ântero-lateral
Este estudo teve por objetivo analisar a qualidade de vida dos estudantes de medicina, nos diferentes estágios da formação, do primeiro ao sexto ano do curso. Para a pesquisa de corte transversal, descritivo e exploratório, além de questionário socioeconômico, a escala de Flanagan composta por 15 itens foi utilizada para a determinação da qualidade de vida estratificando o grau de satisfação individual em relação ao bem-estar físico e mental, relacionamentos, atividades sociais, comunitárias e cívicas, recreação e desenvolvimento e enriquecimento pessoal. Foi realizada uma análise descritiva dos resultados e o teste de Spearman foi aplicado para avaliar as correlações obtidas com o ano de curso e as questões do instrumento utilizado. As correlações obtidas mostraram-se fracas, mas indicaram que quanto maior a série em que o estudante se encontra, menor a satisfação em relação em alguns componentes da escala.
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