Association between mental health screening by self-report questionnaire and insomnia in medical students.

Epidemiological research points to the high prevalence of psychiatric disorders among insomniacs. We carried out a cross-sectional study with medical students with the aim of evaluating the association between insomnia and suspicion of psychiatric disorder; 302 medical students were included (184 males and 118 females; mean age = 20.47+/-1.89 years). The main association was tested by logistic regression analysis. The overall prevalence of positivity in a screening test for psychiatric disorder was 22.19%; and of insomnia, 28.15%. Difficulty initiating sleep (OR=3.45), difficulty maintaining sleep (OR=7.61), falling asleep later (OR=1.99) and waking up earlier (OR=1.91) were associated with suspicion of psychiatric disorder. As a group, the variables difficulty initiating sleep, difficulty maintaining sleep, falling asleep after 11 pm, and waking up before 6 am presented an odds ratio of 5.96 for positivity in the screening for psychiatric disorder. Furthermore, difficulty maintaining sleep (OR=2.24) was associated with "being female," and falling asleep later (OR=0.43) was associated with "being male". These results underscore the importance of determining in what cases difficulty sleeping may have severe clinical repercussions or affect performance.

Effect of heat treatment on the biological value of beta-carotene added to soybean cooking oil in rats.

Vitamin A deficiency is one of the major nutritional problems in the world, most common in developing countries. Food fortification is a recognised approach to supply vitamins and minerals to needed populations. Vegetable cooking oils were previously suggested by us as a carrier for vitamin A fortification. Fortification of cooking oil with beta-carotene could also be a strategy to prevent vitamin A deficiency. The objective of this article is to start studies on the use of cooking soya oil as a vehicle for synthetic carotene, to evaluate its stability to heat treatment, and to test its bioavailability and bioconversion to vitamin A in rats. Batches of carotene-fortified soybean oil were prepared, containing 2, 4 and 8 RE/g of diet. Some of them were heated to test its stability. At 100 degrees C there was no loss of carotene, at higher temperature carotene retention was 65%. The bioavailability and bioconversion of beta-carotene added to soybean oil was measured through feeding nursing rats and their pups method. Weight gain was good and plasma vitamin A increased significantly in all groups. Liver vitamin A values of rats fed diets with fortified soybean oil heated at 100 degrees C was similar to the 4 RE non-heated fortified oil group (0.72 +/- 0.06 and 0.64 +/- 0.08 mumol/g, respectively). Heated at 170 degrees C the liver total vitamin A value was reduced (0.45 +/- 0.04 mumol/g), but kept bioavailable vitamin A equivalent to 2 RE (0.47 +/- 0.09 mumol/g). Bioconversion of beta-carotene to vitamin A was validated by the plasma and liver findings. beta-carotene added to soybean oil showed good stability to heat and its bioconversion to vitamin A was shown in rat assays. beta-carotene mixed well with edible soybean oil and the fortified cooking oil showed potential as a carrier to be used for the prevention of vitamin A deficiency.

Independent lung ventilation with a single ventilator using a variable resistance valve.

Independent lung ventilation using two ventilators has been attempted in the treatment of acute respiratory failure due to unilateral lung disease. However, this method has been found to be cumbersome and difficult to use. We reasoned that a bifurcated endotracheal tube with a variable resistance valve may enable us to change the inspiratory airway pressures and, hence, the inspired tidal volume to one lung using a single ventilator. We tested this hypothesis in eight anesthetized sheep and created a bronchopleural fistula in one lung as a model of unilateral lung disease. A bifurcated endotracheal tube was placed to separate the ventilation to each lung and, through a "Y" connector, both right and left lungs were ventilated simultaneously with a single ventilator. A variable resistance valve was placed between the "Y" connector and the tube ventilating the experimental lung with bronchopleural fistula. With a ventilator-generated peak inspiratory pressure of 31 +/- 2 cm H2O, the airway pressure distal to the valve was randomly changed from 31 cm H2O to 23 +/- 2, 15 +/- 1, 8 +/- 1, and 0 cm H2O. This resulted in progressive diversion of tidal volume from the experimental lung to the control lung and an increase in exhaled tidal volume due to a decrease in air leak from the bronchopleural fistula. These data suggest that a variable resistance valve may be used for independent lung ventilation using a single ventilator.

Mammary reduction combined with reverse abdominoplasty.

We present the surgical technique of reverse abdominoplasty combined with mammary reduction in a single stage. The technical details are described, with special reference to patient selection and postoperative care. Comments about the midsternal scar line are also included.

The square chin and the pointed chin: Another refinement in facial aesthetics.

The authors present a simple surgical procedure for changing a pointed chin into a square one, through the resectioning of a horizontal bone fragment of the free edge of the mentum. An amount of soft tissue of this region can be resected during surgery as a secondary reshaping maneuver. A third technical detail can be added to improve the final result, using a small bone resection wedge in the middle of the mentum edge. A lazy groove on the new square chin line is obtained. A comparative, preoperative and postoperative study of the face contour is presented.

Correction of lower limb lipodystrophy.

The authors study various types of thigh lipodystrophy. To each type is applied a special technique. The complications are studied and the limitations given.

Anatomical and technical refinements for abdominoplasty.

Several important details pertinent to the classic transversal low-incision abdominoplasty, commonly underestimated, are pointed out. Metameric sensitivity distribution is focused in the normal individual and then transformed by abdominoplasty. Emphasis is also given to the vascularization, lymphatic drainage, and treatment of the muscle-aponeurotic plane and femoral cutaneous nerve under effects of abdominoplasty. Attention is called to how effectively they can help to obtain symmetric postoperative results and how important it is to have a normal-looking, aesthetically pleasing navel. First introduced as a corrective procedure for abdomens grossly deformed by lipodystrophies or greatly compromised by hernias or problems related to multiple surgeries, abdominoplasty is no longer merely a reconstructive procedure. In the last 10 years, requests for abdominoplasty for aesthetic improvement of lax skin, "striae," and scars of even "good quality" situated in the infraumbilical area have increased in indirect proportion to the size of today's bathing suits.The great number of cosmetic abdominal surgeries calls for a better solution to problems such as the placement and quality of scars, the positioning of the umbilicus, and the resulting waistline. An increasing number of demands are made regarding minute details of asymmetry, sensibility, edema, and pain. Like the young surgeon in training, we had to search our anatomy books to find explanations and ways to avoid problems justifiable in earlier days but unacceptable today.