Objective To assess postoperative clinical data considering the association of preoperative fasting with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA). Methods 57 patients undergoing coronary artery bypass grafting (CABG) were randomly assigned to receive 12.5% maltodextrin (200 mL, 2 h before anesthesia), (CHO, n=14); water (200 mL, 2 h before anesthesia), (control, n=14); 12.5% maltodextrin (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (CHO+W3, n=15); or water (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (W3, n=14). The need for vasoactive drugs was analyzed, in addition to postoperative inflammation and metabolic control. Results There were two deaths (3.5%). Patients in CHO groups presented a lower incidence of hospital infection (RR=0.29, 95% CI 0.09-0.94; P =0.023), needed fewer vasoactive drugs during surgery and ICU stay ( P <0.05); and had better blood glucose levels in the first six hours of recovery ( P =0.015), requiring less exogenous insulin ( P =0.018). Incidence of postoperative atrial fibrillation (POAF) varied significantly among groups ( P =0.009). Subjects who receive ω-3 PUFA groups had fewer occurrences of POAF (RR=4.83, 95% CI 1.56-15.02; P =0.001). Patients in the W3 group had lower ultrasensitive-CRP levels at 36 h postoperatively ( P =0.008). Interleukin-10 levels varied among groups ( P =0.013), with the highest levels observed in the postoperative of patients who received intraoperative infusion of ω-3 PUFA ( P =0.049). Conclusion Fasting abbreviation with carbohydrate loading and intraoperative infusion of ω-3 PUFA is safe and supports faster postoperative recovery in patients undergoing on-pump CABG.

Features of personality disorders (PDs) have been found to explain meaningful variance in the onset, maintenance, and symptomatic presentation of eating disorders (EDs), and a co-occurent personality pathology is commonly associated with poorer response to ED treatment. The “pathoplasty model” of the relationship between personality and EDs implies that, once both conditions are established, they are likely to interact in ways that modify therapy outcome; however, to date, no studies have explored overall personality functioning, and especially PD clusters, as a mediator of treatment outcome. The present study aimed at conjointly exploring the associations between personality functioning and PDs, respectively, with pre-treatment ED symptomatic impairment and therapy outcome; and the mediating role of personality variables. At treatment onset, a sample of 107 women with ED problems were evaluated using both the Structured Clinical Interview for DSM-5 (SCID-5-CV) and the Shedler-Westen Assessment Procedure-200 (SWAP-200)—a clinician-rated procedure to dimensionally assess personality. Participants were also asked to complete self-report questionnaires on overall ED symptomatology, symptoms of binge eating and purging behaviors, and therapy outcome. The findings showed that, over and above the categorical ED diagnosis, the SWAP-200 healthy personality functioning score mediated the relationship between baseline ED symptom severity and therapy outcome, as well as the association between baseline bulimic symptoms and treatment outcome; furthermore, SWAP-200 Cluster B PD scores mediated the link between baseline binge eating and purging symptoms and therapy outcome, whereas scores in Clusters A and C showed no significant effects. The findings suggest that personality-based outcome research may improve treatment effectiveness in this difficult-to-treat population.

RESUMO Objetivo: investigar em uma série de casos de pacientes submetidos a operações de médio porte em cirurgia geral, o uso da conduta de realimentação pós-operatória “ultra precoce”(dieta oral líquida oferecida na recuperação pós-anestésica), avaliando-se o volume de fluidos endovenosos recebidos no pós-operatório por estes pacientes, assim como a ocorrência de complicações e o tempo de internação hospitalar. Métodos: estudo prospectivo, observacional. Avaliou-se a aderência à rotina de realimentação “ultra precoce”, abreviação do jejum pré-operatório, volume de hidratação venosa perioperatório, tempo de internação e morbidade operatória. Resultados: um total de 154 pacientes com média da idade de 46±15 anos, foram acompanhados. Realimentação “ultra precoce” foi realizada em 144 casos (93,5%). Pacientes que não receberam realimentação “ultra precoce” receberam volume significativamente maior de fluidos endovenosos no pós-operatório do que pacientes realimentados de maneira “ultra precoce” (500ml versus 200ml, p=0,018). O tempo de internação foi de 2,4±2,79 dias (realimentação convencional) versus 1,45±1,83 dias (realimentação “ultra precoce”), sem diferença estatística (p=0,133).Não houve diferença no percentual de complicações gerais (p=0,291), vômitos (p=0,696) ou infecção do sítio cirúrgico (p=0,534). Conclusão: a realimentação “ultra precoce” apresentou-se como uma conduta de elevada aderência em operações de médio porte em Cirurgia Geral nesta série de casos e, esteve relacionada a infusão de volume significativamente menor de fluidos endovenosos no pós-operatório, com índices baixos de complicações e sem impacto no tempo de internação.

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Purpose Atheoretical and descriptive conceptualizations of eating disorders (EDs) have faced substantial criticism due to their limited ability to assess patients’ subjective characteristics and experiences, as needed to determine the most appropriate treatment options. The present article provides an overview of the clinical and empirical literature supporting the potential contribution of the Psychodynamic Diagnostic Manual (PDM-2) to both diagnostic assessment and treatment monitoring. Methods Following a discussion of the most relevant shortcomings of current diagnostic models of EDs and a description of the rationale and structure of the PDM-2, evidence supporting the core PDM-2 dimensions of ED patients’ subjective experiences (i.e., affective states, cognitive processes, relational patterns, somatic/bodily experiences and states) are examined, alongside their relevance to ED diagnosis and treatment. Results Overall, the reviewed studies support the diagnostic importance of these patterns of subjective experiences in EDs, highlighting their potential role as either predisposing or maintaining factors to target in psychotherapy. A growing body of multidisciplinary evidence also shows that bodily and somatic experiences are central to the diagnosis and clinical management of ED patients. Moreover, there is evidence that a PDM-based assessment may enable closer monitoring of patient progress during treatment, with regard to both subjective experiences and symptom patterns. Conclusions The study suggests that current diagnostic frameworks for EDs would benefit from the addition of a person-centered perspective that considers not only symptoms, but also patients’ full range of functioning—including their deep and surface-level emotional, cognitive, interpersonal, and social patterns—to improve patient-tailored interventions. Level of evidence Level V, narrative review.

This study aimed to investigate whether there is a relation, as well as its configuration, between the dissatisfaction with body image and the occurrence of disordered eating behaviors in undergraduate female students. For this purpose, an integrative review was conducted in the Lilacs, Scielo, PMC and PubMed indexed databases in January and February 2019, by means of DeCS and BVL terms: feeding/ eating behavior, college/ university students, body dissatisfaction, and eating habits. The search resulted in 433 references with a final sample of 21 articles, which underwent summarization, and evidenced not only that body dissatisfaction is a potent component for the adoption of high-risk eating habits, but also that women face great social pressure regarding their weight and body shape.

Transcatheter aortic valve implantation is considered a standard treatment for many symptomatic patients with severe aortic stenosis. Coronary artery occlusion after transcatheter aortic valve implantation is associated with a mortality rate of up to 50%. In this case report we described a patient with severe aortic bioprosthesis dysfunction, at high risk of coronary obstruction after transcatheter aortic valve implantation. This patient underwent Basilica procedure followed by valve-in-valve transcatheter aortic valve implantation. The patient demonstrated good improvement and was discharged from hospital after 2 days, without any symptoms. The patient remained asymptomatic at 6 months of follow-up.