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Stress is a fundamental biological response that can be associated with alterations in cognitive processes. Unhealthy dietary habits are proposed to modulate this effect, notably through their pro-inflammatory potential. This cross-sectional study aimed to evaluate the influence of an obesogenic dietary pattern with inflammatory potential on stress-induced cognitive alterations in healthy volunteers.Fifty healthy adult participants were stratified into two diet groups: obesogenic vs. non-obesogenic, based on their self-reported consumption of fat, sugar, and salt, assessed by the French National Program for Nutrition and Health questionnaire and a food frequency questionnaire. Serum high-sensitive C-reactive protein (hsCRP) was measured as a marker of systemic inflammation using ELISA. Verbal memory and sustained attention were evaluated through the Verbal Recognition Memory (VRM) test and the Rapid Visual Information Processing (RVP) test respectively, from the Cambridge Neuropsychological Test Automated Battery. Assessments were performed before and after exposure to the psychological stressor Trier Social Stress Test (TSST). Stress response was evaluated by subjective stress perception, salivary cortisol, blood pressure, and heart rate.Twenty-two participants (44%) presented an obesogenic diet. Systemic inflammation was significantly higher in the obesogenic diet group (p=0.005). The TSST induced a significant stress response, regardless of dietary habits (Time effect p

The percutaneous MitraClip system is a catheter-based device designed to perform edge-to-edge mitral valve (MV) leaflet repair at the site of regurgitation. MitraClip implantation is an alternative procedure in patients at high surgical risk with symptomatic severe mitral regurgitation (MR) who are not candidates for MV repair/replacement due to their degree of comorbidity and associated high mortality risk. The procedure is guided by 3-dimensional (3D) transesophageal echocardiography (TEE) and fluoroscopy. A clip is positioned between the anterior and posterior leaflet to reduce valve regurgitation. Quantitatively, the reduction in MR is less than with surgical repair, but it significantly improves patients’ quality of life and functional capacity. Advantages are avoidance of sternotomy and cardiopulmonary bypass, beating-heart repair of the MV and reduction in post-operative duration of mechanical ventilation, intensive care unit (ICU) stay and need for blood transfusion.General anesthesia (GA) with orotracheal intubation is the most common approach in the literature because of the TEE probe and the need for the patient to be immobilized during the procedure. Since May 2014, of the 39 patients who have had MitraClip implantation in our hospital, only two were under deep sedation.We describe here the case of a MitraClip implantation performed under deep sedation with ketamine and propofol infusion in a patient unsuitable for surgical repair because of her comorbidities. Resumo: A implantação percutânea de MitraClip é feita através de um dispositivo tipo catéter concebido para reparar a zona central das duas cúspides da valva mitral insuficiente, como procedimento alternativo em doentes de alto risco cirúrgico, com uma insuficiência mitral severa sintomática, que não são adequados ou são recusados para reparação cirúrgica ou substituição valvular pelas suas comorbilidades e portanto elevada mortalidade. O procedimento é guiado por ecocardiografia transesofágica tridimensional e fluoroscopia. Um clip é posicionado entre o folheto anterior e posterior para reduzir a regurgitação valvular. A redução quantitativa da regurgitação é menor do que a da reparação cirúrgica, mas melhora significativamente a capacidade funcional dos doentes e a sua qualidade de vida. As vantagens são a evicção de esternotomia e do bypass cardiopulmonar, a reparação da válvula sem paragem cardiocirculatória, a redução do tempo de ventilação mecânica pós-operatória, do tempo de internamento em unidade de cuidados intensivos e da necessidade de transfusão sanguínea.No que diz respeito à abordagem anestésica, a anestesia geral com intubação orotraqueal é a mais frequentemente descrita na literatura, quer pelo uso do eco transesofágico quer pela necessidade de imobilização, durante o procedimento. Desde maio de 2014 até à data presente, 39 doentes foram submetidos à implantação de MitraClip na nossa instituição hospitalar, apenas dois dos quais sob sedação profunda.Descrevemos, neste manuscrito, um caso de implantação de MitraClip feita sob sedação profunda, com perfusão de ketamina e propofol, numa doente recusada para reparação cirúrgica pelas suas comorbilidades. Keywords: Mitral regurgitation, Percutaneous MitraClip implantation, General anesthesia, Sedation, Propofol, Ketamine, Transesophageal echocardiography, Palavras-chave: Insuficiência mitral, Implantação percutânea de MitraClip, Anestesia geral, Sedação, Propofol, Ketamina, Ecocardiografia transesofágica