AC appears as effective as AG for treating EFIE patients and can be used with virtually no risk of renal failure and regardless of the high-level aminoglycoside resistance status of E. faecalis.

Infective endocarditis (IE) remains a major clinical problem, with mortality rates of 20% to 40%. [1][2][3] During the active course of IE, neurological complications occur in 20% to 40% of patients 1,4,5 and have been linked to a poorer outcome. 1,2,5,6 In several of the related reports, however, neurological complication is a generic term referring to a broad spectrum of complications ranging from nonspecific manifestations, such as nonfocal encephalopathy, seizures, or headache, to stroke or severe cerebral hemorrhage. 4,7 This all-inclusive approach can lead to confusion when investigating the true effect of brain involvement on the outcome of IE or the relationships between brain injury and certain characteristics Background-The purpose of this study was to assess the incidence of neurological complications in patients with infective endocarditis, the risk factors for their development, their influence on the clinical outcome, and the impact of cardiac surgery. Antimicrobial treatment reduced (by 33% to 75%) the risk of neurological complications. In patients with hemorrhage, mortality was higher when surgery was performed within 4 weeks of the hemorrhagic event (75% versus 40% in later surgery). Conclusions-Moderate to severe ischemic stroke and brain hemorrhage were found to have a significant negative impact on the outcome of infective endocarditis. Early appropriate antimicrobial treatment is critical, and transitory discontinuation of anticoagulant therapy should be considered. Methods and Results-This García-Cabrera et al Endocarditis, Neurological Complications 2273of IE (eg, vegetation size or affected valve). Another debated point requiring clarification is whether brain damage may worsen after valve surgery in patients experiencing these complications. Several of the previous studies investigating these and other issues have the limitations of retrospective data collection, 8,9 referral center bias, 8,10 or analysis of too few events to obtain valid conclusions. 4,8 Clinical Perspective on p 2284The objectives of the present study were to assess the incidence of neurological complications in IE patients, the risk factors for their development, the associated risk of death, and the influence of valve surgery in this situation on patient outcome. Methods Study Design and PatientsThe study included patients consecutively diagnosed with IE in 7 hospitals in Andalusia (southern Spain) and registered in a dedicated database from January 1984 to December 2009. Five of the participating centers are tertiary referral hospitals for cardiac surgery, and 2 are community hospitals, where patients at higher risk are transferred to the referral centers for assessment for surgery. The information in this database was merged with data from the Vall d'Hebron Hospital database for IE. Vall d'Hebron is a 1000-bed teaching hospital in Barcelona, Spain, and a referral center for cardiac surgery, with a prospective IE cohort registered from January 2000 to December 2009. The specific variables included in both registri...

The aim of this cross-sectional study was to establish the frequency, phenotype and characteristics of metabolic syndrome (MS), as defined by the Adult Treatment Panel III, in a cohort of patients with systemic lupus erythematosus (SLE) and its possible association with cardiovascular diseases (CVD). A total of 160 patients with SLE and 245 age, sex, educational level and ethnically matched controls were included. Association with cardiovascular risk factors, SLE features, treatment of SLE and history of CVD were assessed in patients with SLE and controls with and without MS. MS was non-significantly increased in patients with SLE (20%) compared with controls (13%; P = 0.083). It was more commonly observed in patients with SLE < or =40 years old (15.8%) than in controls of the same age group (4.2%; P < 0.001). The mean number of MS criteria was significantly higher among patients with SLE than in controls. The frequency of CVD was also 28-fold higher among patients with SLE (11.3%) than in controls (0.4%). SLE with MS presented higher levels of inflammatory markers than SLE without MS. In a multivariate analysis, educational level, serum triglycerides, HDL-cholesterol and C3 serum levels and hydroxychloroquine use were independently associated with MS.

Background: Chronic stress worsens the quality of life (QOL) of lupus patients by affecting their physical and psychological status. The effectiveness of a cognitive-behavioural intervention in a group of patients with lupus and high levels of daily stress was investigated. Methods: Forty-five patients with lupus and high levels of daily stress were randomly assigned to a control group (CG) or a therapy group (TG); they received cognitive behavioural therapy (CBT) which consisted of ten consecutive weekly sessions. The following variables were evaluated at baseline and at 3, 9 and 15 months: (1) stress, anxiety, depression, (2) Systemic Lupus Erythematosus Disease Activity Index, somatic symptoms, number of flares, (3) anti-nDNA antibodies, complement fractions C3 and C4 and (4) QOL. A multivariate analysis of repeated measures and various analyses of variance were carried out. Results: We found a significant reduction in the level of depression, anxiety and daily stress in the TG compared to the CG and a significant improvement in QOL and somatic symptoms in the TG throughout the entire follow-up period. We did not find any significant changes in the immunological parameters. Conclusions: CBT is effective in dealing with patients suffering from lupus and high levels of daily stress as it significantly reduces the incidence of psychological disorders associated with lupus and improves and maintains patients’ QOL, despite there being no significant reduction in the disease activity index.

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