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Stress or administration of ACTH to pregnant mice gave rise to much higher plasma corticosterone levels in the second half of pregnancy than in the first half, suggesting that there may be increased adrenal sensitivity to ACTH or decreased metabolism of corticosterone during the second half of pregnancy.

Infective endocarditis (IE) is a serious infectious disease with significant mortality and morbidity placing a burden on healthcare systems. Outpatient antimicrobial therapy in selected patients has been shown to be safe and beneficial to both patients and the healthcare system. In this article, we review the literature on the model of care for outpatient parenteral antimicrobial therapy in infective endocarditis and propose that systems of care be developed based on local resources and all patients admitted with infective endocarditis be screened appropriately for outpatient antimicrobial therapy.

Background: Beta-blockers are widely used post-acute coronary syndrome (ACS). However, beta-blockade has historically been linked to side effects such as depression. Beta-blockers have a pharmacological effect on the autonomic nervous system (ANS) and ANS function has been linked to mood changes. We sought to investigate the possible association between beta-blockade and mood in post-ACS patients and examine whether it is explained by ANS function, as measured by heart rate variability (HRV). Methods: Patients recruited post-ACS had their mood indexed using the Cardiac Depression Scale (CDS) 4 weeks post ACS. A 20-minute ECG trace was analysed for HRV in AD Instruments Labchart 8. Following the exclusion of patients with missing baseline data (n=162), the final sample comprised 252 patients (n=206 males, mean age 59.14610.19). Results: 59.9% (n=151) of patients were taking betablockers, 78.8% on metoprolol. The relationship between beta-blocker use and CDS total score was significant (r=-0.124, p,0.05) but weak, indicating that patients taking a beta-blocker had lower CDS scores. A significant inverse relationship between beta-blockade and the CDS mood component was found (r=-0.131, p,0.05). Split by the presence of 'probable depression', logistic regression analysis showed that the relationship between beta-blockade and depression was fully mediated by increased Average RR (p,0.05). Conclusion: Beta-blockade in post-ACS patients has an inverse association with depressive symptoms and this relationship is mediated by reduced heart rate, suggesting a possible mechanism of action.

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