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Intro: A 67 year old man presented to St Vincent’s Hospital, Melbourne, with increasing fatigue, poor concentration, anhedonia and increasing tearfulness. The patient also reported a loss of appetite, dyspnoea and significant weight loss of 10kg over the prior 6months. He had a previous history of mitral valve prolapse and bicuspid aortic valve disease that was under regular review by his physician and had recently been diagnosed with atrial fibrillation. He denied any history of fever, night sweats or arthralgia. On examination he was cachectic with evidence of a depressed affect and would frequently and unpredictably burst into tears during consultations. A psychiatric evaluation felt that the sudden and frequent bouts of emotional lability suggested the possibility of an underlying organic cause. Conclusion: This case highlights the diversity in presentation of endocarditis and that it should always be considered as a differential diagnosis in any patient who presents with initially unclear diagnostic features with pre existing valvular disease. In this particular patient a presentation with depressed affect and weight loss without significant features of active infection predominated. The diagnosis was only established because blood cultures were collected, and those results directed further investigations for endocarditis. In patients with atypical neuropsychiatric presentations, careful clinical assessment is warranted to exclude organic disease. really slim diet pills The other tip is to simply make your vacation itself active! If you’re a chronic window shopper or you’re keen on architecture, walking for hours at brisk paces during the boring bits and slow paces at the good bits, is much better for both sight seeing and energy levels than just taking a tour bus or a car.