Q fever is a rare systemic infection caused by CoxiellaBurnetii.The presentation with Q fever endocarditis is insidious, with negative blood cultures, and often it is not obvious in diagnostic imaging studies until hemodynamic changes or valve destruction is reached. We report a case of Q fever endocarditis involving native mitral valve on top of rheumatic heart disease and severe mitral stenosis in 45 years old male admitted to the hospital with fever and left lower lobe pneumonia with pleural effusion. Was investigated for pulmonary Tuberculosis, which was negative. Echocardiography showed severe mitral valve stenosis with mass attached to the mitral valve leaflet. Blood cultures were negative. Serology for CoxiellaBurnetii was positive. Challenges in the diagnosis, surgical treatment and different aspects of this rare case are described.

Patients with ACS remain at high risk of major coronary events and require further therapy to improve their survival and lower morbidity. A total of 35 Canadian hospitals participated and enrolled NSTEMI ACS patients admitted with the first event. Patients surviving to hospital discharge were followed up at 4 and 6 months to assess the use of recommended secondary prevention measures. Physicians were reminded of the recommended secondary prevention measures by way of a clinical reminder which was shown if an individual patient management did not conform to the recommendations. A total of 423 patients (70% male) who were 63.4 ± 11.2 years old were recruited by 28 hospitals. Systolic and diastolic BP was 140 ± 23 and 80 ± 14 mmHg, respectively and the heart rate was 75±15 beats per minute. Time from symptom onset to presentation was 1-12 hours in 57%, 12-24 hours in 20%, and > 24 hours in 23%. Presenting ECG was normal in 43%, revealed T wave inversion in 30%, ST segment depression in 26% and non-specific changes in 18%. While in hospital 93% of patients had an angiogram, PCI was performed in 67% and CABG in 12%. Recommended secondary prevention measures were prescribed in only 31% of patients at hospital discharge; the use of the clinical reminder was associated with significant increase in secondary prevention treatments during the follow up (p=0.0072). Simple clinical reminders offered as part of the electronic data entry appear feasible and may support optimizing patient care based on guidelines and recommendations.

Background: Platelet inhibition is necessary in post PCI period as it is one of the risk factor for stent thrombosis and there are only few studies on platelet aggregation and inhibition for gender comparison between males and females. Methods: We have studied 142 consecutive in patients from NIMS cardiology department from august 2014 to 2016 who underwent PTCA, in the follow up period of 15th day we did platelet aggregation test for all the patients. We calculated platelet inhibition by 100–platelet aggregation. Results: Out of 142 patients 30 are females 112 are males. Both the groups are matched in baseline characteristic of mean age 57 years, hypertension, diabetes, type of presentation (stable or unstable) weight, eGFR, type of stent, presence or absence of LV dysfunction, single or multi vessel disease. There is significant difference in smoking (p=0.000) between males and females, and hemoglobin levels (12.12 v/s 13.60 g/dl, p = 0.04) but there is tendency for higher platelet aggregation (i.e. lesser platelet inhibition) in females, Chi square test person uncorrected chi square = 1.238, p=0.266,(fisher exact test 2 tailed p value 0.545) (Odds ratio (OR) = 0.00, 95% CI 0.00 to 6.649 Relative Risk (RR) = 0.00, 95% CI 0.00 TO 5.389). There are 9 (30%) females with higher end on platelet activity >50% in whom there are nil events in them and there are 24 (21.43%) males with higher end platelet activity >50% in whom there are 3 non cardiac events ( AV fistula, CSA+CIN, CCF)in them but total event rate is higher in females(10%) than in males (8.04%). When estimate of difference is calculated with 95% CI is (-0.125) with test for difference 0 and p value of 0.064 Conclusion: Though there is a tendency of lesser platelet inhibition in female’s events rates are higher compared to males (10% v/s 8.04%) with p = 0.064 which again shows tendency but not significance

Previous studies have shown an association of Coronary Artery Disease (CAD) with Acid Phosphatase locus 1 (ACP1) and Adenosine Deaminase locus 1 (ADA1) genetic polymorphisms. Both systems are involved in immune reactions and several studies point to a significant autoimmune component in the pathogenesis of CAD. In the present note we have investigated the role of the two polymorphisms on age of onset of the disease. Hundred and thirty patients admitted to Valmontone Hospital for the first episode of CAD have been studied. Informed consent was obtained by the patients to participate in the study that was approved by the Sanitary Direction of the Hospital. In patients at the first episode of CAD, ACP1 genotype was determined in 130 subjects and ADA1 genotype in 126 subjects by DNA analysis. SPSS programs performed statistical analyses. The age at onset of CAD is lower in subjects with low ACP1 activity genotypes and in those with low ADA1 activity genotypes. The association is stronger in females than in males. The effects of the two systems appears additive with a lower age of onset in subjects carrying the two factors associated with lower age at onset and a higher age in subjects with no factor. The pattern is stronger in females than in males. Gender differences in autoimmunity are well documented: women with low ACP1 activity and/or ADA1 genotype seem to have a high risk of early clinical manifestations as compared to women carrying genotypes with high activity. These differences support the hypothesis of significant autoimmune component in the pathogenesis of CAD.

Lutembacher syndrome is defined as a combination of mitral stenosis (mostly rheumatic) with a left to right shunt at the atrial septal level. It is a rare disease with a higher prevalence in areas, where rheumatic heart disease is common. Diagnosis on physical examination can be challenging and therefore echocardiography is generally required to make the diagnosis. If not diagnosed and treated early, patient may develop right heart failure and arrhythmic complications, which bear a bad prognosis. We present a case-based reappraisal of Lutembacher syndrome in a 23-years old female, who presented with symptoms of pulmonary hypertension and heart failure.