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Background Brucellosis is a zoonotic bacterial infection caused by a gram-negative aerobic coccobacillus. It can have varied presentation. Most severe complications include neurological and cardiovascular involvement (most commonly in the form of infective endocarditis). Aortic valve is most commonly involved (75%). Blood culture is highly specific, while serologic tests are more sensitive for diagnosing brucellosis. Transthoracic and transesophageal echocardiography plays a major role in diagnosing infective endocarditis. Treatment of Brucella endocarditis includes combination of antibiotic therapy and surgical valve replacement. We are presenting here a case series of seven cases of B. endocarditis with different presentations and varied underlying cardiac conditions. Materials and Methods Total seven cases of B. endocarditis were reported. The age group ranges from 22 to 45 years. Majority of them were from agriculture and dairy industry. All have presented with fever and three patients had severe breathlessness. Three cases were rheumatic valve diseases, one was bicuspid aortic valve, and one was congenital heart disease with prosthetic valve. Six patients had native valve endocarditis (four had predisposing cardiac condition with diseased valves, two had normal valves), whereas one had prosthetic valve endocarditis. Four had aortic valve involvement and three had mitral involvement. All cases were diagnosed using blood culture, serology, and echocardiography. Conclusion All were treated initially with antibiotics and valve replacement was done in five cases. Mortality was the outcome in two cases on conservative treatment and before surgery. Other five patients recovered after surgery.

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The incidence of varicosities of upper extremity is far most uncommon from that of lower extremity varicose veins for varied reasons even though the causes are almost the same. Here, the authors present a case of right upper limb varicose veins in a 55-year-old female who is a housewife. After ruling out all the secondary and congenital causes on clinical and Doppler study, the authors diagnosed it as a case of primary upper extremity varicose veins. They referred the case to a vascular surgeon but the patient denied the surgery, and is lost to follow-up. Hence, the authors report this case of primary upper limb varicosities as the incidence is very low when compared with lower extremity, and not much of literature is available except for a few case reports.

Sinus of Valsalva aneurysm is a rare cardiac anomaly which is more often congenital than acquired. Rupture of the aneurysm can present as plain as an asymptomatic murmur to as dramatic as a myocardial infarction or cardiogenic shock or even death. Ruptured sinus of Valsalva (RSOV) is very rare in the elderly, and an asymptomatic rupture in an octogenarian is rarer still. An octogenarian, accompanying his wife for her diabetic follow-up, was found to have a continuous murmur by chance examination. Echocardiography unmasked a RSOV; surprisingly, the elderly man was completely asymptomatic. The patient was referred to a cardiothoracic center for further management. A RSOV is a precarious disposition needing prompt recognition and urgent intervention even though asymptomatic. This case report highlights the importance of recognizing such entities even among the elderly despite its rarity. This case also highlights the cardiovascular auscultation as one of the most important, simple, and inexpensive clinical investigations.