Background: Blue Rubber Bleb Nevus syndrome (BRBNS) is a rare disorder, that results in congenital cutaneous hemangiomas of the skin and gastrointestinal tract. Although asymptomatic, the nevi present as soft, non-mobile, dark blue, compressible papules. Clinically it presents as iron deficiency anemia due to occult gastrointestinal bleeding. Case presentation: A 22-year-old female patient presented with complaints of shortness of breath, fatigue, and palpitation for 2 months. On examination, she had a pale effect and widespread hemangiomas on her lips, hands, and feet. Laboratory results revealed iron deficiency anemia with hemoglobin (Hb) of 2.1 gm/dl and histopathology results of the hemangioma specimen showed angiokeratomas. Based on clinical manifestations and laboratory results, the patient was diagnosed with a case of BRBNS. The patient was transfused with red cell concentrate her symptoms improved but on the first follow-up visit her Hb again dropped to 8.6 mg/dl. Conclusion: A high suspicion of BRBNS diagnosis should be considered if a patient presents with iron deficiency anemia and multiple cutaneous hemangiomas. Further screening should be done to explore internal bleeding and hemangiomas.

Splenic hematoma following an acute pancreatitis is a rare complication which is thought to be due to the distribution of pancreatic exudates to the spleen. We presented a case of a 44-year-old patient with acute pancreatitis who developed splenic hematoma. He responded well to conservative management and the hematoma resolved.

Introduction: Cerebral venous sinus thrombosis (CVST) is a rare but highly fatal neurological condition mostly caused by prothrombotic conditions like antiphospholipid syndrome, factor V Leiden, and G20210A prothrombin polymorphism. Snake bites are a rare cause of cerebral venous sinus thrombosis that must be recognized and treated promptly to improve survival. Case presentation: We present a case of a 25-year-old male who developed headaches and seizures following a Viper snake bite. The diagnosis was made based on a magnetic resonance venogram (MRV) showing transverse sinus thrombosis with sigmoid sinus stenosis. Initially, the patient was treated with antivenom and supportive treatment for disseminated intravascular coagulation (DIC). After the diagnosis of CVST, the patient was treated with rivaroxaban and levetiracetam. The patient improved within 1 week of treatment and was advised to follow up in 3 months. Conclusion: A high index of suspicion for cerebral venous sinus thrombosis is required if the patient presents with headaches, seizures, or abnormal vision following a snake bite. Early diagnosis and management can prevent further neurological damage.

Objectives: To determine the microbiologic spectra and their antibiotic susceptibility patterns in type 2 diabetic patients with UTIs Materials and Methods: This descriptive cross-sectional study was conducted in the Department of Medicine, Khyber Teaching Hospital, Peshawar from 1st July 2021 to 31st December 2021. Type II Diabetic patients with urinary tract infections were recruited in the study. Their urine culture for sensitivities was carried out. The frequency of positive urine culture was stratified among age and gender to see the effect modifications. Antibiotic sensitivity and resistance patterns were stratified among male and female diabetic patients. Results: Out of 150 patients, 125 were females and 25 were males. 27 patients (24.3%) had positive urine cultures, out of whom 19 (70.4%) were females, and 8 (29.6%) were males. The most common organism found in females was E.coli (42%). Among male patients with positive urine cultures, E.coli was the most common organism isolated in 5 (62.51%). Cefixime had the highest resistance, with 21(77.8%) of 25 culture-positive patients resistant to it. All the patients with positive urine cultures were sensitive to piperacillin/tazobactam, Meropenem, Doripenem, Cefepime, Aztreonam, and Tigecycline. Conclusion: Diabetic females are more prone to UTIs with an increased prevalence of positive urine cultures as compared to diabetic men. The most common isolate was E.coli. The highest antimicrobial resistance was reported for Cefixime. All patients were sensitive to Meropenem, Tazobactam/Piperacillin, Aztreonam, Tigecycline, Doripenem, and Cefepime. Key Words: Antibiotic susceptibility; Diabetes mellitus; urine culture and sensitivity