Cutibacterium acnes is a skin commensal which is most often regarded as a contaminant when detected on blood cultures. In rare instances, it may be the causative pathogen in severe systemic illnesses. Subacute endocarditis, especially of prosthetic valves and devices, is an important grave pathology caused by Cutibacterium acnes. Herein we report two cases of prosthetic valve endocarditis with varied presentations as valve dehiscence with a "rocking" prosthetic valve apparatus in one encounter and as a septic embolic stroke in the second encounter. Although a rare cause of endocarditis, it becomes an especially important entity in patients with prosthetic devices and should be high in the list of differentials.

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Introduction: Seizures are one of the most common presentation in children requiring urgent care in Emergency Departments. This study was conducted to determine the clinical profile, management and spectrum of patients presenting to Emergency department in a low middle income country. Methods: This was an observational cross-sectional study carried out in tertiary care hospital. Data was collected on a predesigned questionnaire from June 2018–May 2019. Qualitative variables like gender and type of seizure were expressed as percentages and frequencies. Quantitative variables like age, levels of sodium, potassium and calcium were expressed as median, interquartile ranges and Wilcoxon Rank Sum test was used. Results: The prevalence of seizures amongst children presenting to pediatric emergency room was found to be 9.36 per 1000 children. A total of 186 patients presented to pediatric emergency department with seizures. There were 58.1% boys and 41.9% females. The median age of children presented with seizure was 26 months. The most common type of seizure noticed by eye witness were grandmal 95 (51.1%), simple partial 6 (3.3%), complex 1 (0.5%). Hyponatremia was the most commonly reported abnormality 54.2%. Febrile Convulsion were reported in 46.8%, 24.7% were known epileptic, 9.1% had an infective source, 5.4% metabolic & 2.7% had afebrile seizures. Conclusion: Seizure was one of the commonest neurological condition occurring predominantly in males. Febrile seizures usually do not require hospitalization. Emergency Department care was needed in majority of children and 45.7% were discharged directly from Emergency Room. Highlights:

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