Medical Journal of The Islamic Republic of Iran (MJIRI)

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A prospective, randomized trial on 416 consecutive cases of appendicectomies was carried out in which half of the cases had simple ligation of the stump and the rest had invagination of the stump in addition. The two groups were matched for age, sex, state of personal hygiene and nutrition. The incidence of wound infection, and early and late post-operative complications remained comparable between the two groups. However, the mean operating time was significantly less in case of simple ligation. Barium enema in suspected cases of caecal neoplasm in post-operative cases did not reveal any ceacal deformity in the group of simple ligation thus avoiding confusion of mistaking deformed caecum due to the invaginated stumps as neoplasm. Simple ligation of the appendiceal stump is therefore advocated during appendicectomy.

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 Sheehan’s syndrome (SS) refers to the occurrence of varying degree of hypopituitarism after parturition (1). It is a rare cause of hypopituitarism in developed countries owing to advances in obstetric care and its frequency is decreasing worldwide. However, it is still frequent in underdeveloped and developing countries. Sheehan’s syndrome is often diagnosed late as it evolves slowly (2,3). Reports of psychoses in patients with Sheehan’s syndrome are rare. Herein, a case report of psychosis in a 31 year old woman who developed Sheehan’s syndrome preceded by postpartum haemorrhage is presented. Treatment with thyroxine and glucocorticoids resulted in complete remission after attaining euthyroid and eucortisolemic state.

 

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Non–Hodgkin lymphoma (NHL) causes many deaths worldwide with increasing incidence. Non-Hodgkin's lymphoma (NHL) may involve the gynecologic tract, and the ovary to be one of the commoner anatomic sites as reported. Ovarian involvement by NHL is usually secondary, occurring as a part of systemic disease. The diagnosis is often made incidentally while investigating for gynecological symptoms. We report an interesting case of NHL in a 35 year old female, who primarily presented with acute abdomen disease with secondary ovarian and cervical involvement and occult extra-ovarian disease.

 

 

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  Background :Wide distribution and low half-life of acyclovir has led to a high dose consumption of the drug. Recent studies have shown that encapsulation of acyclovir in nano-carriers can increase effectiveness and decrease its side effects. We investigated the inhibitory effect of acyclovir loaded nano-niosomes against herpes simplex virus type-1 (HSV-1) in cell culture.

  Methods : In-vitro cytotoxicity study of empty niosomes (E-N), acyclovir loaded niosomes (ACV-N) and ACV as a free drug against HeLa cell line was performed by MTT assay and the viral titers was tested by TCID50 assay.

  Results : The results indicated that a significant higher antiviral activity for acyclovir loaded nano-niosomes of about 3 times in comparison with free drug.

  Conclusion : The results of this study revealed ACV-N have a higher antiviral activity compared with free drug it could be a suitable carrier for delivery of acyclovir in the treatment of HSV-1 infections.

 

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Background: Lennox-Gastaut syndrome (LGS) is an epileptic encephalopathy, characterized by drug-resistant multiple seizure types. The aim of this study was to determine if the adjunctive use of electroconvulsive therapy (ECT) in patients with LGS and drug-resistant epilepsy is efficacious in decreasing their seizure frequency and also to investigate its safety and tolerability.

  Methods: This was an open-label pilot study with convenience sampling from one center. Bitemporal electrode placement was selected. ECT was administered three times per week for four weeks (considered as the induction phase), and then once a week for two months (considered as the maintenance phase). Follow-up visits were scheduled at 2, 3, 4, and 6 months to determine the seizure types and counts and also to determine the safety and tolerability of adjunctive use of ECT in these patients. All patients and / or their caregivers consented in writing to their participation.

  Results: Seven patients were studied. Just one patient experienced more than 50% reduction in seizure frequency. One patient experienced more than 50% seizure increase with ECT. In three patients, there was an increase in aggressive behavior after receiving ECT. Two patients experienced mild and transient ataxia with ECT. One patient experienced mutism with ECT, which was transient and resolved with the termination of the procedure.

  Conclusion: In this small study, adjunctive use of an intensive ECT program in patients with LGS was not efficacious in decreasing their seizure frequency. However, the safety profile was acceptable, and patients tolerated the adjunctive use of ECT very well. This finding can pave the road for future investigations.

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Background: Family system has been found to affect the satisfaction level among the family members. The objective of our study was to determine the satisfaction level and its predictors among joint and nuclear family systems in District Abbottabad, Pakistan.
   Methods: We conducted a population-based cross-sectional study in all 52 :union: Councils (UCs) of District Abbottabad, Khyber Pakhtunkhwa province, Pakistan from March 2015 to August 2015. Multistage cluster sampling technique was used to select 2063 participants from both nuclear and joint family houses. Proportionate sampling was done for selecting mohalla from each UCs, and then subsequently households from respective mohalla’s. Simple random sampling was done for selecting the 18 years and above-aged participant for the study. A structured demographic questionnaire was used to collect information from study participants. Univariate and multivariate logistic regression analysis was done to find out the predictors of satisfaction level among joint and nuclear family systems using SPSS version 20 A p-value of <0.05 was considered as significant.
   Results: Level of satisfaction was found to be higher among people living in the joint family system i.e., 87.5 % v/s 81 % (<0.001) compared to the nuclear family system. Multivariate regression analysis of nuclear family system showed that people having higher education level and higher socioeconomic status (SES) were more satisfied as compared to no education & low SES respectively. While, in the joint family system, only high SES was a significant predictor of satisfaction in the joint family system as compared to low SES.   
   Conclusion: Our study reported a high level of satisfaction among joint and nuclear family systems in Pakistan. High education level and high SES were identified as important predictors of satisfaction among both systems.
 

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Background: : In 2017, American College of Cardiology (ACC) and the American Heart Association (AHA) presented a new guideline for assessing blood pressure in adults. This study aimed to assess the prevalence of hypertension in Iranian adults based on ACC/AHA 2017 guideline.
   Methods: Data from 9801 Iranian adults (59.2% women) aged between 20–69 years were obtained from the sixth round of National Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD) performed in 2011. Blood pressure was classified as normal, elevated blood pressure, and stage 1 and 2 hypertension using a weighted analysis and 2017 ACC/AHA guidelines. Data were presented as prevalence and 95% confidence interval (95% CI). All analyses were performed in Stata/SE 14.0.
   Results: Overall prevalence of hypertension in Iranian men was 52.0%. Also, 32.9% (95% CI: 29.9-36.0) and 19.1% (95% CI: 16.9-21.6) of men had stage 1 and 2 hypertension, respectively. In addition, 44.3% of women had hypertension, of whom 26.3% (95% CI: 24.5 - 28.2) had stage 1 and 18.0% (95% CI: 16.1-20.1) stage 2 hypertension. Furthermore, 16.5% (95% CI: 14.4-18.9) and 9.6% (95% CI: 7.86-11.7) of men and women had elevated blood pressure, respectively.
   Conclusion: The findings of this study indicated that adopting the 2017 ACC/AHA guidelines showed a higher prevalence of adult hypertension (48.2%) in Iran. In this study, the prevalence of hypertension in men was higher than in women, which was steadily increased by age in older adults in both sexes.

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Background: To evaluate the outcome of retrograde endopyelotomy as a minimally invasive option for management of failed open pyeloplasty in children and assess how the duration of post-procedural stenting may affect the endopyelotomy outcome.
   Methods: A total of 15 patients with secondary UPJO (Ureteropelvic junction obstruction) underwent retrograde endopyelotomy.  The procedure was done using low-energy monopolar electrocautery hook under direct vision of pediatric ureteroscope and control of fluoroscopy. Double J stent was placed after the operation in all cases. Stent was removed in another session, 8 weeks (Group A, n=7) vs. 12 weeks (Group B, n=8) after endopyelotomy. Patients in both Groups were followed one, six and twelve months after the stent removal, and the anteroposterior renal pelvis diameter (APD), renal cortical thickness (CT) and degree of hydronephrosis (HDN) were recorded using the repeated measure test. P-value less than 0.05 were significant. We analyzed the data using SPSS software, version 20.
   Results: The median interquartile range (IQR) age at time of surgery for group A and B were 24 (62) months and 12 (50) months respectively. Median (IQR) times between previous pyeloplasty and endopyelotomy were 6 (6) months and 12 (8.5) months in groups A and B, respectively. The success rate of endopyelotomy after 12 months was 57.1% in group A and 87.5% in group B. The resolution of HDN was more prominent in the 12 week stenting group compared to the 8 week group during the 12 months follow-up period (p=0.030). The APD and CT in group B compared to group A was improved during follow-up period.
   Conclusion: A higher one-year success rate of retrograde endopyelotomy in terms of improvements in the degree of HDN, APD and CT was observed when the double j stent was remained for 12-weeks rather than 8-weeks. This observation need to be validated in a large cohort study with a long term post procedural follow up.

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Pakistan has recently been overwhelmed by extreme torrential rains, with its most populous city of Karachi experiencing its worst floods in almost a century. Poor flood control and water disposal facilities have led to an immense risk of another dengue outbreak, with multiple cases being reported recently. The enormous accumulation of stagnant water in urban areas is a major source of mosquito breeding and transmission. Historical data has shown the correlation between the number of dengue cases and average rainfall in the region. The monsoon rains have pounded at a time where health authorities are battling to contain the Coronavirus (COVID-19) pandemic. There is a need to implement centralized dengue control strategies to undertake large scale water drainage, sanitation, and disinfection drives in disaster-stricken areas alongside public health awareness programs to combat the after-effects of this natural calamity.

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Background: The oncological outcomes of bladder cancer are directly associated with disease pathology and surgical technique. Therefore, we investigated the pathologic factors of radical cystectomy (RC) specimens.
   Methods: In this retrospective study, 365 patients who underwent RC between March 2013 to March 2018 in hospitals affiliated to Shiraz University were enrolled. The patients’ clinicopathological parameters, such as tumor type, tumor grade, carcinoma in situ, lymph node (LN) involvement, lymphovascular invasion (LVI), perineural invasion (PNI), and age, were recorded from their pathology reports. For comparison of variables, an independent t test was used.  P < 0.05 was regarded as significant. The statistical software SPSS version 22 was used to examine the data.
   Results: The participants’ mean age was 64.52 ± 11.54 years, and 320 (87.7%) patients were men and 45 (12.3%) were women. The mean dissected LN was 9.69 ± 8.70 nodes and 1.06 ±3.49 of the dissected LNs were involved by tumor. PNI and perivesical invasion were presented in 148 (40.5%) and 96 (26.3%) patients, respectively. Ureteral, urethral, and prostate involvements were seen in 23 (6.3%), 50 (13.7%), and 66 (18.1%) patients. Most patients had pathologic tumor stage 2 (36.4%). Factors such as LVI, PNI, perivesical invasion, and prostate involvement, were strongly correlated with positive LN (P ≤ 0.05).
   Conclusion: The examination of the RC specimen is critical for patient care, outcome, and justification of adjuvant therapy.  Factors such as LVI, perineural invasion, perivesical invasion, and prostate involvement were strongly correlated with positive LN.
 

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Background: Acute kidney injury (AKI) is frequent in hospitalized patients with critical illness and presents in up to one-quarter of patients with non-severe community-acquired pneumonia (CAP), resulting in increased short and long-term mortality. There is a paucity of literature from resource-limited settings regarding the incidence and risk factors for AKI in patients with CAP. In this study, we looked at the incidence and risk factors for AKI in patients hospitalized with CAP in a resource-limited setting
   Methods: This prospective observational study conducted over 1 year period included patients ≥ 18 years of age diagnosed with CAP admitted to a tertiary care center. The differences in baseline characteristics between hospitalized CAP patients with and without AKI; and risk factors for AKI and the need for renal replacement therapy (RRT) were analyzed using Chi-square test, t-test, Mann-Whitney U test, and logistic regression with p-value <0.05 considered statistically significant.
   Results: We observed 27.6 % (58/210) of patients had AKI in our study. Patients with AKI had significantly higher baseline comorbidities of chronic kidney disease (p=0.005) and coronary artery disease (p=0.032), and significantly higher uric acid (p=0.002), lower albumin  (p=0.005), lower total protein (p=0.015), higher bilirubin (p=0.001), higher LDH (p=0.041), and higher CURB-65 score (p<0.001) in addition to elevated creatinine, BUN (p<0.001) compared to the no-AKI group. The patient group requiring RRT had significantly more males (p=0.019), with significantly higher phosphorus (p=0.038), lower ALT (p=0.022), and expectedly higher creatinine (p<0.001) and blood urea nitrogen (p=0.016). The adjusted logistic regression analysis revealed that patients with higher CURB-65 scores were at increased odds of undergoing RRT (OR 8.74, 95% CI 5.27 to 12.21, p=0.039).
   Conclusion: There is a high incidence of AKI in patients hospitalized for CAP in developing countries. Clinicians should be alert for the prevention and early detection of AKI in CAP patients.

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Background: Coronavirus Disease (COVID-19) pandemic can affect mental health. Heads of the household are at higher risk of this effect because of their financial and social responsibilities. This study aimed to assess the psychological well-being and its associated factors during the COVID-19 pandemic among heads of households in Pakistan.
   Methods: We conducted an online survey in May 2020. A convenience sampling strategy was used to enroll the heads of the households from all regions of Pakistan. A validated English and Urdu version of the WHO-5 well-being scale was used to assess well-being. The prevalence of poor well-being and its associated factors among heads of the households was measured using logistic regression.
   Results: A total of 509 heads of households participated in the survey. About 35% of the participants were dependent on financial sources other than salary. The news was considered a source of fear as 70% assumed that avoiding such news may reduce the fear. The most common coping strategies used during lockdown were; spending quality time with family, eating healthy foods, adequate sleep and talking to friends on the phone. The prevalence of poor well-being was found to be 41% (95% CI: 36.62-45.51). Individuals with any chronic illness were at a higher risk of poor wellbeing adjusted odds ratio of 1.64 (95% CI: 1.04–2.59).  Worriedness was also found to be associated with a higher risk of poor wellbeing adjusted OR 1.13 (95% CI: 1.06–1.19). Reading books showed a protective association with poor mental wellbeing adjusted OR 0.64 (95% CI: 0.42–0.98).
   Conclusion: There was a high prevalence of poor mental wellbeing among heads of households in Pakistan. Worriedness related to the pandemic and having chronic illness were significant predictors of poor psychological wellbeing. Actions are required in the form of targeted mass psychological support systems for the heads of the families to improve their mental health during the COVID-19 crises.

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Background: Mental health is integral to public health in adolescents. Although previous studies have shown that low socioeconomic status (SES) is associated with mental disorders (MD), it is unclear which mental health domains are most important. Thus, our study aimed to investigate the associations between 5 domains of mental disorder and SES inequality in adolescents.
   Methods: We conducted a cross-sectional study among adolescents (N = 1724). Associations between SES inequality with mental disorders, such as emotional symptoms, conduct problems, hyperactivity, peer relationship problems, and prosocial behavior, were examined. We used the concentration index (CI) to determine inequality. The gap between the low and high socioeconomic groups was decomposed into its determinants using the Blinder-Oaxaca decomposition method.
   Results: Mental health's overall CI was –0.085 (P ˂ 0.001). The emotional problem was primarily caused by SES inequality (–0.094 [P = 0.004]). Decomposition of the gap between the 2 economic groups showed that physical activity, school performance, exercise, parents' smoking status, and gender were the most important determinants of inequality.
   Conclusion: SES inequality plays a vital role in adolescents' mental health. It seems that the emotional problem domain of mental health might be more amenable to interventions than other domains.
 

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Background: Swine flu (H1N1) and Coronavirus diseases (COVID-19) have been compared in the past few months. Both pandemics sparked a worldwide major panic. Although both have some common symptoms and diagnoses, they are quite different in many aspects. The current study aimed to investigate the differences in clinical and viral behaviors between H1N1 Influenza and COVID-19 pneumonia.
   Methods: This was a retrospective study of adult patients hospitalized with H1N1 influenza pneumonia between January 2019 and February 2020, and patients hospitalized with COVID-19 during the outbreak.  A demographic and clinical characteristic of H1N1 influenza and COVID-19 patients were recorded. Both groups were compared—using an independent samples student t test for continuous variables and a chi-square test for categorical data—to identify significantly different parameters between the 2 diseases.
   Results: A total of 78 patients were included and divided into 2 groups: 33 patients (42.3%) with H1N1 and 45 patients (57.7%) with COVID-19. The mean age of the patients was 43.3 ± 10.6 years. Bronchial asthma was significantly higher among patients with H1N1, while diabetes mellitus was significantly higher among patients with COVID-19. Right lower lobe affection was significantly present among those with H1N1 than those with COVID (100% vs 0%). The monocytic count was significantly higher among those with H1N1 than COVID-19 (11.63 ± 1.50 vs 7.76 ± 1.68; P < 0.001). Respiratory rates of more than 22 c/min significantly increased in patients with HINI than in those with COVID-19 (18.2% vs 4.4%; P = 0.05). Mortality increased in patients with HINI than in those with COVID-19 (18.2% vs 6.7%). However, the difference did not reach statistical significance (P = 0.15).
   Conclusion: Clinically, it is difficult to distinguish between H1N1 and COVID-19. Thus, a polymerase chain reaction is recommended for all patients suffering from influenza-like symptoms to rule out influenza A subtype H1N1 and/or SARS-CoV2.
 

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Background: Recently, obesity witnessed a dramatic increase and its related comorbidities have grown. Bariatric surgeries were developed to reduce weight. However, all techniques had their advantages and shortages. In this work, we aimed to assess our new modification of combining sleeve gastrectomy with Roux en-y bypass for the management of obesity, hoping to gain benefits from both techniques to increase the excess bodyweight loss (EBW%).
   Methods: The study was a prospective observational study on 23 Morbidly obese patients. The study was held from January 2020 to April 2022. The recruited patients were submitted to detailed clinical assessment and investigations to check fitness for surgery. Besides operative data, any intra- or post-operative complications were recorded. Each patient was followed up for at least one year.  The follow-up visits were scheduled at regular intervals (one week, one month, six months, and twelve months).
   Results: The mean operative time was 113.91 minutes (65-150). No intraoperative complications or conversion. There was intraluminal bleeding in one patient within 48 hours postoperatively with successful conservative management. There was a complete cure of diabetes mellitus (DM) for 5, 2, and 3 patients and antidiabetic drugs were reduced for 64.3%, 21.43%, and 7.14% at 1, 6, and 12 months follow up respectively. Hypertension was cured in 1,1,2 patients, and antihypertensives were reduced for 2,1,1 patient, at 1, 6, and 12 months follow up respectively. EWL% was 14.4%, 40.78%, and 73.74% at 1,6,12 months follow up respectively. Hemoglobin concentration and ionized calcium improved over time. Finally, serum albumin at 1, 6, and 12 months follow-up was 3.64, 3.58, 3.78 g/dL respectively.
   Conclusion: New modifications of combining LSG and LRYGB have shown to be safe and effective procedures. In addition, it is associated with minimal postoperative nutritional complications and permits complete visualization of the biliary system using endoscopy.
 

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Background: Predicting the outcome of blunt chest trauma by scoring systems is of utmost value.
We aimed to assess the role of the chest trauma scoring system (CTS) in predicting blunt chest trauma outcomes among Egyptians.
   Methods: A prospective observational study included 45 patients admitted to the cardiothoracic emergency unit of Al-Azhar University hospitals. We documented their demographic data, history, cause and mode of trauma, vital parameters, and necessary investigations (e.g., chest X-ray and Computed Tomography) when the patient was admitted to the cardiothoracic department. All patients were assessed using the chest trauma scale (CTS) and followed up till death or discharge.   
   Results: The patient's age ranged between 18 to 76 years (mean 42.67 years). Eighty percent were males, and 48% needed mechanical ventilation (MV). The period of MV was ranged from 1 to 5 days (mean 2.81 days). Twenty-two patients had pneumonia. Eight patients died with a chest trauma scale ranging from 2 to 12 with a median of 6. About 87 percent of patients had unilateral lesions, and 5 had criminal causes. Road traffic accidents were the most typical cause of trauma (60%). There was a significant relation between mortality among the studied patients and each MV, length of ICU duration, chest trauma scale, laterality of trauma, and associated injuries. There was a statistically significant relation between the chest trauma scale and the need for MV, the timing of MV, the presence of pneumonia, and mortality.
   Conclusion: CTS ≥ 6.5 can predict mortality with 100.0% sensitivity, specificity of 62.2%, and accuracy of 68.9%. However, a score of ≥ 5.5 can predict the development of pneumonia with a sensitivity of 81.8%, specificity of 78.3%, and accuracy of 80%.

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Background: Diabetes is associated with left ventricular remodeling. Myocardial wall stress is a measurable factor connected to the ventricular breadth and force and is related to myocardial thickness; it can be measured by echocardiography. The present study aimed to assess the link between heart failure (HF) and echocardiography-derived myocardial wall stress in diabetic patients with ST elevation myocardial infarction (STEMI) who were managed with revascularization.
   Methods: This study was a comparative prospective study that took place between February 2022 and February 2023. It included 100 diabetic patients presented with STEMI and managed by percutaneous coronary intervention (PCI). Patients were selected from the cardiology departments at Al-Azhar University Hospital, Damietta, Egypt. During the hospital stay, patients were checked for HF symptoms and signs. They were also observed for 3 months after discharge for detection of HF. Those who did not develop HF were assigned to group I, and those with HF were assigned to group II. 
   Results: The mean value of end-systolic wall stress (ESWS) was 77.09 ± 12.22 and 97 ± 13.44, and the mean value of end-diastolic wall stress (EDWS) was 12.61 ± 2.76 and 15.87 ± 2.86 in groups I and II respectively, with significant differences between the 2 groups. The cutoff point to detect HF was 88 KPa for ESWS and 13.5 KPa for EDWS, with a sensitivity of 70% and 79% and a specificity of 80% and 61% for ESWS and EDWS, respectively.
   Conclusion: Elevated left ventricle (LV) myocardial stress is related to increased HF in diabetic patients whose HF was managed by PCI after STEMI. LV wall stress is a potentially helpful risk stratification tool using routine echocardiography to determine the treatment plane according to the risk status.
 

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Background: Pectus excavatum is the most frequent congenital defect of the chest wall. Surgical treatment with modified Ravitch-type repair is recommended in patients with cosmetic dissatisfaction or considerable cardiopulmonary symptoms.  We aimed to analyze the surgical, aesthetic, cardiopulmonary functions and patient satisfaction outcomes of modified Ravitch repair pre and postoperatively.
   Methods: This was a prospective analysis of 13 pectus excavatum patients undergoing repair by modified Ravitch using a permanent titanium plate fixed with a screw from September 2021 to August 2023. Patients were included  to relieve pressure on the heart and lungs if complaining of exercise intolerance, cosmetic impairment, shortness of breathing, chest pain, or psychological disturbance with an age range from 10 years to 30 years old. While patients who had received conservative or surgical treatment previously or patients with scoliosis, Marfan syndrome or bronchial asthma were excluded. At the 6-month postoperative visit, a postoperative satisfaction survey was conducted.
   Results: The means of the age of patients (16.4 ± 2.36 years); operative duration (120 minutes); blood loss (200± 15.47 mL) and Haller index was (3.8± 0.35)  preoperatively compared with less than 3.0 (2.7± 0.08  postoperatively; hospital stay (7 days). The most frequent complications were seroma in one patient (7.69%), postoperative bleeding in one patient (7.69%) and skin infection in one patient (7.69%) of patients. No recorded infection of the sternal plate or required operative re-exploration for infection. All patients were subjectively satisfied with the excellent surgical results. Exercise intolerance despite increased exercise performance was observed following surgery, including less sensation of dyspnea.
   Conclusion: Modified Ravitch-type repair is a secure and reliable method for treating pectus excavatum with better relief of preoperative symptoms.
 

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Background: The anatomy of the eyelid changes with age. Multiple changes were observed in the eyelids and the surrounding structures including the malar region. Aging affects the appearance of eyelids and midface by the formation of tear trough deformity and malar flattening and ptosis. To define the effect of malar fat suspension on the lateral part of the infraorbital wall and orbital fat transposition in tear-trough and malar flattening and ptosis.
   Methods: A retrospective study was carried out on 15 patients who had surgeries between January 2020 and January 2022. This technique combines orbital fat transposition to the medial side of the infraorbital wall and malar fat suspension to the lateral side of the infraorbital wall. The average follow-up period was 12 months. Values were compared by paired samples student or Wilcoxon signed rank test for quantitative and qualitative data respectively.
   Results: There was a significant improvement in tear trough deformity, malar ptosis, and midface lift (P < 0.5). No recurrence was observed on follow-up of 12 months. One patient experienced minor postoperative complications in the form of prolonged ecchymosis for 2 months.
   Conclusion: The transcutaneous lower blepharoplasty with orbital fat transposition and malar fat suspension to the lateral part of the infraorbital wall can be considered a safe and effective intervention with improved aesthetic outcome. Thus, it is recommended in patients with tear trough deformity and malar ptosis.
 

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    Background: Intussusception is one of the most frequent reasons for intestinal obstruction in young children, which needs to be treated immediately. When it comes to non-operative reduction, there is no gold standard. Our goal was to look into how general anesthesia affected the success rate of pneumatically reduced intussusception guided by fluoroscopy.
   Methods: This prospective study was done throughout the time between January 2023 and January 2024 by collaboration between the Pediatric Surgery Unit and Diagnostic Radiology Departments, Al-Azhar University Hospital, New Damietta, Egypt. Under general anesthesia, pneumatic reduction guided by fluoroscopy was performed on all intussusception patients. Children with pathologic lead points discovered by ultrasonography, those with symptoms of intestinal perforation or peritonitis, and those who were hemodynamically unstable were excluded. Statistical analysis of the obtained data was done using the SPSS program (version 20).
   Results: In all, 34 children between the ages of 3-28 months, pneumatic reduction under general anesthesia was successful in 32 individuals (94.1% overall). On the first trial, the intussusception was succeeded in 26 patients; on the second try, it was reduced in 5 patients, and in the third, in 1 patient. In two cases, the intussusception failed after three successive trials. One of them was diagnosed as an extended intussusception mass, which was later surgically confirmed, and the other was an appendico-cecal intussusception. During the reduction efforts, there was no bowel perforation or death reported.
   Conclusion: As a first-line therapy for pediatric intussusception, fluoroscopy-guided PR under GA is straightforward, risk-free, and successful, with no complications or mortalities.