Association Between Helicobacter pylori Infection and Migraine: A Systematic Review

Migraine is a highly debilitating disease affecting humans worldwide. Despite having known this disease for a long time, not many studies have been done to search for a chronic infectious cause of migraine. The goal of this study was to look for an association between migraine and Helicobacter pylori infection. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) standards, we conducted the analysis and literature search using PubMed, Google Scholar and Cochrane databases. After applying the inclusion and exclusion criteria, the search technique produced a total of 10 articles including one cross-sectional study, two randomized controlled trials (RCTs), one cohort study, five case-control studies and one meta-analysis. Analysis of these studies revealed that there could be an association between Helicobacter pylori infection and migraine, especially in the Asian population. However, the mechanism by which the infection could possibly cause this extra-gastric disorder needs further research and analysis.

Race/Ethnicity as a Risk Factor in the Development of Postpartum Hemorrhage: A Thorough Systematic Review of Disparity in the Relationship Between Pregnancy and the Rate of Postpartum Hemorrhage

Postpartum hemorrhage (PPH) is a major cause of maternal death and morbidity worldwide. Throughout the years, there have not been many studies looking into the association of race and ethnicity with the occurrence of PPH. The goal of this study was to assess race and ethnicity as risk factors in the development of PPH in pregnant women. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) standards, we conducted the analysis and conducted a literature search using Google Scholar and PubMed. After applying our inclusion and exclusion criteria, the search technique yielded a total of eight articles. The analysis included seven observational studies and one randomized controlled trial. The incidence of PPH was chosen as the major outcome measure. An evaluation of eight studies revealed that although Hispanics, Asians, Native Hawaiians, and other Pacific Islanders (NHOPI) have a higher chance of developing PPH caused by uterine atony, Caucasians had a greater rate of transfusion than the other groups. In addition, compared to Caucasians, African Americans or African descendants had a lower risk of atonic PPH but increased odds of atonic PPH requiring interventions. On the other hand, compared to non-native groups, Native Americans had increased odds of uterine atony. The results showed that, in contrast to other races/ethnicities, Caucasians had the lowest risk of PPH. Additionally, it was shown that African Americans or those descended from Africans had a higher chance of PPH but a lower risk of atonic PPH.

Radiofrequency Ablation as an Effective Long-Term Treatment for Chronic Sacroiliac Joint Pain: A Systematic Review of Randomized Controlled Trials

Radiofrequency ablation (RFA) has emerged as a popular intervention for chronic pain management, including pain originating in the sacroiliac joint. It offers a less invasive option than surgery but with better results than the previous standard treatment with steroid and anesthetic injections. Procedure volumes have enjoyed significant growth in the market in recent years. The evidence supporting this intervention, in the form of randomized controlled trials, however, is both thin and mixed. The purpose of this systematic review is to evaluate the body of randomized controlled trials (RCTs) to determine the quality of support for and against the use of radiofrequency ablation to treat sacroiliac joint (SIJ) pain. Several important new papers have emerged since previous systematic reviews with similar objectives were published. The review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and three databases were used: PubMed, Google Scholar, and Scopus. Only RCTs were sought, and no other filters, such as a historical timeline cut-off, were used. Among 95 publications that returned in response to the query, 16 were ultimately accepted as meeting the inclusion/exclusion criteria. The Cochrane risk-of-bias tool was utilized as a quality assessment measure, and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework was used to assess the certainty of the evidence. Among the included publications, 15 out of 16 publications featured positive results and conclusions that supported the use of RFA in treating chronic sacroiliac joint pain. The single negative study was also the largest trial (n=681), but it was identified as “High Risk” using the Cochrane risk-of-bias tool. It included several design flaws including neither operator nor patient blinding, missing information, use of inconsistent treatment modalities across groups, and disproportionate drop-out rates. Despite its flaws, we have included this study in the present review because of its sheer size. Taken in aggregate, the total body of research included in this review supports this intervention. Questions continue to exist around whether there are clinically significant benefits associated with different RFA modalities (for example, unipolar vs. bipolar), with convincing evidence supporting each of them. Finally, it can be concluded that while the benefits are reasonably and justifiably supported in this patient population for up to one year, there is a dearth of evidence beyond a 12-month post-intervention follow-up.

Bacillus mycoides PM35 Reinforces Photosynthetic Efficiency, Antioxidant Defense, Expression of Stress-Responsive Genes, and Ameliorates the Effects of Salinity Stress in Maize

Soil salinity is one of the abiotic constraints that imbalance nutrient acquisition, hampers plant growth, and leads to potential loss in agricultural productivity. Salt-tolerant plant growth-promoting rhizobacteria (PGPR) can alleviate the adverse impacts of salt stress by mediating molecular, biochemical, and physiological status. In the present study, the bacterium Bacillus mycoides PM35 showed resistance up to 3 M NaCl stress and exhibited plant growth-promoting features. Under salinity stress, the halo-tolerant bacterium B. mycoides PM35 showed significant plant growth-promoting traits, such as the production of indole acetic acid, siderophore, ACC deaminase, and exopolysaccharides. Inoculation of B. mycoides PM35 alleviated salt stress in plants and enhanced shoot and root length under salinity stress (0, 300, 600, and 900 mM). The B. mycoides PM35 alleviated salinity stress by enhancing the photosynthetic pigments, carotenoids, radical scavenging capacity, soluble sugars, and protein content in inoculated maize plants compared to non-inoculated plants. In addition, B. mycoides PM35 significantly boosted antioxidant activities, relative water content, flavonoid, phenolic content, and osmolytes while reducing electrolyte leakage, H₂O₂, and MDA in maize compared to control plants. Genes conferring abiotic stress tolerance (CzcD, sfp, and srfAA genes) were amplified in B. mycoides PM35. Moreover, all reactions are accompanied by the upregulation of stress-related genes (APX and SOD). Our study reveals that B. mycoides PM35 is capable of promoting plant growth and increasing agricultural productivity.

The iHealth-T2D study, prevention of type 2 diabetes amongst South Asians with central obesity and prediabetes: study protocol for a randomised controlled trial

BACKGROUND

People from South Asia are at increased risk of type 2 diabetes (T2D). There is an urgent need to develop approaches for the prevention of T2D in South Asians that are cost-effective, generalisable and scalable across settings.

HYPOTHESIS

Compared to usual care, the risk of T2D can be reduced amongst South Asians with central obesity or raised HbA1c, through a 12-month lifestyle modification programme delivered by community health workers.

DESIGN

Cluster randomised clinical trial (1:1 allocation to intervention or usual care), carried out in India, Pakistan, Sri Lanka and the UK, with 30 sites per country (120 sites total). Target recruitment 3600 (30 participants per site) with annual follow-up for 3 years.

ENTRY CRITERIA

South Asian, men or women, age 40-70 years with (i) central obesity (waist circumference ≥ 100 cm in India and Pakistan; ≥90 cm in Sri Lanka) and/or (ii) prediabetes (HbA1c 6.0-6.4% inclusive).

EXCLUSION CRITERIA

known type 1 or 2 diabetes, normal or underweight (body mass index < 22 kg/m2); pregnant or planning pregnancy; unstable residence or planning to leave the area; and serious illness.

ENDPOINTS

The primary endpoint is new-onset T2D at 3 years, defined as (i) HbA1c ≥ 6.5% or (ii) physician diagnosis and on treatment for T2D. Secondary endpoints at 1 and 3 years are the following: (i) physical measures: waist circumference, weight and blood pressure; (ii) lifestyle measures: smoking status, alcohol intake, physical activity and dietary intake; (iii) biochemical measures: fasting glucose, insulin and lipids (total and HDL cholesterol, triglycerides); and (iv) treatment compliance.

INTERVENTION

Lifestyle intervention (60 sites) or usual care (60 sites). Lifestyle intervention was delivered by a trained community health worker over 12 months (5 one-one sessions, 4 group sessions, 13 telephone sessions) with the goal of the participants achieving a 7% reduction in body mass index and a 10-cm reduction in waist circumference through (i) improved diet and (ii) increased physical activity. Usual care comprised a single 30-min session of lifestyle modification advice from the community health worker.

RESULTS

We screened 33,212 people for inclusion into the study. We identified 10,930 people who met study entry criteria, amongst whom 3682 agreed to take part in the intervention. Study participants are 49.2% female and aged 52.8 (SD 8.2) years. Clinical characteristics are well balanced between intervention and usual care sites. More than 90% of follow-up visits are scheduled to be complete in December 2020. Based on the follow-up to end 2019, the observed incidence of T2D in the study population is in line with expectations (6.1% per annum).

CONCLUSION

The iHealth-T2D study will advance understanding of strategies for the prevention of diabetes amongst South Asians, use approaches for screening and intervention that are adapted for low-resource settings. Our study will thus inform the implementation of strategies for improving the health and well-being of this major global ethnic group.

IRB APPROVAL

16/WM/0171 TRIAL REGISTRATION: EudraCT 2016-001350-18 . Registered on 14 April 2016. ClinicalTrials.gov NCT02949739 . Registered on 31 October 2016, First posted on 31/10/2016.

Effects of a lifestyle intervention programme after 1 year of follow-up among South Asians at high risk of type 2 diabetes: a cluster randomised controlled trial

INTRODUCTION

South Asians are at high risk of type 2 diabetes (T2D). We assessed whether intensive family-based lifestyle intervention leads to significant weight loss, improved glycaemia and blood pressure in adults at elevated risk for T2D.

METHODS

This cluster randomised controlled trial (iHealth-T2D) was conducted at 120 locations across India, Pakistan, Sri Lanka and the UK. We included 3684 South Asian men and women, aged 40-70 years, without T2D but with raised haemoglobin A1c (HbA1c) and/or waist circumference. Participants were randomly allocated either to the family-based lifestyle intervention or control group by location clusters. Participants in the intervention received 9 visits and 13 telephone contacts by community health workers over 1-year period, and the control group received usual care. Reductions in weight (aim >7% reduction), waist circumference (aim ≥5 cm reduction), blood pressure and HbA1C at 12 months of follow-up were assessed. Our linear mixed-effects regression analysis was based on intention-to-treat principle and adjusted for age, sex and baseline values.

RESULTS

There were 1846 participants in the control and 1838 in the intervention group. Between baseline and 12 months, mean weight of participants in the intervention group reduced by 1.8 kg compared with 0.4 kg in the control group (adjusted mean difference -1.10 kg (95% CI -1.70 to -1.06), p<0.001). The adjusted mean difference for waist circumference was -1.9 cm (95% CI -2.5; to 1.3), p<0.001). No overall difference was observed for blood pressure or HbA1c. People who attended multiple intervention sessions had a dose-dependent effect on waist circumference, blood pressure and HbA1c, but not on weight.

CONCLUSION

An intensive family-based lifestyle intervention adopting low-resource strategies led to effective reduction in weight and waist circumference at 12 months, which has potential long-term benefits for preventing T2D. A higher number of attended sessions increased the effect on waist circumference, blood pressure and HbA1c.

TRIAL REGISTRATION NUMBER

EudraCT: 2016-001350-18; ClinicalTrials.gov: NCT02949739.

Novel Pathogenic Mutation Mapping of ASPM Gene in Consanguineous Pakistani Families with Primary Microcephaly

Autosomal recessive primary microcephaly (MCPH) is a neurodevelopmental disorder characterized by a congenitally reduced head circumference (-3 to -5 SD) and non-progressive intellectual disability. The objective of the study was to evaluate pathogenic mutations in the ASPM gene to understand etiology and molecular mechanism of primary microcephaly. Blood samples were collected from various families across different remote areas of Pakistan from February 2017 to May 2019 who were identified to be affected with primary microcephaly. DNA extraction was performed using the salting-out method; the quality and quantity of DNA were evaluated using spectrophotometry and 1% agarose gel electrophoresis, respectively in University of the Punjab. Mutation analysis was performed by whole exome sequencing from the Cologne Center for Genomics, University of Cologne. Sanger sequencing was done in University of the Punjab to confirm the pathogenic nature of mutation. A novel 4-bp deletion mutation c.3877_3880delGAGA was detected in exon 17 of the ASPM gene in two primary microcephaly affected families (A and B), which resulted in a frame shift mutation in the gene followed by truncated protein synthesis (p.Glu1293Lysfs*10), as well as the loss of the calmodulin-binding IQ domain and the Armadillo-like domain in the ASPM protein. Using the in-silico tools Mutation Taster, PROVEAN, and PolyPhen, the pathogenic effect of this novel mutation was tested; it was predicted to be "disease causing," with high pathogenicity scores. One previously reported mutation in exon 24 (c.9730C>T) of the ASPM gene resulting in protein truncation (p.Arg3244*) was also observed in family C. Mutations in the ASPM gene are the most common cause of MCPH in most cases. Therefore, enrolling additional affected families from remote areas of Pakistan would help in identifying or mapping novel mutations in the ASPM gene of primary microcephaly.

There is a silver lining: carbon footprint reduction by holding Preventive Cardiology conference 2020 virtually

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Special Research Fund (BOF), Hasselt University

Introduction

The transportation sector is one of the major sectors influencing climate change, contributing around 16% of total Greenhouse gases (GHG) emissions. Aviation contributes to 12% of the transport related emissions. Among other climate change impacts, elevated heat exposure is associated with increased cardiac events and exposure to air pollution caused by GHG emissions has also well-known association with increased cardiovascular related morbidity and mortality. The global temperature rise should be restricted to less than 2 °C which requires keeping carbon emission (CO2) less than 2900 billion tonnes by the end of the 21st century. Assuming air travel a major contributing source to GHG, this study aims to raise the awareness about potential carbon emissions reduction due to air travel of international events like a scientific conference.

Purpose

Due to the global pandemic of COVID-19, the Preventive cardiology conference 2020 which was planned to be held at Malaga Spain, instead was held in virtual online way. This study aims to calculate the contribution of reduced CO2  emissions in tons due to ESC preventive cardiology conference 2020, which was then held online and air travel of the registered participants was avoided.

Methods

Anonymized participant registration information was used to determine the country and city of the 949 registered participants of the Preventive Cardiology conference 2020. It is assumed that participants would have travelled from the closest airports from their reported city locations to Malaga airport, Spain. At first, the closest city airports were determined using Google maps and flights information, then the flight emissions (direct and indirect CO2-equivalent emissions) per passenger for the given flight distances were calculated. The CO2 emissions (tons) were calculated for round trips in economy class from the participants of 68 nationalities (excluding 60 participants from Spain as they are assumed to take other modes of transport than airplane).

Results

In total, 1156.51 tons of CO2  emissions were saved by turning the physical conference into a virtual event. This emission amount is equivalent to the annual CO2 production of 108 people living in high-income countries.

Conclusion

The pandemic situation has forced us to rethink the necessity of trips by air and has shown us the feasibility of digitally organized events. The information from this study can add to the awareness about reduced amount of carbon emission due to air travel by organizing events in a virtual way when possible. Apart from only digitally organized events there are others options to reduce the carbon footprint of conferences such as limiting the number of physical attendees, encouraging the use of relatively sustainable transport modes for participants from nearby countries (e.g. international trains and use of active transport modes at conference venue etc.) and including CO2 emission offsetting costs.

Caecal Adenocarcinoma in a Patient Mimicking Complicated Appendicitis

Colorectal cancer (CRC) presenting with intestinal obstruction is uncommon in paediatric age and carries poor prognosis. We report a case of a 13-year-old boy who presented with acute intestinal obstruction, clinically appearing to be secondary to complicated appendicitis. Exploratory laparotomy revealed a caecal mass which was resected. Histopathology report showed only inflammatory cells with no sign of malignancy. The patient was discharged home after smooth recovery but re-admitted after 2 months with recurrence of intestinal obstruction. Considering clinical behavior of the patient, the tissue blocks obtained from first surgery were reviewed and it turned out to be a poorly differentiated adenocarcinoma with positive mesenteric lymph nodes for metastatic carcinoma.

Obstructed Inguinal Hernia in a New-Born

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A giant lymphatic cyst of the transverse colon mesentery

Mesenteric cysts are not uncommon in pediatric age group but giant lymphatic cysts of mesentery are reported infrequently. This is a report of six years old female who had vague abdominal pain with distension for two years. Investigations revealed a large cystic mass in abdomen. On exploration a giant lymphatic cyst in the mesentery of transverse colon found. More than 1500 ml of milky fluid was drained. The cyst was unilocular and appeared to be the collection of lymph (chyle) between two leaves of the mesentery of transverse colon. It is postulated that trauma to or malformation of lymphatics at the root of mesentery might have lead to this pathology.

Anterior sacral meningocele

Anterior sacral meningocele is a rare condition presenting as a lower abdominal mass. One such case was seen in a baby girl aged 2 months, who was admitted with abdominal distension and urinary difficulty for one week. She had a lower abdominal mass which investigated by MRI, turned out to be an anterior sacral meningocele causing her symptoms. The meningocele was excised successfully via an open abdominal approach. Postoperative recovery and follow-ups remained uneventful. Presentation, various diagnostic modalities and treatment options for an anterior sacral meningocele are briefly discussed.

A study of ovarian lesions in pre-menarche girls

OBJECTIVE

To analyze various clinical presentations and the surgical management of ovarian pathologies in pre-menarche girls.

DESIGN

Case series.

PLACE AND DURATION OF STUDY

Surgical Unit B, National Institute of Child Health, Karachi, from September 2002 to August 2004.

PATIENTS AND METHODS

Case records of all the pre-menarche girls child having an ovarian pathology and managed during the study period were reviewed. Age of the patients, presenting symptoms, investigations performed, surgical approaches, operative findings and final histological diagnosis were noted. Ovarian lesions were classified according to WHO criteria.System proposed by the Children's Cancer Group and the Paediatric Oncology Group was used for staging of tumors. Following resection, patients with malignant tumors were followed-up by oncologist.

RESULTS

There were 18 patients with ovarian lesions. Age range of patients was from day 1 to 13 years. Mass in abdomen was the most common presenting symptom (60% patients ) followed by pain (50%). Right ovary was involved in 12 (55%) cases and left in 6 (45%). Six patients had non-tumorous cysts, 3 had benign tumors and 9 were with malignant lesions. Of the non-tumorous cysts, 3 patients had simple follicular cysts and 2 were hemorrhagic cysts. There were 2 patients with benign teratoma and one with dermoid cyst. Four patients had malignant teratoma, 4 dysgerminoma and one yolk sac tumor. Malignant tumors were all of stage IA according to Paediatric Oncology Group staging.

CONCLUSION

Ovarian tumors are rare in paediatric age group especially in pre-menarche girls. Except one, all malignant tumors were found in patients above 7 years of age. Benign (tumorous and non-tumorous) and malignant lesions occurred with equal frequency in pre-menarche girls in this study.

Correlation of the size of undescended testis with its locations in vatrious age groups

OBJECTIVE

To assess the correlation of the size of undescended testis with its location in children of various age groups, per-operatively.

DESIGN

Cross-sectional study.

PLACE AND DURATION OF STUDY

Surgical Unit B, National Institute of Child Health, Karachi from February 2004 - November 2005.

PATIENTS AND METHODS

Children presenting with undescended testis at surgical outpatient were recruited. Physical examination and relevant investigations (haemoglobin, ultrasound for location and size of testes) were performed. Patients were divided randomly into three age groups, group I (8 months - 2.5 years), group II (2.6 - 8 years), group III (8.1-13 years). At orchiopexy location and size of undescended testis were noted. Patients were further sub-divided into groups according to peroperative location of undescended testis, group A (intra-abdominal), group B (intra-canalicular), group C (distal to superficial inguinal ring - pubic). Where no testis was found, a separate group D was assigned. The size of undescended testis at different locations in various age groups was compared with reference to normal descended testicular size in the respective age group, for statistical significance. ANOVA test was used for intergroup comparison for the size of undescended testis and Student t- test was applied for comparison with reference to normal values of the size of testis.

RESULTS

A total of 102 patients with undescended testis were included in the study. The total number of 107 testicular units were assessed. Group I had 28, group II, 41 and group III, 38 testes. There were 24 intra-abdominal, 68 intra-canalicular and 12 pubic in location. In 3 cases, no testis was found at exploration. We found no statistically significant difference amongst groups (p-value=0.090) between the size of the undescended testis at different peroperative locations. The size of undescended testis grew with the age as undescended testis of larger size were found in older age group as compared to younger age group. By applying Student t-test, we did not find statistically significant difference in relation to the size of undescended testis in various age groups in comparison to the reference of mean volume of normally descended testis in the respective age groups.

CONCLUSION

Pre-pubertal size of undescended testis does not differ significantly from that of normal reference value of descended testis in relation to age and location. The ultimate size of the testis can only be assessed after puberty whether it is a normally descended or undescended testis.

Complications of inguinal hernia surgery in children

OBJECTIVE

To determine the postoperative complications of elective inguinal hernia surgery in children

DESIGN

Descriptive study.

PLACE AND DURATION OF STUDY

Surgical Unit B, National Institute of Child Health, Karachi, from February 2004 to November 2005.

PATIENTS AND METHODS

Children with inguinal hernia, admitted electively through surgical outpatient, were included. Patients operated earlier and presenting with complications were excluded. Patients with concomitant diseases, regarded as predisposing factors for hernia development, were also excluded. Physical examination and relevant investigations (hemoglobin level and ultrasound of scrotum) were performed. Inguinal hernia was repaired electively by Rehbein procedure. Patients were followed at day 7, 1 month, 3 months and 9 months to note the postoperative complications of the surgery. Ultrasound was repeated at 6 and 9 months postoperatively for the size of testes.

RESULTS

A total of 223 patients with inguinal hernia were included in the study. Age ranged from 8 days to 12 years. There were 188 males with 75 patients under 1 year of age. The longest follow-up was upto 9 months in 133 patients. The complications of scrotal edema occurred in 6 (2.97%), haematoma in 1(0.49%), wound infection in 2 (0.99%) and 5 events of recurrence of hernia in 4 patients. All appeared within 3 months of follow-up. Four recurrent hernia were operated. In all cases intact sac was found. No patient developed decrease in size of testes nor ascent of testes was noted at follow-up.

CONCLUSION

in this series, there were minimal complications observed in relation to inguinal hernia surgery.

Sirenomelia (Mermaid baby)

Sirenomelia is a rare anomaly that rarely occurs as an isolated lesion. Several theories have been proposed regarding the etiopathogenesis. In this communication, we report a case of sirenomelia. Our patient was referred to hospital at the age of four hours. On examination, fusion of both lower limbs with hook shaped appendage, attached distally, absent genitalia and absent anal orifice was found. Spine was deficient in sacral region. Upper torso looked normal. Baby also had frothing from mouth. Abdomen was non-distended. Feeding tube no.10 was tried to pass through mouth, which got obstructed at the level of upper esophagus that suggested oesophageal atresia. The skeletogram revealed absence of pelvic bones, sacral agenesis, absent fibulae and fracture of both femora. The patient died at the age of 12 hours.

Congenital pyloric atresia: isolated and associated with aplasia cutis congenita

Two cases of congenital pyloric atresia (CPA) are, hereby, reported. One was suspected on antenatal ultrasound and turned out to be an isolated anomaly. Other patient had a rare association of aplasia cutis congenita with congenital pyloric atresia. The lesions of aplasia cutis congenita were multiple while congenital pyloric atresia was of type II. The patient with an isolated lesion survived following surgery while the other baby died of sepsis in postoperative period.

Management of simultaneously ingested and aspirated foreign bodies in an infant

This report describes the management of a 7-month-old baby who aspirated one and ingested two paper pins at a time. Bronchoscopic removal was done for aspirated pin and ingested pins were observed for spontaneous passage in stool, which occurred in 48 hours without any untoward incidence.

Management of idiopathic rectal prolapse in children

OBJECTIVE

To determine the percentage of patients of idiopathic rectal prolapse improving on spontaneously over the period of observation (phase I), and to determine the outcome of patients with rectal prolapse who received injection sclerotherapy (phase II).

DESIGN

Quasi-experimental study.

PLACE AND DURATION OF STUDY

National Institute of Child Health, Karachi from April 2001 to March 2002.

PATIENTS AND METHODS

The study was conducted in two phases. In phase I of the study, newly diagnosed patients of idiopathic rectal prolapse were followed without any treatment, till the spontaneous resolution of rectal prolapse. The time period at which 50% patients improved clinically was called 'time for spontaneous resolution 50%, (TSR 50%). In phase II, injection sclerotherapy (IST) was given to those patients whose prolapse was of more than three months duration. This was a separate cohort of patients.

RESULTS

One hundred patients were inducted in the study. They all had idiopathic rectal prolapse and their ages ranged from 6 months to 12 years with mean age of 5.30 +/- 2.30 years. In phase I, out of a total 50 patients, 40 could be followed with non-interventional strategy. In more than 50% of patients, the prolapse disappeared within 3 months. This was called TSR 50%. In phase II study, out of 50 patients who received IST, 29 improved within 2 weeks of single injection while 12 more improved with second injection within two months. Overall rate of resolution of prolapse at two months (41/50) was highly significant in comparison with proportion of improvement in phase I patients with p-value of 0.001. Four patients received third injection. At the end of three months prolapse disappeared in all patients of this phase (p-value < 0.0001). No complication related to injection occurred.

CONCLUSION

Both non-operative and injection sclerotherapy are effective in managing idiopathic rectal prolapse in paediatric population, but in terms of early recovery injection sclerotherapy is recommended as it is associated with less morbidity and is cost-effective.