Peutz–Jeghers syndrome (PJS) is an autosomal dominant condition characterized by the association of gastrointestinal polyposis, mucocutaneous pigmentation and cancer predisposition McGarrity, Amos, Baker (Peutz–Jeghers Syndrome, GeneReviews(R), National Center of Biotechnology Information.). Intussusception and malignant polyps are not rare complications of PJS, where the lifetime risk of intussusception is 48% and the possibility of developing any cancer by age 65 years is 37% Kopacova, Tacheci, Rejchrt, Bures (Peutz-Jeghers syndrome: diagnostic and therapeutic approach. World J Gastroenterol 2009;15:5397–408.). Very few cases of malignant polyps causing intussusception associated with synchronous malignant polyp in PJS have been reported to date Cai, Tian, Zhou, He, Hu, Deng (Jejunal intussusception and polyps with different types of malignant transformation in Peutz-Jeghers syndrome: report of a case. Oncol Lett 2013;5:239–41.). We describe a case of a patient with PJS presenting with symptomatic jejunal intussusception and an incidentally found malignant hamartoma in the sigmoid colon.

Acute scrotal pain is a true emergency that needs to be identified, diagnosed, and managed quickly to avoid any testicular tissue loss. In pediatric emergency, testicular torsion has been the most worrisome diagnosis that needs to be included or excluded as fast as possible. Point-of-care ultrasound (POCUS) has been reported to be a game changer. However, because testicular rupture is an extremely rare entity in the pediatric age group, there are limited reports about POCUS use in diagnosing the condition. We describe a case of a 4-year-old boy who presented with acute scrotal pain secondary to trauma 2 days previous, where POCUS was able to identify and diagnose testicular rupture in a timely fashion that facilitated management and intervention.

Background: Nephrotic syndrome (NS) in children is a disease of glomerular filtration barrier failure, manifesting with severe proteinuria leading to hypoalbuminemia, hypercholesterolemia, and generalized edema. it could be primary or secondary. In primary NS, also known as idiopathic NS, the histological findings of Primary NS include minimal change disease which mainly respond to steroids (steroid sensitive NS), focal segmental glomerulosclerosis which are usually steroid resistant or membranous nephropathy. Rituximab has been shown to be effective for patients with complicated FRNS/SDNS and refractory SRNS. While the incidence of nephrotic syndrome (NS) is increasing, the morbidity of difficult-to-treat NS is significant.Methods: This is a retrospective cohort study that took place in King Abdulaziz University Hospital from 2012 to 2016. Patients included: Any patient under 18 years, and diagnosed with steroid resistant and dependent nephrotic syndrome. Patients excluded: Any patient above 18 years, and known to have secondary Nephrotic Syndrome.Results: Present study consists of 24 children with nephrotic syndrome (NS) were recruited in the study. In the population 8 patients (33.33 %) were diagnosed with SDNS, while the other 16 patients (66.67%) were diagnosed SRNS. Also, patients who were treated with Rituximab we found that (the mean) number of relapses per year before rituximab was about 2.67±1.49 (standard deviation 1.49), while patient who relapsed after rituximab was about 1.09±1.38 (standard deviation 1.38).Conclusions: Rituximab is a biological agent that started to be widely used in difficult nephrotic syndrome cases. The effectiveness of rituximab is most observed in steroid depended nephrotic syndrome patients since it decreases the frequency of relapses and steroid dependency. However, it has been shown that it is less effective in steroid resistant nephrotic syndrome cases and was associated with significant numbers of relapses.

Background: Coronavirus (COVID-19) is the newest pandemic disease. The surgical management of acute appendicitis was the gold standard, but new studies suggest the safety of antibiotics treatment alone. NOTA avoid surgery, risks of general anesthesia; long hospital stay and risk of corona virus exposure. We aim to study the safety, cost effectiveness and outcome of NOTA during Covid-19 pandemic and compare it to Single incision pediatric endo-surgery appendectomy (SIPESA) Methods A prospective cohort study for NOTA of patients from 6–12 years old in Covid-19 pandemic period from 1st April 2020 to 30th April 2021. Patients divided in 2 groups: Group S managed by SIPESA; group N managed by NOTA. Family education and assurance with detailed explanation was done for early detection of any complication and we continue monitoring of the patients until complete recovery. Results sixty patients were managed. Group S had 24 cases (40%), mean age 9.3 years. Group N had 36 cases (60%), mean age 9.1 years. six cases (17%) in group N were converted to surgical management in first 6 month of study. Mean length of hospital stay dropped from 72 hours to 18 hours. The mean cost dropped from 2736$/day to 400$/day. Mean psychological stress for the children improved from 4.4 in April to 2 in September. Mean follow up was 3.5 months. Conclusions NOTA is safe and cost-effective. we recommend it especially during the COVID-19 pandemic. Level of evidence: Cost Effectiveness Study: Level II