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Highlights • THE COMBINATION OF Enteric duplication and intestinal malrotation IS rare but can coexist. • Malrotation MUST BE kept in mind in patients with preoperatively diagnosed duplication cyst. • Surgical correction in form of A LADD's procedure and resection of THE duplication WITH anastomosis IS CURATIVE. • Ultrasound seems TO BE a good diagnostic tool for THE PREOPERATIVE diagnosis of both conditions., Introduction Both Enteric duplication and intestinal malrotation are concerning causes for intestinal obstruction in the pediatric age group and they very rarely coexist in the same patient. Presentation of cases We present 2 cases of previously healthy children, the first is a 4-month-old infant and the second is a 1.5-year-old boy, both presented with recurrent attacks of bilious vomiting that proved to be due to acute midgut volvulus caused by an enteric duplication cyst associated with intestinal malrotation. Discussion Enteric duplication and intestinal malrotation are two of the concerning causes of billious vomiting in the pediatric age group. They could be encountered at any level of the alimentary tract from the tongue to the anus. The term malrotation refers to all abnormalities of intestinal position. The coincidence of intestinal malrotation and an enteric duplication cyst (EDC) is very rare and has been described only in a few case reports. Conclusion The concomitance of EDC and intestinal malrotation is extremely rare and should be kept in mind in a child presenting with bilious vomiting especially in a child preoperatively diagnosed with a duplication cyst.

Highlights • Sac dissection is a key step in Hernia Uterii ovarii. • Disorder of sexual development needs to be considered and excluded. • Consider Laparoscopic exploration as a diagnostic and treatment option., Introduction Inguinal hernia is the most frequent hernia of childhood. About 15–20% of females with inguinal hernias, the ovaries and/or the fallopian tubes may be contents of the herniation sac. Meanwhile uterus is very rare to be encountered. Our aim is to alert Pediatric surgeons to such condition and remind them of the important technical steps to treat and manage this condition. Case report Elective surgery on an 18 months old female child with right inguinal hernia was performed electively through an open inguinal approach; the uterus, fallopian tubes and ovary were found in the hernia sac. Discussion The etiology of the hernia uterine inguinale in general is controversial, however there may be some degree of weakness of the uterine and ovarian suspensory ligament. Thompson noted that if there is failure of fusion of the Mullerian ducts, it leads to increase in the mobility of ovary and uterus, increasing the possibility of herniation of ovary, tubes and uterus. It was reported to be associated with disorders of sexual development. Surgical procedure for inguinal hernias containing uterus is often different from the ones containing only the ovary, as these organs are strongly attached to the hernia sac and it has to be freed from the wall of the hernia sac. Conclusion We want to stress that in hernia uterii ovarii, dissection of the sac is essential for successful hernia repair unlike routine hernioraphy and to consider associated disorder of sexual differentiation.

Objectives: This work was carried out to investigate the efficacy of galvanic vestibular stimulation in improving of gait performance and upright postural stability in hemiplegic cerebral palsy children. Method: Thirty children were enrolled in this study and randomly assigned into two groups; group A (galvanic vestibular stimulation plus vestibular training program), and group B (vestibular training program only). Stride length and time, walking speed tests and modified Ashworth, pediatric balance scales were used to detect and follow the walking performance and upright postural stability. This measurement was taken before initial treatment and after 12 weeks of treatment. The children parents in both groups A and B were instructed to complete 3 hours of the home routine program. Results: Data analysis was available on the 30 hemiplegic cerebral palsied children participated in the study. The difference between pre and post-treatment results was significant representative in stride length , time and walking velocity, spasticity changes and pediatric balance scores in study groups while insignificant improvement in control groups. Conclusion: The combined vestibular training program and trans-mastoidal vestibular galvanic stimulation are suggested in improving walking performance and upright postural stability in a static and dynamic situation. So this selective physiotherapy approach may be used as a strong choice for improving walking and balance abilities in hemiplegic C.P children.

Highlights • Multiple magnet ingestion in children is challenging to diagnose if asymptomatic. • Symptoms include vomiting, abdominal pain, discoloured stools or fever. • Meticulous history, patient examination and investigations are necessary. • Intestinal pressure necrosis and multiple fistulas can occur yet remain asymptomatic. • Resection and anastomosis may be the sole management in such cases., Introduction Foreign body ingestion cases are very common in children. They usually present with obvious symptoms allowing proper diagnosis and management; however, magnet ingestion can be asymptomatic. This disorder is considered uncommon as well as challenging to diagnose before complications of intestinal obstruction or peritonitis occur due to entrapment of intestinal walls in the magnetic field. Case presentation An asymptomatic four-year-old male child was admitted to our centre after passing two bullet-shaped magnets in stool that were noticed by his mother. The child was asymptomatic. An abdominal X-ray revealed five bullet-shaped magnets in the lower abdomen. Laboratory investigations were normal except for a mild leukocytosis. Surgery was performed with excision of seven entero-enteric fistulae and two intestinal anastomoses. Discussion Between 2003 and 2006, the Centers for Disease Control and Prevention reported 20 complicated cases of magnet ingestion in children aged 10 months to 11 years among whom 75% had bowel perforations, and 20% suffered from generalized peritonitis. Half that number of patients required emergency laparotomy. As a result, the Consumer Product Safety Commission (CPSC) issued the first warning announcing the hazards of high-powered magnets used in children’s toys, which had been increasing exponentially. It is clear that the diagnosis of magnet ingestion is made commonly due to complications, such as peritonitis or death. However, the patient in this case was completely asymptomatic and had no complications. Conclusion A high index of suspicion regarding complications is recommended in asymptomatic cases of suspected magnet ingestion. Avoid delaying intervention once a diagnosis has been made.

Jordan has one of the lowest levels of water in the world, with Jordan's population is expected to continue to grow, the gap between water supply and water consumption (demand) threatens to wider significantly. On the other hand, the exploitation of new water supply recourses is costly, therefore, Jordan authorities invested heavily in the development of water infrastructure and tools to lower the excessive demand of water with the danger of water supply deficiency. This forces water supply corporation to act extensively to utilize all de-marketing tools to deal with this problem along with governmental parties. As a result of these challenges, the researcher intended to examine the relationship between de-marketing tools as a strategic option to lower the excessive demand (consumption) of water in Jordan through using different de-marketing tools represented by higher prices of water bill, counter advertising, warning labels, limited advertising, limited distribution, availability of substitute sources and reducing the quantity of water supplied during summer season. An analytical analysis of all these strategic options are considered by the researcher in order to examine the relationship between de-marketing tools adopted by the water municipal corporation and government of Jordan in order to lower the excessive demand of water and to find out solutions for this problem. The study concluded that all related parties in Jordan are working together in order to utilize de-marketing tools as a strategic option to solve this extensive problem. Finally the paper provided certain recommendations for water municipal corporation and to the government of Jordan to adopt all de-marketing tools which will help in dealing with water shortage problem.

Peptic ulcer is a relatively uncommon disease in children, compared to adults, with an incidence of 2–8%. Although well-established in adults' sector, the management of perforate peptic ulcer is still challenging in pediatric population. we reported two cases, two- and five-years old males, who presented with peritonitis following perforation of duodenal ulcer and managed with Graham's patch laparoscopically. The postoperative period of the two cases was uneventful and the cases were discharged on the 8th postoperative day. We found that laparoscopic omental repair was safe and effective among children with perforated peptic ulcer.

Retroperitoneal sarcomas are aggressive tumours with a poor prognosis. Staging and prognostic criteria do not always predict the behaviour of these tumours. We report a case of retroperitoneal sarcoma which did not quite follow the known prognostic criteria.

The extension of the flange in the sublingual crescent region is an important factor for mandibular denture stability and retention. Making the impression with minimal pressure on the floor of the mouth while the tongue is at rest allows greater mobility of the underlying muscles without denture dislodgment and without occlusion of the sublingual gland ducts. The anatomy of the sublingual crescent region and the clinical procedure for recording the anterior lingual seal region are described. Upon completion of the impression, resistance to dislodgment is usually achieved.