Background: Diagnosis of microsporidiosis is difficult due to its small size needing special stains and identification by an expert. Nowadays, application of polymerase chain reaction (PCR) made diagnosis more sensitive, specific and easier. Objectives: To update the prevalence of intestinal microsporidia and to clarify their genotype patterns in symptomatic and asymptomatic immune compromised and immune competent cases. Patients and Methods: Totally, 323 stool samples were collected and subdivided as 173 from immune compromised (group I) and 150 from immune competent (group II) individuals. Samples were examined for microsporidiosis by light microscopy smears stained by Weber's modified trichrome (WMT) and modified Ziehl Neelsen (MZN), as well as by nested and RFLP PCR techniques. Results: Microsporidial spores were microscopically detected in 45/323 (13.9%) individuals; 25/173 (14.5%) immune compromised and 20/150 (13.3%) immune competent cases. In the two groups, 25/45 (55.6%) were symptomatic complaining of diarrhea, abdominal pain, distension, mal-digestion and weight loss, with statistical significant difference (P<0.001) between infection and presence of symptoms. Nested and RFLP PCR missed only one positive case, thus scoring 97.8% sensitivity and 100% specificity, positive predictive value 100%, negative predictive value 99.6% and diagnostic accuracy 97.8%. In group I, 5 cases were associated with Enterocytozoon (Ent.) bieneusi, 5 with Encephalitozoon (Enc.) species and 15 had mixed infection. In group II, 6 had Ent. bieneusi, 3 had Enc. species and 10 had mixed infection. Sequencing of the internal transcribed spacer of rDNA of five samples demonstrated the Ent. bieneusi anthroponotic genotype B and the zoonotic potential for genotypes D and K, in addition to one Enc. intestinalis sequence. Conclusion: Prevalence of microsporidiosis was insignificantly higher in immune compromised than immune competent population. Intestinal microsporidiosis can be manifested by different abdominal symptoms or it can be asymptomatic. PCR technique highlighted that mixed infection with Ent. bieneusi and Encephalitozoon species was the commonest finding among the studied groups. Ent. bieneusi genotypes appeared to be related to animal contact and human infection. This, however, could not be accurately defined due to the limited number of available sequences.

Background: Pediatric chronic constipation and obstructed defecation is a challenging problem, with bad impact on quality of life affecting both the child and family. It is a complex disorder of multifactorial etiology and pathophysiology. Many symptoms-based systems have been instructed for clarifying definitions for chronic constipation and obstructed defecation such as ROME IV criteria, PACCT criteria, NICE guideline. Most protocols of management of functional constipation usually include; disimpaction enemas, feeding regulations, bowel diaries and laxatives. Aim of Study:To evaluate the effectiveness of adding anal Botox injection to those already following management plan for pediatric age group suffering from chronic constipation and obstructed defecation. Patients and Methods:The current study included 40 children with functional constipation, and obstructed defecation. The study started in April 2017 and completed the patients follow-up in November 2019. Bowel management program was applied with Botulinum toxin injection. Patients were followed-up at 2 months, and 6 months using Rintala Scores. Results:The study included 45% female members and 55% male ones, with age range between 3-12 years. Improvement was achieved in 22.5% of children after 2 months of the management, all patients were followed-up at least for 6 months period, with a mean follow-up of 11.35 months. Rintala scores at initial presentation, 2 months and 6 months followup showed improvement. Overall, across all the study subjects, females did better and showed more improvement. Conclusion:This study has confirmed that BT injection did not add any significant effect, to children with obstructed defecation and chronic FC.