Image Exchange in the Middle East: a Survey.

Developing an enterprise approach to imaging technology rather than a radiology focus has recently increased. The communicator needs to be aware of this shift.The Middle East countries participated in the survey have confirmed the following major benefits of Medical Image Exchange: ✔ Fast access to both image and report ✔ Enable tele-services for second opinion, consulting and reporting ✔ Improve patient journey, workflow and diagnosis ✔ Allowed more patient engagement to be in place The Middle East countries that participated in this survey have agreed on the following shared challenges regarding Medical Imaging Exchange: ✔ Lack of enterprise imaging governance at the early stage of implementation. It will organize the who, when, and how. In addition, any fees and or payment involved for physicians ✔ Infrastructure availability to handle such large volume of data. Growing from mega-byte to petabyte per year is challenge for infrastructure. Cloud against On Premises-Installation implementation model ✔ Interoperability and integration to connect multi specialties from different systems. In addition, how far existing systems are ready for that. A standard-based framework is mature for image exchange, but what follows for other domains? There is a need to move beyond radiology images so as to include images from pathology, ophthalmology, and dermatology There are other countries in the region requiring guidance, support, and funding to move forward from the compact disc into internet-based interoperable image exchange. This should be considered part of the World Health Organization and the United Nation development to the region in the healthcare sector.

Impedance planimetry values for predicting clinical response following peroral endoscopic myotomy.

BACKGROUND: There is growing interest in developing impedance planimetry as a tool to enhance the clinical outcomes for endoscopic and surgical management of achalasia. The primary aim of this study was to determine whether impedance planimetry measurements can predict clinical response and reflux following peroral endoscopic myotomy (POEM). METHODS: A multicenter cohort study of patients with achalasia undergoing POEM was established from prospective databases and retrospective chart reviews. Patients who underwent impedance planimetry before and after POEM were included. Clinical response was defined as an Eckardt score of ≤ 3. Tenfold cross-validated area under curve (AUC) values were established for the different impedance planimetry measurements associated with clinical response and reflux development. RESULTS: Of the 290 patients included, 91.7 % (266/290) had a clinical response and 39.4 % (108/274) developed reflux following POEM. The most predictive impedance planimetry measurements for a clinical response were: percent change in cross-sectional area (%ΔCSA) and percent change in distensibility index (%ΔDI), with AUCs of 0.75 and 0.73, respectively. Optimal cutoff values for %ΔCSA and %ΔDI to determine a clinical response were a change of 360 % and 272 %, respectively. Impedance planimetry values were much poorer at predicting post-POEM reflux, with AUCs ranging from 0.40 to 0.62. CONCLUSION: Percent change in CSA and distensibility index were the most predictive measures of a clinical response, with a moderate predictive ability. Impedance planimetry values for predicting reflux following POEM showed weak predictive capacity.

Deleterious mtDNA mutations are common in mature oocytes.

Heritable mitochondrial DNA (mtDNA) mutations are common, yet only a few recurring pathogenic mtDNA variants account for the majority of known familial cases in humans. Purifying selection in the female germline is thought to be responsible for the elimination of most harmful mtDNA mutations during oogenesis. Here we show that deleterious mtDNA mutations are abundant in ovulated mature mouse oocytes and preimplantation embryos recovered from PolG mutator females but not in their live offspring. This implies that purifying selection acts not in the maternal germline per se, but during post-implantation development. We further show that oocyte mtDNA mutations can be captured and stably maintained in embryonic stem cells and then reintroduced into chimeras, thereby allowing examination of the effects of specific mutations on fetal and postnatal development.

The role of Crooke's changes in recurrence and remission after gamma knife radiosurgery.

PURPOSE: The objective of this study is to evaluate the role of Crooke's changes (CC) in normal the peri-tumoral anterior pituitary gland, in patients with Cushing's disease (CD) with a histopathological confirmed corticotroph adenoma, and determine if there is any difference in the recurrence and remission rates in CD patients after treatment with Gamma Knife Radiosurgery (GKRS). METHODS: All patients treated with GKRS for CD from 2005 to 2016 at our institution were identified. Patients had a confirmed adrenocorticotropic (ACTH)-secreting adenoma, i.e. corticotroph adenoma, and normal pituitary gland included in the surgical specimen, and specimens were stained with hematoxylin and eosin and also immunostaining for cytokeratin and ACTH. Statistical analyses were performed in a total of 61 patients who met the inclusion criteria. Additionally, we analyzed 20 patients in each group, with and without CC, after they were matched in a propensity score fashion. RESULTS: Endocrine remission defined as, a normal 24 h urine free cortisol while off suppressive medication, occurred in 48 patients (78.7%), with 76.9% in those with CC and 81.8% in those without CC. There was no statistical significant difference between the two groups in regarding remission (p = 0.312) or recurrence (p = 0.659) in either the unmatched or matched cohorts. CONCLUSION: The presence or absence of CC in normal pituitary gland does not appear to confer a lower rate of remission or a higher rate of recurrence after GKRS. Patients with pituitary corticotroph adenomas that present with CC features may be well served by Stereotactic radiosurgery (SRS).

The risk of misclassifying subjects within principal component based asset index.

The asset index is often used as a measure of socioeconomic status in empirical research as an explanatory variable or to control confounding. Principal component analysis (PCA) is frequently used to create the asset index. We conducted a simulation study to explore how accurately the principal component based asset index reflects the study subjects' actual poverty level, when the actual poverty level is generated by a simple factor analytic model. In the simulation study using the PC-based asset index, only 1% to 4% of subjects preserved their real position in a quintile scale of assets; between 44% to 82% of subjects were misclassified into the wrong asset quintile. If the PC-based asset index explained less than 30% of the total variance in the component variables, then we consistently observed more than 50% misclassification across quintiles of the index. The frequency of misclassification suggests that the PC-based asset index may not provide a valid measure of poverty level and should be used cautiously as a measure of socioeconomic status.

Relationship Between Quality of Sleep and Psychological Well-being Among Frontline Nurses During the COVID-19 Pandemic in Saudi Arabia.

Background: The coronavirus 2019 (COVID-19) pandemic is a world health emergency crisis that challenges the global health system and healthcare providers, especially frontline nurses' physical and mental well-being. Objective: The aim of the study was to examine the association between depression, anxiety, and sleep quality among nurses working in Saudi Arabian hospitals during the COVID-19 pandemic. Methods: This is an quantitative cross-sectional study. An online self-reported data was collected from 187 nurses who were on duty during COVID-19 pandemic. Results: About 87.2% of the nurses were female nurses; not surprising that 88% had poor sleep quality; 44.4% had moderate anxiety, and 44% of the studied nurses had mild to moderate depression. The study revealed that there was an association between level of anxiety and poor sleep quality. Poor sleep quality and emotional stability of nurses play a major role in quality of care and patients' safety. Conclusion: We conclude that healthcare leaders should adopt an occupational wellbeing program for nurses that focuses on their psychological wellbeing and sleep quality.

Two-Dimensional MXene as a Promising Adsorbent for Trihalomethanes Removal: A Density-Functional Theory Study.

This groundbreaking research delves into the intricate molecular interactions between MXene and trihalomethanes (THs) through a comprehensive theoretical study employing density-functional theory (DFT). Trihalomethanes are common carcinogenic chlorination byproducts found in water sanitation systems. This study focuses on a pristine MXene [Mn+1·Xn] monolayer and its various terminal [Tx] functional groups [Mn+1·XnTx], strategically placed on the surface for enhanced performance. Our investigation involves a detailed analysis of the adsorption energies of THs on different MXene types, with the MXene-Cl layer emerging as the most compatible variant. This specific MXene-Cl layer exhibits remarkable properties, including a total dipole moment (TDM) of 12.443 Debye and a bandgap of 0.570 eV, achieved through meticulous geometry optimization and computational techniques. Notably, THs such as trichloromethane (CHCl3), bromide-chloromethane (CHBrCl2), and dibromochloromethane (CHBr2Cl) demonstrate the highest TDM values, indicating substantial changes in electronic and optical parameters, with TDM values of 16.363, 15.998, and 16.017 Debye, respectively. These findings highlight the potential of the MXene-Cl layer as an effective adsorbent and detector for CHF3, CHClF2, CHCl3, CHBrCl2, and CHBr2Cl. Additionally, we observe a proportional increase in the TDM and bandgap energy, indicative of conductivity, for various termination atom combinations, such as Mxene-O-OH, Mxene-O-F, Mxene-O-Cl, Mxene-OH-F, Mxene-F-Cl, and Mxene-OH-Cl, with bandgap energies measured at 0.734, 0.940, 1.120, 0.835, and 0.927 eV, respectively. Utilizing DFT, we elucidate the adsorption energies of THs on different MXene surfaces. Our results conclusively demonstrate the significant influence of the termination atom nature and quantity on MXene's primitive TDM value. This research contributes to our understanding of MXene-THs interactions, offering promising avenues for the development of efficient adsorbents and detectors for THs. Ultimately, these advancements hold the potential to revolutionize water sanitation practices and enhance environmental safety.

Traumatic Dental Injuries and their Association with Demographics and Other Predisposing Risk Factors in School Children Aged between 8-13 Years: A Descriptive, Cross-Sectional Study.

Background: Traumatic dental injuries are most commonly seen in school age children. This not only affects physical, but, also, the psychological and social well-being of a child. The aim of the present study was to assess the prevalence of traumatic dental injuries in school children aged between 8 and 13 years and their association with the demographics and other predisposing risk factors. Materials and Methods: The present study was conducted as a cross-sectional study design on 1500 school children aged between 8 and 13 years. Apart from clinical examination, all the participants were asked to complete a questionnaire related to the injuries sustained. Statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) version 21.0 (IBM, Chicago). Pearson's Chi-square (Χ²) test was used for categorical data analysis and distribution to determine the association between categorical variables, while P < 0.05 was considered statistically significant. Results: The prevalence of traumatic dental injuries in the present study was calculated at 9.7%. Also, the occurrence of such injuries was found to be higher in the age group of 8-11 years with 10 years being the peak age of incidence for sustaining such injuries. Again, crown fracture involving enamel was found to be the most common type of injury sustained, while proclination observed in relation to upper anterior teeth, and incompetent lips were found to be the independent, significant risk predictors associated with the frequency and severity of such injuries. Conclusions: The results obtained in the present study suggested a high prevalence of traumatic dental injuries in school children aged between 8 and 13 years highlighting the need for conducting educational programs, for increasing knowledge and awareness of parents, school children and school faculty in this regard to save the affected child patients from the more dreaded sequelae including complete loss of tooth structure, and social and emotional trauma.

Effectiveness of Porcelain Polishing Methods on the Roughness and Color Stability of CAD-CAM Ceramics after Orthodontic Bracket Debonding.

Increased utilization of all ceramic restorations for aesthetic consideration in combination with routine adult orthodontic practice has led to numerous clinical challenges. Obtaining adequate bond strength between the orthodontic bracket and all-ceramic restoration and damage to the ceramic surface during the bracket debonding procedure needs to be better understood. This study analyzed the surface texture and color change of glazed and bracket-debonded ceramic CAD-CAM materials and the efficiency of porcelain polishing systems in restoring surface morphology and color. A total of 30 rectangular test specimens from each lithium disilicate CAD (LD-CAD), polymer-infiltrated ceramic (PICN), zirconia-reinforced lithium silicate glass ceramic (ZLS), and 5YTZP zirconia (5YZP) were prepared. The ceramic samples were embedded within acrylic resin, and baseline surface roughness and color were recorded using an optical profilometer and a reflected color spectrophotometer. The porcelain samples were bonded with lower incisor ceramic brackets. The samples were thermocycled 2000 times between 5 and 55 °C. Afterward, the brackets were peeled with bracket-removing pliers. The resin adhesive from the debonded surface was eliminated with tungsten carbide bur, and samples were randomly divided into three subgroups of (n = 10) to be polished with Diapol-twist (DT), a Keramik-Politur 4313B Komet polishing kit (KK), and a Horico diamond polisher (HDP). The polished surface roughness and color were recorded. The data were statistically analyzed using a two-way analysis of variance at p < 0.05. The debonded porcelain surfaces across the groups displayed significantly higher mean surface roughness (Ra) compared to glazed surfaces. The debonded 5YZP showed the least Ra at 0.661 (0.09), while the highest Ra was recorded by PICN at 4.057 (0.82). All of the polishing systems evaluated in the study significantly reduced the surface roughness. However, they were unsuccessful in regaining the surface topography of the glazed surface. The flexible discs (DT) produced the smoothest surface, followed by the diamond-impregnated rubber points (KK). Unpolished porcelain surfaces had a discernable mean color difference from glazed surfaces. Polished surfaces from the different polishing systems among the all-ceramic groups achieved a clinically acceptable mean color difference. Polishing debonded rough porcelain surfaces is imperative, and flexible discs performed better in all of the tested CAD-CAM ceramic materials.

ZnO doped C: Facile synthesis, characterization and photocatalytic degradation of dyes.

Carbon doped ZnO nanoparticles have been synthesized from the thermal decomposition of Zinc citrate precursor. The precursor was synthesized from semi-solid paste and then subjected to calcination at 700 °C to produce ZnO nanoparticles. The precursor and ZnO were characterized by Fourier Transform Infrared Spectroscopy, UV-visible (UV-Vis) spectra, Transmission Electron Microscope, Field Emission Scanning Electron Microscope, Energy Dispersive Analysis by X-ray (EDAX), X-ray powder diffraction (XRD), and X-ray photoelectron spectroscopy (XPS). The results ensured the formation of hexagonal 2D-ZnO nanoparticles with a layer thickness of 25 nm. The optical band gap of ZnO was determined and found to be 2.9 eV, which is lower than the bulk. Photocatalytic degradation of Fluorescein dye as an anionic dye and Rhodamine B as a cationic dye was evaluated via C-ZnO NPs under UV irradiation. ZnO displayed 99% degradation of Fluorescein dye after 240 min and a complete photocatalytic degradation of Rhodamine B dye after 120 min under UV irradiation.

Facial Demodicosis-Induced Skin Hyperpigmentation in an Immunocompromised Man Treated Successfully with Ivermectin 1% Cream: A Case Report.

Demodex folliculorum is a common ectoparasite of humans that inhabits follicular infundibulum and sebaceous ducts. Its role in various dermatological diseases is well studied. However, data on demodex-induced skin pigmentation are very limited. A diagnosis of this entity can be easily missed for other causes of facial hyperpigmentation such as melasma, lichen planus pigmentosus, erythema dyschromicum perstans, post-inflammatory hyperpigmentation, and drug-induced hyperpigmentation. Here, we report a case of facial demodicosis-induced skin hyperpigmentation in a 35-year-old Saudi male who is on multiple immunosuppressive agents. He was successfully treated with ivermectin 1% cream and had a dramatic improvement at his 3-month follow-up. Our aim is to shed light on this underdiagnosed cause of facial hyperpigmentation which can be easily diagnosed and followed up by bed side dermoscopic examination and managed effectively by anti-demodectic therapies.

Primary Cutaneous Follicle Center Lymphoma Presenting as a Solitary Nodule on the Forearm of an Adolescent Girl: A Case Report and Literature Review.

Primary cutaneous B-cell lymphomas (PCBCLs) are very rare to be seen in pediatric and adolescent age group, especially primary cutaneous follicle center lymphoma (PCFCL) which is considered the least occurring main subtype. Here, we describe a 16-year-old girl who developed a slowly growing solitary firm smooth surfaced erythematous nodule over her forearm. Histopathological examination showed a dense dermal nodular, periadnexal and perivascular lymphoid infiltrate extending deep to the subcutis. Immunohistochemical staining showed a B-cell population with positivity for CD20, variable staining for BCL6 and CD10 and uniquely staining for BCL2. Although a primary cutaneous marginal zone lymphoma (PCMZL) was considered but the presences of interfollicular BCL6 and CD10 positivity established the diagnosis of PCFCL. To our knowledge, only 12 cases of pediatric and adolescent PCFCL have been described in the literature.

Terbium Removal from Aqueous Solutions Using a In2O3 Nanoadsorbent and Arthrospira platensis Biomass.

Terbium is a rare-earth element with critical importance for industry. Two adsorbents of different origin, In2O3 nanoparticles and the biological sorbent Arthrospira platensis, were applied for terbium removal from aqueous solutions. Several analytical techniques, including X-ray diffraction, Fourier-transform infrared spectroscopy, and scanning electron microscopy, were employed to characterize the adsorbents. The effect of time, pH, and terbium concentration on the adsorption efficiency was evaluated. For both adsorbents, adsorption efficiency was shown to be dependent on the time of interaction and the pH of the solution. Maximum removal of terbium by Arthrospira platensis was attained at pH 3.0 and by In2O3 at pH 4.0-7.0, both after 3 min of interaction. Several equilibrium (Langmuir, Freundlich, and Temkin) and kinetics (pseudo-first order, pseudo-second order, and Elovich) models were applied to describe the adsorption. The maximum adsorption capacity was calculated from the Langmuir model as 212 mg/g for Arthrospira platensis and 94.7 mg/g for the In2O3 nanoadsorbent. The studied adsorbents can be regarded as potential candidates for terbium recovery from wastewater.

Assessment of Public's Awareness Regarding Irritable Bowel Syndrome in Aseer Region, Saudi Arabia.

Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by altered bowel habits, abdominal pain, or discomfort. It is a highly prevalent disorder that affects patients' quality of life. A workup is usually required to diagnose IBS, as its differential diagnosis includes some serious conditions such as carcinoma of the colon. The present study aimed to assess the awareness and beliefs of the general population regarding IBS. This study was conducted in the Aseer Region, in the southwestern part of Saudi Arabia. It followed a cross-sectional research design that was conducted during the period from January to March 2021 using a structured self-administered questionnaire to assess the demographic variables in addition to questions to assess participants' awareness and beliefs related to IBS. Following a convenience sample, the study included 779 participants, with 43.3% being male, mostly in the age group 21-30 years (36.7%), and 68.7% being university graduates. Most participants (70.5%) were aware of IBS, and had the correct knowledge about its etiology, symptoms, risk factors, prognosis, and management. It is recommended to conduct various awareness-raising programs regarding IBS to improve the public's knowledge and to decrease functional disabilities and their impact on life.

Public awareness of side effects of systemic steroids in Asir region, Saudi Arabia.

Background: Corticosteroids have been used since the 50s and it represent the most important and frequently used class of anti-inflammatory and immunosuppressive drugs for the treatment of several diseases such as numerous neoplastic, asthma, allergy, rheumatoid arthritis, and dermatological disorders. This study aims to determine the public awareness of side effects of systemic steroids in Asir region, Saudi Arabia. Methods: A descriptive cross-sectional web-based study was used. An online questionnaire was developed by the study researchers based on the literature review and consultations of the field experts. The questionnaire included the following components: Participants demographic data, medical history, and steroids use. Also, it covered participants awareness regarding systemic steroids and side effects. Results: A total of 439 participants fulfilling the inclusion criteria completed the study questionnaire. Ages ranged from 18 to 65 years with mean age of 26.1 ± 13.9 years old, of those, 227 (51.7%) respondents were males. Around 346 (78.8%) had poor overall awareness level while only 93 (21.2%) had good awareness regarding systematic steroids. The study also showed that awareness was significantly higher among young aged participants in the health care field and among those who previously used steroids. Two hundred and eighty two (64.2%) of the respondents reported previous use of steroids. Conclusion: In conclusion, the current study showed that nearly one out of each five people know about systemic steroids and related side effects which is below the satisfactory level. Higher awareness was observed with regards drug associated side effects and long-term use consequences.

Promise of Real-World Evidence for Patient Centricity in Gulf Cooperation Council Countries: Call to Action.

Presently, Gulf Cooperation Council countries are lagging in the generation of real-world data and use of real-world evidence for patient-centered care compared with the global average. In a collaborative effort, experts from multiple domains of the healthcare environment from the Gulf Cooperation Council countries came together to present their views and recommended key action points for the generation of robust real-world data and leveraging real-world evidence in the countries. The opinions of the experts are presented, along with existing barriers to the effective generation of real-world evidence in the countries. The Gulf Cooperation Council countries are undergoing transformative changes paving the way for improved healthcare measures; however, the challenges in generating reliable, robust, accessible, and secure real-world evidence are persistent. Hence, ongoing public-private engagements, as well as collaborations between regulators, policymakers, healthcare professionals, insurance and pharmaceutical companies, and patients, are warranted. A few notable examples of real-world evidence studies highlighting the benefits of real-world evidence for gaining valuable insights into patient-centric decision making are also discussed. The actionable steps identified for successful real-world evidence generation would provide long-term, real-world evidence-based patient-centric benefits for the countries.

Highly Accurate Identification of Bacteria's Antibiotic Resistance Based on Raman Spectroscopy and U-Net Deep Learning Algorithms.

Bacterial pathogens especially antibiotic-resistant ones are a public health concern worldwide. To oppose the morbidity and mortality associated with them, it is critical to select an appropriate antibiotic by performing a rapid bacterial diagnosis. Using a combination of Raman spectroscopy and deep learning algorithms to identify bacteria is a rapid and reliable method. Nevertheless, due to the loss of information during training a model, some deep learning algorithms suffer from low accuracy. Herein, we modify the U-Net architecture to fit our purpose of classifying the one-dimensional Raman spectra. The proposed U-Net model provides highly accurate identification of the 30 isolates of bacteria and yeast, empiric treatment groups, and antimicrobial resistance, thanks to its capability to concatenate and copy important features from the encoder layers to the decoder layers, thereby decreasing the data loss. The accuracies of the model for the 30-isolate level, empiric treatment level, and antimicrobial resistance level tasks are 86.3, 97.84, and 95%, respectively. The proposed deep learning model has a high potential for not only bacterial identification but also for other diagnostic purposes in the biomedical field.

Treatment of idiopathic internal jugular vein thrombosis in a healthy woman with enoxaparin and rivaroxiban: Case report and literature narrative review.

Introduction: Venous thrombosis is a medical condition that occurs when a blood clot forms in a vein. These clots usually develop in the lower leg, thigh, or pelvis but can also occur in the arm. It is essential to know about Venous thrombosis because it can happen to anybody and cause severe illness and disability. Fortunately, if the diagnosis is early, the outcomes will be excellent. However, idiopathic or spontaneous internal jugular vein thrombosis is a rare but potentially fatal condition. Method: here, we presented a rare case of Internal jugular vein thrombosis (IJVT) and reviewed the literature on cases of IJVT to describe clinical features, associated risk factors, possible complications, ways of investigations, and outcomes. Results: Among 57 cases (56 in the literature plus our case), 25 patients out of 57 had a chief complaint of neck swelling, and only five complained of neck pain; on the other hand, four patients were asymptomatic. Thirty-five patients had a risk factor of developing thrombosis, 19 patients had a malignancy, and 22 did not have an obvious risk factor. To diagnose IJVT, ultrasound alone was used in 11 patients, Ct alone was used in 13 patients, and a combination of CT and ultrasound was used in 21 patients. Conclusion: IJVT thrombosis is a rare condition, but its diagnosis requires reasonable radiological and laboratory investigations; early treatment is warranted to avoid fetal complications.

Understanding the Mechanism Underlie the Antidiabetic Activity of Oleuropein Using Ex-Vivo Approach.

Background: Oleuropein, the main constituent of olive fruit and leaves, has been reported to protect against insulin resistance and diabetes. While many experimental investigations have examined the mechanisms by which oleuropein improves insulin resistance and diabetes, much of these investigations have been carried out in either muscle cell lines or in vivo models two scenarios with many drawbacks. Accordingly, to simplify identification of mechanisms by which oleuropein regulates specific cellular processes, we resort, in the present study, to isolated muscle preparation which enables better metabolic milieu control and permit more detailed analyses. Methods: For this purpose, soleus muscles were incubated for 12 h without or with palmitate (1.5 mM) in the presence or absence of oleuropein (1.5 mM), and compound C. Insulin-stimulated glucose transport, glucose transporter type 4 (GLUT4) translocation, Akt substrate of 160 kDa (AS160) phosphorylation and adenosine monophosphate-activated protein kinase (AMPK) phosphorylation were examined. Results: Palmitate treatment reduced insulin-stimulated glucose transport, GLUT4 translocation and AS160 phosphorylation, but AMPK phosphorylation was not changed. Oleuropein administration (12 h) fully rescued insulin-stimulated glucose transport, but partially restored GLUT4 translocation. However, it fully restored AS160 phosphorylation, raising the possibility that oleuropein may also have contributed to the restoration of glucose transport by increased GLUT4 intrinsic activity. Inhibition of AMPK phosphorylation with compound C (50 µM) prevented oleuropein -induced improvements in insulin-stimulated glucose transport, GLUT4 translocation, and AS160 phosphorylation. Conclusion: Our results clearly indicate that oleuropein alleviates palmitate-induced insulin resistance appears to occur via an AMPK-dependent mechanism involving improvements in the functionality of the AS160-GLUT4 signaling system.

Pelvic osteotomies in hip dysplasia: why, when and how?

Acetabular dysplasia is a significant problem in the spectrum of developmental dysplasia of hip. In a younger child, positioning the femoral head into the acetabulum helps in reciprocal remodeling of the acetabulum and correction of dysplasia. In an older child, the remodeling potential is limited and often the acetabular dysplasia needs surgical intervention in the form of a pelvic osteotomy. Thus, pelvic osteotomy forms an integral part of surgical management of hip dysplasia. The ultimate goal of these osteotomies is to preclude or postpone the development of osteoarthritis and add more years of life to the native hip. Pelvic osteotomies play a pivotal role in normalizing hip morphology. The choice of pelvic osteotomy depends on the age of a child, the type of dysplasia and the status of the tri-radiate cartilage. Several types of re-directional and reshaping pelvic osteotomies have been described in the literature to improve the stability and restore the anatomy and biomechanics of the dysplastic hip. This article attempts to review the current indications for various pelvic osteotomies with a brief description of their techniques along with the outcomes and complications published thus far. Besides, the guidelines to choose the right pelvic osteotomy are also provided.