miRNA-133 and lncRNA-H19 expressions and their relation to serum levels of PKM2 and TGF-ß in patients with systemic sclerosis.

Background and aims: Systemic sclerosis (SSc) is a common autoimmune disorder involving the skin, blood vessels, and internal organs with an elusive pathophysiology. SSc is believed to be a genetically prone T-cell-mediated autoimmune disease. miRNAs and lncRNAs were thought to be involved in the etiology of several immunological diseases including SSc. This work aimed to assess the expression of miRNA-133, lncRNA-H19, PKM2, and TGF-ß levels in SSc in comparison to controls and their relationship to the clinical course and severity of disease. Patients and methods: Fifty patients with SSc and 40 healthy age and sex-matched controls were included in this study. miRNA-133 and H19 expression levels were detected using quantitative RT-PCR while serum levels of PKM2 and TGF-ß were measured using ELISA techniques. Patients' clinical data and treatments received were extracted and correlated with proteins investigated. Results: Our results showed that miRNA-133 was significantly downregulated in SSc patients in comparison to controls (Mean + SD of SSc = 0.61 ± 0.22, Mean ± SD of HC = 0.97 ± 0.007, p = 0.003). However, there was significant upregulation of the serum expressions of all other tested biomarkers in SSc patients in comparison to controls; H19 (Mean + SD of SSc = 10.37 ± 3.13, Mean ± SD of HC = 1.01 ± 0.01, p = 0.0001), PKM2 (Mean + SD of SSc = 28.0 ± 4.84, Mean ± SD of HC = 16.19 ± 1.32, p = 0.005) and TGF-ß (Mean + SD of SSc = 150.8 ± 6.36, Mean ± SD of HC = 23.83 ± 0.93, p = 0.0001). We also detected several correlations between serum levels of the investigated proteins in patients with SSc. Conclusion: Along with TGF-ß, our results show that miRNA-133, H19, and PKM2 seem to be potential contributors to SSc pathogenesis and could be promising biomarkers in the diagnosis of SSc patients. The lncRNA-H19 correlations with TGF- ß, miRNA-133, and PKM2 suggest a possible influential effect of this RNA molecule on the pathogenesis of SSc.

Union in Lateral Column Lengthening by Plate Fixation Without Bone Graft in Flexible Flatfoot: A Case Series.

Purpose: This study's goal was to evaluate the outcomes of lateral column lengthening by plate fixation without bone graft in the management of symptomatic flexible flatfoot. Methods: A prospective randomized trial study included 30 feet (27 patients) and was performed from March 2017 to December 2019. Functional and radiological evaluations were done pre-operative and at the final post-operative follow-up. The functional assessment was done using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Results: The mean follow-up was 16.5 ± 3.027 months. The mean age of patients was 22.6 ± 6.29 years. All cases showed union ranging from 8 to 12 weeks, with a mean of 10 ± 1.88 weeks. The mean AOFAS score improved from 51.6 ± 6.75 to 92.2 ± 6.21. The mean anteroposterior (AP) talo-first metatarsal angle improved from 25.3° ± 8.31° to 3.4° ± 5.10°. The mean anteroposterior (AP) talo-navicular coverage improved from 22.10° ± 4.28° to 2.3° ± 3.46°. The mean Lateral talo-first metatarsal angle improved from 18.6° ± 4.79° to 3.3° ± 3.16°. The calcaneal pitch angle improved from 9.6° ± 4.14° to 15.1° ± 4.43°. The mean lateral talo-calcaneal angle improved from 45.7° ± 3.77° to 37.5° ± 3.47°. Conclusion: Using an interposition wedge plate for LCL without bone graft leads to a high union rate, maintains the correction, and avoids possible complications of autografts and allografts.

DGTTSSA: Data Gathering Technique Based on Trust and Sparrow Search Algorithm for WSNs.

Wireless Sensor Networks (WSNs) have been successfully utilized for developing various collaborative and intelligent applications that can provide comfortable and smart-economic life. This is because the majority of applications that employ WSNs for data sensing and monitoring purposes are in open practical environments, where security is often the first priority. In particular, the security and efficacy of WSNs are universal and inevitable issues. One of the most effective methods for increasing the lifetime of WSNs is clustering. In cluster-based WSNs, Cluster Heads (CHs) play a critical role; however, if the CHs are compromised, the gathered data loses its trustworthiness. Hence, trust-aware clustering techniques are crucial in a WSN to improve node-to-node communication as well as to enhance network security. In this work, a trust-enabled data-gathering technique based on the Sparrow Search Algorithm (SSA) for WSN-based applications, called DGTTSSA, is introduced. In DGTTSSA, the swarm-based SSA optimization algorithm is modified and adapted to develop a trust-aware CH selection method. A fitness function is created based on the nodes' remaining energy and trust values in order to choose more efficient and trustworthy CHs. Moreover, predefined energy and trust threshold values are taken into account and are dynamically adjusted to accommodate the changes in the network. The proposed DGTTSSA and the state-of-the-art algorithms are evaluated in terms of the Stability and Instability Period, Reliability, CHs Average Trust Value, Average Residual Energy, and Network Lifetime. The simulation results indicate that DGTTSSA selects the most trustworthy nodes as CHs and offers a significantly longer network lifetime than previous efforts in the literature. Moreover, DGTTSSA improves the instability period compared to LEACH-TM, ETCHS, eeTMFGA, and E-LEACH up to 90%, 80%, 79%, 92%, respectively, when BS is located at the center, up to 84%, 71%, 47%, 73%, respectively, when BS is located at the corner, and up to 81%, 58%, 39%, 25%, respectively, when BS is located outside the network.

Gradual on top-of-acute correction of neglected adolescent tibia vara by percutaneous tibial osteotomy and two-ring Ilizarov frame.

OBJECTIVES: This study aims to assess the effect of gradual correction after acute translation of the tibia in tibia vara using a two-ring Ilizarov frame on the correction of mechanical axis deviation (MAD), union time, and the rate of complications. PATIENTS AND METHODS: Between September 2018 and January 2021, a total of 30 patients (25 males, 5 females; mean age: 20±5 years; range, 15 to 25 years) with adolescent tibia vara were included. The patients had a transverse fibular ostectomy and percutaneous tibial osteotomy below the level of the tibial tuberosity. Acute correction of the rotation deformity combined with acute translation was done. A two-ring Ilizarov frame with a medial distractor and two lateral hinges were used to fix the osteotomy and the coronal plane deformity was gradually corrected. RESULTS: The mean follow-up was 24±4 months. All patients had improvement in the mechanical medial proximal tibial angle (mMPTA) and MAD postoperatively. There was an improvement in the Hospital for Special Surgery knee score at one year postoperatively. No neurovascular complications or union complications were observed. CONCLUSION: Acute translation followed by gradual angulation of the proximal tibia in cases with adolescent tibia vara yields better correction of the mechanical axis with good functional and radiological outcomes.

Utilization of the emergency department by kidney transplant recipients: a retrospective cohort study from a high-volume transplant center.

This study aims to assess the trends of emergency department (ED) visits among kidney transplant recipients in a high-volume transplant centre. Methods: This retrospective cohort study targeted patients who underwent renal transplantation at a high-volume transplant centre from 2016 to 2020. The main outcomes of the study were ED visits within 30 days, 31-90 days, 91-180 days, and 181-365 days of transplantation. Results: This study included 348 patients. The median (interquartile range) age of patients was 45.0 years (30.8, 58.2). Over half of the patients were male (57.2%). There was a total of 743 ED visits during the first year after discharge. 19% (n=66) were considered high-frequency users. High-volume ED users tended to be admitted more frequently as compared to those with low frequencies of ED visits (65.2% vs. 31.2%, respectively, P<0.001). Conclusion: As evident by the large number of ED visits, suitable coordination of management through the ED remains a pivotal component of post-transplant care. Strategies addressing prevention of complications of surgical procedures or medical care and infection control are aspects with potential for enhancement.

Galectin-1 in Psoriatic arthritis, Psoriasis, Rheumatoid arthritis and its relation with disease activity and skin lesion.

Immune mediated inflammatory diseases (IMIDs) are a diverse range of diseases that affect joints with early overlapping symptoms. Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are the most common disorders sharing immune-pathogenic mechanisms that cause peripheral arthritis. Psoriasis (Ps) is a chronic inflammatory autoimmune skin disease characterized by epidermal hyperplasia with significant invasion by inflammatory cells. New biomarkers are required to enable an early diagnosis and differentiation between different types of IMIDs. In autoimmune disorders, galectin 1 (Gal-1) is a recognized as negative immune system regulator. This study aimed to determine the possibility of using gal-1 as a diagnostic marker to differentiate between RA and PsA with polyarthritis pattern, and between PsA and Ps, and to assess its relationship with disease activity and with skin lesion. In this case-control study included 40 PsA patients with polyarthritis pattern, 40 psoriatic patients, 40 RA patients and 20 normal controls. Gal-1 levels were measured in serum and skin biopsy and disease Activity Score (DAS-ESR) was assessed. Serum gal-1 level was significantly higher in RA group in comparison to PsA, psoriatic and control. In addition, compared to the normal group, psoriatic skin lesions from PsA and Ps patients had lower levels of gal-1. Serum gal-1 levels in the RA group did not correlate with other factors such as age, disease duration, deformity, extra-articular symptoms, or DAS-ESR. Furthermore, there was no correlation between the skin's level of gal-1 and psoriatic area and severity index (PASI) score, body surface area (BSA). In conclusion, serum Gal-1 concentration may serve as a diagnostic biomarker to distinguish between RA and PsA. However, it cannot assess activity or severity of RA, and cannot differentiate psoriatic lesion either from only Ps or PsA.

Expression of Long Noncoding RNA, HOTAIR, and MicroRNA-205 and Their Relation to Transforming Growth Factor ß1 in Patients with Alopecia Areata.

Introduction: Alopecia areata (AA) is a common autoimmune condition that affects anagen hair follicles. The most commonly recognized theory is that it is a T-cell-mediated autoimmune disorder in a genetically susceptible individual. MicroRNAs (miRNAs) and long noncoding RNAs (lncRNAs) were thought to play a function in the pathogenesis. The expression of lncRNA HOTAIR and miRNA-205 and their relation to transforming growth factor ß1 (TGF-ß1) in AA were not studied. Aim: The aim of the studywas to evaluate the role of miRNA-205, lncRNA, HOTAIR, and TGF-ß1 levels in AA pathogenesis, clinical course, and severity of AA. Methods: Two groups of subjects were included in this case-control study: 50 patients with AA and 50 healthy matched controls. miRNA-205 and lncRNA HOTAIR expression levels were assayed using quantitative RT-PCR, while serum levels of TGF-ß1 were assayed using ELISA techniques. Results: The serum expression of lncRNA HOTAIR was significantly downregulated in AA patients with a p value < 0.001, while the serum expression of both miRNA-205 and TGF-ß1 were significantly upregulated in patients. Discussion/Conclusion: This study highlights the potential role of high serum expression of miRNA-205 and TGF-ß1 and the low serum expression of lncRNA HOTAIR in AA pathogenesis. This could be used as a therapeutic target to treat AA.

Bibliometric analysis on the adoption of artificial intelligence applications in the e-health sector.

Artificial Intelligent (AI) applications in e-health have evolved considerably in the last 25 years. To track the current research progress in this field, there is a need to analyze the most recent trend of adopting AI applications in e-health. This bibliometric analysis study covers AI applications in e-health. It differs from the existing literature review as the journal articles are obtained from the Scopus database from its beginning to late 2021 (25 years), which depicts the most recent trend of AI in e-health. The bibliometric analysis is employed to find the statistical and quantitative analysis of available literature of a specific field of study for a particular period. An extensive global literature review is performed to identify the significant research area, authors, or their relationship through published articles. It also provides the researchers with an overview of the work evolution of specific research fields. The study's main contribution highlights the essential authors, journals, institutes, keywords, and states in developing the AI field in e-health.

ERCP: Energy-Efficient and Reliable-Aware Clustering Protocol for Wireless Sensor Networks.

Wireless Sensor Networks (WSNs) have been around for over a decade and have been used in many important applications. Energy and reliability are two of the major problems with these kinds of applications. Reliable data delivery is an important issue in WSNs because it is a key part of how well data are sent. At the same time, energy consumption in battery-based sensors is another challenge. Therefore, efficient clustering and routing are techniques that can be used to save sensors energy and guarantee reliable message delivery. With this in mind, this paper develops an energy-efficient and reliable clustering protocol (ERCP) for WSNs. First, an efficient clustering technique is proposed for sensor nodes' energy savings considering different clustering parameters, including the link quality metric, the energy, the distance to neighbors, the distance to the sink node, and the cluster load metric. The proposed routing protocol works based on the concept of a reliable inter-cluster routing technique that saves energy. The routing decisions are made based on different parameters, such as the energy balance metric, the distance to the sink node, and the wireless link quality. Many experiments and analyses are examined to determine how well the ERCP performs. The experiment results showed that the ECRP protocol performs much better than some of the recent algorithms in both homogeneous and heterogeneous networks.

A review on recent studies utilizing artificial intelligence methods for solving routing challenges in wireless sensor networks.

Wireless sensor networks (WSNs) are becoming increasingly important, providing pervasive real-time applications that have been used to enhance smart environments in various fields such as smart cities, manufacturing, and the Internet of Things (IoT). This survey reviews and analyzes the research trends related to the utilized Artificial Intelligence (AI) methods for WSN and the potential enhancement of WSNs using these methods. We highlight the routing challenge in WSN and present a comprehensive discussion on the recent studies that utilized various AI methods in addressing the routing challenge to meet specific objectives of WSN, during the span of 2010 to 2020. This would guide the reader towards an understanding of up-to-date applications of AI methods with respect to routing challenge in WSN. In addition, a general evaluation is provided along with a comparison of utilized AI methods in WSNs, which guides the reader in identifying the most appropriate AI methods that can be utilized for solving the routing challenge. Finally, we conclude the paper by stating the open research issues and new directions for future research.

COVID-19 hot-spot strategy: a special innovation in pandemic response, Oyo State Nigeria.

BACKGROUND: COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has evolved into a pandemic. Oyo state, Nigeria with a population of 9,233,010, recorded the first case of COVID-19 on the 12th of March 2020 and it is among the highest contributing States to the nation's burden of the disease with 3267 confirmed cases, including 40 deaths as of date, with an overall test positivity rate of 18.1%, far higher compared to the National average within a limited period from recorded index case. A 'Hotspot strategy' was designed by the Presidential Task Force on COVID-19 and Oyo State was selected to implement the strategy through upscaling case detection, isolation and treatment, quarantine of contacts and strengthening public health and social measures. METHODS: We used a descriptive cross-sectional survey of 3 identified hotspot Local Government Areas (LGAs) in Oyo State using mobile phones under Surveillance, Outbreak Response Management and Analysis System (SORMAS) platform to collect data from October to December 2020. Interventions comprised of enhanced active case search, contact line listing, contact investigation, and contact follow-up as well as to facilitate data collection and entry, community sensitization and management of alert/rumors. Baseline information and that after the 3-month period was then analyzed with the descriptive statistics presented. RESULTS: The implementation of the hotspot strategy was shown to have had a major impact in Irepo LGA, where more than a 100% increase in samples tested, confirmed cases, contacts listed and contacts followed were recorded, while there were no significance changes noticed in Ibadan North and Lagelu LGAs. However, test positivity rates among contacts were found to be quite high in Ibadan North LGA (48%), compared to the other two, even though Lagelu LGA (5.7%) tested more contacts than Ibadan North. CONCLUSION: The observed increase in number of samples tested, cases confirmed, contact listed and investigated as well as test positivity rate in the 3 LGAs after the intervention implies that the hotspot strategy can be said to have contributed positively to the sensitivity of COVID-19 surveillance in Oyo State, Nigeria. This implies that strengthening this 'hotspot strategy' may be a key area of focus to improve COVID-19 surveillance sensitivity and response and in turn may help in breaking the transmission and bringing the pandemic to a halt.

MicroRNA-22 Level in Patients with Multiple Sclerosis and Its Relationship with Vitamin D and Vitamin D Receptor Levels.

INTRODUCTION: Multiple sclerosis (MS) is known to be a multifactorial disorder. Numerous observational studies have suggested the implication of multiple genetic and environmental factors in the pathogenesis of MS. The aim of this work was to evaluate expression of the microRNA-22 (miRNA-22) level, in relation to vitamin D (VD) and VD receptor (VDR) levels in patients with MS during remission state. METHODS: This case-control study was conducted in 50 patients with clinically definite MS and 50 age- and sex-matched healthy controls. miRNA-22 expression was assessed in both MS patients and controls using quantitative RT-PCR. The serum level of VD and VDR was assessed in both MS patients and controls using ELISA techniques. RESULTS: The miRNA-22 level was significantly downregulated in MS patients in comparison to controls (p value <0.001). MS patients had also significantly lower VD and VDR levels in comparison to controls (p value <0.001 and <0.001, respectively). Patients with secondary progressive MS (SPMS) have a significantly higher miRNA-22 level than patients with relapsing remitting MS (RRMS) (p value = 0.042). There was a statistically significant positive correlation between the miRNA-22 level and EDSS (p value = 0.033). There was also a statistically significant positive correlation between the miRNA-22 level and VDR level (p value = 0.002). CONCLUSION: The miRNA-22 level was significantly downregulated in MS patients, but it had a positive correlation with disability status. Patients with SPMS have a significantly higher miRNA-22 level than patients with RRMS. VD and VDR levels were significantly lower in MS patients than controls. The miRNA-22 level was positively correlated with the VDR level.

Omitting the Early Postoperative Follow-up in Uncomplicated Operative Supracondylar Humerus Fractures in Children Does Not Negatively Affect Outcomes.

BACKGROUND: Supracondylar humerus (SCH) fractures are the most common surgically treated elbow injuries in children. There have been debates regarding if an early postoperative follow-up before pin removal is necessary to decrease the complications related to surgical fixation. To date, studies examining this topic have included smaller sample sizes, limiting the generalizability of their findings. METHODS: A retrospective chart review of outcomes after operative management of Gartland type II and III SCH fractures at a single level 1 pediatric trauma center between 2005 and 2015 was performed. Patient demographics, fracture characteristics, pin number and configuration, timing of initial follow-up, change in treatment plan after initial follow-up, time to pin removal, initial and final fracture radiographic parameters, and complications were observed via chart review. RESULTS: A total of 1518 SCH fractures underwent operative fixation: 755 Gartland type II and 765 type III. Of the 1518 SCH fractures identified, 1370 met inclusion criteria and were included for analysis. Of these, 1196 patients returned for initial follow-up within 1 to 2 weeks of surgery, and 174 patients had their initial follow-up 3 to 4 weeks postoperatively. There were 8 incidences where initial early follow-up resulted in a change of management; however, change in management was limited to cast alteration in 7 of these cases. CONCLUSIONS: Closed reduction and percutaneous pin fixation of otherwise uncomplicated closed SCH fractures have good outcomes and a very low complication rate at a level 1 pediatric trauma center. Early postoperative follow-up before the pin removal visit provides minimal utility in decreasing complications and may be safely omitted as long as the initial fracture fixation is deemed to be stable. LEVEL OF EVIDENCE: Level III.

Role of Near-Infrared Spectroscopy in Monitoring the Clinical Course of Asphyxiated Neonates Treated with Hypothermia.

OBJECTIVE: Hypoxic-ischemic encephalopathy (HIE) affects millions of newborns annually, especially in low-resource settings. Real-time monitoring of hypoxic-ischemic brain damage is urgently needed for assessment of severity and management of neonates with birth asphyxia. Aim of the work is monitoring of near-infrared spectroscopy (NIRS)-measured cerebral regional oxygen saturation (cRSO2) and cerebral fractional tissue oxygen extraction (FTOE) in neonates after birth asphyxia in relation to their clinical course. STUDY DESIGN: Forty asphyxiated-term and near-term neonates with mild to severe HIE admitted at neonatal intensive care unit of Alexandria University Maternity Hospital from March to October 2019, received therapeutic hypothermia (TH) and had continuous NIRS monitoring of cRSO2 for 72 hours. Infants were categorized into HIE with seizing and nonseizing groups, and abnormal and normal magnetic resonance imaging (MRI) groups. RESULTS: Clinical seizures (CS) occurred in 15 (37.5%) of HIE neonates and 13.3% of them died (n = 2). In the current study, significantly higher cRSO2 and lower FTOE values were found in the seizing infants as compared with nonseizing group (p < 0.001). NIRS-measured day 2-cRSO2 and day 1-FTOE were associated with CS in newborns with HIE and day 1-cRSO2 and FTOE were associated with abnormal MRI at 1 month of age. cRSO2 values were found to correlate positively with initial Thompson score especially in days 1 and 2. Further, neonates with CS were more likely to have MRI abnormalities at follow-up. CONCLUSION: NIRS measures may highlight differences between asphyxiated neonates who develop CS or later MRI abnormalities and those who do not. KEY POINTS: · Day 1 FTOE is the early and sensitive predictor for both clinical seizures and abnormal MRI.. · Cerebral oxygenation metrics help in selecting patients in urgent need of an early MRI scan.. · Cerebral oxygenation metrics can be used hand in hand with clinical assessment using Thompson score at admission to select patient candidate for therapeutic hypothermia..

Compressive sensing based secure data aggregation scheme for IoT based WSN applications.

Compressive Sensing (CS) based data collection schemes are found to be effective in enhancing the data collection performance and lifetime of IoT based WSNs. However, they face major challenges related to key distribution and adversary attacks in hostile and complex network deployments. As a result, such schemes cannot effectively ensure the security of data. Towards the goal of providing high security and efficiency in data collection performance of IoT based WSNs, we propose a new security scheme that amalgamates the advantages of CS and Elliptic Curve Cryptography (ECC). We present an efficient algorithms to enhance the security and efficiency of CS based data collection in IoT-based WSNs. The proposed scheme operates in five main phases, namely Key Generation, CS-Key Exchange, Data Compression with CS Encryption, Data Aggregation and Encryption with ECC algorithm, and CS Key Re-generation. It considers the benefits of ECC as public key algorithm and CS as encryption and compression method to provide security as well as energy efficiency for cluster based WSNs. Also, it solves the CS- Encryption key distribution problem by introducing a new key sharing method that enables secure exchange of pseudo-random key between the BS and the nodes in a simple way. In addition, a new method is introduced to safeguard the CS scheme from potential security attacks. The efficiency of our proposed technique in terms of security, energy consumption and network lifetime is proved through simulation analysis.

Chest X-Ray Findings in COVID-19 Patients Presenting to Primary Care during the Peak of the First Wave of the Pandemic in Qatar: Their Association with Clinical and Laboratory Findings.

When managing coronavirus disease 2019 (COVID-19) patients, radiological imaging complements clinical evaluation and laboratory parameters. We aimed to assess the sensitivity of chest radiography findings in detecting COVID-19, describe those findings, and assess the association of positive chest radiography findings with clinical and laboratory findings. A multicentre, cross-sectional study was conducted involving all primary health care corporation-registered patients (2485 patients) enrolled over a 1-month period during the peak of the 2020 pandemic wave in Qatar. These patients had reverse transcription-polymerase chain reaction-confirmed COVID-19 and underwent chest radiography within 72 hours of the swab test. A positive result on reverse transcription-polymerase chain reaction was the gold standard for diagnosing COVID-19. The sensitivity of chest radiography was calculated. The airspace opacities were mostly distributed in the peripheral and lower lung zones, and most of the patients had bilateral involvement. Pleural effusion was detected in some cases. The risk of having positive chest X-ray findings increased with age, Southeast Asian nationality, fever, or a history of fever and diarrhoea. Patients with cardiac disease, obesity, hypertension, diabetes, and chronic kidney disease were at a higher risk of having positive chest X-ray findings. There was a statistically significant increase in the mean serum albumin, white blood cell count, neutrophil count, and serum C-reactive protein, hepatic enzymes, and total bilirubin with an increase in the radiographic severity score.

Comparison between Malerba osteotomy and combined Evans/medial displacement calcaneal osteotomies for the management of flexible pes planus in young adults: a prospective randomised control trial, three years follow-up.

PURPOSE: The aim of the current study is to evaluate the functional and radiological outcomes of Malerba osteotomy in comparison to the standardized combined Evans/Medial Displacement Calcaneal Osteotomy (MDCO) in the management of symptomatic flexible pes planus in young adults. METHODS: Prospective randomized control trial included 34 feet (33 patients), 17 cases in each group. Functionally, patients were assessed by AOFAS and FADI scores. Radiographic evaluation included calcaneal pitch, lateral talo-1st metatarsal, AP talo-first metatarsal, AP talo-calcaneal angles, and the talar coverage percentage. RESULTS: Pre-operative and three years follow-up scores and angles were compared between both groups. No statistically significant difference could be detected between both groups (P value 0.87). However, the data showed statistically significant difference in each group when comparing (pre-operative and third year follow-up scores and angles) (P value < 0.001). The mean union rate was eight weeks in Malerba group and nine weeks in Evans/MDCO group. No incidence of nonunion. Complications like calcaneocuboid subluxation, calcaneal anterior process fracture, and lateral column pain were exclusively reported in Evans/MDCO group. CONCLUSION: Malerba osteotomy is a strong valid option for the operative management of flexible pes planus in young adults. Authors recommend Malerba osteotomy in all mild and moderate deformities due to lower complication rate while the combined Evans/MDCO is preferred in severe deformity due to relatively higher corrective power with consideration of possible complications.