Search results for: Adriaan Roux

Authors: Michael Ayomoh, Adriaan Roux, Oyindamola Omotuyi

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This paper presents an efficient robot navigation model in a multi-target domain amidst static and dynamic workspace obstacles. The problem is that of developing an optimal algorithm to minimize the total travel time of a robot as it visits all target points within its task domain amidst unknown workspace obstacles and finally return to its initial position. In solving this problem, a classical algorithm was first developed to compute the optimal number of paths to be travelled by the robot amidst the network of paths. The principle of shortest distance between robot and targets was used to compute the target point visitation order amidst workspace obstacles. Algorithm premised on the standard polar coordinate system was developed to determine the length of obstacles encountered by the robot hence giving room for a geometrical estimation of the total surface area occupied by the obstacle especially when classified as a relevant obstacle i.e. obstacle that lies in between a robot and its potential visitation point. A stochastic model was developed and used to estimate the likelihood of a dynamic obstacle bumping into the robot’s navigation path and finally, the navigation/obstacle avoidance algorithm was hinged on the hybrid virtual force field (HVFF) method. Significant modelling constraints herein include the choice of navigation path to selected target points, the possible presence of static obstacles along a desired navigation path and the likelihood of encountering a dynamic obstacle along the robot’s path and the chances of it remaining at this position as a static obstacle hence resulting in a case of re-routing after routing. The proposed algorithm demonstrated a high potential for optimal solution in terms of efficiency and effectiveness.

Keywords: multi-target, mobile robot, optimal path, static obstacles, dynamic obstacles

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Authors: Osama Terra, Hatem Hussein, Adriaan Van Brakel

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Dense wavelength division multiplexing (DWDM) technology requires tight specification and therefore measurement of wavelength accuracy and stability of the telecommunication lasers. Thus, calibration of the used Optical Spectrum Analyzers (OSAs) that are used to measure wavelength is of a great importance. Proficiency testing must be performed on such measuring activity to insure the accuracy of the measurement results. In this paper, a new comparison scheme is introduced to test the performance of such calibrations. This comparison scheme is implemented between NIS-Egypt and NMISA-South Africa for the calibration of the wavelength scale of an OSA. Both institutes employ reference gas cell to calibrate OSA according to the standard IEC/ BS EN 62129 (2006). The result of this comparison is compiled in this paper.

Keywords: OSA calibration, HCN gas cell, DWDM technology, wavelength measurement

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Authors: Piotr Tylec, Alicja Dudek, Grzegorz Torbicz, Magdalena Mizera, Natalia Gajewska, Michael Su, Tanawat Vongsurbchart, Tomasz Stefura, Magdalena Pisarska, Mateusz Rubinkiewicz, Piotr Malczak, Piotr Major, Michal Pedziwiatr

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Introduction: Quality of life after bariatric surgery is an important factor when evaluating the final result of the treatment. Considering the vast surgical options, we tried to globally compare available methods in terms of quality of following the surgery. The aim of the study is to compare the quality of life a year after bariatric intervention using network meta-analysis methods. Material and Methods: We performed a systematic review according to PRISMA guidelines with Bayesian network meta-analysis. Inclusion criteria were: studies comparing at least two methods of weight loss treatment of which at least one is surgical, assessment of the quality of life one year after surgery by validated questionnaires. Primary outcomes were quality of life one year after bariatric procedure. The following aspects of quality of life were analyzed: physical, emotional, general health, vitality, role physical, social, mental, and bodily pain. All questionnaires were standardized and pooled to a single scale. Lifestyle intervention was considered as a referenced point. Results: An initial reference search yielded 5636 articles. 18 studies were evaluated. In comparison of total score of quality of life, we observed that laparoscopic sleeve gastrectomy (LSG) (median (M): 3.606, Credible Interval 97.5% (CrI): 1.039; 6.191), laparoscopic Roux en-Y gastric by-pass (LRYGB) (M: 4.973, CrI: 2.627; 7.317) and open Roux en-Y gastric by-pass (RYGB) (M: 9.735, CrI: 6.708; 12.760) had better results than other bariatric intervention in relation to lifestyle interventions. In the analysis of the physical aspects of quality of life, we notice better results in LSG (M: 3.348, CrI: 0.548; 6.147) and in LRYGB procedure (M: 5.070, CrI: 2.896; 7.208) than control intervention, and worst results in open RYGB (M: -9.212, CrI: -11.610; -6.844). Analyzing emotional aspects, we found better results than control intervention in LSG, in LRYGB, in open RYGB, and laparoscopic gastric plication. In general health better results were in LSG (M: 9.144, CrI: 4.704; 13.470), in LRYGB (M: 6.451, CrI: 10.240; 13.830) and in single-anastomosis gastric by-pass (M: 8.671, CrI: 1.986; 15.310), and worst results in open RYGB (M: -4.048, CrI: -7.984; -0.305). In social and vital aspects of quality of life, better results were observed in LSG and LRYGB than control intervention. We did not find any differences between bariatric interventions in physical role, mental and bodily aspects of quality of life. Conclusion: The network meta-analysis revealed that better quality of life in total score one year after bariatric interventions were after LSG, LRYGB, open RYGB. In physical and general health aspects worst quality of life was in open RYGB procedure. Other interventions did not significantly affect the quality of life after a year compared to dietary intervention.

Keywords: bariatric surgery, network meta-analysis, quality of life, one year follow-up

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Authors: T. Arkle, D. Pournaras, S. Lam, B. Kumar

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Introduction: Fundoplication is widely recognised as the best surgical option for gastro-oesophageal reflux disease (GORD) in the general population. However, there is controversy surrounding the use of conventional fundoplication in obese patients. Whilst the intra-operative failure of fundoplication, including wrap disruption, is reportedly higher in obese individuals, the more significant issue surrounds symptom recurrence post-surgery. Could a bariatric procedure be considered in obese patients for weight management, to treat the GORD, and to also reduce the risk of recurrence? Roux-en-Y gastric bypass, a widely performed bariatric procedure, has been shown to be highly successful both in controlling GORD symptoms and in weight management in obese patients. Furthermore, NICE has published clear guidelines on eligibility for bariatric surgery, with the main criteria being type 3 obesity or type 2 obesity with the presence of significant co-morbidities that would improve with weight loss. This study aims to identify the proportion of patients who undergo conventional fundoplication for GORD and/or hiatus hernia, which would have been eligible for bariatric surgery referral according to NICE guidelines. Methods: All patients who underwent fundoplication procedures for GORD and/or hiatus hernia repair at a single NHS foundation trust over a 10-year period will be identified using the Trust’s health records database. Pre-operative patient records will be used to find BMI and the presence of significant co-morbidities at the time of consideration for surgery. This information will be compared to NICE guidelines to determine potential eligibility for the bariatric surgical referral at the time of initial surgical intervention. Results: A total of 321 patients underwent fundoplication procedures between January 2011 and December 2020; 133 (41.4%) had available data for BMI or to allow BMI to be estimated. Of those 133, 40 patients (30%) had a BMI greater than 30kg/m², and 7 (5.3%) had BMI >35kg/m². One patient (0.75%) had a BMI >40 and would therefore be automatically eligible according to NICE guidelines. 4 further patients had significant co-morbidities, such as hypertension and osteoarthritis, which likely be improved by weight management surgery and therefore also indicated eligibility for referral. Overall, 3.75% (5/133) of patients undergoing conventional fundoplication procedures would have been eligible for bariatric surgical referral, these patients were all female, and the average age was 60.4 years. Conclusions: Based on this Trust’s experience, around 4% of obese patients undergoing fundoplication would have been eligible for bariatric surgical intervention. Based on current evidence, in class 2/3 obese patients, there is likely to have been a notable proportion with recurrent disease, potentially requiring further intervention. These patient’s may have benefitted more through undergoing bariatric surgery, for example a Roux-en-Y gastric bypass, addressing both their obesity and GORD. Use of patient written notes to obtain BMI data for the 188 patients with missing BMI data and further analysis to determine outcomes following fundoplication in all patients, assessing for incidence of recurrent disease, will be undertaken to strengthen conclusions.

Keywords: bariatric surgery, GORD, Nissen fundoplication, nice guidelines

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Authors: Ahuja Ashish, Nain Prabhdeep Singh

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Introduction: Polycystic ovarian syndrome(PCOS) is the most common endocrine disorder among women of reproductive age.Pcos encompasses a broad spectrum of signs&symptoms of ovary dysfunction,obesity,blood pressure,insulin resistance & infertility. Bariatric Surgery can be an effective means of weight loss in Pcos & curing infertility. Materials and Methods: 15 female patients were enrolled in the study from 2012-2014.66%(n=10) were in age group of 20-25 years,33%(n=5) were in age group of 25-33 years who underwent. Bariatric surgery in form of Laproscopic sleeve Gastrectomy(LSG)& Roux-en-Y gastric bypass. LSG 73%(n=11), RYGB26% (n=4). Results: There was a significant improvement in obesity (60% excess weight loss)over 1 year after bariatric surgery, in 12 patients there was gross improvement in restoration of menstrual cycle who had irregular menstrual cycle. In 80% patients the serum insulin level showed normal value. Over two years 8 patients become pregnant. Conclusions: 1)Obese women with Pcos maybe able to conceive after Bariatric Surgery. 2) Women with Pcos should only consider bariatric surgery if they were already considering it for other reasons to treat obesity, blood pressure & other co-morbid conditions.

Keywords: obesity, bariatric surgery, polycystic ovarian syndrome, infertility

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Authors: Natasha Venter

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Recent publications, including Truth to Power by André de Ruyter, Gangster State by Pieter-Louis Myburgh, and Enemy of the People by Pieter du Toit and Adriaan Basson, expose alleged corrupt acts by high-ranking members of State, as well as those in charge of State-owned entities. These literary contributions have gripped the attention of a nation plagued by corruption scandals and the alleged misappropriation of state funds on an almost daily basis. The books, however, leave the populace with the burning question of why “nothing happens” to these individuals who are so directly implicated in the literature. The process followed by the State in the largest successful prosecution of a corrupt state official, Jackie Selebi, sheds some light as to how such high-ranking persons might be brought to book. The Supreme Court of Appeal’s definition of corruption and the interpretation of the facts (as presented by the State prosecutors) by the court is also valuable. Furthermore, some insight into the laws that criminalise corruption in South Africa, as well as applicable international instruments, is necessary. South Africa is ranked as the 70th most corrupt country out of 180 countries by Transparency International’s 2021 Corruption Perceptions Index. This is worrisome as South Africa is a signatory of the United Nations Convention Against Corruption (2004) and, as such, has certain international obligations to fulfil. However, if the political will to prosecute corrupt officials in South Africa exists, there are laws and instruments available to punish these individuals. This would not only vindicate the authors of literature about corruption in the country but also restore the hope of South Africans that, ultimately, crime does not pay.

Keywords: corruption, eskom, state capture, government, literature, united nations, law, legal, Jackie selebi, supreme court of appeal

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Authors: Tomilola J. Ajayi, Moses Ollengo, Lukas le Roux, Michael N. Pillay, Richard J. Staples, Shannon M. Biros Werner E. van Zyl

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The formation, characterization, and dye-sensitized solar cell application of nickel(II), zinc(II) and cadmium(II) ferrocenyl dithiophosphonate complexes were investigated. The multidentate monoanionic ligand [S₂PFc(OH)]¯ (L1) was synthesized from the reaction between ferrocenyl Lawesson’s reagent, [FcP(=S)μ-S]₂ (FcLR), (Fc = ferrocenyl) and water. Ligand L1 could potentially coordinate to metal centers through the S, S’ and O donor atoms. The reaction between metal salt precursors and L1 produced a Ni(II) complex of the type [Ni{S₂P(Fc)(OH)}₂] (1) (molar ratio 1:2), a tetranickel (II) complex of the type [Ni₂{S₂OP(Fc)}₂]₂ (2) (molar ratio (1:1), as well as a Zn(II) complex [Zn{S₂P(Fc)(OH)}₂]₂ (3), and a Cd(II) complex [Cd{S₂P(Fc)(OH)}₂]₂ (4). Complexes 1-4 were characterized by 1H and 31P NMR and FT-IR, and complexes 1 and 2 were additionally analysed by X-Ray crystallography. After co-sensitization, the DSSCs were characterized using UV-Vis, cyclic voltammetry, electrochemical impedance spectroscopy, and photovoltaic measurements (I-V curves). Overall finding shows that co-sensitization of our compounds with ruthenium dye N719 resulted in a better overall solar conversion efficiency than only pure N719 dye under the same experimental conditions. In conclusion, we report the first examples of dye-sensitized solar cells (DSSCs) co-sensitized with ferrocenyl dithiophosphonate complexes.

Keywords: dithiophosphonate, dye sensitized solar cell, co-sensitization, solar efficiency

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Authors: Boshra Mozaffar, Iskandar Idris

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Taste change is a common complication after Bariatric surgery (BS). However, the cause of this is still not clear. Since zinc is important fortaste perception, zinc deficiency, which is common after BS, may play an important role for taste change after BS. In this review, we aimto collate evidence relating to taste change and zinc deficiencyin relation to BS; effects of zinc replacement on taste perception in general and thereafter discuss the possible role of zinc deficiency to induce taste change after BS. A literature search was conducted, using four electronic bibliographical databases—EMBASE, PubMed, AMED and MEDLINE. We identified all available and relevant articles published before 30th February 2021.In total, 33 studies were included. The total number of participants analysed was N= 3264. We showed that taste change is a frequent complication after BS, especially after Roux-en-Y gastric bypass RYGBP comparing to other types of procedures. Patients' taste sensitivity differs among studies, but the most important decline in taste preference was observed for sweet food. Twelve studies investigating zinc deficiency following BS showed a significant decrease in zinc levels at six months after surgery. Supplementation with 45–50 mg of zinc sulphate was effective in improving taste, except in cancer patients, who showed no improvement in taste following zinc supplementation. Zinc deficiency appears to be associated with taste change after BS. Supplementation with much higher levels of zinc, at 45–50 mg, was effective in taste change treatment for many cases of taste disorder. The currently recommended levels of zinc replacements currently prescribed to patients following BS were not effective for avoiding zinc deficiency after BS—and thus not effective for averting taste change. It is therefore suggested that taste change following BS is closely related to zinc deficiency induced by the surgery.

Keywords: taste change, taste disorder, bariatric surgery, zinc, zinc sulphate or Zn, deficiency, supplementation, and micro-nutrient deficiencies

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Authors: Maretha Le Roux, Corinna Walsh, Mariette M. Nel

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Introduction: The first 1000 days from conception to 24 months, is a critical period for healthy growth and development. In South Africa, stunting is a major public health issue with significant health consequences. We determined associations between demographic, health and anthropometric indicators of mothers and their infants. Methods: A cross-sectional study was conducted in all districts in the Northern Cape. All mothers with 5-7 week old babies visiting PHC facilities could participate. A questionnaire was completed in a structured interview with each mother. Weight and length of the baby at birth and at 6 weeks were used to determine stunting, while weight and height of the mother were measured for body mass index (BMI). Results: Eight hundred questionnaires were completed in 92 facilities. The median age of mothers was 26 years (range 10-46 years), and 44,9% were married. Almost 40% relied on a government grant as main source of income. Two-thirds (64,9%) had not planned the pregnancy, and 19.4% had a Caesarian section. Although 79% breastfed exclusively, more than a quarter (26,1%) smoked cigarettes or used snuff during pregnancy, while 9,4% drank alcohol. At birth, 17.7% of boys and 13.0% of girls were stunted (height-for-age below -2SD from the WHO reference values), while at 6 weeks this had increased to 30.8% of boys and 14.1% of girls. In terms of mothers, 25,4% were classified as obese and 24,6% as overweight at 6 weeks. Compared to babies that were not stunted, significantly more babies of mothers that were older, overweight, used ART, relied on a grant and smoked/snuffed during pregnancy were stunted. Conclusion: To address stunting, interventions aimed at encouraging healthy lifestyles with the emphasis on maintaining a healthy weight, healthy eating and smoking cessation before pregnancy are urgently required.

Keywords: growth, health, South Africa, stunting

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Authors: Arun Prasad, Abhishek Tiwari, Rekha Jaiswal, Vivek Chaudhary

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Background: Robotic Roux en Y gastric bypass is being done for some time but is technically difficult, requiring operating in both the sub diaphragmatic and infracolic compartments of the abdomen. This can mean a dual docking of the robot or a hybrid partial laparoscopic and partial robotic surgery. The Mini /One anastomosis /omega loop gastric bypass (MGB) has the advantage of having all dissection and anastomosis in the supracolic compartment and is therefore suitable technically for robotic surgery. Methods: We have done 208 robotic mini gastric bypass surgeries. The robot is docked above the head of the patient in the midline. Camera port is placed supra umbilically. Two ports are placed on the left side of the patient and one port on the right side of the patient. An assistant port is placed between the camera port and right sided robotic port for use of stapler. Distal stomach is stapled from the lesser curve followed by a vertical sleeve upwards leading to a long sleeve pouch. Jejunum is taken at 200 cm from the duodenojejunal junction and brought up to do a side to side gastrojejunostomy. Results: All patients had a successful robotic procedure. Mean time taken was 85 minutes. There were major intraoperative or post operative complications. No patient needed conversion or re-explorative surgery. Mean excess weight loss over a period of 2 year was about 75%. There was no mortality. Patient satisfaction score was high and was attributed to the good weight loss and minimal dietary modifications that were needed after the procedure. Long term side effects were anemia and bile reflux in a small number of patients. Conclusions: MGB / OAGB is gaining worldwide interest as a short simple procedure that has been shown to very effective and safe bariatric surgery. The purpose of this study was to report on the safety and efficacy of robotic surgery for this procedure. This is the first report of totally robotic mini gastric bypass.

Keywords: MGB, mini gastric bypass, OAGB, robotic bariatric surgery

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Authors: Werner Roux Uys

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The Commissioner for the South African Revenue Service (SARS) holds a high position of trust in South African society and a lack of trust by taxpayers in the Commissioner’s actions or conduct could compromise SARS’ management of public finances. Tax morality – which is implicit in the social contract between taxpayers and the state – includes distinct phenomena that can cause a breakdown if there is a perceived lack of action on the part of the Commissioner to ensure public finances are kept safe. To promote tax morality, the Commissioner must support the judiciary in the exercise of its discretion to punish fraudulent tax activities and corrupt tax practices. For several years the political meddling in the Commissioner’s actions and conduct have caused perceived abuse of power at SARS, and taxpayers believed their hard-earned income paid over to SARS would be fruitless and wasteful expenditure. The purpose of this article is to identify and analyse previous decisions held by the South African judiciary regarding the Commissioner’s actions and conduct in tax matters, as well as consider important political statements and newspaper bulletins for the purpose of this research. The study applies a qualitative research approach and exploratory case study technique. Keywords were selected and inserted in the LexisNexis electronic database to systematically identify applicable case law where the ratio decidendi of the court referred to the actions and/or conduct of the Commissioner. Specific real-life statements, including political statements and newspaper bulletins, were selected to support the topic at hand. The purpose of the study is to educate the public about the perceptions that have transformed taxpayers’ behaviour towards the Commissioner for SARS since South Africa’s fledgling constitutional democracy was inaugurated in 1994. The study adds to the literature by identifying key characteristics or distinct phenomena regarding the actions and conduct of the Commissioner affecting taxpayers’ behaviour, including discretionary decision-making. From the findings, it emerged that SARS must abide by its (own) laws and that there is a need to educate not only South African taxpayers about tax morality, but also the public in general.

Keywords: commissioner, SARS, action and conduct, judiciary, discretionry, decsion-making

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Authors: Piotr Tylec, Julia Wierzbicka, Natalia Gajewska, Krzysztof Przeczek, Grzegorz Torbicz, Alicja Dudek, Magdalena Pisarska-Adamczyk, Mateusz Wierdak, Michal Pedziwiatr

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Introduction: Many patients have described changes in taste perception after weight loss surgery. However, little data is available about short term changes in taste after surgery. Aim: We aimed to evaluate short-term changes in taste preference after bariatric surgeries in comparison to colorectal surgeries. Material and Methods: Between April 2018 and April 2019, a total of 121 bariatric patients and 63 controls participated. Bariatric patients underwent laparoscopic sleeve gastrectomy or Roux-en-Y gastric by-pass. Controls underwent oncological colorectal surgeries. Patients who developed clinical complications requiring restriction of oral intake after surgery or withdraw their consent were excluded from the study. In the end, 85 bariatric patients and 44 controls were included. In all of them, the 16-item ERAS Protocol was applied. Using 10-points Numeric Rating Scale (1-10) patients completed questionnaire and rated their appetite and thirst (1 - no appetite/not thirsty, 10 – normal appetite/very thirsty) and flavoured standardized liquids' taste (1- horrible, 10-very tasty) and food images for the 6 group of taste (sweet, umami, sour, spicy, bitter and salty) (1 - not appetizing, 10 - very appetizing) preoperatively and on the first postoperative day. Data were analysed with Statistica 13.0 PL. Results: Analysed group consist of 129 patients (85 bariatric, 44 controls). Mean age and BMI in a research group was 44.91 years old, 46.22 kg/m² and in control group 62.09 years old, 25.87 kg/m², respectively. Our analysis revealed significant differences in changes of appetite between both groups (research: -4.55 ± 3.76 vs. control: -0.85 ± 4.37; p < 0.05), ratings bitter (research: 0.60 ± 2.98 vs. control: -0.88 ± 2.58; p < 0.05) and salty (research: 1.20 ± 3.50 vs. control: -0.52 ± 2.90; p < 0.05) flavoured liquids and ratings for sweet (research: 1.62 ± 3.31 vs. control: 0.01 ± 2.63; p < 0.05) and bitter (research: 1.21 ± 3.15 vs. control: -0.09 ± 2.25; p < 0.05) food images. There were statistically significant results in the ratings of other images, but in comparison to the control group, they were not statistically significant. Conclusion: The study showed that bariatric surgeries quickly decreases appetite and desire to eat certain types of food, such as salty. Moreover, the bitter taste was more desirable in the research group in comparison to control group. Nevertheless, the sweet taste was more appetible in the bariatric group than in control.

Keywords: bariatric surgery, general surgery, obesity, taste preference

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Authors: Tshipeng Mwenze, Charles Okujeni, Abdi Siad, Russel Bailie, Dirk Frei, Marcelene Voigt, Petrus Le Roux

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The Platreef is a platinum group element (PGE) deposit in the northern limb of the Bushveld Igneous Complex (BIC) which was emplaced as a series of mafic and ultramafic sills between the Main Zone (MZ) and the country rocks. The PGE mineralisation in the Platreef is hosted in different rock types, and its distribution and style vary with depth and along strike. This study contributes towards understanding the processes involved in the genesis of the Platreef. Twenty-four Platreef (2 harzburgites, 4 olivine pyroxenites, 17 feldspathic pyroxenites and 1 gabbronorite) and few MZ (1 gabbronorite and 1 leucogabbronorite) quarter core samples were collected from four drill cores (e.g., TN754, TN200, SS339, and OY482) and analysed for whole-rock Sr-Nd isotope data. The results show positive ɛNd values (+3.53 to +7.51) for harzburgites suggesting their parental magmas derived from the depleted Mantle. The remaining Platreef rocks have negative ɛNd values (-2.91 to -22.88) and show significant variations in Sr-Nd isotopic compositions. The first group of Platreef samples has relatively high isotopic compositions (ɛNd= -2.91 to -5.68; ⁸⁷Sr/⁸⁶Sri= 0.709177 - 0.711998). The second group of Platreef samples has Sr ratios (⁸⁷Sr/⁸⁶Sri= 0.709816-0.712106) overlapping with samples of the first group but slightly lower ɛNd values (-7.44 to -8.39). Lastly, the third group of Platreef samples has low ɛNd values (-10.82 to -14.32) and low Sr ratios (⁸⁷Sr/⁸⁶Sri= 0.707545-0.710042) than those from samples of the two Platreef groups mentioned above. There is, however, a Platreef sample with ɛNd value (-5.26) in range with the Platreef samples of the first group, but its Sr ratio (0.707281) is the lowest even when compared to samples of the third Platreef group. There are also five other Platreef samples which have either anomalous ɛNd or Sr ratios which make it difficult to assess their isotopic compositions relative to other samples. These isotopic variations for the Platreef samples indicate both multiple sources and multiple magma chambers where varying crustal contamination styles have operated during the evolution of these magmas prior their emplacements into the Platreef setting as sills. Furthermore, the MZ rocks have different Sr-Nd isotopic compositions (For OY482 gabbronorite [ɛNd= +0.65; ⁸⁷Sr/⁸⁶Sri= 0.711746]; for TN754 leucogabbronorite [ɛNd= -7.44; ⁸⁷Sr/⁸⁶Sri= 0.709322]) which do not only indicate different MZ magma chambers, but also different magmas from those of the Platreef. Although the Platreef is still considered a single stratigraphic unit in the northern limb of the BIC, its genesis involved multiple magmatic processes which evolved independently from each other.

Keywords: crustal contamination styles, magma chambers, magma sources, multiple sills emplacement

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Authors: Thaminda Liyanage, Chamila Shamika Kurukulasuriya

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Introduction: Morbid obesity has been successfully treated with bariatric surgery for over 60 years. Although operative procedures have improved and associated complications have reduced substantially, surgery still carries the risk of post-operative malabsorption, malnutrition and a range of gastrointestinal disorders. Overweight by itself can impair libido in both sexes and cause erectile dysfunction in males by inducing a state of hypogonadotropic hypogonadism, proportional to the degree of obesity. Impact of weight reduction on libido and sexual activity remains controversial, however it is broadly accepted that weight loss improves sexual drive. Zinc deficiency, subsequent to malabsorption, may lead to impaired testosterone synthesis in men while excessive and/or rapid weight loss in females may result in reversible amenorrhoea leading to sub-fertility. Methods: We describe a 37 year old male, 6 years post Roux-en-Y gastric bypass surgery, who presented with erectile dysfunction, loss of libido, worsening fatigue and generalized weakness for 4 months. He also complained of constipation and frequent muscle cramps but denied having headache, vomiting or visual disturbances. Patient had lost 38 kg of body weight post gastric bypass surgery over four years {135kg (BMI 42.6 kg/m2) to 97 kg (BMI 30.6 kg/m2)} and the weight had been stable for past two years. He had no recognised co-morbidities at the time of the surgery and noted marked improvement in general wellbeing, physical fitness and psychological confident post surgery, up until four months before presentation. Clinical examination revealed dry pale skin with normal body hair distribution, no thyroid nodules or goitre, normal size testicles and normal neurological examination with no visual field defects or diplopia. He had low serum testosterone, follicular stimulating hormone (FSH), luteinizing hormone (LH), T3, T4, thyroid stimulating hormone (TSH), insulin like growth factor 1 (IGF-1) and 24-hour urine cortisol levels. Serum cortisol demonstrated an appropriate rise to ACTH stimulation test but growth hormone (GH) failed increase on insulin tolerance test. Other biochemical and haematological studies were normal, except for low zinc and folate with minimally raised liver enzymes. MRI scan of the head confirmed a solid pituitary mass with no mass effect on optic chiasm. Results: In this patient clinical, biochemical and radiological findings were consistent with anterior pituitary dysfunction. However, there were no features of raised intracranial pressure or neurological compromise. He was commenced on appropriate home replacement therapy and referred for neurosurgical evaluation. Patient reported marked improvement in his symptoms, specially libido and erectile dysfunction, on subsequent follow up visits. Conclusion: Sexual dysfunction coupled with non specific constitutional symptoms has multiple aetiologies. Clinical symptoms out of proportion to nutritional deficiencies post bariatric surgery should be thoroughly investigated. Close long term follow up is crucial for overall success.

Keywords: obesity, bariatric surgery, erectile dysfunction, loss of libido

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