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This paper is devoted to the study of a fractional q-difference equation involving dual hybrid terms and equipped with nonlocal multipoint and Riemann-Liouville fractional q-integral boundary conditions. Applying a fixed point approach, we investigate the existence criteria for solutions to the given problem. Examples are constructed for illustrating the obtained results. We emphasize that our results are new in the given configuration, and some new results follow as special cases of the present ones.

In this article, we introduce and study a new class of higher-order fractional q-difference equations involving Riemann-Liouville q-derivatives with dual hybrid terms, supplemented with nonlocal multipoint q-integral boundary conditions. The existence of a unique solution to the given problem is shown by applying Banach’s fixed point theorem. We also present existing criteria for solutions to the problem at hand with the aid of Krasnoselskii’s fixed point theorem and Leray-Schauder’s nonlinear alternative. Illustrative examples are given to demonstrate the application of the obtained results.

An anomalous origin of the right coronary artery has been documented in up to 0.92% of the general population, which is more common than an anomalous origin of the left coronary artery. We present a case of an elderly hypertensive man who developed mild dyspnoea on exertion for 3 months with associated retro-sternal pain as well as occasional palpitation which all tend to subside at rest. An electrocardiogram showed evidence of left atrial enlargement. A coronary computed tomographic angiogram was acquired with a 160-slice scanner which revealed the right coronary artery to originate from the left aortic sinus with a retro-aortic pattern of anatomical course. Vascular wall calcifications were noted with multilevel luminal narrowing on the left anterior descending however distal opacification was adequate. Our case further depicts the reason for keeping in mind anatomical variations while evaluating cardiac pathologies even among Black Africans.

Introduction: Malignant causes of biliary obstruction are common in low and middle-income countries (LMICs) and patients usually present late with unresectable masses. The options for endoscopic and surgical management are scarce in many LMICs. In settings with access to ultrasound and fluoroscopy, percutaneous biliary drainage (PBD) is a promising and minimally invasive option for relieving obstruction and improving the quality of life of these patients. Method: We present a case series of six patients in northwestern Nigeria with cholestatic jaundice caused by malignant biliary obstruction successfully treated by PBD. Results: In five cases, imaging revealed a locally invasive pancreatic head mass causing obstruction. One of the patients had obstruction from biopsy-proven cholangiocarcinoma. Three patients had internal biliary drainage past the obstruction and three patients had only external biliary drainage due to the severity of the obstructions. One patient with internal drainage went on to cholangioplasty and deployment of the balloon-expandable stent over the stenotic segment. All procedures were uncomplicated and patients had a gradual clearance of jaundice and resolution of pruritus. Two of the elderly patients died within six months of the procedure (one from hepatic encephalopathy and the other from stroke). The remaining four survived but were lost to follow-up by 10 months. Conclusions: PBD is a feasible and beneficial option for decompressing malignant biliary obstruction in LMICs.

Abstract Metabolic and bariatric surgery (MBS) is widely considered the most effective option for treating obesity, a chronic, relapsing, and progressive disease. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) issued new guidelines on the indications for MBS, which have superseded the previous 1991 National Institutes of Health guidelines. The aim of this study is to establish the first set of consensus guidelines for selecting procedures in Class I and II obesity, using an Expert Modified Delphi Method. In this study, 78 experienced bariatric surgeons from 32 countries participated in a two-round Modified Delphi consensus voting process. The threshold for consensus was set at an agreement or disagreement of ≥ 70.0% among the experts. The experts reached a consensus on 54 statements. The committee of experts reached a consensus that MBS is a cost-effective treatment option for Class II obesity and for patients with Class I obesity who have not achieved significant weight loss through non-surgical methods. MBS was also considered suitable for patients with Type 2 diabetes mellitus (T2DM) and a body mass index (BMI) of 30 kg/m2 or higher. The committee identified intra-gastric balloon (IGB) as a treatment option for patients with class I obesity and endoscopic sleeve gastroplasty (ESG) as an option for patients with class I and II obesity, as well as for patients with T2DM and a BMI of ≥ 30 kg/m2. Sleeve gastrectomy (1) and Roux-en-Y gastric bypass (RYGB) were also recognized as viable treatment options for these patient groups. The committee also agreed that one anastomosis gastric bypass (OAGB) is a suitable option for patients with Class II obesity and T2DM, regardless of the presence or severity of obesity-related medical problems. The recommendations for selecting procedures in Class I and II obesity, developed through an Expert Modified Delphi Consensus, suggest that the use of standard primary bariatric endoscopic (IGB, ESG) and surgical procedures (SG, RYGB, OAGB) are acceptable in these patient groups, as consensus was reached regarding these procedures. However, randomized controlled trials are still needed in Class I and II Obesity to identify the best treatment approach for these patients in the future.

In this article, we consider the Cauchy problem for a semi-linear wave equation with time-dependent damping and memory nonlinearity. Conditions for global existence are presented in the energy space H1(Rn)×L2(Rn){H}^{1}\left({{\mathbb{R}}}^{n})\times {L}^{2}\left({{\mathbb{R}}}^{n}), n≥1n\ge 1.

Abstract Religious fasting in Ramadan the 9th month of the lunar year is one of five pillars in Islam and is practiced for a full month every year. There may be risks with fasting in patients with a history of metabolic/bariatric surgery (MBS). There is little published evidence on the possible complications during fasting and needs stronger recommendations and guidance to minimize them. An international survey was sent to surgeons to study the types of complications occurring during religious fasting in patients with history of MBS to evaluate the risk factors to manage and prepare more evidence-based recommendations. In total, 21 centers from 11 countries participated in this survey and reported a total of 132 patients with complications occurring during religious fasting after MBS. The mean age of patients with complications was 36.65 ± 3.48 years and mean BMI was 43.12 ± 6.86 kg/m2. Mean timing of complication occurring during fasting after MBS was 14.18 months. The most common complications were upper GI (gastrointestinal) symptoms including [gastroesophageal reflux disease (GERD), abdominal pain, and dyspepsia], marginal ulcers and dumping syndrome in 24% (32/132), 8.3% (11/132) and 23% (31/132) patients respectively. Surgical management was necessary in 4.5% of patients presenting with complications (6/132) patients due to perforated marginal or peptic ulcer in Single Anastomosis Duodenoileostomy with Sleeve gastrectomy (SADI-S), one anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG), obstruction at Jejunojenostomy after Roux-en-Y gastric bypass (RYGB) (1/6) and acute cholecystitis (1/6). Patients after MBS should be advised about the risks while fasting including abdominal pain, dehydration, and peptic ulcer disease exacerbation, and a thorough review of their medications is warranted to minimize complications.

Abstract Background Metabolic and bariatric surgery (MBS) in patients with low body mass index patients is a topic of debate. This study aimed to address all aspects of controversies in these patients by using a worldwide survey. Methods An online 35-item questionnaire survey based on existing controversies surrounding MBS in class 1 obesity was created by 17 bariatric surgeons from 10 different countries. Responses were collected and analysed by authors. Results A total of 543 bariatric surgeons from 65 countries participated in this survey. 52.29% of participants agreed with the statement that MBS should be offered to class-1 obese patients without any obesity related comorbidities. Most of the respondents (68.43%) believed that MBS surgery should not be offered to patients under the age of 18 with class I obesity. 81.01% of respondents agreed with the statement that surgical interventions should be considered after failure of non-surgical treatments. Conclusion This survey demonstrated worldwide variations in metabolic/bariatric surgery in patients with class 1 obesity. Precise analysis of these results is useful for identifying different aspects for future research and consensus building.

The present study aimed to prepare hydrogel based on polyvinyl alcohol (PVA) and gelatin (Ge) and characterization of PVA/Ge hydrogel for their potential use as a sustained drug delivery system. Polyvinyl Alcohol (PVA) and-Gelatin (Ge) were cross-linked using glutaraldehyde (GA) as a crosslinking agent and hydrochloric acid (HCl) as a catalyst. Different feed polymer ratio and crosslinking agent concentration were used to prepare a series of PVA/Ge hydrogels. The obtained PVA/Ge hydrogels were investigated for dynamic and equilibrium swelling studies. The effect of polymers ratio, degree of crosslinking and pH of the medium on swelling of PVA/Ge hydrogels was investigated. Furthermore, the values of diffusion coefficient (D), volume fraction, polymer-solvent interaction parameter, molecular weight between crosslink and crosslink density were calculated. For swelling studies, 0.05M USP phosphate buffer solutions of different pH (1.2, 5.5, 6.5 and 7.5) were used. For the drug release study, ciprofloxacin HCl was loaded into selected samples as a model drug. The release of drug from these samples was performed for 12 hours in USP phosphate buffers of pH 1.2, 5.5 and 7.5. The release data from these samples were fitted into various kinetic models like zero order, first order, Higuchi and Peppas models to investigate the release mechanism. It was found that by varying the composition of PVA/Ge hydrogel and GA concentration, a significant difference was observed in drug release kinetics. FTIR spectroscopy and X-ray diffraction were used for the characterization of hydrogels. PVA/Ge hydrogel showed sustained release of the model drug at various pH values suggesting its potential use as a sustained drug delivery system.