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Article ; Online: Donut rush to laparoscopy: post-polypectomy electrocoagulation syndrome and the 'pseudo-donut' sign.

Plumptre, Isabella / Tolppa, Timo / Jawad, Zaynab A R / Zafar, Noman

BJR case reports

2020 Volume 6, Issue 2, Page(s) 20190023

Abstract: Colonoscopic polypectomy is a routine procedure with the potential for rare but well-known complications, including perforation and bleeding. Post-polypectomy electrocoagulation syndrome (PPES) is a less recognized cause of abdominal pain following this ... ...

Abstract	Colonoscopic polypectomy is a routine procedure with the potential for rare but well-known complications, including perforation and bleeding. Post-polypectomy electrocoagulation syndrome (PPES) is a less recognized cause of abdominal pain following this procedure. However, it is important to diagnose PPES in order to avoid unnecessary intervention. We present the case of a patient with abdominal pain after polypectomy. The patient underwent an unnecessary diagnostic laparoscopy on the basis of misinterpreted radiological findings. Her CT scan demonstrated the "donut" sign that was suggestive of ileocaecal intussusception. This case highlights the importance of recognizing PPES as a possible cause for abdominal pain after colonoscopic polypectomy and that it may also present with a "pseudodonut" sign on CT scan. It also demonstrates the importance of communicating and then integrating full clinical details with radiological findings when formulating a differential diagnosis.
Language	English
Publishing date	2020-09-29
Publishing country	England
Document type	Case Reports
ISSN	2055-7159
ISSN (online)	2055-7159
DOI	10.1259/bjrcr.20190023
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Article ; Online: Perioperative group and save testing are not routinely indicated for emergency laparoscopic appendicectomy and laparoscopic hernia repairs: A North West London retrospective study.

Al-Musawi, Jasim / Reece, Ieuan / Chen, Jun Yu / Britton, Clemency / Shakweh, Ealaff / Vutipongsatorn, Kritchai / Ng Yin Ling, Clarissa / Kotecha, Shreeya / Lawler, Michael / Daga, Garima / Zafar, Noman

Journal of perioperative practice

2022 Volume 33, Issue 5, Page(s) 153–157

Abstract: Introduction: Two valid group and saves are commonly required for patients undergoing laparoscopic appendicectomy and laparoscopic hernia repairs preoperatively; however, perioperative blood transfusions are seldom required. This is financially ... ...

Abstract	Introduction: Two valid group and saves are commonly required for patients undergoing laparoscopic appendicectomy and laparoscopic hernia repairs preoperatively; however, perioperative blood transfusions are seldom required. This is financially burdensome and frequently leads to delays in theatre lists. We performed a retrospective analysis to investigate blood transfusions performed perioperatively and within 28 days of these procedures. Method: We used our electronic records to collect data of all laparoscopic appendectomies and laparoscopic hernia repairs between March 2017 and March 2021. Patients of any age undergoing these operations were included. Patients requiring concomitant intra-abdominal surgery or who had incomplete medical records were excluded. Results: A total of 1891 patients were included, of which 1462 (77.3%) had a laparoscopic appendicectomy versus 429 (22.7%) who had a laparoscopic hernia repair. In all, 3507 group and saves were taken costing £47,398.50. One patient (0.068%) required emergency blood transfusion (4 units of red cells) secondary to major haemorrhage. Conclusion: Our findings demonstrate that the incidence of perioperative blood transfusions for laparoscopic appendicectomy and laparoscopic hernia repairs is low, challenging the indication for routine preoperative group and saves.
MeSH term(s)	Humans ; Retrospective Studies ; Herniorrhaphy ; Appendectomy/methods ; London ; Laparoscopy
Language	English
Publishing date	2022-08-08
Publishing country	England
Document type	Journal Article
ZDB-ID	2226186-2
ISSN	2515-7949 ; 1750-4589
ISSN (online)	2515-7949
ISSN	1750-4589
DOI	10.1177/17504589221110333
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Zs.A 4006: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Intermittent visual field defects caused by a dilated Virchow-Robin space close to the optic radiation: Therapeutic and pathomechanical considerations.

Zafar, Noman / Alaid, Awad / Rohde, Veit / Mielke, Dorothee

British journal of neurosurgery

2015 Volume 29, Issue 4, Page(s) 549–551

Abstract: Objective: Virchow-Robin spaces (VRSs) are extensions of subarachnoid spaces that accompany vessels entering the brain. T2-weighted magnetic resonance imaging detects VRS in about 95 percent of patients in a recent study. VRSs are considered a normal ... ...

Abstract	Objective: Virchow-Robin spaces (VRSs) are extensions of subarachnoid spaces that accompany vessels entering the brain. T2-weighted magnetic resonance imaging detects VRS in about 95 percent of patients in a recent study. VRSs are considered a normal variant with benign prognosis. Occasionally, VRS might become symptomatic causing neurological deficits depending on their location. Case description: We report the case of a 55-year-old female patient with dilated VRS presenting with visual field disturbances and cognitive deficits. The patient underwent endoscopic fenestration of a large periventricular VRS located next to the visual radiation into the posterior horn of the right lateral ventricle. During the postoperative course, visual field disturbances were resolved but cognitive deficits remained unchanged. Conclusion: Dilated VRSs can cause a variety of neurological deficits depending on their size and location. Therefore, patients harboring dilated VRS should undergo early close inspection and in case of progressive neurological deficits, an operative therapy should be done; as valve mechanisms can cause a reduction of size when brain scans are conducted and later lead to occurrence of severe neurological deficits during phase of dilation.
MeSH term(s)	Axons/pathology ; Cerebrum/pathology ; Cerebrum/surgery ; Cognition Disorders/pathology ; Cognition Disorders/surgery ; Dilatation, Pathologic/surgery ; Female ; Geniculate Bodies/pathology ; Hemianopsia/pathology ; Hemianopsia/surgery ; Humans ; Lateral Ventricles/pathology ; Middle Aged ; Neuroendoscopy ; Pia Mater/pathology ; Visual Cortex/pathology
Language	English
Publishing date	2015
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	639029-8
ISSN	1360-046X ; 0268-8697
ISSN (online)	1360-046X
ISSN	0268-8697
DOI	10.3109/02688697.2015.1019417
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Article ; Online: Ethanol inhibits long-term potentiation in hippocampal CA1 neurons, irrespective of lamina and stimulus strength, through neurosteroidogenesis.

Ramachandran, Binu / Ahmed, Saheeb / Zafar, Noman / Dean, Camin

Hippocampus

2015 Volume 25, Issue 1, Page(s) 106–118

Abstract: Ethanol inhibits memory encoding and the induction of long-term potentiation (LTP) in CA1 neurons of the hippocampus. Hippocampal LTP at Schaffer collateral synapses onto CA1 pyramidal neurons has been widely studied as a cellular model of learning and ... ...

Abstract	Ethanol inhibits memory encoding and the induction of long-term potentiation (LTP) in CA1 neurons of the hippocampus. Hippocampal LTP at Schaffer collateral synapses onto CA1 pyramidal neurons has been widely studied as a cellular model of learning and memory, but there is striking heterogeneity in the underlying molecular mechanisms in distinct regions and in response to distinct stimuli. Basal and apical dendrites differ in terms of innervation, input specificity, and molecular mechanisms of LTP induction and maintenance, and different stimuli determine distinct molecular pathways of potentiation. However, lamina or stimulus-dependent effects of ethanol on LTP have not been investigated. Here, we tested the effect of acute application of 60 mM ethanol on LTP induction in distinct dendritic compartments (apical versus basal) of CA1 neurons, and in response to distinct stimulation paradigms (single versus repeated, spaced high frequency stimulation). We found that ethanol completely blocks LTP in apical dendrites, whereas it reduces the magnitude of LTP in basal dendrites. Acute ethanol treatment for just 15 min altered pre- and post-synaptic protein expression. Interestingly, ethanol increases the neurosteroid allopregnanolone, which causes ethanol-dependent inhibition of LTP, more prominently in apical dendrites, where ethanol has greater effects on LTP. This suggests that ethanol has general effects on fundamental properties of synaptic plasticity, but the magnitude of its effect on LTP differs depending on hippocampal sub-region and stimulus strength.
MeSH term(s)	Animals ; Behavior, Animal/drug effects ; CA1 Region, Hippocampal/drug effects ; Central Nervous System Depressants/pharmacology ; Dendrites/drug effects ; Ethanol/pharmacology ; Long-Term Potentiation/drug effects ; Male ; Mice ; Mice, Inbred C57BL ; Pyramidal Cells/drug effects
Chemical Substances	Central Nervous System Depressants ; Ethanol (3K9958V90M)
Language	English
Publishing date	2015-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1074352-2
ISSN	1098-1063 ; 1050-9631
ISSN (online)	1098-1063
ISSN	1050-9631
DOI	10.1002/hipo.22356
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Zs.A 3227: Show issues

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Article ; Online: Volumetric analysis of bilateral spinal canal decompression via hemilaminectomy versus laminoplasty in cervical spondylotic myelopathy.

Hernández-Durán, Silvia / Zafar, Noman / Behme, Daniel / Momber, Matthias / Rohde, Veit / Mielke, Dorothee / Fiss, Ingo

Acta neurochirurgica

2020 Volume 162, Issue 9, Page(s) 2069–2074

Abstract: Background: Cervical spondylotic myelopathy (CSM) is a degenerative process of the cervical spine requiring surgical decompression to prevent neurological deterioration. While both anterior and posterior approaches yield satisfactory results, posterior ... ...

Abstract	Background: Cervical spondylotic myelopathy (CSM) is a degenerative process of the cervical spine requiring surgical decompression to prevent neurological deterioration. While both anterior and posterior approaches yield satisfactory results, posterior decompression is preferred in cases of the multilevel disease. In 2015, we described a muscle-sparing, novel technique of bilateral osteoligamentous decompression via hemilaminectomy (OLD) for CSM. In this study, we investigate whether this technique offers comparable volumetric results to laminoplasty in terms of spinal canal enlargement and whether this technique can yield significant clinical improvement. Methods: Patients undergoing OLD due to CSM were prospectively enrolled in this study and then matched to and compared with a historic cohort of patients with CSM treated by laminoplasty. An independent sample t test was performed to analyze whether the volumetric gain in the two separate groups was statistically significant. Patients in the OLD cohort were clinically evaluated with the mJOA score preoperatively and 3 months postoperatively. To assess clinical improvement, a paired sample t test was performed. Results: A total of 38 patients were included in the analysis: 19 underwent OLD and 19 underwent laminoplasty. Both groups were well matched in terms of sex, age, preoperative spinal canal volume, and involved levels. Both surgical methods yielded statistically significant volumetric gain in the cervical spinal canal, but a trend towards a greater volume gain was seen in the OLD group. In the OLD group, a statistically significant clinical improvement was also demonstrated. Conclusions: Our study reveals that OLD can yield a comparable extent of decompression to laminoplasty in CSM while also delivering statistically significant clinical improvement.
MeSH term(s)	Adult ; Aged ; Cervical Vertebrae/surgery ; Female ; Humans ; Laminectomy/adverse effects ; Laminectomy/methods ; Laminoplasty/adverse effects ; Laminoplasty/methods ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Spinal Canal/surgery ; Spinal Osteophytosis/surgery
Language	English
Publishing date	2020-06-25
Publishing country	Austria
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80010-7
ISSN	0942-0940 ; 0001-6268
ISSN (online)	0942-0940
ISSN	0001-6268
DOI	10.1007/s00701-020-04453-z
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Uk I Zs.180: Show issues

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Article ; Online: Time course of the response to navigated repetitive transcranial magnetic stimulation at 10 Hz in chronic neuropathic pain.

Lawson McLean, Aaron / Frank, Susanne / Zafar, Noman / Waschke, Albrecht / Kalff, Rolf / Reichart, Rupert

Neurological research

2018 Volume 40, Issue 7, Page(s) 564–572

Abstract: Objective This prospective study evaluated the time to response and outcomes of navigated repetitive transcranial magnetic stimulation (TMS) at a frequency of 10 Hz in patients with chronic neuropathic pain. Methods This prospective study included ... ...

Abstract	Objective This prospective study evaluated the time to response and outcomes of navigated repetitive transcranial magnetic stimulation (TMS) at a frequency of 10 Hz in patients with chronic neuropathic pain. Methods This prospective study included patients with unilateral chronic neuropathic pain. All patients received motor cortex stimulation at 10 Hz over nine consecutive days using repetitive TMS. Outcome was evaluated over a six-week follow-up period using the visual analogue scale, the German Pain Questionnaire and time to pain reduction. Results Fifty patients (23 female, 27 male) were recruited. Two patients were excluded from analysis owing to premature discontinuation of treatment and follow-up. 31/48 patients in the cohort suffered from atypical facial pain. The pain duration ranged approximately from six months to 27 years. After six weeks, 28/46 patients reported a significant level of pain relief (P < 0.001). Conclusion Navigated repetitive TMS for chronic pain is a non-invasive modality with demonstrable clinical benefit. In particular, patients with atypical facial pain with a clear clinicoanatomical correlate responded well to high-frequency stimulation. Patients with a mean pain history of less than five years benefited significantly from this treatment, so early treatment with repetitive TMS should be encouraged.
MeSH term(s)	Adult ; Aged ; Chronic Disease ; Female ; Humans ; Male ; Middle Aged ; Neuralgia/therapy ; Pain Measurement ; Prospective Studies ; Statistics as Topic ; Time Factors ; Transcranial Magnetic Stimulation/methods ; Treatment Outcome
Language	English
Publishing date	2018-03-27
Publishing country	England
Document type	Journal Article
ZDB-ID	424428-x
ISSN	1743-1328 ; 0161-6412
ISSN (online)	1743-1328
ISSN	0161-6412
DOI	10.1080/01616412.2018.1453636
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Zs.A 1491: Show issues

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Article ; Online: Mitigating surgical emergency practice during COVID-19 pandemic?

Zafar, Noman / Kashora, Florence / Qurashi, Kamran / Al-Musawi, Jasim / Watfah, Josef / Liasis, Lampros / Sen, Manoj / Gould, Stuart / J Vaizey, Carolynne / Warusavitarne, Janindra / Leo, Cosimo Alex

Annali italiani di chirurgia

2021 Volume 92, Page(s) 312–316

Abstract: Purpose: To define the change in Emergency Surgical Unit (ESU) workload during the COVID-19 pandemic.: Methods: Patient data for a three-week period was prospectively collected for ESU patients during lockdown period and compared to the ESU workload ... ...

Abstract	Purpose: To define the change in Emergency Surgical Unit (ESU) workload during the COVID-19 pandemic. Methods: Patient data for a three-week period was prospectively collected for ESU patients during lockdown period and compared to the ESU workload for the same time period prior to lockdown. Results: Surgical emergencies admissions reduced by 2.5 times during our study period (p value = 0.001). In this changed paradigm, the overall number of surgical emergencies were reduced. A high mortality (n = 4, 5.7%) was noted during lockdown period as compared to pre-lockdown period (n = 1, 0.58%, p value = 0.025). Almost half of surgical admissions were tested for COVID-19 based on their symptoms and more than third (n=14, 38.9%) of them were positive. Gastrointestinal symptoms were common in COVID-19 positive group (85.7%) and only a third (36%) of COVID-19 positive patients needed surgical attention. Chest x-ray findings were comparable to PCR testing in terms of sensitivity and specificity but CT chest was more sensitive. Conclusions: It remains unclear how COVID-19 reduced surgical emergencies. A significant proportion of COVID-19 presented with gastrointestinal symptoms. In a new outbreak all General Surgical patients should be tested with CRP and WCC used as a triage adjunct. Key words: Coronavirus, COVID-19, Emergency Surgery Pandemic, General Surgery.
MeSH term(s)	COVID-19/diagnosis ; Communicable Disease Control ; Emergencies ; Emergency Service, Hospital/organization & administration ; Gastrointestinal Diseases/etiology ; Humans ; Pandemics ; SARS-CoV-2 ; Surgical Procedures, Operative ; Workload
Language	English
Publishing date	2021-07-01
Publishing country	Italy
Document type	Comparative Study ; Journal Article
ZDB-ID	418927-9
ISSN	2239-253X ; 0003-469X
ISSN (online)	2239-253X
ISSN	0003-469X
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Article ; Online: Assessment of flood-induced changes in soil heavy metal and nutrient status in Rajanpur, Pakistan.

Hafeez, Farhan / Zafar, Noman / Nazir, Rashid / Javeed, Hafiz Muhammad Rashad / Rizwan, Muhammad / Faridullah / Asad, Saeed Ahmad / Iqbal, Akhtar

Environmental monitoring and assessment

2019 Volume 191, Issue 4, Page(s) 234

Abstract: Flood events around the globe have severely impaired the soil functioning resulting in compromised food security in several parts of the world. The current study was aimed to explore the impacts of floods on soil heavy metals and nutrients status at ... ...

Abstract	Flood events around the globe have severely impaired the soil functioning resulting in compromised food security in several parts of the world. The current study was aimed to explore the impacts of floods on soil heavy metals and nutrients status at three locations; Tibbi Solgi (TS), Vinri Khosa (VK), and Noshehra West (NW-control) in the district Rajanpur of Punjab, Pakistan. TS and VK sites were under regular influence of flooding over the last many years, but no flood event was reported on NW site during the same tenure; hence, it served as control. Sampling was carried out before and after flooding on the experimental sites. Vegetation cover was monitored through remote sensing techniques. Results revealed varying effects of floods on soil heavy metals; Cd, Cr, Pb, and soil phosphorous and nitrates. Flood events increased the Cd while lowered Pb concentration at VK site; however, flooding did not influence the status of Cr in soil. Similar to the trend observed in case of Cd, soil phosphorous and nitrates were reduced after flood events. Correlation analyses of soil physicochemical properties with soil heavy metals and nutrients indicated that after flood events, soil texture and organic carbon content seem to be the major factors driving the shift in soil heavy metals and nutrient concentrations. Although pollution indices indicated a marginally low contamination levels, but as projected in empirical studies, regular flood events in the studied sites may contaminate the whole ecosystem rendering it unfit for agricultural productivity.
MeSH term(s)	Agriculture ; Ecosystem ; Environmental Monitoring ; Environmental Pollution/statistics & numerical data ; Floods ; Metals, Heavy/analysis ; Nitrogen/analysis ; Pakistan ; Phosphorus/analysis ; Soil ; Soil Pollutants/analysis
Chemical Substances	Metals, Heavy ; Soil ; Soil Pollutants ; Phosphorus (27YLU75U4W) ; Nitrogen (N762921K75)
Language	English
Publishing date	2019-03-21
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	782621-7
ISSN	1573-2959 ; 0167-6369
ISSN (online)	1573-2959
ISSN	0167-6369
DOI	10.1007/s10661-019-7371-x
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Article: Validating computationally predicted TMS stimulation areas using direct electrical stimulation in patients with brain tumors near precentral regions.

Opitz, Alexander / Zafar, Noman / Bockermann, Volker / Rohde, Veit / Paulus, Walter

NeuroImage. Clinical

2014 Volume 4, Page(s) 500–507

Abstract: The spatial extent of transcranial magnetic stimulation (TMS) is of paramount interest for all studies employing this method. It is generally assumed that the induced electric field is the crucial parameter to determine which cortical regions are excited. ...

Abstract	The spatial extent of transcranial magnetic stimulation (TMS) is of paramount interest for all studies employing this method. It is generally assumed that the induced electric field is the crucial parameter to determine which cortical regions are excited. While it is difficult to directly measure the electric field, one usually relies on computational models to estimate the electric field distribution. Direct electrical stimulation (DES) is a local brain stimulation method generally considered the gold standard to map structure-function relationships in the brain. Its application is typically limited to patients undergoing brain surgery. In this study we compare the computationally predicted stimulation area in TMS with the DES area in six patients with tumors near precentral regions. We combine a motor evoked potential (MEP) mapping experiment for both TMS and DES with realistic individual finite element method (FEM) simulations of the electric field distribution during TMS and DES. On average, stimulation areas in TMS and DES show an overlap of up to 80%, thus validating our computational physiology approach to estimate TMS excitation volumes. Our results can help in understanding the spatial spread of TMS effects and in optimizing stimulation protocols to more specifically target certain cortical regions based on computational modeling.
MeSH term(s)	Adult ; Aged ; Brain Neoplasms/physiopathology ; Computer Simulation ; Electric Stimulation/methods ; Evoked Potentials, Motor ; Female ; Humans ; Male ; Middle Aged ; Models, Neurological ; Motor Cortex/physiopathology ; Nerve Net/physiopathology ; Reproducibility of Results ; Sensitivity and Specificity ; Transcranial Magnetic Stimulation/methods
Language	English
Publishing date	2014-03-18
Publishing country	Netherlands
Document type	Evaluation Study ; Journal Article ; Validation Study
ZDB-ID	2701571-3
ISSN	2213-1582
ISSN	2213-1582
DOI	10.1016/j.nicl.2014.03.004
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Conference proceedings: Comparison between open-door laminoplasty and bilateral spinal canal decompression via unilateral approach in patients with cervical spondylotic myelopathy

Hernandez Duran, Silvia / Zafar, Noman / Momber, Matthias / Mielke, Dorothee / Rohde, Veit / Fiss, Ingo

2017 , Page(s) P 132

Event/congress	68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS); Magdeburg; ; Society of British Neurological Surgeons; 2017
Keywords	Medizin, Gesundheit
Publishing date	2017-06-09
Publisher	German Medical Science GMS Publishing House; Düsseldorf
Document type	Conference proceedings
DOI	10.3205/17dgnc695
Database	German Medical Science

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