Publications by authors named "N M J Siti Fatimah"

6 Publications

Neurectomy versus Nerve Sparing in Open Inguinal Hernia Repair: A Randomised Controlled Trial.

J Coll Physicians Surg Pak 2020 Sep;30(9):917-920

Department of General Surgery, Services Hospital, Lahore, Pakistan.

Objective:  To determine the effect of neurectomy in reducing the frequency of chronic inguinodynia after mesh hernioplasty in open inguinal hernia repair.

Study Design: Single blind randomised controlled-trial.

Place And Duration Of Study: Surgical Unit-I, Department of General Surgery, Services Hospital, Lahore, Pakistan from September 2018 to September 2019.

Methodology: All male patients undergoing open groin hernia surgery were included in the study. A total of 100 patients were randomly categorised into group A (neurectomy group) and group B (nerve sparing group). Patients were followed up for three months for the development of chronic inguinodynia. Signifiance was determined at p <0.05 using Chi-square and Fisher's exact tests.

Results: Out of 100 patients, 50 patients were enrolled in group A, while 50 were enrolled in group B. Mean age of patients was 42.1 ± 17.5 years. The median (IQR) acute pain score in neurectomy group was 3.0 (2.0-4.0), while median (IQR) acute pain score was 4.0 (3.0-6.0) in nerve sparing group with statistically significant difference (z = -3.256, p = 0.001). The frequency of chronic inguinodynia was significantly less in group A compared to group B [3 (6%) vs. 13 (26%), p = 0.012].

Conclusion: Excision of ilioinguinal and iliohypogastric nerve in inguinal mesh hernioplasty reduces the frequency of chronic inguinodynia. Ilioinguinal neurectomy may be practised routinely in patients undergoing Lichtenstein mesh hernioplasty.   Key Words: Inguinal neurectomy, Inguinal hernia, Chronic inguinodynia, Lichtenstein mesh hernioplasty.
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http://dx.doi.org/10.29271/jcpsp.2020.09.917DOI Listing
September 2020

Acute Presentation and Management of Abdominal Tuberculosis.

J Coll Physicians Surg Pak 2020 Feb;30(2):129-133

Department of General Surgery, Services Hospital, Lahore, Pakistan.

Objective: To study the clinicopatholgical profile and outcomes of surgical management of abdominal tuberculosis (ATB) Study Design: Cross-sectional observational study.

Place And Duration Of Study: Department of Surgery, Services Hospital, Lahore, Pakistan, from May 2008 to April 2018.

Methodology: All patients who underwent emergency laparotomy during the study period due to abdominal tuberculosis, and consented to participate in the study were included. Demographic variables and type of surgical procedure performed were recorded. Patients were followed-up for histopathology, recurrence, or any anti-tuberculous therapy related complications at 1, 4, 6, and 12 months. Data were analysed using SPSS version 21.

Results: Out of the 80 patients, 36 were males and 44 were females. The median age was 23.5 years (range = 11-90 years). Mean weight of the patients was 48.7 ±12.2 kg. Commonest presenting symptom was abdominal pain 72 (90%). On exploration, ileocecal region was most commonly involved segment 68 (85%). Stoma formation was the most common surgical procedure performed in 59 (73.8%) patients. Complications and mortality rate were 48 (60%) and 7 (8.7%), respectively. A significant relationship of complications was found with prolonged hospital stay (p <0.001).

Conclusion: Abdominal tuberculosis is a major public health concern. Vague symptoms lead to diagnostic delay so patients present late with intestinal obstruction. Ileocecal tuberculosis is the most common site of involvement.
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http://dx.doi.org/10.29271/jcpsp.2020.02.129DOI Listing
February 2020

Stone in the distal jejunum presenting as small bowel obstruction: A case report.

Int J Surg Case Rep 2018 4;52:20-22. Epub 2018 Oct 4.

Department of General Surgery, Services Institute of Medical Sciences, Lahore, 54600, Pakistan.

Introduction: Gallstone ileus is a rare presentation of cholelithiasis accounting for around 4% of cases of small bowel obstruction under 65 years of age but rises to 25% in those more than 65 years of age. Most gall stones, if impact in the bowel, are seen to lodge at the ileocecal valve as this is the most narrow part of the bowel.

Presentation Of Case: We present a case of small intestinal obstruction because of a gallstone stuck in the distal jejunum. Patient was explored and one-stage surgery was done i.e. cholecystectomy, enterotomy and stone retrieval, and fistula repair. Our patient had uneventful postoperative recovery and was discharged after a week.

Discussion: Gallstone ileus is a rare entity presenting a significant diagnostic challenge to surgeons due to lack of specific findings. Moreover, the surgical management options to be adopted are diverse and depend upon the condition of the patient. Stable patients can be managed with two-stage procedures i.e. enterotomy and stone retrieval earlier with cholecystectomy in an elective setting. Our patient was managed with one-stage procedure i.e. cholecystectomy was done in the same setting and our patient did well.

Conclusion: Gallstone ileus needs to be kept in the differential diagnosis list of intestinal obstruction in middle aged patients even in the absence of history of gallstones as this may be the first presentation of gallstone disease.
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http://dx.doi.org/10.1016/j.ijscr.2018.09.045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176843PMC
October 2018

Undifferentiated vasculitis or an evolving systemic autoimmune rheumatic disease?

Oxf Med Case Reports 2016 Aug 25;2016(8):omw066. Epub 2016 Aug 25.

Department of Rheumatology and Immunology, Shaikh Zayed Medical Complex , 54600 Lahore , Pakistan.

Undifferentiated connective tissue diseases usually present with arthralgias, sicca symptoms, Raynaud's phenomenon and leucopenia. This case presents the atypical presentation of an undifferentiated connective tissue disease with extensive cutaneous involvement of fingers and toes leading to gangrene with absence of typical rheumatological symptoms. The autoimmune profile showed positive ANA and anti-Ro/SS-A. Thromboembolism was ruled out on the basis of transthoracic and transesophageal echo. She was treated with I/V corticosteroids and cyclophosphamide that halted the disease progression.
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http://dx.doi.org/10.1093/omcr/omw066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5002063PMC
August 2016

Predictors of response to intra-articular steroid injections in patients with osteoarthritis of the knee joint.

Clin Rheumatol 2016 Oct 30;35(10):2541-7. Epub 2016 Jul 30.

Fauji Foundation Hospital, Jhelum road, Rawalpindi, 46000, Pakistan.

This study aimed to determine the factors associated with response to intra-articular steroid injection (IASI) in patients with knee joint osteoarthritis. One hundred seventy-four female patients, age ranging from 30 to 80 years, diagnosed to have osteoarthritis of the knee joint, were given IASI. Response to IASI was assessed by using WOMAC and VAS at 2 weeks, 4 weeks and 3 months. At 3 months, the subjects were categorized as responders, partial responders and non-responders to treatment by IASI. Various factors were narrowed down to see their effect on response, namely age, BMI, smoking habits, comorbidities, presence of clinical effusion, radiographic score, local knee tenderness, range of movement and socioeconomic status. One hundred twenty-four patients completed the study. 16.1 % showed 50 % or more improvement in WOMAC score at 3 months post IASI therapy, whereas 38.7 % of OA patients had more than 50 % improvement in VAS score. Out of all factors, range of movement, local knee tenderness and radiographic score of the affected joint are the three parameters which can predict the improvement in WOMAC score after 3 months of IASI therapy (P = 0.013, P = 0.045 and P = 0.000, respectively). Age of the patient can predict improvement in VAS at 3 months post IASI (P = 0.027). We conclude that age, range of movement, local knee tenderness and radiographic score of the affected joint can predict response to IASI after 3 months of IASI therapy.
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http://dx.doi.org/10.1007/s10067-016-3365-zDOI Listing
October 2016
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