History and Physical

Journal Article Summary

Article: To Compare efficacy Between Cryotherapy and Mitomycin Microneedling for the Treatment of Plantar Warts

Journal of J Ayub Med Coll Abbottabad

• Plantar warts (Verrucae Plantaris) are treated with salicylic acid and sometimes cryotherapy. Cryotherapy, after 3-4 sessions can treat 50-70% of the lesions. However, cryotherapy can result in blistering and scarring. Mitomycin is drug with anti-tumor and anti-viral properties that can be used to treat plantar warts. This study compared the efficacy of cryotherapy and mitomycin microneedling for the treatment of plantar warts.

• This is a randomized controlled trial that used 60 participants (from May 2021-December 2021 at the Dermatology Department of CMH, Abbottabad) with plantar warts, both groups were treated for 4 months: 

• 30 participants received treatment with cryotherapy (freeze-thaw cycle 20 sec, repeated every 2 weeks).

• 30 participants received treatment with mitomycin microneedling (1u/mL every 3 weeks).

• Inclusion Criteria:

• Male and females older than 15 years old with plantar warts

• Did not receive plantar wart treatment within the last 3 months

• Exclusion Criteria:

• Pregnant women/nursing mothers

• Children under 15 years old

• Patients with immune deficiencies/HIV infected patients

• Patients with high sensitivity to mitomycin 

• Patients that had wart treatment within past 3 months 

• The main outcome was complete remission of the plantar wart. Patients who received mitomycin were entirely cured in 23 (76.7%) cases, while patients who had cryotherapy were wholly cured in 17 (56.7%) cases. Mitomycin microneedling and cryotherapy respectively failed to treat six (20.07%) and twelve (39.97%) patients. One (3.33%) showed partial treatment response among the patients in each group.

• Secondary outcomes: adverse effects

• Liquid nitrogen caused pain (27 patients out of 30, 90%) and blisters (5 patients out of 30, 16%).

• Mitomycin microneedling caused pain during the microneedling (25 patients out of 30%, 83.3%).

• Overall, according to this study mitomycin microneedling is more effective in the treatment of plantar warts and has less adverse effects compared to cryotherapy.

• Limitations: The main limitation of this study was the small sample size. Future research can focus on the efficacy and adverse effects of using mitomycin microneedling for common cutaneous warts and anogenital warts. 

Citation:

Khan, F. A., Hussain, M., Khan, B. M., Afsar, S., Shafique, M., Haq, S. U., Akbar, N., & Siddique, A. (2023). To Compare Efficacy Between Cryotherapy And Mitomycin MicroneedlingFor The Treatment Of Plantar Warts. Journal of Ayub Medical College, Abbottabad : JAMC, 35(1), 133–136. https://doi.org/10.55519/JAMC-01-10932

Site Evaluation Presentation Summary

In my ninth rotation, I had PA Gary Maida as my site evaluator. During the site evaluation, I presented three History and Physicals (H&Ps) based on my experience in Dr. Nicasio Arana Pediatrics. The first H&P was based on an 8 year old female patient who was brought in by her mother for complaint of right ear pain that started 3 days ago. Prior to her symptoms mother stated patient had a viral illness which she has since recovered from. The potential diagnoses considered included acute otitis media, secondary otalgia, otitis externa, and ear trauma from foreign bodies. Overall, she was diagnosed with otitis media and received amoxicillin.

Typhon Posting

Rotation Self Reflection

1. What was a memorable patient or experience that I’ll carry with me?

One of the most memorable patient encounters that I’ll carry with me, was when I had to triage a family of 8. Interestingly enough all of the patients had the same initials. I was overwhelmed, but I used a pen and paper to help me remain organized. 

2. Skills or situations that are difficult for you (e.g. presentations, focused H&Ps, performing specific types of procedures or specialized interview/pt. education situations) and how you can get better at them.

I found it challenging to deal with getting blood from patients younger than 3 years old. Children are prone to moving, even hitting or kicking. In these situations, it’s often helpful when the parent holds the child properly.

3. Types of patients you found challenging in this rotation and what you learned about dealing with them.

Among the patients I encountered, the most challenging ones were the parents who often displayed hostility towards vaccination from misinformation. When faced with hostile parents, I made an effort to educate them about the misinformation surrounding vaccines, the benefits from vaccines, and the potential adverse effects.  However, if the parents were unreceptive or were still adamant against vaccination, I would defer to the doctor’s judgment.

4. How your perspective may have changed as a result of this rotation (e.g. elderly patients, kids, IV drug users, etc)?

Many individuals at Dr. Arana’s clinic were recent immigrants to the United States, leading to frequent encounters with a language barrier. Moreover, these patients had limited health literacy, often resorting to home remedies for their children’s ailments, inadvertently exacerbating symptoms. This experience underscored the significance of having an efficient team to manage healthcare paperwork, patient education, etc.