Liaquat National Journal of Primary Care

Human papillomaviruses (HPV) cause warts, which are the benign epithelial proliferation of the mucous membrane and skin. HPV-3 and HPV-10 commonly cause plane warts. Multiple treatment options must be used as no specific treatment option is available. We have a lot of limitations for the face as treatment can cause permanent scarring on the face. We report a case of 41 years immunocompetent male presenting with many plane warts on the face who was successfully treated with topical application of 40% Salicylic acid cream and 16% lactic acid cream made up of 44% of bees wax on lesions after a failure of many other treatment options, a) Topical zinc oxide twice per day for 3 months, b) Topical 5% salicylic acid dispensing cream made in 95% bees wax, c) Topical 5% fluorouracil cream, d) Topical imiquimod cream, e) Topical retinoids cream only at night for one month, f) Oral Isotretinoin 20mg twice per day for 2 months, and 3 sessions of cryotherapy. The patient's last treatment was oral isotretinoin 20 mg twice per day for the last 2 months. In general, doctors avoid using more than 5% salicylic acid, but after a detailed discussion with the patient, we decided to try this combination and succeeded.

Karimullah Makki

Syed Ahsan

Ali Jafri

Resistant Plane Warts Treated by 40% Salicylic Acid and 16% Lactic Acid Combination on the Face

面部难治性扁平疣采用40%水杨酸和16%乳酸联合治疗

Background Proton Pump Inhibitors (PPIs) are commonly prescribed drugs and their inadequate prescription can have adverse outcomes. Multiple factors are responsible for inappropriate use of PPIs including self-medication, less knowledge about PPIs in medical staff, and consumer-oriented advertising. Objective To assess the knowledge and practices about PPI use among Physicians in Tharparkar District of Sindh province, Pakistan. Methods This is a cross Sectional study that was done in the rural hospitals (Basic Health Unit, Rural Health Centre, Talukka, and District Hospital) in Tharparkar District Sindh. The study took place for 6 months from October 13, 2019, to April 12, 2020. All PMC licensed Physicians working in district Tharparkar for at least 6 months were consecutively enrolled. Knowledge questions comprised of questions about PPI and their indication and side effects while practice questions such as indication, route, and duration of action were asked. All participants were classified as having adequate knowledge and adequate practice based on the correct answer to each question. The study included PMC-licensed physicians with one-year internship/ house job experience and Physicians who had worked at district Tharparkar in a rural setting for at least 6 months. Physicians who did not give consent were excluded from the study. Results Of 102 practitioners, the mean age of the participants was 39.57 ±9.14 years. The majority of the practitioners were males (n=82, 80.4%). Most of the practitioners (n=66, 65%) were working in district hospitals, 21 (19.6%) in rural health centers, and 15 (14.7%) in basic health units. Adequate knowledge was observed in 34 (33.3%) while adequate practice in 33 (32.4%) participants. Conclusion The knowledge and practices about Proton Pump Inhibitor (PPI) use were found to be unsatisfactory among Physicians working at Tharparkar.

Pardeep Kumar

Swaleha Tariq Bhombal

Sawairah Mukhtiar

Aiman Ahsan

Uzair Abbas

Use of Proton Pump Inhibitors: An Exploration of Awareness and Practice of Health Care Professionals of Tharparkar District

质子泵抑制剂的使用：塔尔帕卡尔区医疗保健专业人员对意识和实践的探索

Background: As oral cavity and oropharynx cancers are the second most common type of tobacco-related cancer reported in Jaipur city so it is imperative to study the drug utilization pattern in these cancers. Objectives: The objective of this study was to evaluate the trends in drug usage patterns for oral cancer patients in Jaipur city. Methods: The prescriptions of oral cancer patients attending the outpatient department of SMS and Bhagwan Mahaveer cancer hospital from May 2017 to August 2017 were studied. They were studied for WHO Prescribing indicators for good prescribing practice. Results: A total of 188 prescriptions were studied. An average of 2.6 (0.5) antineoplastic medications were prescribed per prescription. The combination of paclitaxel and carboplatin was the most frequently prescribed antineoplastic drug, prescribed to 29.8% of patients. The drafting of the prescriptions was of average quality. In 5% of the prescriptions, a diagnosis was omitted, and in 48% of the prescriptions, the patient's weight and/or body surface area (BSA) were omitted. Only 52% of the prescriptions contained the medications' generic names. Conclusion: The quality of prescribing was fair and moderately acceptable. To ensure rational prescribing and safe and successful treatment of cancer patients, interventions such as new policy formulation and educational measures should be developed.

An Observation Study to Evaluate the Drug Utilization Pattern for Oral Cancer Patients Receiving Chemotherapy Treatment at a Private and Government Tertiary Care Hospital in Jaipur City

一项观察性研究，评估在斋浦尔市私立和公立三级护理医院接受化疗治疗的口腔癌患者的药物使用模式

Background: Neonatal septicemia is one of the primary causes of disease and death in low-income countries which makes early diagnosis an important factor to prevent microbial resistance and initiate antibiotic therapy. C-reactive protein is an essential biological indicator that might play an important role in the early detection of neonatal sepsis. Objective: The present study was conducted to determine the sensitivity and specificity of CRP against blood culture in the identification of neonatal sepsis. Methods: This study was carried out on 416 neonates identified with sepsis at the NICU and SICU of the National Institute of Child Health, Karachi, Pakistan for a span of 06 months from April 2022 to September 2022. The first blood sample for the evaluation of CRP and blood culture was drawn at the time of admission. The second sample of CRP and blood culture was drawn 72 hours after the first blood collection. The sensitivity and specificity of CRP were calculated on both occasions. Results: Of the total 416 neonates, 165(39.6 %) patients’ blood culture was positive and in 273 (65.9%) patients CRP was positive. The validation study of CRP in the diagnosis of neonatal septicemia reported sensitivity, specificity, positive predictive value, and negative predictive value to be 87.1%, 45.9%, 52.6%, and 83.7% 72 hours after the admission in comparison to 80.6%, 44.2%, 48.7%, and 77.6% at the time of admission. Conclusion: The high specificity and sensitivity of CRP against blood culture make it an important diagnostic modality that might play a helpful role in the diagnosis of neonatal sepsis.

Sensitivity and Specificity of C-Reactive Protein Against Blood Culture in Patients with Neonatal Sepsis - A Hospital-Based Study

新生儿脓毒症患者中C反应蛋白对血培养的敏感性和特异性——一项基于医院的调查研究

Background: C Treatment in all forms of CAH includes lifelong replacement of steroids. Steroids have an impact on bone health in multiple ways and are known to cause osteoporosis when given in high doses or for a longer duration. Objective: To evaluate bone mineral density (BMD), using dual-energy X-ray absorptiometry (DEXA) scan in children with CAH taking long-term steroids presenting in the pediatric endocrinology ward of National Institute of Child Health, (NICH) Karachi, Pakistan. Materials and Methods: This cross-sectional study was performed at the Department of Pediatric Endocrinology, National Institute of Child Health, Karachi from October 2021 to July 2022. A total of 47 diagnosed cases of CAH taking steroids for more than 5 years were enrolled. Assessment of BMD was done using a DEXA scan. Lumbar spine BMD was done and Z-score was modified for height for age z-score. The dose of steroids and duration was calculated. Results: Out of 47 patients, low BMD was observed in 8 (17.02%) patients. Individuals with low BMD had significantly higher median duration, (p=0.017), dose (p=0.003), and median alkaline phosphate level (p=0.036),) but low median BMD value (p=0.009) and z score (p&lt;0.001) than normal BMD individuals. Although median bone age (p=0.009) was appropriate for chronologic age in low BMD patients. A moderate negative significant correlation was observed between z score and age (rho=-0.319, p=0.029), z-score and duration of steroid treatment (rho=-0.364, p=0.012), z score and alkaline phosphate (rho=-0.466, p=0.001), z score and bone age (rho=-0.378, p=0.009). Conclusion: Low BMD was observed in 17% of children on the DEXA scan. Moreover, these individuals had significantly higher median average duration and dose of hydrocortisone.

Bone Mineral Density in Children with Congenital Adrenal Hyperplasia

先天性肾上腺增生儿童的骨矿物质密度

Globalization has resulted in more women participating in the workforce, but it has also led to an alarming increase in human rights violations. A persistent issue in the modern workplace is harassment. Workplace harassment takes many forms, including verbal abuse, physical assault, discrimination, and sexual misconduct. It creates hostile and offensive experiences for individuals and groups, despite being illegal in many places. This not only hampers productivity and job satisfaction but also harms employees' mental and physical health. Organizations have a moral and legal duty to address workplace harassment. Organizations should promote awareness of the legal and ethical consequences of sexual harassment through dialogue, leadership support, and accessible resources. Key strategies to combat workplace harassment include clear policies, training, inclusive culture, strong legal frameworks, victim support, monitoring, and collaboration. Implementing these strategies creates safe and thriving workplaces. This article focuses on workplace harassment, particularly sexual harassment against women. It highlights the prevalence of harassment, its various forms, and the challenges women face in addressing it. The article emphasizes the need for societal and governmental recognition to effectively combat workplace harassment. It also explores global and regional prevalence of workplace harassment, its consequences, and strategies for prevention.

Addressing Workplace Harassment in Pakistan: Building a Safe and Inclusive Environment

解决巴基斯坦职场骚扰问题：构建安全包容的工作环境

A deficiency of the enzyme HMB Hydroxymethylbilane synthase function, also known as porphobilinogen deaminase, leads to the emergence of acute intermittent porphyria (AIP). AIP is an uncommon form of hepatic porphyria inherited in an autosomal dominant fashion. We present a case involving a young girl who experienced a sudden onset of quadriparesis, a severe neurological condition that necessitated ventilator support due to respiratory distress. Her condition was consistent with motor axonal neuropathy, which is a characteristic feature of Acute Intermittent Porphyria (AIP). During her last hospital admission, she developed new-onset generalized tonic-clonic seizures, and MRI findings at that time indicated the presence of hyperintense lesions in the posterior parietal region, likely attributed to Posterior Reversible Encephalopathy Syndrome (PRES). To manage her symptoms, she received Dextrose saline due to the elevated levels of urinary porphobilinogen. This case underscores the significance of recognizing two alarming complications associated with porphyria, namely PRES and acute motor axonal neuropathy. Despite an appropriate and timely diagnosis, our efforts were unsuccessful in averting these complications. The unavailability of Hematin, a vital treatment for acute porphyria attacks, was the primary reason for her unfortunate demise.

Acute Intermittent Porphyria: Flaccid Quadriplegia and Encephalopathy due to Posterior Reversible Encephalopathy Syndrome (PRES)

急性间歇性卟啉病：后部可逆性脑病综合征（PRES）引起的弛缓性四肢瘫痪和脑病

Background and Objective: The intention of pregnancy is considered one of the major factors contributing to the foetal or maternal outcome. An exploration of the magnitude of this problem and its related factors can lead to improved foetal or maternal health. Thus, the objective of this study was to assess pregnancy intention and its related factors among females attending antenatal clinics of tertiary care hospitals. Methods: It is a Cross-sectional (analytical) study conducted at the Antenatal clinic, Jinnah Hospital Lahore, within the duration of January-April 2022. Two hundred and fifty(250) pregnant women aged 20 to 39 years were enrolled using non-probability convenience sampling. All the information was noted in a structured questionnaire based on study variables. The collected data was analysed using SPSS version 27.0 and frequency tables were generated. Appropriate test of significance was applied and p-value &lt; 0.05 was taken as statistically significant. Results: Among 250 pregnant females, about 195(78%) of the females reported the current pregnancy to be intentional while 55(22%) were unintentional. It was also seen that age and parity were significantly related to the intention of pregnancy p-value&lt;0.05. The main reasons behind unintentional pregnancies were; 28(51%) unaware about contraception, and 20(36.4%) contraception methods had failed. Conclusions: Approximately one-fourth of all pregnancies were unintentional which raises a concern regarding contraceptive usage and its effectiveness. The prevalence is high compared to reported by the Pakistan demographic health survey. Health education, advocacy, and health protection measures taken on all levels of health care to increase the use and access to contraceptive services are need of hour to address this unwanted situation of unwanted pregnancies.

Assessment of Pregnancy Intention and Its Related Factors among Females Attending the Antenatal Clinic

评估产前门诊就诊女性妊娠意愿及其相关因素

Even though methicillin-resistant Staphylococcus aureus (MRSA) is considered a source of nosocomial pneumonia, a few cases have likewise depicted instances of community-acquired pneumonia (CAP) among healthy individuals that were caused by MRSA. Mostly CA-MRSA causes skin and soft tissue infection but can be responsible for severe invasive infection with higher morbidity. Invasive CA-MRSA requires aggressive management to prevent complications. CA-MRSA strains are now recognized as distinct clonal entities that differ from traditional hospital-acquired MRSA (HA-MRSA) strains. The increasing prevalence of MRSA in the community is an important public health problem, which needs increased vigilance in the diagnosis and management of suspected and confirmed staphylococcal infections. We present an intense case of CAP brought about by MRSA with impending respiratory failure in a 19-year-old male, who presented with acute febrile illness with swelling over lips with no co-morbid and insignificant past medical history. Through this case, we intend to increase awareness among physicians about the growing role of CA-MRSA in the population; they should be meticulous in treating patients with CA-MRSA, and be aware of the complications of this disease and the appropriate empiric and target antibiotics regimen for such infections, whenever it is suspected, to enhance better clinical outcomes.

Community-acquired Methicillin-resistant Staphylococcus Aureus Pneumonia: A Diagnostic Challenge

社区获得性耐甲氧西林金黄色葡萄球菌肺炎：诊断挑战

Background: The most prevalent and significant arboviral disease affecting humans is dengue. It is spread by the Aedes genus of mosquitoes, which are common in tropical and subtropical regions of the world. Thrombocytopenia occurs commonly among patients suffering from dengue fever, making them more prone to hemorrhagic complications. The predisposing factors leading to thrombocytopenia and bleeding manifestations after dengue infection are not well-known Objective: We attempted to determine the frequency of thrombocytopenia and its co-relation with serum vitamin B12 levels among dengue patients. Methods: This Cross-sectional study after taking approval from the hospital ethical committee was carried out at the Department of Medicine PNS Rahat Hospital from 01/06/2022 to 30/11/2022 over six months. A total of 145 diagnosed patients suffering from dengue fever fulfilling the inclusion criteria were enrolled. Patients with concomitant sepsis, malignancy, autoimmune disorder, hematological disorder, and drugs causing thrombocytopenia were not included in the study. Precise history and bio data were entered in the Pro forma. Patients were investigated for CBC, VIT B12 LEVEL, and other routine investigations. SPSS v27 was used for data analysis. P-value≤0.05 was considered as significant. Results: Out of a total of 145 patients, 78 (53.8%) were males and 64 (46.2%) were females With a mean age of 38.22±15.93 years.139 patients (95%) had thrombocytopenia with variable severity, and platelet count is positively correlated with serum vitamin B12 Level (p=0.000). Conclusion: Dengue fever patients with thrombocytopenia were found to have vitamin B12 deficiency. Thrombocytopenic patients may require more platelet transfusion and longer hospitalizations.

Publication Information	Publisher: Liaquat National Hospital and Medical College，Publishing cycle: ，Journal Type: journal，Open Access Journals: Yes
Basic data	Year of publication: 2023，Proportion of original research papers: ，Self Citation Rate:， Gold OA Rate:
Average review cycle	12 weeks

Liaquat National Journal of Primary Care

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