Stress fractures in military recruits: A prospective study for evaluation of incidence, patterns of injury and invalidments out of service.

BACKGROUND: Stress fractures (SFs) occur because of repetitive submaximal stresses to the bone over a period of time. SFs cause an economic loss to the organization and to the individuals who get invalided out of army because of SFs. This study was conducted to determine the incidence, distribution, onset of SFs, and invalidment patterns due to SFs. METHODS: This prospective study was carried out among recruits undergoing training at training centres in a cantonment of Central India. The recruits enrolled were followed up through their training period for occurrence of SF. On occurrence of SF, the clinical features, site of bone involved, and the weeks of completed military training were noted. The SFs were graded into four grades based on clinicoradiological features and managed accordingly. RESULTS: A total of 8974 recruits were enrolled into the study, of which 208 recruits suffered SFs. The commonest bone involved was the tibia (86.5%), commonest site being the proximal one-third of the tibia shaft (46.2%). Average week of developing SF was the 15th week of training. Seven recruits were invalided out of army because of SFs, the commonest cause being femoral neck SFs. CONCLUSION: Prevention is the best approach for SFs. It is suggested to increase the intensity of training gradually over the first 16 weeks and recruits are to be given a training pause at around the 12th week for healing of stressed bones just before the peak time of occurrence of SFs. Femoral neck SFs are the commonest SFs responsible for invalidment of recruits.

Frequency and Spectrum of Cutaneous Metastases of Visceral Malignancies: A Retrospective Observational Study of Three Years Duration in a Tertiary Care Hospital.

BACKGROUND: In spite of the skin being the largest organ of the body, cutaneous malignancies are uncommon especially in people of color as compared to the white population. The incidence of cutaneous metastases of visceral malignancies is further low and accounts for 0.5% to 10% of cancer cases as per written literature. Cutaneous metastasis as the presenting sign of underlying internal malignancy is extremely rare and is a marker of poor prognosis. Limited data is available in written literature about the frequency and spectrum of metastatic skin lesions in the Asian population. OBJECTIVE: 1) To find the frequency of metastasis of visceral malignancies in skin biopsies. 2) To evaluate the clinicopathological presentation and immunohistochemistry (IHC) profile of cutaneous metastases. SUBJECTS AND METHODS: It is a retrospective analysis of all the skin biopsies received in our department of Pathology for HPE from 01 Jan 2017 till 31 Dec 2019. Cases of cutaneous malignancy were segregated into primary and metastatic categories. Clinical details of the cases of cutaneous metastases were retrieved and analyzed. All the cases of cutaneous metastases were studied in detail for their clinical presentation, histomorphological features, and findings on IHC. RESULTS: Out of a total of 484 skin biopsies in 3 years, 9.7% showed features of malignancy. Total ten cases of cutaneous metastases (2%) were found, out of which three were the primary presentation of silent visceral malignancy. The lung, breast, colon, and ovary were the common primary sites to manifest as cutaneous metastases with the abdominal wall being the commonest site. Histomorphological features aided by the IHC panel helped in diagnosing the cutaneous metastases and site of the primary malignancy. CONCLUSION: Cutaneous metastasis as the primary presentation of visceral malignancy is rare and should not be missed as it indicates a poor prognosis. Clinico-pathological correlation and histomorphological features assisted by IHC markers help pathologists in diagnosing the site of primary malignancy in cases of cutaneous metastases.

Primary mucinous carcinoma of eyelid: a rare clinical entity.

Primary cutaneous mucinous carcinoma of the eyelid, a rare pathologic entity, is an adenocarcinoma of the eccrine glands. Though it has low metastatic potential, it does have a significant recurrence rate. We present the occurrence, clinical and histological features, and management of this tumor in a 62-year-old male who presented with a recurrent, firm, nodular left lower lid lesion. He underwent excision with a 5 mm margin and the defect was repaired with a Mustarde's cheek rotation flap. A full oncological screening, including whole-body Positron Emission Tomography scan, excluded the presence of primary mucinous carcinoma elsewhere and any metastatic spread. This case underscores the importance of considering this tumor in recalcitrant eyelid lesions and highlights the pathology of this tumor.

To determine the utility of fluorodeoxyglucose-positron emission tomography-computed tomography scan in predicting pathological response in operated carcinoma rectum patients after initial neoadjuvant chemoradiation.

BACKGROUND: The objective of this study was to determine whether [18F]-fluorodeoxyglucose-positron emission tomography-computed tomography (FDG-PET CT) scan could predict the pathological response in carcinoma rectum patients after surgery in patients receiving neoadjuvant concurrent chemoradiotherapy (NACCRT). SETTING AND DESIGN: A prospective study was carried out from March 2015 to March 2017; 39 patients of histopathologically proven, locally advanced, potentially operable, of adenocarcinoma rectum were included in the study. METHODS: Patients had a pretreatment FDG-PET-CT scan and repeat scan after 6-8 weeks of NACCRT. The change in mean maximum standardized uptake value ([%Δ SUVmax]) was compared with the tumor regression grade (TRG) in the postoperative histology. TRG of 1 and 2 was deemed responders and 3-5 was nonresponders. STATISTICAL ANALYSIS: Chi-square test, one-way ANOVA, and receiver operating characteristics curve analysis were used. All analyses were done using SPSS 17.0 version. RESULTS: In 61.5% responders receiving NACCRT, the SUV fell from 10.91 ± 3.70 to 4.14 ± 1.73, respectively, while in 38.5% nonresponders, SUV fell from 11.65 ± 2.66 to 4.23 ± 1.3. SUV Δ% was 63.03 ± 10.17 in nonresponders and 61.32 ± 11.81 in responders with a nonsignificant P = 0.646. The P value did not reach a statistical significance as far as reduction in SUV values pre- and post-NACCRT is concerned in both responders as well as nonresponders. CONCLUSION: Hence, we concluded that assessment with FDG PET CT scan in carcinoma rectum patients' postneoadjuvant treatment cannot be the only imaging modality or assessing the response and postoperative histopathology remains the gold standard.

Occupational Stress in the Indian Army Oncology Nursing Workforce: A Cross-sectional Study.

OBJECTIVE: This cross-sectional, quantitative epidemiological study was aimed at finding out the degree of work-related stress among the staff nurses working in oncology. METHODS: This study was conducted on 81 out of 100 oncology-trained nurses working in various oncology centers of Indian Army who consented to participate in it. It was carried out in five oncology centers of our organization where oncology-related facilities are available. Predesigned and pretested questionnaire covering their sociodemographic variables in part I and professional life stress scale by David Fontana in part II. The association between stress and various variables was found using Chi-square test. RESULTS: Risk for professional stress was found more among unmarried young respondents of 20-30 years age group. No statistically significant association (P < 0.131) was found between department of posting and level of stress. Nurses reported that they had no time for rest, of whom 62.96% were suffering from moderate range of stress for a busy professional while only one admitted to have severe stress requiring remedial action. While 82.7% felt that they are able to achieve major objectives in life, 71.6% of them reported that they feel inadequately valued for their commitment at work. CONCLUSIONS: The main nurses' occupational stressors were criticism, feeling of not being appreciated for hard work, and having time for self. This type of assessment should be carried out in all hospitals so that working conditions for this important component of health care can be improved.