Upper Back Research Articles

High Physical Exposure During Female Recruits' Basic Military Training inSweden-A Descriptive Study.

There is a knowledge gap concerning the occurrence of physical complaints/injuries, i.e., musculoskeletal disorders (MSD), among Swedish women who undergo basic military training (BMT). The aims were to describe prevalence and factors related to MSD and explore physical exposure and performance in Swedish female recruits during BMT. A total of 144 females (mean age 22 years) who underwent BMT in 2016 participated in this cross-sectional study. Data regarding self-reported MSD, physical performance, physical activity and exercise, motivation and mental and physical preparation, and physical exposure during BMT and perceived health were collected at the end of BMT through the Musculoskeletal Screening Protocol questionnaire. Additional data on muscle strength were retrieved from IsoKai isokinetic lift tests. Descriptive and analytic (paired samples t-test and logistic binary regression) statistics were used. The prevalence of MSD was high, with 33% (n = 48) reporting MSD before BMT, 78% (n = 113) during, and 50% (n = 72) at the end of BMT. Knee and upper back were the most frequently reported MSD locations. Forty-four (30%) participants felt insufficiently physically prepared for BMT. The physical exposure was high with loaded marches/runs and carrying heavy loads as the most demanding tasks. The longest walking distance was reportedly 55 km, and the reported maximum load was 50 kg. Forty-five participants (31%) had carried a load representing over 50% of their body weight. Most participants reported good to excellent health at the end of BMT. There was a small (8 N) but significant (P = 0.045) increase in mean force over time. Two variables, MSD before BMT (odds ratio 2.24, P = 0.03) and being physically unprepared (odds ratio 3.03, P < 0.01), were associated with MSD at the end of BMT. This study showed that the prevalence of MSD in Swedish female recruits was high before, during, and at the end of BMT, with knee and upper back as the most frequent locations. Although the physical exposure during BMT was occasionally high, self-rated health was mainly perceived as good to excellent at the end of BMT. Previous MSD and being physically unprepared were related to MSD at the end of BMT. These important and relevant findings indicate the necessity for implementing interventions to increase physical fitness and treat MSD at the beginning of BMT.

Treatment of Upper Crossed Syndrome: A Narrative Systematic Review.

Upper crossed syndrome (UCS) is a common musculoskeletal condition that is characterized by tightness and weakness of the muscles of the neck, shoulders, and upper back. The aim of this current study is to summarize and provide an overview of the treatment in patients with UCS. A MEDLINE (PubMed), Cochrane library, Embase, Scopus, and Web of Science database search was conducted for English-language articles about upper crossed syndrome that were published until 19 January 2023. To identify potentially relevant articles, the following key search phrases were combined: "upper crossed syndrome", "upper cross syndrome", "diagnosis", and "treatment". A total of 233 articles were identified. After reading the titles and abstracts and assessing their eligibility based on the full-text articles, 11 articles were finally included in this review. The risk of bias (RoB) was assessed using RoB-2 and ROBINS-I for the randomized controlled trials (RCTs) and the non-randomized clinical trial (non-RCT), respectively. Among eleven studies that investigated the effect of treatment programs for UCS, five studies compared the therapeutic effect of exercise programs with controls, whereas six compared different rehabilitative treatment strategies, such as the muscle energy technique, soft-tissue mobilization, and stretching exercises. In addition, regarding the study design, ten studies were RCTs and only one study was a prospective observational study. Treatment programs including various types of exercises and techniques to correct an abnormal posture and restore neuromuscular imbalances are effective for decreasing pain and improving neck disabilities and postural deviations in patients with UCS.

Cutaneous Manifestations of Scleroderma: A Case Report

Background: Scleroderma or systemic sclerosis is a rare multisystemic autoimmune disease characterized by vasculopathy, inflammation, and progressive fibrosis of the skin and multiple organs. Cutaneous manifestations and Raynaud’s phenomenon, usually becomes the initial presentation of scleroderma which noticed by the patient.&#x0D; Case: A 47-year-old-women presented with hardened and thickened skin on her arms and legs for&#x0D; 3 years which spreaded to her face and trunk. The lesions initially appeared as multiple red patches which progressed into white, thick and hard patches. The patient had history of recurrent Raynaud's phenomenon, dry cough, and shortness of breath. In the physical examination, the patient had skin hardening with salt and pepper appearance on her upper back and chest. The thoracic CT scan revealed interstitial lung disease. The patient diagnosed as definitive scleroderma based on The European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) criteria with score of 18. She has treated with methotrexate, methylprednisolone, topical corticosteroid and moisturizer. The skin lesion improved with the reduction of Rodnan skin score from 31 to 19 after 4 months of treatment.&#x0D; Conclusion: Cutaneous manifestation could be the early alarm and initial manifestation of scleroderma. As the pathology is deep beyond the skin, throughout examination should be performed to find any organ involvement. Dermatologist play a significant role in early identification of skin disorder and made multidiciplinary refferal. Early diagnosis and prompt treatment could reduce morbidity and mortality in scleroderma

The characterization of thermal perception in recreational surfers wearing wetsuits

The purpose of this study was to characterize the perception of heat loss, comfort, and wetness in recreational surfers wearing wetsuits, to compare these data with changes in skin temperature reported in prior studies, and to examine the impact of wetsuit thickness, zipper location, and accessory use on thermal sensation and comfort. Following their surf session, nine-hundred and three male (n = 735) and female (n = 168) recreational surfers responded to a series of questions regarding thermal comfort/sensation, wetsuit characteristics, and surfing history. Average whole body thermal sensation rating was 0.8 ± 3.6 on a scale of −10 to +10 and average whole body thermal comfort rating was 1.5 ± 1.2, midway between “just comfortable” and “comfortable.” Overall, surfers felt coldest in their feet, hands, and head. Under their wetsuits, surfers felt the coldest, wettest, and least comfortable in their chest, lower legs, lower arms, and upper back. Wetsuit accessory use had the greatest impact on regions identified as coldest, least comfortable, and wettest. These data suggest that wetsuit design should focus on optimizing water access points and improving accessories for the feet, hands, and head.

Prevalence and Pattern of Musculoskeletal Disorder in Panteka Mechanic Village, Kaduna

Musculoskeletal disorders (MSDs) are illnesses that make working people disabled and generate significant economic loss worldwide. Automobile mechanics are at risk of injury at the onset of MSDs due to repetitive tasks, uncomfortable posture, and heavy lifting of objects. The frequency and pattern of work-related musculoskeletal disorders among auto mechanics in Panteka Village, Kaduna State, are investigated in this study. Using a version of the standard Nordic Musculoskeletal questionnaire, a quatitative method was used to gather data on the prevalence pattern of musculoskeletal illnesses at Panteka Village. To analyze the data obtained, purposive sampling method was employed. The study found that there was a high prevalence of MSDs among auto mechanics in Panteka village, with rates of 90% (Neck), 92.3% (shoulder), 56.4% (knee) and over 70% prevalence of MSD for lower and upper back. The results of relationship between age of respondents, years spent as a mechanic and prevalence of the musculoskeletal disorders showed no significant relationship. However, there was a significant relationship between the respondent's section of mechanic activities ie the nature of their job and MSD. These are primarily the result of poor ergonomics and insufficient rest periods at their workshop. Also, manual handling of heavy loads, repetitive tasks and force exertion were the identified factors. Ergonomic and MSD awareness among workers should be increased through training. In addition, govermnents should investigate more in other to reduce or eliminate risk factors leading to musculoskeletal disorders. Members of the Panteka village committee can use the research's findings to enhance the working environment for mechanics. Therefore, Mechanics will need to be educated more on risk factors associated with MSDs.

Seasonal Change in Countermovement Jump Performance in NCAA Women’s Golfers

Background of Study: The countermovement vertical jump (CMJ) task has been reported to have positive associations with golf-specific performance variables. Additionally, the CMJ is commonly used to assess neuromuscular fatigue in athletic populations. Objective: Thus, this investigation sought to examine the changes in CMJ performance throughout a competitive season in NCAA collegiate women’s golfers. Methods: Using a longitudinal study design, six collegiate women golfers completed three sessions (pre, mid, and post) of CMJ testing during the spring competition period. During each testing session, two successful jump trials were collected using a portable force platform sampling at 1000 Hz. During each trial, an arm swing was restricted by the use of a dowel placed across the upper back. A one-way repeated measures analysis of variance was used to determine if differences were present between testing sessions. Results: Propulsive net impulse significantly increased from pre to mid (p 0.05) and pre to post (p 0.05). No other variables showed a statistically significant change over the duration of the study, though moderate effect size increases were in countermovement depth from pre to mid-testing (0.73) and jump height from pre to post-testing (0.72). Conclusions: These findings support previous findings of an increase in vertical jump performance over the course of a season in collegiate golfers, though strategies for maximal performance may shift.

Study of Musculoskeletal Disorders in Farmers Involved in Manual Paddy Bagging Task

Filling paddy bags by hand is a common task during harvesting, but it can cause musculoskeletal disorders (MSDs) in various body regions. The current study aims to evaluate posture and find an association between MSDs and body posture scores. The Nordic questionnaire and rapid entire body assessment (REBA) were used to collect MSDs and postures from farmers. The MSD in various body regions (neck, elbows, hands, upper back, knees, ankles, lower back, hips, thighs, and buttocks) was found to be 6.7%, 10%, 3.3%, 6.7%, 16.7%, 20%, and 10%, respectively, during the last 12-month period. In REBA score findings, holding bags, filling the bucket, and the bag were found to have a very high risk of causing MSDs. Despite the fact that MSDs are not very common among farmers who engage in paddy bagging tasks, posture analysis reveals what causes MSDs. Further investigation is needed to improve and reduce MSDs.

Effect of Assisted Surgery on Work-Related Musculoskeletal Disorder Prevalence by Body Area among Surgeons: Systematic Review and Meta-Analysis.

Surgeons are highly exposed to work-related musculoskeletal disorders (WMSDs). The objective of this review was to summarize the WMSD prevalence by body area with and without assistive devices. The underlying question was whether there is an effect of assistive device use (robot, video, or other) during surgery on WMSD prevalence by body area among surgeons, regardless of their specialty. The systematic review was conducted according to the PRISMA guidelines. The Google Scholar, Pubmed/Medline, and ScienceDirect databases were scanned to identify relevant studies. The article selection, review, critical appraisal, and data extraction were performed by two authors independently. Among the 34,854 unique identified records, 77 studies were included. They were divided into two groups: 35 focused on robotic- and video-assisted surgery (RVAS) and 48 concerning surgery without video/robotic assistance (WAS) (6 studies evaluated the prevalence for both groups). WMSD prevalence was reported for 13 body areas: the neck, back, upper back, mid-back, lower back, shoulders, elbows, wrists, fingers, thumbs, hips, knees, and ankles. The results showed that WMSD prevalence was significantly higher (unpaired t-test, p < 0.05) for RVAS in the shoulders (WAS: 28.3% vs. RVAS: 41.9%), wrists (WAS: 20.9% vs. RVAS: 31.5%), and thumbs (WAS: 9.9% vs. RVAS: 21.8%). A meta-analysis was performed for 10 body areas (with 4 areas including more than 25 studies). No sufficient data were available for the mid-back, thumbs, or hips. A high heterogeneity (Cochran's Q test and I2 statistic) was observed. A random-effects model revealed that the highest worldwide prevalence was in the neck (WAS: 41% and RVAS: 45.3%), back (WAS: 37.7% and RVAS: 49.9%), lower back (WAS: 40.0% and RVAS: 37.8%), and shoulders (WAS: 27.3% and RVAS: 41.4%). Future work could focus on work environment design, particularly the positioning and adjustment of equipment, and on postural analysis to reduce the appearance of WMSDs. Recommendations are proposed for future reviews and meta-analyses.

Musculoskeletal Disorders among Traditional Bangladeshi Fishermen

Background: Fishing is one of the most important economic activities in riverine Bangladesh. We studied musculoskeletal disorders (MSDs) among Bangladeshi fishermen which is generally high.Objective: To study patterns and extend of MSDs among Bangladeshi fishermen.Materials and Methods: A total 150 fishermen enrolled with at least six months employment history attended at out-patient department of Physical Medicine and Rehabilitation of Khwaja Yunus Ali Medical College and Hospital of Sirajganj district, Bangladesh, in this cross-sectional study using a random sampling procedure. The Nordic Questionnaire was used to assess work-related musculoskeletal disorders. To determine the significance of age, BMI and working experience with pain and discomfort in different regions of the body, Pearson Correlation test was done.Results: Musculoskeletal disorder among fishermen due to extreme physical demand during the hauling of fishing nets on the raft in Jamuna River and its tributaries with the prevalence significantly higher. All body region were affected by musculoskeletal problems, among them the highest prevalence found in lower back and lowest in upper back (37.3%) region. There were significant associations of age with wrist pain (P=0.039), lower back pain (0.025) and knee pain (0.021). There was no significant association of BMI with any pain or discomfort. Total working experience of fishermen had significant association with pain or discomfort within last 12 months in shoulder (p=0.008), wrist (0.023), lower back (0.022) and knee (0.001).Conclusion: Long hours of fishing in a traditional fishing boat with age-old equipments adopting inconvenient ergonomic posture can lead high prevalence of musculoskeletal problems among fishermen. KYAMC Journal Vol. 14, No. 01, April 2023: 11-15

Prevalence of Musculoskeletal Disorders among Garment Workers: A Cross-Sectional Study in Bangladesh

Background: The prevalence of musculoskeletal disorders is particularly high among garment workers, which poses a serious occupational health hazard. This issue is not taken seriously as an important issue in low-income countries like Bangladesh. Aim: Determine the prevalence of musculoskeletal conditions (MSDs) among garment workers in nine body regions and explore the relationship between MSDs and the general characteristics of the participants. Materials and methods: A cross-sectional study including 383 garment workers was done. A structured questionnaire (Standardized Nordic Musculoskeletal) was used. Results: The most common form of pain in the last year was lower back pain. Nine anatomical locations were studied, and workers most commonly experienced problems with their lower back (45.4%), upper back (36.6%), and knees (33.2%). Workers reported having more trouble in the knee (31.9%), upper back (35.0%), and lower back (43.9%) regions over the past seven days. In the past year and the last seven days, shoulder injuries were the least common. Conclusion: MSDs are widespread among garment industry employees. The back condition is the most commonly affected. The development of MSD is directly correlated with age and work experience.

External Load Monitoring in Female Basketball: A Systematic Review.

The primary aim of this systematic review was to summarize the current state of research in relation to external load monitoring in female basketball. The review was conducted according to the PRISMA-P® statement. Publications included in the review: 1) were original research, 2) evaluated healthy female basketball players, and 3) monitored basketball practice and competition. The STROBE scale was used to assess quality. A total of 40 publications were included. The external load was assessed during practice (n = 9), competition (n = 11) or both events (n = 8). Also, time-motion analysis was implemented in practice (n = 2), competition (n = 9), or both events (n = 1). Accelerometry (n = 28) and time-motion (n = 12) analysis were the most frequently used methods. However, a wide range in methods and variables were used to quantify the external load. Placement of devices on the upper back and measuring with a sampling frequency of 100 Hz were most common. Player Load (PL) values increased with the competitive level of players and were higher in competition compared to training. Small-sided games can be used to gradually increase loads in female basketball (PL 5v5: 34.8 ± 8, PL 3v3: 47.6 ± 7.4, TD 5v5: 209.2 ± 35.8 m, and TD 3v3: 249.3 ± 2.8 m). Tasks without defense seemed to be less demanding. More research is needed to reach a consensus on load control in women's basketball, on what data are important to collect, and how to use and transfer knowledge to stakeholders.

Digital Survey Assessment of Individual and Occupational Factors Associated with Musculoskeletal Disorders among Indian Ophthalmologists.

To study the prevalence of musculoskeletal disorder (MSD) and the associated occupational risk factors among Indian ophthalmologists, including residents and fellows. A cross-sectional survey was conducted among ophthalmologists in India using a semi-structured questionnaire in a web-based survey. The questionnaire was prepared in English after extensive literature research and consulting with subject experts. It was pretested on ten ophthalmologists and after confirming that there were no ambiguities, the questionnaire was circulated. After providing informed consent online and ensuring the confidentiality of information, respondents could fill out the questionnaire containing questions to assess demographic details, risk factors, and musculoskeletal symptoms. We received 551 valid responses, out of which 74.77% reported musculoskeletal symptoms since starting practice in ophthalmology. We found a statistically significant association of work-related MSD with greater hours of practice, a higher number of hours of surgery, and a larger patient load. The self-reported symptoms were maximum in lower back (56.55%), followed by neck (49.03%), upper back (38.59%), and shoulder (23.79%). As a remedial measure, 58.98% resorted to rest while only 8.98% consulted orthopedist. Only 46% were aware of good ergonomic practices. Surgery (74.5%), indirect ophthalmoscopy (51.69%), and slit-lamp examination (50.73%) were reported as the major culprits. Respondents declared an interference with personal life (39.56%), with work (33.74%) as well as having caused psychological stress (43.2%) due to work-related MSD. A vast majority of our respondents reported work-related MSD. Major risk factors were hours of practice, hours of surgery, higher body mass index, sedentary lifestyle, and higher patient load. The awareness of ergonomic practices was low.

Description of Musculoskeletal Disorders in Dental Professional Program Students at Dental and Oral Hospital of Universitas Muhammadiyah Semarang

Background: Dentists when performing treatment to patients require accuracy which results in the dentist having to look down at the patient (awkward position) which can cause Musculoskeletal Disorders (MSDs). This complaint can also occur in dental students because if they perform treatment in the wrong position, repeatedly, for a long time it can cause Musculoskeletal Disorders (MSDs). The aim of this study was to know the description of Musculoskeletal Disorders complaints in Dentist Professional Program Students at RSGM Unimus. Method: This research is a descriptive study with a cross-sectional approach. The subjects were dental students with more than one year of practice at RSGM Unimus as many as 38 people with sampling technique using accidental sampling. The data collection technique was done by interview using Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) instrument. Result: Most respondents were female (84.2%), 25 years old (39.5%), and the length of daily practice was about 2 hours (39.5%). Most respondents had mild Musculoskeletal Disorders (MSDs) complaints in all parts of the body, but there were also severe complaints in the lower back (23.7%), neck (7.9%), upper back (7.9%), and waist or buttocks (7.9%). Conclusion: Musculoskeletal Disorders (MSDs) complaints among dental students at RSGM Unimus are still in the low category but there are also body parts that have severe categories, namely the lower back, neck, upper back, and waist or buttocks.

Neck Pain Among Occupational Bike Riders Wearing Helmet in Twin Cities: A Cross Sectional Survey

Neck pain is a pain, stress, and fatigue of the muscles in or around the spine beneath head. Sometimes this pain may continue from the neck region into the shoulders, arms and upper back. Bike riders wearing helmet are more prone to neck pain due to prolonged use of helmet. Objective: To find the frequency of neck pain in bike riders who wear helmet in Twin Cities. Methods: A descriptive cross-sectional survey was conducted among bike riders wearing helmet working with Careem, Bykea and InDriver considering non-probability convenient sampling. 227 participants were selected agreeing to inclusion and exclusion criteria. Data were collected from bike riders at different locations of Rawalpindi and Islamabad. Association of neck pain to the use of helmet and weight was observed in this study. Pain intensity was measured by Neck Pain and Disability Scale. Data were analyzed by using SPSS 26. Results: Out of 370 participants, 227 were helmet users, 149 (65.6%) had neck pain. 78 participants wearing helmet did not feel neck pain. Conclusions: This study concluded that there was 65.6% frequency of neck pain among bike riders wearing helmet in Twin Cities

IDENTIFICATION OF TOPOLOGICALLY CHARACTERISTIC MUSCULOSKELETAL PAIN OCCURRENCE AMONG YOUNG FEMALE ATHLETES

The purpose of this study was to identify pain occurrence among young female athletes in aesthetic sports by defining the proportions of pain status of fourteen body regions. Three groups of young female athletes (artistic gymnasts, rhythmic gymnasts and contemporary dancers) were analysed and compared. The sample consisted of overall 99 competitive athletes. Using the “Self-estimated functional inability because of pain” (SEFIP) questionnaire, athletes were asked to assess their current pain status in 14 body regions on a 5-point scale, with 0 being no pain and 4 being pain so severe that they are unable to practice. According to the Wilk’s test there was a significant multivariate effect (F= 4.60; p&lt;0.001) between artistic gymnasts, rhythmic gymnasts and compulsory dancers in training experience and body status. The most common locations for incidence of pain on the total sample of subjects were in the lower back (44%), knees (35%) and ankles/feet (31%). Artistic gymnasts mostly report pain in the ankles/feet (51.43%), and lower (37.14%) and upper back (34.29%). Rhythmic gymnasts of the same age mostly report pain in lower back area (46.42%), knees (42.86%) shins, ankles and feet (28.57%)¸ while dancers experience pain mostly in lower back (50%), upper back (44%) and knees (38.89%). According to the results of the Chi-square test, artistic gymnasts reported significantly higher pain incidence in ankles/feet region (p&lt;0.01). Early detection of even low intensity pain, accompanied with the adjustment of training load and usage of appropriate safety requirements, can prevent the occurrence of injuries among young athletes.

The Impact of Harvesting Height on Farmers’ Musculoskeletal Tissue

This study aimed to examine whether different agricultural work patterns may cause MSDs in different body areas and assess their severity. In previous studies, musculoskeletal disorders (MSDs) have been recognized as an occupational disease in agricultural workers. However, not all MSDs resulting from agriculture occur in the same body areas or have similar severity. This study conducted a questionnaire survey to inquire about the body areas and severity of MSDs among fruit farmers. A total of 212 valid answers were collected. Subsequently, their main harvesting postures were classified into three groups to examine the differences in MSD occurrence and severity among those groups. The results indicate that the harvesting posture did result in different severities of MSDs in certain body areas. Raising hands above the shoulders caused significantly higher MSD severity in the neck, shoulder, upper back, and elbows despite the same standing posture. Additionally, those who squatted, bent, or kneeled had a significantly higher severity of MSDs in the shoulders compared to those who stood but did not raise their hands above their shoulders. This study confirmed that the different harvesting heights of fruits can affect farmers’ posture, leading to differences in the body areas affected by, and severity of, MSDs.

Clinical characteristics of patients with hypermobile type Ehlers-Danlos syndrome (hEDS) and generalized hypermobility spectrum disorders (G-HSD): an online survey.

To examine the perspective of individuals with Hypermobile Ehlers-Danlos Syndrome (hEDS) and Generalized Hypermobility Spectrum Disorder (G-HSD), needed to help identify priorities and improve the lives of people living with these conditions. We conducted an online survey between November 2021 and January 2023. Participants were recruited through the Ehlers-Danlos Society's Research Surveys website. We obtained 483 responses and 396 were analyzed. 80% of the survey's respondents were individuals with hEDS, 90% were females, 30% were between 21 and 30, and 76% lived in North America, with 85% of the participants living in North America indicated being White or European American. Participants reported exercising from none to less than three times per week, with no physical therapy treatment. Ninety-eight percent of participants reported pain mainly at the neck (76%), lower (76%) and upper back (66%), knees (64%), shoulders (60%), and hips (60%). Approximately 80% of participants reported fatigue, joint hypermobility, joint instability, interference with daily activities, gastrointestinal problems, orthostatic hypotension, muscle weakness, and emotional distress. About 60% of respondents indicated walking issues, balance issues, and reduced joint proprioception. Nearly 40% of participants reported pelvic floor dysfunction and cardiovascular problems. Participants with hEDS and G-HSD reported pain on an average (SD) of 6.4 (± 1.3) and 5.9 (± 1.5) days in a typical week, respectively. People with hEDS and G-HSD desperately need more effective treatment options, a better diagnostic process, and education among health care providers.

CPC07 Lupus comedonicus: a not so common entity

Abstract Lupus comedonicus (LC) is an exceedingly rare variant of chronic cutaneous lupus erythematosus (CCLE), with only 13 reported cases in the literature to date. While its aetiology remains unknown, hallmarks include the presence of comedones on erythematous plaques, particularly in seborrhoeic areas. We report a case of LC involving the scalp, concha bowl and upper back. A 53-year-old female smoker with a 20-pack-year history and previous unprovoked pulmonary embolism presented to dermatology with a 2-year history of alopecia and rash affecting her face and upper back. She was initially reviewed by oral medicine for ulcers, where erythematous buccal mucosal plaques with white striations were seen. The initial biopsy showed a patchy lichenoid inflammatory infiltrate, raising suspicions for lichen planus; however, repeat biopsy highlighted perivascular inflammation and keratin plugging suggestive of lupus. Full skin examination revealed patchy scarring alopecia with perifollicular scale and erythema. Erythematous infiltrated plaques were seen on the face with similar more indurated lesions on the upper back associated with open comedones. The eponymous Shuster sign was observed in the left conchal bowl, with associated follicular occlusion. Laboratory studies all returned within normal limits, including antinuclear antibody titres and complement levels. Differential diagnosis included lupus erythematosus tumidus, discoid lupus erythematosus and LC. Lesional biopsies taken from her back confirmed LC, highlighting lichenoid inflammation involving follicles and interfollicular skin, with superficial and deep perivascular infiltrate. We commenced oral hydroxychloroquine at 200 mg once daily for management, with topical mometasone furoate 0.1% to be used while awaiting its full effect. Smoking cessation has also been advised given the potentially antagonistic effect of smoking with lupus and hydroxychloroquine. Hypotheses of the pathogenesis of LC include the effect of sun exposure. Ultraviolet radiation is known to not only enhance the activity of CCLE but may also contribute to the formation of comedones. Actinic damage alters collagen of normal skin, promoting sebum retention and follicular plugging. Given its infrequency, LC could be mistaken for benign conditions, including acne vulgaris, naevus comedonicus and Favre–Racouchot disease. It is plausible that the small case numbers are due to current underdiagnoses. It is important for dermatologists to be aware of and accurately diagnose LC. Apart from its potentially destructive, scarring complications, especially in untreated and misdiagnosed cases, it is associated with systemic lupus in 30% of cases. Delay in diagnosis and therapeutic management can be associated with significant potential morbidity and even mortality.

BI24 Cutaneous pseudolymphoma secondary to pembrolizumab

Abstract A 35-year-old man presented with a 7-week history of itchy, nontender, indurated erythematous plaques and nodules on his forehead and upper back, with no discriminatory clinical features. He was systemically well. Three months previously, he had completed a 12-month course of adjuvant pembrolizumab for stage IIIC melanoma. The primary melanoma had been excised from his left cheek, with involvement of left parotid and supraclavicular lymph nodes, treated with clearance via superficial parotidectomy and left neck dissection. Clinical and imaging surveillance revealed no evidence of melanoma recurrence. Incisional biopsies of the lesions on his back and forehead both demonstrated a superficial and deep dermal perivascular and periadnexal infiltrate of small- and medium-sized lymphoid cells. There was no epidermotropism and B- and T-cell clonality studies were negative. Morphological appearance and immunophenotype favoured a CD4+-reactive lymphoid process in keeping with cutaneous pseudolymphoma (CPL), secondary to pembrolizumab. The conspicuous forehead lesion was unresponsive to clobetasol propionate under occlusion. A single course of intralesional triamcinolone acetonide 10 mg mL–1 resulted in significant improvement within days, with subsequent complete resolution. The lesion on the back resolved spontaneously. Drug-induced CPL describes an adverse cutaneous drug reaction mimicking B- or T-cell lymphomas clinically and/or histologically. It has been described with anticonvulsants, antidepressants and biologic agents, often with resolution on cessation of the responsible drug (Etesami I, Kalantari Y, Tavakolpour S et al. Drug-induced cutaneous pseudolymphoma: a systematic review of the literature. Australas J Dermatol 2023; 64:41–9). It has been proposed that the drugs affect immune surveillance, leading to an abnormal cutaneous lymphocyte response. A case report (Ayoubi N, Haque A, Vera N et al. Ipilimumab/nivolumab-induced pseudolymphoma in a patient with malignant melanoma. J Cutan Pathol 2020; 47:390–3) has described drug-induced CPL secondary to ipilimumab and nivolumab in a 38-year-old man presenting with erythematous plaques on the hands and face, similar to the presentation of our patient, which responded to prednisolone. As with the other adverse effects of immunotherapy, it is likely that CPL in this cohort is due to an iatrogenic immune dysregulation leading to T-cell overactivity. We present the first reported case of CPL secondary to pembrolizumab and highlight the successful use of intralesional steroid as a treatment option. It is important to recognize CPL as an adverse cutaneous effect of immunotherapy and be aware that it can present after completing treatment due to an ongoing immune response.

Effects of Corrective Exercises on Work-Related Musculoskeletal Disorders and Quality of Life in Surgical Residents: A Pilot, Quasi-Experimental Study

Work-related musculoskeletal disorders (WMSDs) are one of the most important reasons for absenteeism, high costs of health care and human injuries; the latter are very common in medical staff. The present study was designed to evaluate the effects of corrective exercises on quality of life and work-related musculoskeletal disorders in surgical residents. In a quasi-experimental study with a one-group pretest-posttest design, we assessed the eligibility of 135 surgical assistants. All recruited participants performed corrective exercises and were followed for 12 months. The primary outcome of the study was any change in the surgical residents' work-related musculoskeletal disorders, which was assessed using the Nordic Musculoskeletal Questionnaire(NMQ) and the Numerical Pain Rating Scale (NPRS) prior to, and 3, 6, and 12 months after intervention. The secondary outcome was any change in the surgical residents' quality of life (QOL) score, which was assessed at baseline, 6 and 12 months after the intervention using the World Health Organization Quality of Life - BREF (WHOQOL-BREF) questionnaire. One hundred eligible surgical residents were enrolled, of whom 67 (67%) completed the study. At baseline the majority of the participants were female and >30 years of age. Fifty-five percent of them used analgesic drugs. The use of analgesic drugs per week fell by 14.7% from baseline to 12 months; the change was statistically significant (p = 0.042). The effect of corrective exercises on the intensity of pain in the shoulder (p = 0.002), hand/wrist (p = 0.001), upper back (p = 0.03), lower back (p = 0.02) and knee (p = 0.01) was significant. Corrective exercises also led to a significant rise in the quality-of-life score (p < 0.019). This study demonstrated the effectiveness of corrective exercises in reducing work-related musculoskeletal disorders and improving quality of life among surgical residents.