Breast Pain Research Articles

Diagnostic Challenge: A case report of primary breast tuberculosis mimicking recurrent pyogenic breast abscess

Introduction: Breast tuberculosis is a rare form of extra pulmonary tuberculosis with its primary form considered even rarer. Case presentation: A 28-year-old female initially diagnosed with a breast abscess presented with chronic right breast pain and nipple discharge. Despite initial treatment, symptoms recurred, and further investigations revealed a space-occupying lesion. Fine needle aspiration confirmed recurrent breast abscess, but subsequent DNA detection of tubercular bacilli in the pus sample led to a diagnosis of primary breast tuberculosis, necessitating anti-tubercular therapy. Clinical discussion: Breast tuberculosis, being rare and often misdiagnosed as an abscess, poses diagnostic challenges. However, Persistent symptoms despite treatment should prompt consideration of breast tuberculosis in TB endemic regions. Conclusion: Primary Breast Tuberculosis might not have any systemic symptoms to drag the clinician towards a possible diagnosis so culturing the aspirate for acid-fast bacilli or looking for MTB DNA in the available clinical sample should always be kept in mind for better outcomes.

Clomiphene citrate as a new modality in management of vaginal bleeding with depomedroxyprogesterone acetate (DMPA): A randomized controlled trial

BackgroundDepo-medroxyprogesterone acetate (DMPA) functions as a contraceptive method by inhibiting the secretion of gonadotropins, which prevents follicular maturation and ovulation, as well as thinning of the endometrium leading to unscheduled vaginal bleeding and subsequent discontinuation of DMPA. Our study aimed to evaluate the efficacy and safety of clomiphene citrate (CC) in stopping bleeding among DMPA users. Materials and MethodsWe randomly assigned 200 DMPA users using a computer-generated random numbers table in a 1:1 ratio to one of two groups; the study group, which received CC at a dose of 50 mg twice daily for five days (n = 100), and the control group, which received a placebo for five days (n = 100). Our primary outcome measure was the onset and duration of bleeding cessation. Secondary outcomes included endometrial thickness, recurrence of vaginal bleeding, and any reported side effects associated with CC use. ResultsClomiphene citrate significantly resulted in early cessation of vaginal bleeding in 83 % of the patients, which continued for three months of follow-up. In addition, the recurrence of vaginal bleeding was significantly reduced in the CC group compared to the control group (11 % vs. 67 %; p < 0.001). Endometrial thickness was significantly greater in the CC group than in the control group (p < 0.001). Breast tenderness was more frequently reported in the study group, with no difference in dyspareunia between the two groups. ConclusionsClomiphene citrate is effective in controlling bleeding among DMPA users. Further studies are encouraged to confirm our findings.

Acute adverse events of ultra-hypofractionated whole-breast irradiation after breast-conserving surgery for early breast cancer in Japan: an interim analysis of the multi-institutional phase II UPBEAT study

BackgroundThe applicability of ultra-hypofractionated (ultra-HF) whole-breast irradiation (WBI) remains unknown in Japanese women. This study aimed to evaluate the safety and efficacy of this approach among Japanese women and report the results of an interim analysis performed to assess acute adverse events (AEs) and determine whether it was safe to continue this study.MethodsWe enrolled Japanese women with invasive breast cancer or ductal carcinoma in situ who had undergone breast-conserving surgery, were aged ≥ 40 years, had pathological stages of Tis–T3 N0–N1, and had negative surgical margins. Ultra-HF-WBI was delivered at 26 Gy in five fractions over one week. When the number of enrolled patients reached 28, patient registration was paused for three months. The endpoint of the interim analysis was the proportion of acute AEs of grade ≥ 2 (Common Terminology Criteria for Adverse Events v5.0) within three months.ResultsOf the 28 patients enrolled from seven institutes, 26 received ultra-HF-WBI, and 2 were excluded due to postoperative infections. No AEs of grade ≥ 3 occurred. One patient (4%) experienced grade 2 radiation dermatitis, and 18 (69%) had grade 1 radiation dermatitis. The other acute grade 1 AEs experienced were skin hyperpigmentation (n = 10, 38%); breast pain (n = 4, 15%); superficial soft tissue fibrosis (n = 3, 12%); and fatigue (n = 1, 4%). No other acute AEs of grade ≥ 2 were detected.ConclusionsAcute AEs following ultra-HF-WBI were within acceptable limits among Japanese women, indicating that the continuation of the study was appropriate.

Effectiveness of Evening Primrose and Vitamin E for Cyclical Mastalgia: A Prospective Study.

Cyclical mastalgia, which is characterized by cyclic breast pain associated with the menstrual cycle, is a common condition among premenopausal women. Despite their prevalence, effective treatment options remain limited. Evening primrose oil (EPO) and vitamin E have been proposed as potential therapies for cyclical mastalgia; however, their efficacy remains uncertain, particularly when used in combination. This study aimed to evaluate the efficacy of EPO, vitamin E, and their combination in alleviating breast pain associated with cyclical mastalgia through a randomized controlled trial. Premenopausal women (n=126) with cyclical mastalgia were recruited from gynecology clinics and randomized to receive EPO (1000 mg twice daily), vitamin E (400 mg once daily), their combination, or a placebo for six months. Randomization was performed using computer-generated random numbers. Participants were assessed at baseline and monthly intervals for six months. The primary outcome was the change in breast pain severity measured using a validated pain questionnaire such as the short-form McGill Pain Questionnaire. The secondary outcomes included changes in breast pain characteristics, adverse effects, and treatment adherence. A total of 126 participants participated in this study. The combination of EPO and vitamin E demonstrated superior efficacy in reducing breast pain severity compared with individual treatments and placebo (p < 0.001). Participants in the combination group experienced a mean reduction in breast pain severity of 4.5 points on the pain scale, whereas those in the EPO and vitamin E groups experienced reductions of 2.5 and 3.0 points, respectively. Both EPO and vitamin E alone also showed significant improvements compared with placebo (p < 0.05), with mean reductions in breast pain severity of 2.0 and 2.5 points, respectively. Adverse effects were minimal and comparable across the treatment groups. Combination therapy with EPO and vitamin E appears to be an effective treatment option for cyclical mastalgia, offering superior pain relief compared with individual treatments and placebo.

IJCM_31A: Menstrual characteristics and school absenteeism among adolescent school girls of Aligarh--A Cross-sectional Study

Background: Menstruation is a significant event during adolescence. It is often a challenging period for adolescent girls since it poses significant challenges. The stigma associated with menstruation, difficulties due to menstrual disorders, and period poverty can often lead to school absenteeism and school dropout among girls. Objectives: 1) To identify menstrual characteristics and explore the symptoms associated with menstrual cycles among adolescent schoolgirls of Aligarh. 2) To examine whether adolescent schoolgirls experience absenteeism during menstruation and to elucidate the reasons for such occurrences. Methodology: This is a cross-sectional study carried out among adolescent school girls of Aligarh. Two urban and two rural schools were selected randomly from the co-educational schools in Aligarh, with inclusion criteria comprising adolescent girls in grades six to ten who had experienced menarche at least six months prior. Parental consent and participant assent were obtained, resulting in the participation of 164 students. Data collection was conducted through a questionnaire method. Results: The respondents’ average age was 14.5±1.33 years, with 84.1% exhibiting regular menstrual cycles out of the 164 participants. The mean age at menarche was 12.7±1.02, and the average duration of menstruation was 4.90±1.54 days. Only 12% of students did not experience pain during menstruation, while the majority reported mild (35.4%), pain only on the first day (30.5%), or excessive (2.8%) pain. Predominant pre-menstrual symptoms included irritability, mood disturbances, and breast tenderness. Despite these challenges, a majority of students (84.1%) affirmed not taking leave during menstruation. Among those who did, the reasons included a lack of facilities for changing pads, insufficient disposal systems for pads, and dysmenorrhoea. Conclusion: This study sheds light on the menstrual characteristics and challenges faced by adolescent schoolgirls in Aligarh. Despite the challenges, the students attend school during menstruation which shows the importance of targeted interventions to address the challenges

A Challenging Conundrum; Learning Disability, Schizophrenia and Autism - a Case Report

IntroductionPsychiatric disorders are common in patients with learning disabilities. There are also patients with the triad of autism, schizophrenia and learning disability. Patients with this background can be admitted to general hospitals for psychiatric or non-psychiatric reasons.We are presenting a case who had a very complicated clinical course and her discharge planning was challenging.ObjectivesThe objective of this work was to show the challenges in the investigation, medical management, and discharge planning of the patients with concomitant learning disability, schizophrenia and autism.MethodsWe scrutinized the patient’s casenotes, including blood results and all relevant imaging. We paid a particular attention to all the entries from the psychiatry team, general medical doctors, oncologists, learning disability team and discharge planners.ResultsThe lady had a protracted 4-month inpatient admission throughout which she was physically and verbally aggressive to hospital staff. She was deemed to lack capacity for hospital admission and treated in her best interests under Mental Capacity Act (MCA), frequently requiring sedation with Haloperidol and Lorazepam. Following consultation with the local Psychiatrist her medications were altered to: Risperidone 2 mg BD, Diazepam 5 mg OM, 5 mg afternoon and 10 mg evening, Procyclidine 5 mg BD, Chlorpromazine 25 mg BD, Promethazine 25 mg OD PRN, and Midazolam 10 mg buccal PRN.A change in her clinical condition was noted by the Psychiatry team; increased agitation, confusion and dysarthria. A repeat blood test was advised, due to patient refusal this took weeks to achieve despite the use of buccal Midazolam following Anaesthesiologist advice. Although blood tests were not significantly deranged, she was treated for presumed urinary tract infection with a course of antibiotics. A urine sample was unobtainable.She reported right breast pain and underwent a mammogram. This showed a hypoechoic lesion 8x7x9 mm. Following consultation with a Breast Surgeon and Oncologist, Letrozole was replaced with Tamoxifen. The Psychiatric team concluded that the clinical deterioration with dysarthria was related to anxiety, associated with Autistic patients. The movement disorder was deemed secondary to antipsychotics exacerbated by stress and anxiety.The patient’s discharge planning was complex. She was declined by numerous care homes. At time of writing, she remains an inpatient.ConclusionsThe management of patients with a triad of Learning Disability, Schizophrenia and Autism is extremely difficult, particularly within an acute medical setting. Physical deterioration could be related to medication adverse effects or change in environment. Anxiety and stress are linked to these conditions. The challenging behaviour that these patients often have will make discharge planning very difficult as specialised care homes to accommodate these unique patients are very limiteDisclosure of InterestNone Declared

A Study Comparing Centchroman and Evening Primrose Oil in the Treatment of Benign Breast Disease

ABSTRACT Introduction: Females seeking medical attention at breast clinics commonly present with nonmalignant breast conditions, including nonspecific breast pain or distinct masses like fibroadenomas. Due to its variability, it may be difficult to quantify breast pain. The purpose of the research was to compare centchroman and evening primrose oil to identify a cost-effective, secure, and efficient treatment for benign breast disease. Material and Methods: In this prospective hospital-based observational study, 100 breast diseases with or without lumpiness for 1 year were included and divided into two groups with 50 cases each, Group-A (Centchroman) and Group-B (Evening primrose oil). Results: Centchroman exhibited a significantly greater treatment response for alleviating pain-free mastalgia compared to evening primrose oil. Additionally, centchroman showed an excellent response (P &lt; .05). Among participants with mastalgia, centchroman significantly reduced the number of mastalgia patients with tender nodularity post-treatment (P = .035) than evening primrose oil. On the basis of fibroadenoma, partial and complete response was significantly seen in higher number of cases in the centchroman group (P = .007). Conclusion: Centchroman therapy demonstrates that the treatment for benign breast disease is safe, effective, and economical.

Best acupuncture method for mammary gland hyperplasia: Evaluation of randomized controlled trials and Bayesian network meta-analysis

ObjectiveTo evaluate the effectiveness of different acupuncture treatments for mammary gland hyperplasia (MGH) using a network meta-analysis. MethodsSeveral databases were searched without language restrictions from 2000 to February 2023, including PubMed, Embase, Web of Science, Cochrane Library, China Science and Technology Journal Database, China Biology Medicine Database, Wanfang Database, China National Knowledge Infrastructure Database, and other professional websites and gray literature. Inclusion criteria were adult women diagnosed with MGH; intervention measures included acupuncture and related therapies; the control group was treated with simple drugs; and the research type was a randomized controlled trial (RCT). The primary outcomes were treatment effectiveness and estradiol and progesterone levels. Secondary outcomes were breast lump size and visual analog scale (VAS) score of breast pain. Exclusion criteria were studies unrelated to MGH, incorrect study populations, control measures or interventions, incomplete data, non-RCTs, case reports, and animal experiments. Cochrane tools were used to assess the risk of bias. The R software (x64 version 4.2.1), Review Manager 5.3 software and STATA 16.0 software were used for data analysis. ResultsFollowing a rigorous screening process, data extraction, and quality assessment, 48 eligible RCTs encompassing 4,500 patients with MGH and 16 interventions were included. The results indicated that acupuncture, alone or in combination with traditional Chinese or Western medicine, had better therapeutic effects than conventional therapy. In terms of effectiveness, warm needle acupuncture was the best choice (94.6%). Bloodletting pricking was the most effective method (85.7%) for lowering progesterone levels. Bloodletting pricking was the most effective method (98.3%) for lowering estradiol levels. Manual acupuncture combined with traditional Chinese medicine was the most effective (74.5%) treatment to improve the size of the breast lump. Warm needle acupuncture was the most effective (69.8%) in improving the VAS score. ConclusionAcupuncture therapy was more effective in treating MGH than drug therapy alone, and warm needle acupuncture and bloodletting pricking were the two best options. However, larger sample sizes and high-quality RCTs are required.

GAMBARAN FAKTOR YANG BERHUBUNGAN DENGAN KEJADIAN BENDUNGAN ASI PADA IBU NIFAS DI WILAYAH KERJA UPT PUSKESMAS PANCA MAKMUR TAHUN 2023

The postpartum period is the most vulnerable period for morbidity, one of the causes of morbidity in postpartum mothers is problems with the lactation process. During the puerperium infection and inflammation of the breast can occur, infection occurs through wounds on the nipples, but maybe also through the blood circulation. The signs are chills accompanied by a rise in temperature, sufferers feel lethargic and have no appetite. The cause of the infection is usually staphylococcus aureus, enlarged breasts, breast pain in a place where the skin is red, swollen, and painful to touch. Therefore it is necessary to prevent one of them with breast care.The purpose of this study was to analyze the description of the factors associated with the incidence of breastfeeding in postpartum mothers in the working area of ??the UPT Panca Makmur Health Center, North Morowali Regency in 2023.This study uses a quantitative research method. The research design used in this study is a descriptive survey. Based on the total sampling technique, the number of samples obtained was 33 respondents. The results showed the characteristics of the respondents in terms of age, parity, education and occupation. The average number of respondents aged 25 to 30 years was 16 people (48.5%), while the parity of respondents was more dominant primipara and multipara as many as 13 people each (39.4%), for education more dominant high school graduates were 14 people (42.4%), and 17 people (51.5%) do not work for more dominant jobs. Factors related to breast milk retention include experience of breastfeeding, frequency of breastfeeding, technique of suckling, and shape of the nipples. Regarding breastfeeding experience, only 3 (9%) of mothers who had breastfed before experienced breast milk retention. While mothers who breastfeed more than 12 times, only 5 people (15%) experience breast milk retention. For proper breastfeeding techniques, only 7 people (21%) had normal nipple shapes, and only 1 person (3%) had breast milk.It is hoped that health workers can improve health services to the community, especially for women of reproductive age regarding postpartum health in dealing with breast milk dams during the postpartum period.

The prevalence of premenstrual syndrome symptoms and associated factors among female medical students at Al-Andalus University: a cross-sectional study

Background: Premenstrual syndrome (PMS) is a menstrual disorder defined as a cluster of various physical, emotional, and behavioural symptoms that negatively affect women’s quality of life. This cross-sectional study aimed to assess the prevalence of common PMS symptoms and determine their association with body mass index (BMI), lifestyle, dietary habits, perceived stress, menstrual flow, family history and family income among medical students at Al-Andalus University in Syria. Methods: A sample of 205 female students were interviewed and filled out a questionnaire. All data were coded and entered into excel (Microsoft 2019). One-way analysis of variance (ANOVA) and Chi-square tests were used to evaluate the association between PMS symptoms and the studied factors. Results: The most frequently reported PMS symptoms were anxiety (80%), bloating (74.6%), and breast tenderness (62.9%). Our study found a significant association between weight gain pre-menstruation and BMI (p=0.02). A significant relationship was found between increased premenstrual consumption of sweets and both breast tenderness and bloating (p=0.01). Daily consumption of coffee was significantly correlated with weight gain and headaches (p&lt;0.001). This study found a significant relationship between smoking cigarettes and abdominal and back pain (p=0.04, p=0.02, respectively). Smoking shisha was significantly associated with fatigue and bloating (p=0.01, p&lt;0.001, respectively). A significant relationship was found between menstrual flow and both abdominal pain and headaches (p=0.01, p=0.02, respectively). Conclusions: A high prevalence of PMS symptoms was reported in Al-Andalus University female medical students. Additionally, this study found multiple significant associations between BMI, dietary habits, lifestyle, menstrual flow and the severity of symptoms.

An Image-Rich Educational Review of Breast Pain.

Breast pain is extremely common, occurring in 70% to 80% of women. Most cases of breast pain are from physiologic or benign causes, and patients should be reassured and offered treatment strategies to alleviate symptoms, often without diagnostic imaging. A complete clinical history and physical examination is key for distinguishing intrinsic breast pain from extramammary pain. Breast pain without other suspicious symptoms and with a negative history and physical examination result is rarely associated with malignancy, although it is a common reason for women to undergo diagnostic imaging. When breast imaging is indicated, guidelines according to the American College of Radiology Appropriateness Criteria should be followed as to whether mammography, US, or both are recommended. This review article summarizes the initial clinical evaluation of breast pain and evidence-based guidelines for imaging. Additionally, the article reviews cyclical and noncyclical breast pain and provides an image-rich discussion of the imaging presentation and management of benign and malignant breast pain etiologies.

Efficacy of Oral Prednisolone in the Management of Idiopathic Granulomatous Mastitis

Background: Idiopathic granulomatous mastitis (IGM) is a benign inflammatory lesion of the mammary gland. Globally it possesses a major diagnostic and therapeutic problem. To date, there is no universally agreed treatment for this condition. Many treatment modalities have been attempted from conservative therapy to mastectomy but none of them has shown satisfactory results. Recent studies have shown promising results of corticosteroids on idiopathic granulomatous mastitis, so steroid therapy can be an effective treatment for idiopathic granulomatous mastitis. The goal of the study is to provide a therapeutic strategy in the future for idiopathic granulomatous mastitis. Methods: Our study included all patients with idiopathic granulomatous mastitis confirmed histologically by core needle/incisional biopsy at the general surgery unit of Chittagong Medical College Hospital and the private hospitals in the Chittagong Metropolitan City for a period of one year from October 2016 to September 2017. A total of seventy patients were included in the study provided they fulfilled predetermined criteria. All of them were included in this study by purposive sampling. After diagnosis oral prednisolone (1mg/kg/day) was given and the cases were observed by personal interview and through telephone interview. The patients were on follow-up for 06 months. Age, size of the breast lump, breast pain, nipple discharge, and skin changes were recorded in all cases. Results were analyzed using mean, percentage, and proportion as appropriate. Results: The mean age was 26.35±13.5 years ranging from 19 to 40 years. Out of 70 patients, Core cut biopsy was done in 55 patients (78.58%), and incisional biopsy with abscess drainage was performed in 15 patients (21.42%). 59 patients (84.28%) had complete recovery after a single cycle of steroid treatment, remaining 11 patients (15.72%) had recurrence, among them 6 patients were cured after 2nd cycle of steroids but unfortunately, 5 patients did not respond. Though complications were found in 50 patients, all of them made good progress in the short term. Conclusion: We recommend steroid therapy as the first-line treatment in our study. However, prospective, randomized clinical trials are needed to determine the treatment algorithm. Mediscope 2024;11(1): 22-26

Comparison of Presentation Types and Clinical Findings of Rural and Urban Patients with Mastalgia: A Retrospective Analysis of 730 Patients from Turkey.

BACKGROUND Breast pain, prevalent among women of reproductive age, varies during menstrual cycles and is influenced by sociodemographic and clinical factors. This study aimed to assess these demographic and clinical variables in women with breast pain, considering the spatial distinctions between urban and rural locations. MATERIAL AND METHODS This retrospective study included 730 women presenting with mastalgia between 2010 and 2023. The study evaluated patient demographics, pain characteristics (eg, breast pain duration, site, quadrant-based localization, and radiation of breast pain), radiologic findings, and the presence of comorbid medical conditions. RESULTS There were 498 patients in the urban group and 232 patients in the rural group. Among the radiologic findings, the rate of mastitis was higher in the rural group (P.

Clinicopathological Study of Patients with Non-inflammatory Benign Breast Disease at Combined Military Hospital (CMH) Chattogram

Introduction: Breast lump is a very common problem among females attending surgical outpatient department. Its development and growth are under the control of various hormones and various physiological statuses like menstruation, pregnancy, lactation and menopause. Objectives: To evaluate the clinicopathological status of patients with non-inflammatory benign breast disease (NIBBD). Methods: This clinical study was conducted at the department of surgery, CMH Chattogram, this study was done during January 2018 to May 2019. Patient presented with breast lump, nipple discharge, sinus and mastalgia in whom histopathology revealed any type of non-malignant BBD were included in the study. Patient treated on outdoor patient basis were excluded and patient with malignant breast lesions or acute breast abscess requiring incision and drainage were excluded from the study. Results: Majority of the patients, 41(74.5%) had breast lump followed by 10(18.2%) had breast pain, 6(10.9%) had nipple discharge and 3(5.5%) had enlargement of breast. Most of the site was found unilaterally 54(98.2%). Majority of the patients, 27(49.1%) had fibroadenoma, 14(25.5%) had fibrocystic diseases, 10(18.2%) had fibroadenosis, 2(3.6%) had duct ectasia, 1(1.8%) had cystosarcoma Phyllodes and 1(1.8%) had Lipoma. Conclusion: Maximum age group was 3rd to 4th decade. Most of the patients clinically presented with lumps in the breast followed by pain, enlargement of breast, fever and nipple discharge. Mostly encountered breast lesion was fibroadenoma other common lesion were found fibrocystic diseases, fibroadenosis, duct ectasia, cystosarcomaphyllodes and Lipoma. JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 27-30

Ultra-hypofractionated one-week locoregional radiotherapy for patients with early breast cancer: Acute toxicity results

PurposeModerate hypofractionated radiotherapy is the standard of care for all patients with breast cancer, irrespective of stage or prior treatments. While extreme hypofractionation is accepted for early-stage tumours, its application in irradiating locoregional lymph nodes remains controversial. Materials and methodsA prospective registry analysis from July 2020 to September 2023 included 276 patients with early-stage breast cancer treated with one-week ultra-hypofractionation (UHF) at 26 Gy in 5 fractions on the whole breast (58.3 %) or thoracic wall (41.7 %) and ipsilateral regional lymph nodes and simultaneous integrated boost (58.3 %). Primary endpoint was assessment of acute adverse events (AEs). Secondarily, onset of early-delayed toxicity was assessed. A minimum 6-month follow-up was required for assessing potential treatment-related early-delayed complications. Acute or late complications attributable to treatment were assessed at inclusion using the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 criteria. ResultsWith a median follow-up of 19 months (range 1–49 months), 159 (57.6 %) patients reported AEs, predominantly grade (G) 1 (n = 139, 50.4 %) and G2 (n = 20, 7.8 %). Skin acute toxicity was common (G1/2: 134, G3: 14), while breast oedema occurred in 10 patients (G1: 9, G2: 1), and 15.9 % reported breast pain (G1: 42, G2: 2). Ipsilateral arm oedema was observed in 1.8 % patients. For patients with a follow-up beyond 6 months (n = 213), 23.4 % patients reported G1/G2 skin AEs, 8.8 % had G1/G2 breast/chest wall oedema, and 8.9 % experienced arm lymphedema. There were no cases of brachial plexopathy or G3 toxicity in this group of patients. ConclusionsOne-week UHF adjuvant locoregional radiation is well-tolerated, displaying low-toxicity profiles comparable to other studies using similar irradiation schedules.

Immune pathogenesis of idiopathic granulomatous mastitis: from etiology toward therapeutic approaches.

Idiopathic granulomatous mastitis (IGM) is a noncancerous, chronic inflammatory disorder of breast with unknown causes, posing significant challenges to the quality of life due to its high refractoriness and local aggressiveness. The typical symptoms of this disease involve skin redness, a firm and tender breast mass and mastalgia; others may include swelling, fistula, abscess (often without fever), nipple retraction, and peau d'orange appearance. IGM often mimics breast abscesses or malignancies, particularly inflammatory breast cancer, and is characterized by absent standardized treatment options, inconsistent patient response and unknown mechanism. Definite diagnosis of this disease relies on core needle biopsy and histopathological examination. The prevailing etiological theory suggests that IGM is an autoimmune disease, as some patients respond well to steroid treatment. Additionally, the presence of concurrent erythema nodosum or other autoimmune conditions supports the autoimmune nature of the disease. Based on current knowledge, this review aims to elucidate the autoimmune-favored features of IGM and explore its potential etiologies. Furthermore, we discuss the immune-mediated pathogenesis of IGM using existing research and propose immunotherapeutic strategies for managing this condition.

Theoretical and Hypothetical Study of Premenstrual Syndrome According to Ayurveda

Introduction: Premenstrual syndrome generally occurs in response to change in levels of hormones progesterone &amp; estrogen. A condition which manifests with distressing physical, behavioral &amp; psychological symptoms in absence of organic or underline psychiatric disease. Symptoms of it may interfere females professional life &amp; may alter her interpersonal harmony at social life. There upon over the period of time topic is selected to review on PMS. Aim: To review PMS according to Ayurveda. Methodology: Ayurvedic classics &amp; modern literature were scrutinized to postulate theoretical &amp; hypothetical study for understanding PMS. Review of Literature: Raymond Greene &amp; Katharina Daltone wrote about it for the first time in 1953. Observation: Acne , Breast tenderness, Bloating, Fatigue, Mood Swings, Aggression, Reduce Concentration etc are observed at physical, psychological as well as behavioral level. Discussion: According to Ayurveda Premenstrual Syndrome is manifested due to imbalance of bodily elements such as Tridosha, Dhatu, Updhatu etc. if further scrutinized in detailed it was found that Apana vayu is involving factor to produce the symptoms. As the sight of Apana Vayu is pelvic region &amp; it helps in regular timely excretion of urine, stool, fetus, menstrual fluid etc .Conclusion: It is Observed that symptomology of PMS is ranged at physical, physiological &amp; psychological level. Involvement of Tridosha, specifically symptoms of Prana, Udana, Apana Vayu vitiation were observed. Keywords: Apana Vayu, Ayurveda, Premenstrual syndrome

Menstrual Health and Prevalence of Menstrual Disorders Among Modern Society Females in Dhaka, Bangladesh: A Cross-Sectional Study

Background: Menstrual disorders affect women all around the world, although they are still viewed as minor health problems. Objective: The objective of this study is to investigate the prevalence of menstrual disorders among modern society females in Dhaka, Bangladesh, and explore potential factors that may influence these disorders. Study Design: It is a cross-sectional study using a convenient sampling technique. Method: A convenient sampling technique was used to collect primary data through a semi-structured questionnaire from 342 female residents of Dhaka, aged at least 15 years, between April 2021 and August 2021. Participants were from different demographic backgrounds. Results: The mean age of respondents was 22 years ± 8.03. Participants were predominantly educated, with many pursuing undergraduate studies. They mostly belonged to nuclear families (77.7%) and middle (59.5%) to upper-middle (33.1%) socio-economic classes. Prevalent premenstrual symptoms included a change in mood (71.6%), cramps (68.9%), abdominal bloating (45.9%), and breast discomfort (38.5%). Dysmenorrhea (50.6%) and menorrhagia (35.2%) were common, while polymenorrhea (10.8%) and oligomenorrhea were less frequent. Despite some knowledge about the negative influence of junk foods on menstrual health, a significant proportion of participants reported consuming junk foods regularly. Most participants had easy access to sanitary napkins and menstrual hygiene products. Conclusion: Menstrual disorders are prevalent among young women in modern Dhaka despite their good education rate. Lifestyle and diet are linked to their prevalence. Healthcare professionals must educate and counsel women on menstrual health. Collaborative efforts among professionals, policymakers, and researchers are needed to raise awareness and support women in managing these issues.

(050) Vulvodynia: Risk Associated with Vulvar/Vaginal, Psychological and Physical Side Effects of Oral Contraceptive Use

Abstract Introduction Research has shown that hormonal contraceptive (HC) use is associated with risk for vulvar pain [1] and vulvodynia [2,3]. Although some literature has focused on combined hormonal contraceptives (CHCs), Bouchard et al [2] found that risk was higher for those using high progestin potency HCs. In addition to increased risk associated with HC use, research also suggests that characteristics of the menstrual cycle (eg., premenstrual symptoms) are associated with risk for vulvodynia [4]. Objective Test for associations between having a diagnosis of vulvodynia (including vestibulodynia) and experiencing vulvar/vaginal, psychological, and physical side effects from OC use. Test for differences in these associations across estroprogestinic OCs, progesterone only OCs, and OCs of an unknown composition (based on self-reports). Methods A sample of 2199 females participated in a larger study on genito-pelvic pain and sexuality and provided data on both HC use and genito-pelvic pain. Efforts were made to recruit a heterogenous sample, with an oversampling of females with genito-pelvic pain. The dependent variable was a dichotomous variable of whether they had ever received a diagnosis of vulvodynia or vestibulodynia. Predictor variables were: ever used each type of OC (analyses conducted separately for estroprogestinic, progesterone only, and unknown type); and experiencing the following side effects associated with each OC type: vulvar pain (dichotomous), vaginal dryness (dichotomous), decreased sexual desire (dichotomous), affective symptoms (sum of dichotomous responses to: anxiety, nervousness, depression, anger, mood swings) and physical symptoms (sum of dichotomous responses to: cramps, back and joint pain, bloating, cellulite, breast discomfort). Three nominal logistic regression analyses were conducted (one for each OC), and a final nominal logistic regression was conducted combining the relevant predictors for each OC into one analysis. Results Of the 2199 participants, n=673 had never used OCs, n=827 had used them in the past, and n=699 were currently using them. Regarding vulvar/vaginal pain, n=1083 had no vulvar or vaginal pain, n=341 had only vulvar pain, n=194 had only vaginal pain, and n=581 both vulvar and vaginal pain. Finally, regarding diagnoses, n=582 (26%) had a diagnosis of vulvodynia/vestibulodynia (all types combined). Results from the nominal logistic regressions are presented in Tables 1 and 2. Findings of central importance are: having ever used any of the three categories of OCs was associated with increased risk for a diagnosis; vulvar pain and vaginal dryness were the only side effects of OCs that demonstrated a consistent association with increased risk of having a diagnosis; side effects of estroprogestinic OCs were the most strongly associated with increased risk of having a diagnosis; and the effects observed in the first three models remained significant even when all were included in the same final analysis (with the exception of vulvar pain with progesterone only OC). Conclusions Use of both estroprogestinic and progesterone only OCs are associated with diagnosis of vulvodynia, but side effects of estroprogestinic OCs demonstrated the strongest association. Genital-specific side effects of OCs may represent indicators of a tissue-specific sensitivity to hormonal changes that are associated with risk for vulvodynia. Disclosure No.

The association of breast surgery ASPIRE: breast pain pathway rapid evaluation project - study protocol.

Breast pain accounts for 20-40% of new referrals to breast units in the UK and these patients have a very low risk of breast cancer. Patients have previously been assessed in resource-intensive, cancer-exclusion, one stop clinics, which are now failing to meet government targets due to excessive demand. UK Breast units are increasingly piloting Breast Pain-only Pathways (BPP) to assess these patients, and there is no consensus for the optimal pathway. The aim of this prospective multicentre study is to assess the safety and patient satisfaction of different BPPs to inform future BPP design and implementation. All UK breast units will be invited to join the ASPIRE study between January 2023 and December 2023. Units with a BPP are invited to submit their pathway for evaluation; and those without a BPP who see patients with breast pain-only in a one stop clinics setting are also invited to join the study to evaluate the traditional pathway model concurrently. Patient satisfaction assessments will be collected after their initial consultation and patient outcomes, including subsequent cancer diagnosis, will be followed up at 12 months to determine if they have cancer diagnosis after discharge to assess pathway safety.