BackgroundIdiopathic Granulomatous mastitis (IGM) is a rare inflammatory disease of the breast with poorly understood aetiology or risk factors. IGM has a predilection towards women of child-bearing age with a history of breastfeeding, particularly among Hispanic and Asian ethnicities. However, the true prevalence is unknown with IGM being poorly studied in Middle Eastern Arab and Levantine women who have different genetic, epidemiological, and environmental characteristics.ObjectivesTo study the clinical features of Middle Eastern women diagnosed with biopsy-confirmed IGM.MethodsA retrospective observational study of patients with a biopsy-confirmed diagnosis of IGM, referred to two different private outpatient rheumatology clinics in Amman- Jordan between 2016-2021. The Patients’ characteristics, clinical presentation, treatment, and outcomes were recordedResultsA total of 25 patients were identified in this study. The mean age was 34.9 ± 5.2 years. All females presented with a breast nodule and tenderness, while only 16% reported associated skin changes in the breast and 12% reported galactorrhoea. Bilateral breast involvement occurred in only 4 patients (16%) while 21 patients had unilateral breast involvement. Systematic manifestations including myalgia/arthralgia, skin changes, fever, and axillary lymphadenopathy were reported by 44%, 16%, 20%, and 16% of patients, respectively.Notably, all enrolled females were married at the time of presentation and 3 of them were pregnant or postpartum during the onset of symptoms. The majority of patients (n= 21, 84%) had a prolonged period of breastfeeding (> 6 months). Moreover, 80% of patients had ≥3 pregnancies with 60% having their youngest child aged 3-5 years.20 patients (80%) had a complete resolution of symptoms, and 20% (n=6) were lost to follow-up. Among patients who completed follow-up, treatment duration lasted for ≥ 1 year in 36% (n=9) of patients, whereas 11 patients had a complete resolution in less than a year. Azathioprine, methotrexate, antibiotics, and steroids were used in the treatment of 20%,36%, 60%, and 68%, respectively. Of note, only 1 patient underwent surgical intervention during treatment.ConclusionMany theories had suggested different aetiology for IGM but, in our cohort, it appears that being multiparous and prolonged breastfeeding carry higher risks of developing granulomatous mastitis. Although the aetiology is unclear, early diagnosis and the introduction of treatment using steroid therapy and immunosuppression can improve prognosis and prevent unnecessary surgery. Most of our patients that were treated with corticosteroid, Azathioprine, and Methotrexate had a complete resolution of symptoms after one year of therapy.Disclosure of InterestsNone declared

Background: One of the common cause of admission in surgical ward with acute abdomen in Asian subcontinent is Biliary Ascariasis.The causative agent, Ascarias lumbricoides is distributed throughout the tropics & subtropics & mostly prevent is developing country due to unhygienic livelihood. This study deals with management of Biliary Ascariasis demonstrating the effectiveness of only conservative management in acute condition. Materials and methods: This was an analytical study where 47 patients diagnosed as a case of Biliary Ascariasis were observed & managed accordingly. Complete history, diagnostic tool, complication of Ascarisis & treatment modality were analysed. Result: Here we documented 47 patients throughout the period October-2018 to September -2019 age limit is 13 yrs to 70 yers. Out of which female patient was 78.72% where male was 21.27%. Among female patient 10.63% were pregnant at the time of presentation. 100% patient present with biliary colic, 57.44% had associated nausea & vomiting 38.99% patient present as a case of cholecystitis. Cholangitis developed was 8.5% patient, 8.5% had obstructive jaundices, 4.2% developed liver abscess, 6.38% pancreatitis, 10.63% got cholelithiasis & 8.51% develop chololadocholithiasis &/ or hepaticolithiasis. USG & CBC was advised for all patient as standard diagnostic tool. During conservative treatment endoscopy was advised to all, only 63.82% was able to do this & successful extraction of worm was possible in 26.02%.70% improved by conservative treatment & ERCP required in 10.63%.Surgery for exploring CBD was done in 1 patient (2.1%). 34.02% patient had H/O recurrent attack. 17.02% patient underwent previous endoscopic procedure & 8.51% ERCP procedure. Before discharge review USG found in 68.08% patient with evidence of clear CBD & then discharged with advice of taking Antihelmintic therapy in 2 months interval. Conclusion: Maintenance of hygienic & regular anthelmintic therapy is all prevention of occurance & complication. only conservative management with or without minimal invasive endoscopic retrieval of worm is very much effective for improvement of symptoms. JCMCTA 2019 ; 31 (1) : 9-12