Colonel Malek Medical College

Abstract Background: The liver is affected by a wide range of non-neoplastic and neoplastic lesions, requiring accurate diagnosis for appropriate management and prognostication. Image-guided cytology and biopsy are important diagnostic tools for evaluation of hepatic lesions. Objective: To assess the spectrum of hepatic lesions diagnosed by ultrasonography-guided fine needle aspiration cytology (FNAC) and core biopsy, and to analyze their demographic and pathological distribution. Methods: This retrospective descriptive cross-sectional study was conducted in a private laboratory in Tangail, Bangladesh, from March 2025 to March 2026. A total of 37 cases of radiologically detected hepatic lesions were included by consecutive sampling. Among them, 30 cases underwent USG-guided FNAC and 7 cases underwent USG-guided core needle biopsy. Clinical, radiological, cytological, and histopathological data were reviewed. Data were entered and analyzed using SPSS version 26.0. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequency and percentage. Results: The mean age of the patients was 54.95 ± 13.39 years, with most cases in the 41–60 years age group (54.1%). Male patients predominated (64.9%). Metastatic carcinoma was the most common lesion (62.2%), followed by non-neoplastic lesions (18.9%), hepatocellular carcinoma (13.5%), benign lesions (5.4%), and cholangiocarcinoma (2.7%). Metastatic adenocarcinoma was the most frequent malignant subtype. Radiological-pathological concordance was 83.8%. Conclusion: Metastatic tumors were the predominant hepatic lesions, while hepatocellular carcinoma was the most common primary malignancy. Combined use of radiology, FNAC, and core biopsy remains valuable for accurate diagnosis and management of hepatic lesions.

Background/Aims:: Chronic constipation is a common gastrointestinal (GI) disorder in Asia, characterized by heterogeneous symptom presentation, frequent overlap with other GI symptoms, and limited access to specialized diagnostic tests in many settings. These factors contribute to under-recognition and suboptimal management. The and the APAGE developed a regional consensus to provide practical, evidence-based guidance tailored to the Asian context. Methods:: A multidisciplinary task force comprising 24 voting members and 5 non-voting facilitators from across Asia was convened. Experts were divided into 4 working groups addressing clinical evaluation, non-pharmacological management, pharmacological management, and specialized investigations and treatments. Targeted literature reviews were performed, and statements were developed using a structured Delphi process with iterative anonymous voting. The certainty of the evidence and the strength of the recommendations were graded using the GRADE framework. Results:: Thirty-nine consensus statements were developed, covering clinical assessment and stepwise management. Recommendations emphasize comprehensive symptom assessment, early evaluation of disease severity and psychosocial impact, and prioritizing constipation treatment in patients with overlapping GI symptoms and those with pelvic floor damage. Initial management includes lifestyle modification and conventional laxatives, with treatment response assessed within 4 weeks. For inadequate response, treatment optimization, combination or switching of laxatives, and newer agents are recommended. The algorithm also highlights appropriate use of anorectal physiologic testing and biofeedback therapy for functional defecatory disorders. Surgical interventions are reserved for highly selected patients after comprehensive evaluation. Conclusion:This Asian Neurogastroenterology and Motility Association/Asia-Pacific Association of Gastroenterology consensus provides a practical, algorithm-based framework to improve management of chronic constipation across diverse Asian healthcare settings.

e16063 Background: Gastric cancer continues to represent a major global health challenge, though incidence and mortality have declined markedly in high-income countries including the United States, largely due to reductions in Helicobacter pylori prevalence, dietary improvements, and advances in early detection and treatment. This study evaluated age-standardized rates (ASRs) of DALYs, deaths, incidence, and prevalence from 1990 to 2023 using IHME GBD 2023 data, calculated estimated annual percentage changes (EAPC), and generated projections to 2050 via ARIMA time-series modeling. Methods: Age-standardized rates per 100,000 population were retrieved from the Global Burden of Disease 2023 database for the United States, stratified by sex (Both, Female, Male). Historical trends (1990–2023) were quantified using EAPC from linear regression on log-transformed ASRs. Future projections (2024–2050) were produced with ARIMA models fitted to historical data, yielding point estimates and 95% prediction intervals. Results: From 1990 to 2023, age-standardized DALYs (Both sexes) decreased from 125.34 (95% UI: 116.60–135.49) to 68.51 (95% UI: 61.82–75.62), with an EAPC of -1.88% (95% CI: -1.98 to -1.77); males exhibited a steeper decline (EAPC -2.22%, 95% CI: -2.32 to -2.11) than females (EAPC -1.49%, 95% CI: -1.59 to -1.38). Age-standardized death rates fell from 5.39 to 2.77 (EAPC -2.08%, 95% CI: -2.17 to -2.00), again with greater reductions in males (EAPC -2.39%) than females (EAPC -1.85%). Incidence declined from 8.02 to 4.94 (EAPC -1.59%, 95% CI: -1.66 to -1.52), and prevalence from 18.42 to 14.18 (EAPC -0.99%, 95% CI: -1.12 to -0.85), reflecting successful risk factor control and improved survival. ARIMA forecasts indicate accelerated ongoing declines in age-standardized DALYs (Both: from 67.56 in 2024 toward ~42.84 by 2050), deaths (to ~1.51), and incidence (to ~2.42), while prevalence continues to erode gradually. Conclusions: Age-standardized burden of gastric cancer in the US declined sharply from 1990–2023 across all metrics, with particularly strong reductions in males for DALYs, mortality, and incidence. Projections to 2050 suggest continued substantial decreases in key indicators, approaching very low levels, underscoring the success of primary and secondary prevention efforts, though vigilance remains warranted for high-risk subgroups and potential emerging risk factors. Measure Sex EAPC Lower 95%CI Upper 95%CI DALYs Both -1.88 -1.98 -1.77 DALYs Female -1.49 -1.59 -1.38 DALYs Male -2.22 -2.32 -2.11 Deaths Both -2.08 -2.17 -2 Deaths Female -1.85 -1.94 -1.75 Deaths Male -2.39 -2.47 -2.3 Incidence Both -1.59 -1.66 -1.52 Incidence Female -1.36 -1.44 -1.27 Incidence Male -1.88 -1.94 -1.81 Prevalence Both -0.99 -1.12 -0.85 Prevalence Female -0.76 -0.89 -0.63 Prevalence Male -1.23 -1.37 -1.09

Perforation peritonitis due to duodenal ulcer is the most common surgical emergency and is frequently associated with postoperative wound complications such as seroma, surgical site infection (SSI) and wound dehiscence. Although several preventive measures exist the optimal strategy for minimizing these complications remains unclear. This study aimed to evaluate whether placing a subcutaneous closed-suction drain during laparotomy reduces early wound complications following primary repair of duodenal ulcer perforation. This prospective comparative observational study was conducted in the Sylhet MAG Osmani Medical College Hospital from December 2022 to December 2023. A total of 100 consecutive patients undergoing emergency laparotomy for duodenal ulcer perforation were enrolled and allocated into two groups based on intraoperative wound-closure technique: Group A (primary closure without subcutaneous drain) and Group B (primary closure with subcutaneous closed-suction drain), with 50 patients in each group. Demographic data, operative findings, and postoperative outcomes were recorded. Seroma formation, wound dehiscence, SSI and duration of hospital stay were compared employing chi-square test, t-test, and logistic regression. The mean age of patients was 34.92 +/- 6.09 years and 33.58 +/- 5.87 years in Group A and Group B respectively. Seroma development was significantly lower with subcutaneous closed-suction drain placement compared with no drain (odds ratio [OR] = 0.317 [95% confidence interval, CI: 0.114-0.894]; p = 0.02713). SSI was also reduced in Group B (OR = 0.255319 [95% CI: 0.065-0.992]; p = 0.037). Wound dehiscence occurred less frequently with drains (OR = 0.107 [95% CI: 0.012-0.892]; p = 0.0144) than without. Hospital stay was significantly shorter in Group B than Group A (8.39 +/- 3.53 vs. 12.42 +/- 2.95 days). Subcutaneous suction drain is effective in preventing early wound complications after laparotomy for repair of duodenal ulcer perforation.

Background: COPD is now one of the top three causes of death worldwide and 90% of these deaths occur in low and middle income country.Assessment of functional capacity is vital for appropriate therapy, standard rehabilitation program and also a strong predictor of survival in patients of chronic obstructive pulmonary disease. Field walking tests are simpler and cheaper, require less technical expertise and equipment. Incremental shuttle walking test and the widely practiced 6MWT is a good predictor of functional status for patients with COPD. 2MWT is more feasible in some settings as frail elderly patients were unable to complete a single trial of 6MWT but better able to tolerate 2MWT. So to find a cut off value of walking distance 2MWT and validity of the test this study is necessary. We search relation between 2MWT and airflow limitation of COPD patients. We also search relation of the test with 6MWT. Objective: To assess the usefulness of 2MWT as an assessment tool of functional capacity of stable COPD patients. Materials and Methods: This cross sectional study was conducted in the department of Respiratory Medicine of National Institute of Diseases of the Chest and Hospital (NIDCH) from February, 2022 to March, 2023. Eight five (85) stable COPD patients with mild to very severe airflow obstruction were enrolled in this study. Baseline data (FEV1, FEV1/FVC, resting pulse rate, respiratory rate and SpO2) were collected and then all the patients were subjected to perform 2 min walk Test (2MWT) and 6MWT under normal ambient conditions. Then pertinent post-exercise data (walking distance, pulse rate, respiratory rate, SpO2) were collected. The Statistical Package for Social Science (SPSS) v.23 was used for statistical analysisResults: Out of 85 patients, Majority 30(35.3%) patients had severe COPD, 27(31.8%) had very severe, 18(21.2%) had moderate and 10(11.8%) had mild COPD. Mean pulse, SpO2, respiratory rate - at the end of 2 minute walk test and 6 minute walk test were statistically significant (p<0.05) compare with baseline. Mean distance walked was found 96.6±36.2 meter in the end of 2 minute and 250.3±91.8 meter in the end of 6 minute. Significant relationship was found between severity of COPD and 2MWT (p<0.001). Based on the receiver-operator characteristic (ROC) curves 2 minute walk test had area under curve 0.886.. Receiver-operator characteristic (ROC) was constructed by using 2 min walk test, which gave a cut off value d”95.7 meter, with 82.5% sensitivity and 85.7% specificity for prediction of severe FEV1. Based on the receiver-operator characteristic (ROC) curves 6 min walk test had area under curve 0.839. Receiver-operator characteristic (ROC) was constructed by using 6 min walk test, which gave a cut off value d”286.5 meter, with 89.4% sensitivity and 71.4% specificity for prediction of severe FEV1. The validity of 2 minute walk test vs 6 minute walk testevaluation for severity of airflow limitation of COPDwas correlated by calculating sensitivity (84.7%), specificity (96.2%), accuracy (88.2%), positive predictive value (98.0%) and negative predictive value (73.5%). Conclusion: This study concluded that the 2MWT is a reliable, valid, and sensitive test for the assessment of functional status in patients with stable COPD. It is practical, simple, quick, easy to administer, and well-tolerated by patients with stable COPD. Chest Heart J. 2024; 48(2) : 90-99