Irritable bowel syndrome (IBS) is a poorly understood gastrointestinal disorder that affects a significant percentage of the population and has a strong negative effect on the quality of life. The lack of known pathophysiologic mechanisms has made finding effective treatment strategies difficult. One of the common recommendations by clinicians is a trial of a lactosefree diet. We have wondered if there was sufficient evidence in the currently available literature to support such a recommendation. We have also looked into other possible relationships between malabsorption syndromes and IBS. All the articles used for this review have been found in the PubMed database. We have taken into consideration the possibility that there may be both genetic differences and differences in the gut microbiome between populations living in different geographic regions. Therefore, we have included articles from different geographic regions to increase the generalizability of the findings. While there is a plethora of evidence that IBS patients commonly report milk intolerance, we have not found any conclusive evidence to suggest an objective link between IBS and any known malabsorption syndromes, including lactose malabsorption. Furthermore, trials of lactase supplementation have not led to clinical benefit. We concluded that there was no evidence to support routinely recommending a lactose-free diet for patients diagnosed with IBS, but including hydrogen breath testing in routine workup of IBS is a reasonable clinical decision. Ultimately, we believe that more clinical trials and chemical studies of the feces are needed to determine the pathophysiology and explore possible dietary recommendations for patients with IBS.

Inflammatory bowel disease is a chronic, gastrointestinal disorder which is classified into Crohns’ disease and ulcerative colitis. It has a strong effect on the quality of life and is characterized by chronic periods of exacerbation and remission. It has an unknown etiology but is driven due to excessive immune response in the gut wall. The triggered immune response causes overproduction of proinflammatory cytokines and adhesion molecules. Biological therapies are the monoclonal antibodies that are created in the laboratory to stop certain proteins in the body causing inflammation. These biologics have dramatically changed the therapeutic approach to inflammatory bowel disease. Biologics has three classes: anti-tumor necrosis factor (TNF), anti-integrins, and anti-interleukin (IL) 12/23. This article offers a critical evaluation of the efficacy and safety of biological agents in the management of inflammatory bowel disease. We compared different studies that were available in the PubMed database. All the biologics showed a better clinical response and mucosal healing than placebo. Infliximab has the highest efficacy, but it can make antibodies to infliximab that causes loss of response; then golimumab is effective in these patients. Certolizumab is more effective if it is used as a first-line drug. If corticosteroid and immunomodulator therapy has failed then vedolizumab is effective. As steroid therapy causes major adverse effects and involves the whole body, biological therapy should take over. Still, we need more studies to make biological therapy as a first option in the treatment of inflammatory bowel disease.

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OBJECTIVESTo assess the usefulness of Tri-phasic computed tomography in the evaluation of hepatocellular carcinoma in cirrhotic patients.METHODOLOGYThis cross-sectional study was carried out in the Radiology and Imaging Department of Hayatabad Medical Complex Peshawar from October 2020 to September 2021 (01 year). Tri-phasic CT was done in all patients. Patients with suspected hepatocellular carcinoma diagnosed by clinical and ultrasonography and having high serum α-fetoprotein levels were enrolled in the study.RESULTSMalignant cases on tri-phasic CT were 120(82.8%) while benign cases were 25 (17.2%) Fig -I. In malignant tumor cases, 99(82.5%) patients had hepatocellular carcinoma (HCC), 13(10.8%) had metastases and 8(6.7%) had dysplastic nodule respectively. In benign tumour cases, 15(60%) had regenerative nodules, 6(24%) had hepatic adenoma and 4 (16%) had haemangioma. Tri -phasic CT as a tool in the diagnosis of hepatocellular carcinoma in cirrhotic patients showed a sensitivity of 96.8%, specificity of 79.7%, the accuracy of 95%, positive predictive values of 96.2% and negative predictive values of 88.1%.CONCLUSIONTri-Phasic CT can be an ideal diagnostic tool for detecting as well as characterizing hepatocellular carcinoma in cirrhotic patients.

Background: Post-anticancer chemotherapy changes in lung parenchyma is an important and challenging aetiology for radiologists presenting not uncommonly in cancer patients. Early diagnosis of post-chemotherapy lung toxicity have serious implications on patient's health.Objective: To evaluate post-chemotherapy cancer patients for pulmonary toxicity and establish their association with frequency of chemotherapy cycles and time lapse since last cycle.Material and Methods: This retrospective study was conducted in Kuwait teaching Hospital from January 2018 till December 2018. A total of 204 patients were evaluated with age ranging from 3 to 78 years including 63 male and 141 female patients. Chest CT scan had been done on16 slice Toshiba CT scanner in Radiology department of Kuwait Teaching Hospital. Images were evaluated in axial, coronal and sagittal planes and in lung and soft tissue window on workstation. Data like patient age ,gender , malignancy , number of chemotherapy cycles received , time lapse since last chemotherapy cycle, common CT manifestations of lung toxicity and CT lung findings unrelated to chemotherapy regimens ;was collected and subjected to statistical analysis. Results: Out of the total 204 patients, who already had anticancer therapy, 135 patients (66.2%) did not show any pulmonary abnormality on CT chest . 11 patients (5.4%) showed chemotherapy related pulmonary findings on CT. 46 patients (22.5%) showed CT chest findings which were incidental and irrelevant to chemotherapy.12 patients (5.9%) had both chemotherapy related pulmonary toxicity changes and incidental findings. The types of post chemotherapy CT lung changes were divided into ground-glass haze, ground glass haze with bronchiectasis, ground glass haze with septal thickening giving crazy paving appearance, patches of consolidation and reticular thickening. 10 patients had sole finding of ground glass haze only (43.5%) whereas 4 patient showed ground glass haze with bronchiectatic changes(17.4 %) and 2 patients depicted a crazy paving appearance (8.7%). Significant association (p=0.00) was noted between number of chemotherapy cycles and above mentioned CT lung findings .No positive correlation was present between time lapse since last chemotherapy cycle and these CT lung findings. Conclusion: Ground glass attenuation was found to be the most profounding feature of post chemotherapy lung CT changes.