Social anxiety disorder (SAD) is a highly prevalent and often disabling disorder. This paper reviews the pharmacological treatment of SAD based on published placebo-controlled studies and published meta-analyses. It addresses three specific questions: What is the first-line treatment of SAD? How long should treatment last? What should be the management of treatment-resistant cases? Based on their efficacy for SAD and common comorbid disorders, tolerability, and safety, SSRIs should be considered as the first-line treatment for most patients. Less information is available regarding the optimal length of treatment, although individuals who discontinue treatment after 12-20 wk appear more likely to relapse than those who continue on medication. Even less empirical evidence is available to support strategies for treatment-resistant cases. Clinical experience suggests that SSRI non-responders may benefit from augmentation with benzodiazepines or gabapentin, or from switching to MAOIs, RIMAs, benzodiazepines or gabapentin. Cognitive-behavioural therapy may also be a helpful adjunct or alternative.

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Background: Chronic kidney disease and associated malnutrition is major health problem in developing countries like Pakistan. CKD patient have been related with body wasting and malnutrition. In this study we assess the prevalence of Malnutrition in chronic kidney disease patients. Objective: To determine the prevalence of malnutrition in patients with chronic kidney disease. Study Design: The type of study is a cross-sectional study. Settings: Dialysis and kidney care center in Karachi-Pakistan. Duration: 6 months from December 2017 to May 2018. Methodology: Patients with chronic kidney disease (CKD) were included and patients with severe comorbid conditions were excluded from the study. Diagnosis of CKD was made via detailed history and clinical examination and relevant laboratory investigations. Patients were classified into 3 SGA grades. Data was collected in a pre-designed proforma. Results: 150 patients were included in the study. The mean age of patients was 58.4 ± 5.86 years. There were n= 93 (62%) males and n= 57 (38%) females. The frequency of malnutrition was n= 63 (42%) were moderately malnourished and n= 32 (21.33%) were severely malnourished. None of the patients under the age of 50 years showed signs of malnutrition. The most common etiology for CKD was diabetes mellitus in n= 75 (50%). The mean BMI of 27.6 ± 5.1 kg/m2, Triceps skin fold thickness was 18.2 ± 7.1 mm and a mean mid upper arm circumference of 23.2 ± 3.9 mm2 respectively. Chi-square test shows a significant association between the incidence of malnutrition and undialysed patients suffering from chronic kidney disease. Having a p-value of <0.001. Conclusion: The frequency of malnutrition in undialyzed patients with CKD was very high, mild to moderate malnutrition was more prevalent than severe malnutrition.

Objectives: In our study we evaluate the hyperuricemia levels in patients presenting to us with the chief complaint of chronic lower back pain and determine the associations with age, gender and radiographic findings. Study Design: Cross sectional study. Setting: Dow University of Health Science Civil Hospital Karachi. Period: From April 2017 to September 2017. Material & Methods: Patients with lower back pain of a duration longer than three months and between the ages of 18 and 70 years were included. A complete history and physical examination was done for all the patients including relevant laboratory, radiographic and anthropometric measurements. The neurosurgeon also assessed the patient’s lower back pain and associated findings in the lower limbs. The patients also underwent radiographic evaluations via X-rays and Magnetic resonance imaging. Data were analyzed using IBM SPSS statistical software version 20. We considered a p value of < 0.05 to be statistically significant. Results: The final study population consisted of n= 110 patients of which n= 54 were males and n= 56 were females. Of the total patient population of the study n= 31 (28.18%) had increased serum uric acid and had nearly equal incidence in males and females (27.77% and 28.57% respectively). The highest incidence of hyperuricemia was found patients between 26 and 60 years of age. In our study n= 22 patients did not have any comorbid condition while joint pain was found in n= 24 patients (p-value of <0.05) of these patients they suffered from pain in their knees and tarsal joints. Lumbar disc prolapse was found in n= 21 patients (p-value of <0.05), lumbar disc degeneration was found in n= 16 patients (p-value of <0.0579). Furthermore, disc space narrowing was found in n= 27 patients having a p-value of <0.05. Conclusion: According to the results of our study hyperuricemia is found in one of every four with low back pain. There is a variable association between comorbid conditions and hyperuricemia. While an equal association is found between gender and hyperuricemia. There is also a strong association of hyperuricemia with joint space narrowing and lumbar disc narrowing of the lumbar vertebrae and it augments degenerative spondylolisthesis.

The injection of choked gaseous jets into the still air is investigated experimentally motivated by many industrial applications including flares and burners. The objective is to study the effect of injection angle on the jet mixing with ambient air. The experimental methods consist of particle image velocimetry (PIV) using pulsed Nd:YAG lasers of a choked gas jet, seeded with aluminum oxide particles, injected into still air, seeded with water fog. The computational methods consisted of 7.7 million cells simulation using Star CCM+. The test conditions include injection angles of 0°, 15°, and 30°. The results including mean and fluctuating velocities and the flow vorticity are presented. The flow field is not symmetric along the injection axis due to the asymmetric triggering of expansion fans at the jet exit due to the inclined injection plane. Moreover, the numerical simulation reveals the complex interaction mechanism of the expansion fans and shockwaves within the injection port.