Atomoxetine, a selective norepinephrine inhibitor, is effective in comorbid anxiety and attention deficit hyperactivity disorder, however its role in panic disorder is unknown. We are presenting a case of panic disorder, who initially partially responded to clonazepam. When clonazepam was added with sertraline, escitalopram, desvenlafaxin, she did not improve significantly until paroxetine was added. When clonazepam-paroxetine combination was added with propranolol, etizolam, olanzepine, risperidone and amisulpride the symptom remission did not occur until a trial of Atomoxetine was done.
Anxiety ; Attention Deficit Disorder with Hyperactivity ; Citalopram ; Clonazepam ; Norepinephrine ; Panic Disorder* ; Panic* ; Paroxetine ; Propranolol ; Risperidone ; Sertraline ; Atomoxetine Hydrochloride

Post-burn contractures are common entities seen in developing countries. There are multiple reasons for the development of contractures, most are preventable. In extensive contractures, a strategic plan is necessary to release all contractures and yet not antagonize post-operative positions. It is also necessary to be cost-effective and minimize the number of surgeries needed. Conventionally the release sequence in extensive burn contractures is proximal to distal. In this case report, we discuss an unusual sequence where we released distal contractures before the proximal to achieve optimum results. A 3-year-old child with post-burn contracture of hand, wrist, elbow, and axilla was treated in 2 stages, with the release of wrist contracture and cover with pedicled abdominal flap in the first stage and division of pedicled flap with the release of axilla and elbow contracture in the second stage. Thus, the release of all contractures was achieved without antagonizing post-operative positions and minimized the number of surgeries. A case-based approach may be crucial in making a strategic surgical plan to minimize the rehabilitation phase, rather than following known dictums.
Humans ; Child, Preschool ; Surgical Flaps/surgery* ; Upper Extremity ; Plastic Surgery Procedures ; Skin Transplantation ; Contracture/surgery*

Introduction: The increased prevalence of oral submucous fibrosis (OSMF) in the last few years relates to the increased consumption of areca nut(AN) products. OSMF is a premalignant condition and risk to progression to oral cancer is more when AN is chewed along with tobacco. Moreover, high copper content in AN is responsible for fibroblast dysfunction and fibrosis. This study was conducted with aim to assess and compare pH and copper content of raw AN and popular Indian commercial AN based (with and without tobacco) products. Method: Six samples each of twelve different brands of AN based commercial products i.e. six without tobacco (pan masala) and with tobacco were analyzed for pH and then the samples were dried, and powdered for estimation of the copper content. Results: For the six raw areca nuts (sample 1-6), the pH was found to range from 3.06±1.08 to 5.04±0.81, among the six non tobacco containing samples (sample 7-12), the pH was found to range from 6.03±1.08 to 9.09±0.81, and for six tobacco containing samples (sample 13-18), the pH was found to range from 9.18±0.90 to 11.07±0.09. The mean copper concentration among raw areca nut samples (sample 1-6) was 4.05±0.18 μg/g, among non-tobacco containing samples (sample 7-12) it was 10.17±1.08μg/g and among tobacco samples (sample 13-18),it was 18.09±1.08 μg/g (p<0.001). Conclusion: High copper content present in quid and commercial AN may be a causative factor for an increased fibrosis in OSMF, our findings need evaluation by further research and standardization.