Schizophrenia is a heterogeneous psychiatric disorder in which multiple neurotransmitter systems have been implicated. Increased and decreased dopamine transmission in the subcortical meso-limbic and meso-cortical systems is closely linked to the "positive" and "negative" symptoms of schizophrenia, respectively. Important roles have also been found for serotonin and acetylcholine, both of which are closely linked to dopamine. An abnormality in glutamate functioning involving N-methyl-D-aspartic acid as well as other receptor subtypes may underlie the dopamine dysfunction observed in schizophrenia. Since the discovery of chlorpromazine in 1952, researchers have been developing new molecules targeting various neurotransmitter systems to maximize their efficacy and tolerability. The advancements in molecular genetics have opened up new horizons to manipulate the post-receptor protein cascade and gene expression. Although the magic-wand still eludes us, the newer molecules hold a lot of promise in this condition.

Presence of vitamin D receptors in noncalcemic tissues and subsequent identification of its involvement in growth factor(s)-mediated cellular function suggested its probable beneficial role in genesis, progression and survival of cancerous growths. Data collected from both in vitro and in vivo studies are highly optimistic regarding its potential in prevention and regression of colorectal, prostate and breast cancers. The vitamin has been found to interfere with the transduction pathways of various growth factor(s)-activated receptors (receptor tyrosine kinases) thereby modulating transcription and alteration of genomic functions resulting in inhibition of cell proliferation and angiogenesis and facilitation of cell differentiation and apoptosis. It also increases the level of an endogenous protein - cystatin D, which possesses antitumor and antimetastatic property, by facilitation of the expression of the gene coding for it. Though not as a primary anticancer agent, this vitamin may be used for the prevention of cancer and included as an adjuvant in combination chemotherapy for the treatment of cancer.

Objectives : To study the analgesic and anti-nociceptive activity of hydroethanolic extract of Drymaria cordata Willd. Materials and Methods : Wistar rats and Swiss albino mice were used for studying analgesic and anti-nociceptive activity of Drymaria cordata hydroethanolic extract (DCHE) at doses 50, 100 and 200 mg/kg p.o. Various models viz. acetic acid induced writhing model (female mice), Eddy's hot plate (mice) and tail flick model (rat) for analgesic study and formalin-induced paw licking model (mice) were used for anti-nociceptive study. Results : In acetic acid induced writhing model, effect of DCHE was better than the standard drug- indomethacin 10 mg/kg (p.o.). In the hot plate model, the maximum effect was observed at 60 min at a dose of 200 mg/kg p.o., which was higher than the standard drug morphine sulfate (1.5 mg/kg i.p.), whereas in the tail flick model, effect was comparable with morphine sulfate. In formalin-induced paw licking model, administration of DCHE completely abolished the early phase at 100 and 200 mg/kg p.o. and in the late phase, the effect of DCHE (200 mg/kg p.o.) was higher than indomethacin (10 mg/kg p.o.). Conclusion : DCHE was effective in both non-narcotic and narcotic models of nociception, suggesting its possible action via peripheral and central mechanism. It also abolished the early phase in formalin-induced paw licking model, suggesting complete inactivation of C-fiber at higher dose. The activity can be attributed to the phyto-constituents viz tannins, diterpenes, triterpenes and steroids present in the DCHE extract. In conclusion, DCHE can be developed as a potent analgesic and anti-nociceptive agent in future.

Objectives : Conventional polyethoxylated castor oil (PCO)-based paclitaxel is associated with major adverse drug reactions (ADRs). Nanoxel, a nanoparticle-based formulation, may improve its tolerability by removing the need for PCO vehicle, and also permit its use in a higher dose. We conducted intensive monitoring of the ADR profile of Nanoxel in comparison with conventional paclitaxel in a public tertiary care set-up. Materials and Methods : ADR data were collected from 10 patients receiving Nanoxel and 10 age-matched controls receiving conventional paclitaxel in this longitudinal observational study, conducted in a medical oncology ward over 18 months. Severity was graded as per US National Cancer Institute Common Terminology Criteria for Adverse Events. Results : The groups had comparable demography at baseline. The median disease duration and per cycle median dose of paclitaxel were greater in the Nanoxel arm. Total 119 ADRs were noted with Nanoxel and 123 with conventional paclitaxel. Of these, 25 (21.0%, 95% CI 13.69-28.33%) in the Nanoxel and 20 (16.2%, 95% CI 9.74-22.78%) in paclitaxel group were of grade 3/4 severity. Common events included myalgia, nausea, anemia, paresthesia, alopecia, diarrhea, and vomiting with Nanoxel, and paresthesia, anemia, myalgia, anorexia, alopecia, vomiting, diarrhea, stomatitis, and nausea with paclitaxel. Of the less common events (<5%), grade 2 or 3 arthralgia was seen exclusively with Nanoxel while motor neuropathy with muscular weakness was more frequent and severe with conventional paclitaxel. Hypersensitivity reactions were not encountered in either arm, although no antiallergy premedication was employed for Nanoxel. Conclusions : Despite its ADR profile being statistically comparable to conventional paclitaxel, this observational study suggests that Nanoxel tolerability could be better, considering that a significantly higher dose was employed. This hypothesis needs confirmation through an interventional study.

Objective : To compare and evaluate the price and quality of "branded" and branded-generic equivalents of some commonly used medicines manufactured by the same pharmaceutical company in India. Materials and Methods : Five commonly used medicines: alprazolam, cetirizine, ciprofloxacin, fluoxetine, and lansoprazole manufactured in branded and branded-generic versions by the same company were selected. Price-to-patient and price-to-retailers were found for five "pair" of medicines. Both quantitative and qualitative analysis were performed following the methods prescribed in the Indian Pharmacopoeia 2007 on five "pair" of medicines. The tests performed were identification test, chemical composition estimation test, uniformity of contents test, uniformity of weight, and dissolution studies. Main Outcome Measures : Price-to-patient, retailer mark-up and qualitative analysis of branded and branded-generic medicines. Results : Retailer margin for five branded medicines were in the range of 25-30% but for their branded-generics version manufactured by the same company it was in the range of 201-1016%. Price-to-patient for the branded version of cetirizine, fluoxetine, ciprofloxacin, lansoprazole, and alprozolam was higher by 41%, 33%, 0%, 14%, and 31% than branded-generic. Both versions of five medicines were within their permissible range for all the quantitative and qualitative parameters as prescribed in Indian Pharmacopoeia. Conclusion : Difference in price-to-patient was not as huge as it is expected for generics but margins for retailer were very high for branded-generics. Quality of branded-generics is same as for their branded version. The study highlights the need to modify the drug price policy, regulate the mark-ups in generic supply chain, conduct and widely publicize the quality testing of generics for awareness of all stakeholders.

Objective : The objective of the present study was to evaluate the cognitive enhancing and antioxidant activity of Hibiscus rosa sinensis. Materials and Methods : The learning and memory was impaired by administration of scopolamine (1 mg/kg, i.p.) in mice which is associated with altered brain oxidative status. The object recognition test (ORT) and passive avoidance test (PAT) were used to assess cognitive enhancing activity. Animals were treated with an ethyl acetate soluble fraction of the methanol extract of H. sinensis (25, 50 and 100 mg/kg, p.o). Results : The ethyl acetate soluble fraction of the methanol extract of H. sinensis (EASF) attenuated amnesia induced by scopolamine and aging. The discrimination index (DI) was significantly decreased in the aged and scopolamine group in ORT. Pretreatment with EASF significantly increased the DI. In PAT, scopolamine-treated mice exhibited significantly shorter step-down latencies (SDL). EASF treatment showed a significant increase in SDL in young, aged as well as in scopolamine-treated animals. The biochemical analysis of brain revealed that scopolamine treatment increased lipid peroxidation and decreased levels of superoxide dismutase (SOD) and glutathione reductase (GSH). Administration of extract significantly reduced LPO and reversed the decrease in brain SOD and GSH levels. The administration of H. sinensis improved memory in amnesic mice and prevented the oxidative stress associated with scopolamine. The mechanism of such protection of H. sinensis may be due to augmentation of cellular antioxidants. Conclusion : The results of the present study suggested that H. sinensis had a protective role against age and scopolamine-induced amnesia, indicating its utility in management of cognitive disorders.

Objective : Leaves of Bichofia javanica (BJ) have been traditionally used for many ailments including cancer. In the present study, antileukemic activity of the leaf extract was evaluated on human leukemic cell lines. Materials and Methods : Human leukemic cell lines U937, K562, and HL60 were purchased from National Facility for Animal Tissue and Cell Culture, Pune, India. The cells were routinely maintained in RPMI 1640 medium supplemented with 10% heat inactivated fetal calf serum. Cultures were maintained at 37ºC in a humidified atmosphere containing 5% CO ₂ in air. The methanol extract of BJ (MEBJ) was dissolved in PBS and used at the concentrations of 5, 10, and 15 μg/ml for cell viability and cytotoxicity studies (MTT assay). Cell counts were made in quadruplicate samples at the interval of 24, 48, and 72 h and cytarabine (20 μg/ml) served as standard drug. The apoptotic pathway of cytotoxicity was assessed by DNA agarose gel electrophoresis technique and confirmed by fluorescence and confocal microscopic methods at the concentration of 10 μg/ml. Results : MEBJ showed significant cytotoxicity (P<0.001) in leukemic cell lines in the in-vitro cell proliferation assay. IC ₅₀ of MEBJ was very low (3.5 μg/ml) at 72 h in the HL60 cell line. The apoptotic pathway of cytotoxicity was observed at 10 μg/ml of MEBJ by the fragmented DNA pattern in the apoptosis assay, chromatin condensation, and apoptotic body formation as revealed in the fluorescence and confocal microscopic studies. Conclusion : The present findings support the ethno-medicinal use of BJ for cancer by mediating through the apoptosis pathway.

Objective : The main objective of the prescription audit of the secondary level government hospitals under the Maharashtra Health Systems Development Project (MHSDP) was to develop a list of essential drugs. Other objectives were to articulate measures for improving the prescription practices and to generate information on the core prescribing indicators proposed by the World Health Organization (WHO). Materials and Methods : The study was conducted among a representative sample of 31 secondary level hospitals under MHSDP. A copy of the prescription was obtained with the help of a pre-inserted carbon, in a special format. Data for only 'first encounter prescriptions' was collected for all patients attending the Outpatient Department (OPD). Results : About 77 percent of the prescriptions contained only one diagnosis. The average number of drugs per prescription was 3.1. About 60 percent of the drugs were prescribed by generic names and about 23 percent of the prescribed drugs were in combination. About 25 percent of the prescriptions contained at least one injection, while 35 percent contained at least one antibiotic. In 16 percent of the prescriptions a vitamin or tonic was prescribed. About 46 percent of the single ingredient formulations were as per the WHO 2003, Essential Medicines List (EML). Based on the findings of the Prescription Audit an EML was prepared for each category of the secondary level hospitals, for use in the OPD. Conclusions : Prescription audits are useful in generating data on morbidity, which forms the basis for preparing the list of essential medicines. Mechanisms necessary for improving prescription practices are suggested.

Background and Objectives : In the fields of the pharmaceutical and cosmetic industries and in toxicology, the study of the skin penetration of molecules is very interesting. Various studies have considered the impact of different physicochemical drug characteristics, skin thickness, and formulations, on the transition from the surface of the skin to the underlying tissues or to the systemic circulation; however, the influence of drug concentration on the permeation flux of molecules has rarely been raised. Our study aims to discover the influence of caffeine concentration in a formulation on the percutaneous penetration from gels, as a result of different dose applications to polysulfate membrane and human skin. Materials and Methods : For this purpose, three identical base gels were used at 1, 3, and 5% of caffeine, to evaluate the effect of the concentration of caffeine on in vitro release through the synthetic membrane and ex vivo permeation through the human skin, using diffusion Franz ^TM cells. Results : The diffusion through the epidermal tissue was significantly slower than through the synthetic membrane, which recorded an increase of flux with an increase in the concentration of caffeine. The skin permeation study showed that diffusion depended not only on the concentration, but also on the deposited amount of gel. Nevertheless, for the same amount of caffeine applied, the flux was more significant from the less concentrated gel. Conclusion : Among all the different concentrations of caffeine examined, 1% gel of caffeine applied at 5 mg / cm ² showed the highest absorption characteristics across human skin.

Objectives : To evaluate the antiobesity effects of the ethanolic extract of Argyreia speciosa roots in rats fed with a cafeteria diet (CD). Materials and Methods : Obesity was induced in albino rats by feeding them a CD daily for 42 days, in addition to a normal diet. Body weight and food intake was measured initially and then every week thereafter. On day 42, the serum biochemical parameters were estimated and the animals were sacrificed with an overdose of ether. The, liver and parametrial adipose tissues were removed and weighed immediately. The liver triglyceride content was estimated. The influence of the extract on the pancreatic lipase activity was also determined by measuring the rate of release of oleic acid from triolein. Results : The body weight at two-to-six weeks and the final parametrial adipose tissue weights were significantly lowered (P < 0.01 and P < 0.05, respectively) in rats fed with the CD with Argyreia speciosa extract 500 mg/kg/day as compared to the CD alone. The extract also significantly reduced (P < 0.01) the serum contents of leptin, total cholesterol, low density lipoprotein (LDL), and triglycerides, which were elevated in rats fed with CD alone. In addition, the extract inhibited the induction of fatty liver with the accumulation of hepatic triglycerides. The extract also showed inhibition of pancreatic lipase activity by using triolein as a substrate. Conclusions : The ethanolic extract of Argyreia speciosa roots produces inhibitory effects on cafeteria diet-induced obesity in rats.

Objective : To evaluate the ethanolic and aqueous extracts of aerial parts of Caesalpinia pulcherrima (Linn.) Sw. for anti-inflammatory and antiulcer activities. Materials and Methods : Anti-inflammatory action of the ethanolic and aqueous extracts of C. pulcherrima (100 and 200 mg/kg b.w.) (CPE and CPA) were evaluated by cotton pellet granuloma models. Pylorus ligation and aspirin induced ulcer models were employed for evaluating antiulcer activity for both the extracts. Ulcerogenic potential of CP was also evaluated. Result : The ethanolic and aqueous extracts of C. pulcherrima significantly decreased (P<0.01) the granuloma tissue development. CPE and CPA at both the doses exhibited significant (P<0.01) antiulcer activity by decreasing the ulcer score in both the ulcer models and it was not ulcerogenic. Conclusion : The ethanolic and aqueous extracts of aerial parts of C. pulcherrima (CPE and CPA) possess significant anti-inflammatory and antiulcer activities.

Objectives : To compare the effectiveness and tolerability of misoprostol as a cervical ripening agent in first trimester abortion through three different routes of administration before surgical evacuation (SE). Materials and Methods : It was a hospital based prospective randomized open labeled parallel study. A total of 150 randomly selected married women were divided in three groups for sublingual (S/L), vaginal and oral 400 μg of misoprostol single dose administration. The drug was administered 3-4 h before SE in the S/L and vaginal groups and 12 h before the procedure in the oral group. Efficacy was assessed on the basis of time taken for ripening, dilatation achieved, duration of the procedure, intra-operative blood loss, and pain score. The tolerability was noted on the basis of side effects. Results : The mean time taken for cervical ripening was less in sublingual administration (3.7±1.2 hr) as compared to the vaginal and oral routes. The S/L group had significant cervical dilatation (P<0.001) and the duration of SE was less as compared to the vaginal and oral routes. However, the mean intraoperative blood loss was more in sublingual as compared to the vaginal and oral groups. The intra-operative pain score of the S/L group was significantly lower (1.9±1.1, P<0.05) as compared to the vaginal (2.6±1.7) or oral route (3.3±1.7). Loose motions and nausea/vomiting were more with the S/L and oral routes while blood loss was more in the vaginal route. Conclusion : Administration of misoprostol by the sublingual route is better than the oral and vaginal routes for cervical ripening.

Objective : The purpose of this study has been to assess the efficacy of duloxetine, a selective inhibitor of serotonin and norepinephrine reuptake, in the treatment of stress urinary incontinence (SUI) in women. Materials and Methods : The study included 50 women aged above 18 years with a predominant symptom of stress urinary incontinence (SUI). The case definition included a predominant symptom of SUI with a weekly incontinence episode frequency (IEF) of seven or greater and a positive cough stress test. All the patients received duloxetine 20 mg twice daily for 12 weeks. The primary outcome variables included the IEF and improvement in quality of life. Paired Student's 't' test was used to analyze changes in IEF. Results : The improvement with duloxetine treatment was found in 40 out of 50 patients. Remaining 10 patients did not show any improvement with duloxetine and discontinued the treatment. In 40 patients, the mean baseline IEF was 12.5/week. At the end of three months treatment, IEF was six/week. This shows a statistically significant reduction in the IEF. Also, there was a good improvement in quality of life with 65% of patients in the "very much better" and "much better" categories according to PGI-I scale. In the remaining 10 patients, there was no significant improvement after one month of treatment and patients underwent surgery. Conclusions : The findings support duloxetine as a potential treatment for women with stress urinary incontinence.

Objective : In this work, we report the antibacterial and modulatory activity of Lantana montevidensis Briq. Materials and Methods : The antibacterial activities of leaf (LELm) and root (RELm) extracts alone or in association with aminoglycosides were determined by a microdilution test. Multiresistant strains of Escherichia coli (Ec 27) and Staphylococcus aureus (Sa 358) were used. Results : The results show the inhibitory activity of LELm against E. coli (minimal inhibitory concentration [MIC] 16 μg/mL) and S. aureus (MIC 128 μg/mL). The synergistic effect of the extracts and aminoglycosides was verified too. The maximum effects were obtained with RELm with gentamicin against E. coli with MIC reduction (312 to 2 μL). Conclusion : The data from this study are indicative of the activity antibacterial of extracts of L. montevidensis and its potential in modifying the resistance of aminoglycosides.

Clopidogrel is a prodrug which requires cytochrome P450 2C19 (CYP 2C19) enzyme for its conversion to an active thiol metabolite. Proton pump inhibitors (PPIs) inhibits enzyme CYP 2C19 interfering with the conversion of clopidogrel into its active metabolite. Studies document the possible interaction of clopidogrel and PPIs leading to a decrease in the antiplatelet efficacy of clopidogrel. A PubMed/MEDLINE database literature search was carried out and the bibliographies of found articles were checked for other relevant literature. Most retrospective cohort studies and studies using platelet markers found a significant association between PPI use especially omeprazole and decreased efficacy of clopidogrel while few comparative trials using clinical outcomes found no association between the same. Pantoprazole was not associated with the decrease in the antiplatelet efficacy of clopidogrel. Patients on dual antiplatelet therapy and/or with a history of gastrointestinal bleed will require gastroprotection in the form of PPIs. In such cases, pantoprazole should be the preferred PPI. Rabeprazole can be used as an alternative.

Objectives : Mitoxantrone is an anticancer drug widely used in the treatment of various cancers. In the present study the effect of mitoxantrone on chromatin proteins of intact hepatocytes nuclei was investigated and compared with soluble chromatin. Materials and Methods : UV/Vis spectroscopy, SDS polyacrylamide gel electrophoresis, and western bolting were used. Results : The results show that exposure of intact nuclei to various concentrations of mitoxantrone resulted in the release of histone H1 family proteins, H1 and H1°, in a dose-dependent manner but not core histones and high mobility group proteins. Western blot analysis using antiserum against histones H1 and H1° revealed cross-reactivity and confirmed the result. Spectroscopy results showed that mitoxantrone binds to nuclear components and reduces the absorbances at 608 and 400 nm. The binding isotherms revealed cooperative binding with one binding site. Conclusion : From the results it is suggested that mitoxantrone binds to intact nuclei and chromatin with different affinities and linker DNA can be considered as a main binding site for mitoxantrone at the nuclei level.

Objectives : Gram-negative infections and control infusion of recombinant cytokines in human have been shown to induce sickness behavior characterized by fever, prolong sleep, decreased food and water intake, reduced mobility, depression, and anxiety. Therefore, the present study was undertaken to investigate the effect of bioflavonoid quercetin in lipopolysaccharide (LPS)-induced sickness behavior. Materials and Methods : Wistar albino rats were divided into six groups (n=6). Three groups received vehicle and two doses of quercetin (2 and 25 mg/kg, i.p.) respectively for 2 weeks before being challenged with LPS (1 mg/kg, i.p). One group received vehicle for 2 weeks and was challenged with saline on day 15. The per se effect of quercetin (2 and 25 mg/kg, i.p.) was also seen after 2 weeks of dosing. LPS-induced sickness behavior in rats was quantified by measuring time in social exploration, anxiety, food and water consumption, and weight loss. Levels of cytokines (TNF-α, IL-1β, and IL-6) and oxidative stress in rat brain were also analyzed. Results : Quercetin (2 and 25 mg/kg) administration significantly (P<0.05) attenuated LPS-induced sickness behavior by modulating cytokines production as well inhibiting LPS-induced oxidative stress. Conclusions : Adequate intake of dietary flavonoids (like quercetin) may help promote recovery from sickness behavior.

Objective : To assess the anticataleptic and antiepileptic activity of leaves of Mucuna pruriens in albino rats. Materials and Methods : Haloperidol-induced catalepsy (HIC), maximum electro-shock (MES) method, pilocarpine-induced Status epilepticus (PISE) and single-dose effect of M. pruriens were employed. Results : M. pruriens (100 mg/kg) had significant anticataleptic and antiepileptic activity in HIC, MES, and PISE. Conclusions : M. pruriens extract has the potential to be an anticataleptic and antiepileptic drug. Dopamine and 5-HT may have a role in such activity.

The nephroprotective activity of the ethanolic extract of Bauhinia variegata (Linn.) whole stem against cisplatin-induced nephropathy was investigated by an in vivo method in rats. Acute nephrotoxicity was induced by i.p. injection of cisplatin (7 mg/kg of body weight (b.w.)). Administration of ethanol extract at dose levels of 400 and 200 mg/kg (b.w.) to cisplatin-intoxicated rats for 14 days attenuated the biochemical and histological signs of nephrotoxicity of cisplatin in a dose-dependent fashion. Ethanol extract at 400 mg/kg decreased the serum level of creatinine (0.65 ± 0.09; P<0.001) and urea (32.86 ± 5.88; P<0.001) associated with a significant increase in body weight (7.16 ± 1.10; P<0.001) and urine volume output (11.95 ± 0.79; P<0.05) as compared to the toxic control group. The ethanol extract of B. variegata at 400 mg/kg (b.w.) exhibited significant and comparable nephroprotective potential to that of the standard polyherbal drug cystone. The statistically (one-way-ANOVA followed by Tukey-Kramer multiple comparison) processed results suggested the protective action of B. variegate whole stem against cisplatin-induced nephropathy.

The current study investigates the antihyperhomocysteinemic and antihyperlipidemic effect of chloroform and methanol extracts of the leaves of Trichilia connaroides in methionine-induced hyperhomocysteinemic rats. Hyperhomocysteinemia was induced in albino Wistar rats by oral administration of L-Methionine (1 gm / kg) and they were treated simultaneously with chloroform and methanol extracts (100 mg / kg) from the leaves of Trichilia connaroides. Serum homocysteine, lipid profile, and products of lipid peroxidation (MDA) in the heart homogenate were recorded and treated for statistical significance. Hyperhomocysteinemic animals recorded significantly elevated serum homocysteine changes in lipid profile (P < 0.01) and Thibarbituric acid reactive substances (P < 0.01), compared to the vehicle control animals. Animals treated with chloroform and methanol extracts recorded significantly (P < 0.01) lower serum homocysteine, entire lipid profile, LPO (P < 0.01), except a significant increase in HDL-cholesterol (P < 0.01) compared to hyperhomocysteinemic animals. Thus, we conclude that chloroform and methanol extracts of Trichilia connaroides have significant antihyperhomocysteinemic and antihyperlipidemic effects on methionine-induced hyperhomocysteinemic animals. Trichilia connaroides, therefore, holds promise as a cardioprotective herb.

Introduction : Nevirapine administered as a single dose each to the mother and child within 72 h after birth is used to prevent vertical transmission of human immunodeficiency virus (HIV) under the prevention of parent to child transmission of HIV program (PPTCT). The efficacy of nevirapine in this regard has been proved beyond doubt, but there are unresolved questions about its safety. Hence, the primary objective of this study was to evaluate the safety of this regime. Materials and Methods : HIV-positive pregnant women who consented to participate in the study received a single oral dose of 200 mg nevirapine at the onset of labor followed by administration of 2 mg/kg of nevirapine syrup to the newborn within 72 h of birth. Both mother and child were followed up for 1 week postpartum to note the occurrence of any adverse reactions. Results : The mother and child followed up for 1 week postpartum did not show any serious adverse reactions in the present study. Mothers reported adverse reactions like nausea, vomiting, and headache which were self-limiting and did not require any intervention. Conclusion : The present study substantiates the safety of nevirapine.

Interferons (IFNs) are proteins produced by cells, fibroblasts and macrophages, in response to viral invasion, and mediates immune response. IFN-α and ribavirin are the approved treatment for HCV infection, but also carries a risk of neuropsychiatric adverse effects, viz. insomnia, irritability, mood changes, and depression. We present a case report of depression induced by IFN-α and ribavirin, leading to attempted suicide. Following the episode, antidepressant paroxetine (20 mg o.d.) and zolpidem (10 mg h.s) were added with psychotherapy. No significant improvement was observed. Patient was given a drug dechallenge (IFN-α and ribavirin). Dramatic improvement was seen over 1 month. Following rechallenge with combination, patient again experienced depressive symptoms with suicidal ideation. IFN-α and ribavirin were promptly stopped. Naranjo causality assessment scale revealed probable association with IFN-α and ribavirin. The report intends to improve awareness among clinicians to facilitate early diagnosis and intervention of similar cases.

We report a 5-year-old boy who developed optic neuritis as a paradoxical reaction to anti-tuberculous therapy. Steroids were re-started in the patient with gradual recovery of his vision. The case emphasizes the importance of recognizing paradoxical reactions in patients on anti-tuberculous therapy. Prompt recognition and treatment of such reactions will reduce the associated morbidity.

This case report highlights a clinically significant pharmacokinetic drug interaction between phenytoin, a widely used anticonvulsant and vecuronium, a non-depolarizing neuromuscular blocker which led to vecuronium resistance.

Metformin is an important antidiabetic agent that is widely used for diabetic patients. Here, a case of metformin allergy, presenting with skin lesions, is reported.