Chronic stress is known to result in impairment of learning and memory and precipitate several affective disorders including depression and anxiety. Drugs of natural origin are known to possess several effects on the central nervous system and are emerging as promising alternative therapies. In this context, the hydroalcoholic extract of Euphorbia hirta (Eh) was evaluated for anxiolytic property in chronically stressed rats subjected to elevated plus maze (EPM) and open field test (OFT). Eh treatment (200 mg/kg, p.o.; seven days) showed marked anti-anxiety activity in chronic immobilization stress. In contrast, the forced swim stress-induced anxiety was only partially decreased by Eh. Co-treatment of rats with flumazenil (0.5 mg/kg, i.p.), bicuculline (1 mg/kg, i.p.) or picrotoxin (1 mg/kg, i.p.) resulted in a significant reduction of anxiolytic effect of Eh indicating that its actions are mediated through GABA(A) receptor-benzodiazepine receptor-Cl(-) channel complex. Thus, our studies indicate that Eh is a potential anxiolytic drug, which might be beneficial in the treatment of stress-induced anxiety disorders.

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A 57-year-old female presented in Emergency Department of M.S Ramaiah Medical college, Bangalore with complaints of fever, loose stools, malaise, swelling of lips, oral ulcers and blisters all over the body. The patient had noticed the blisters a few days after developing fever. The patient had been diagnosed with rheumatoid arthritis three years ago and had been taking oral methotrexate 7.5 mg per week for six weeks.Since her joint pain persisted, her family physician added oral etoricoxib 60 mg once daily to the treatment regimen. Patient continued to take etoricoxib 60mg daily for six weeks along with methotrexate. Other concomitant medications included amlodipine 2.5mg, atorvastatin 10mg, chloroquine 200 mg, omeprazole 20 mg and folic acid 5mg . No past history of allergic diathesis was reported.The physical examination was remarkable for cutaneous involvement of trunk, face, lips, palms and soles. Large areas of epidermal detachment involving more than 20% of body surface area were noticed [Table/ Fig-1,2]. Bullous lesions with erosions and peeling were present bilaterally on both the legs [Table/ Fig-3]. Oral erosions were seen. Conjunctival congestion was present. The vital signs recorded were as follows: temperature (axillary)-38.5ºC; pulse rate-88/min; respiration rate-18/min; blood pressure-160/80mmHg.On admission laboratory investigations revealed haemoglobin 9.04 g/dl white blood cell count 5620 mm 3 , platelet count 160,000 mm 3 , serum creatinine 1.1 mg/dl, blood urea nitrogen 18 mg/dl, liver function test was normal. Pus culture was positive for gram positive cocci and coagulase negative Staphylococcus. Blood and urine cultures were sterile. Chest X-ray and ultrasound abdomen were normal.After the patient's initial assessment in the emergency room, consultations by a dermatologist and an ophthalmologist were availed. The diagnosis of SJS-TEN overlap was concurred. All the previous medications taken by the patient were discontinued Keywords: Drug interaction, Non-steroidal anti-inflammatory drugs, Rheumatoid arthritis Rheumatoid arthritis (RA) is an autoimmune disease affecting about 1% of people, with the highest incidence between 40 and 70 years.Methotrexate is an anti-folate analogue that has good efficacy and safety in the treatment of RA. Methotrexate (MTX) and non-steroidal anti inflammatory drugs are often concomitantly administered in clinical practice for the treatment of RA. In this case report, a 57-yearold female was treated with oral methotrexate 7.5 mg per week for a diagnosed case of RA. Since her pain persisted after completing six weeks of treatment with methotrexate, oral etoricoxib 60 mg once daily was added to the treatment regimen. Six weeks later, the patient complained of oral ulcerations and blisters on all fours limbs and trunk. The patient was re-evaluated and was diagnosed with Stevens-Johnson syndrome-Toxic epidermal necrolysis (SJS-TEN) overlap. This case highlights the possible pharmacokinetic interaction between methotrexate and etoricoxib that has a significant clini...

Objective:To evaluate the efficacy and tolerability of ranolazine as an add-on drug in chronic stable angina patients and the impact of ranolazine on the quality of life in chronic stable angina patients receiving other antianginal medications.Materials and Methods:It was a prospective, open-label, hospital-based study involving 144 patients with chronic stable angina. First group received either metoprolol 12.5 or 25 mg/day or other antianginal medications; if the symptoms persist, the dose of metoprolol was increased to 50 mg/day, and to the second group, ranolazine 500 mg BD or 1 g OD was added along with metoprolol or others if the anginal attacks were not subsiding. The patients were followed up to 6 months with electrocardiography, treadmill test, and quality of life questionnaire. Adverse events were recorded at each visit during the study.Results:There was a statistically significant reduction in weekly anginal frequency (P < 0.001) and improvement in an exercise tolerance in both the groups, but more in the ranolazine group. Adverse events reported were mild, infrequent.Conclusion:Ranolazine is could be used as an add-on drug in chronic angina patients not improved with metoprolol or antianginal medications.