OBJECTIVE To evaluate the safety of esketamine nasal spray add-on therapy for treatment-resistant depression by meta analysis. METHODS Randomized controlled trials(RCTs) of esketamine nasal spray+oral antidepressants were searched and meta-analysis was conducted. RESULTS Five RCTs and 1 019 patients were included in the study. Compared with contrast group, treatment group had more adverse reacions, such as dissociation(RR=6.35, 95%CI, 2.84-14.23, P<0.000 01); sedation(RR=5.47, 95%CI, 2.05-14.57, P=0.000 7); somnolence(RR=2.66, 95%CI, 1.30-5.44, P=0.007); headache(RR=1.38, 95%CI, 1.05-1.83, P=0.02); vertigo(RR=5.87, 95%CI, 3.30-69.79, P<0.000 01; diziness(RR=2.98, 95%CI, 1.33-6.68, P=0.008); hypoesthesia(RR=10.25, 95%CI, 3.65-28.83, P<0.000 1); anxiety(RR=2.01, 95%CI, 1.20-3.37, P=0.008); paresthesia(RR=6.62, 95%CI, 2.75-15.98, P<0.000 1); nausea(RR=4.05, 95%CI, 2.71-6.05, P<0.000 01); dysguesia(RR=1.81, 95%CI, 1.35-2.42, P<0.000 1). At the same time, compared with contrast group, in esketamine nasal spray 28 mg subgroup, it had no significant difference in adverse effects; while in 56, 84 mg subgroup, there was significant difference besides of somnolence, headache, dysguesia. CONCLUSION It is showed that the appearance of adverse events has increased, but it is very light in esketamine nasal spray add-on therapy for treatment-resistant depression.

Introduction:: Clinical exposure to assist pharmacology teaching is essential for training the medical students to apply the pharmacological therapeutic principles in medical practice. In view of this, we planned to introduce and implement a new module in pharmacology – case of the month series and get the feedback of undergraduate medical students. Materials and methods:: The study was conducted on second-year MBBS students after obtaining permission from Institutional Ethics Committee. Topics for the case of the month series were predefined and announced to the students. During their clinical posting, the students were given a proforma to collect the details, including the patient details, presenting illness, past history, provisional diagnosis, investigations, and treatment chart. The case of the month had to be submitted to the faculty who would then discuss it with the batch after practical classes. The students‟ feedback was collected at the end of four such case-of-the-month series as a questionnaire with a few open-ended questions. Results:: A total of 204 students submitted the responses online; their mean age was 20.6±1.4 years. 56.3% of students were of the opinion that this exercise was helpful for rational prescription of drugs in the future. 52% of the students opined that the series was interesting and stimulating. Conclusion: The case of the month series was well perceived by students and faculty. It also stimulated the interest of medical students in learning the importance of clinical pharmacology.