Comparison of two doses of leucovorin in severe low-dose methotrexate toxicity - a randomized controlled trial.

BACKGROUND: Leucovorin (folinic acid) is a commonly used antidote for severe toxicity with low-dose methotrexate, but its optimum dose is unclear, varying from 15 to 25 mg every 6-h. METHODS: Open-label RCT included patients with severe low-dose (≤ 50 mg/week) methotrexate toxicity defined as WBC ≤ 2 × 10^9/L or platelet ≤ 50 × 10^9/L and randomized them to receive either usual (15 mg) or high-dose (25 mg) intravenous leucovorin given every 6-h. Primary outcome was mortality at 30-days and secondary outcomes were hematological recovery and mucositis recovery. TRIAL REGISTRATION NUMBER: CTRI/2019/09/021152. RESULTS: Thirty-eight patients were included, most with underlying RA who had inadvertently overdosed MTX (taken daily instead of weekly). At randomization, the median white blood and platelet count were 0.8 × 10^9/L and 23.5 × 10^9/L. 19 patients each were randomized to receive either usual or high-dose leucovorin. Number (%) of deaths over 30-days was 8 (42) and 9 (47) in usual and high-dose leucovorin groups (Odds ratio 1.2, 95% CI 0.3 to 4.5, p = 0.74). On Kaplan-Meier, there was no significant difference in survival between the groups (hazard ratio 1.1, 95% CI 0.4 to 2.9, p = 0.84). On multivariable cox-regression, serum albumin was the only predictor of survival (hazard ratio 0.3, 95% CI 0.1 to 0.9, p = 0.02). There was no significant difference in hematological or mucositis recovery between the two groups. CONCLUSION: There was no significant difference in survival or time-to hematological recovery between the two doses of leucovorin. Severe low-dose methotrexate toxicity carried a significant mortality.

Mechanistic investigations on antifungal and antiaflatoxigenic activities of chemically characterised Carum carvi L. essential oil against fungal infestation and aflatoxin contamination of herbal raw materials.

This study aimed to investigate the efficiency of chemically characterised Carum carvi essential oil (CcEO) against aflatoxin B1 (AFB1) producing strain of Aspergillus flavus (AF-LHP-WS-4) causing deterioration of herbal raw materials (HRM). GC-MS analysis of the EO revealed the presence of carvone (69.85%) as a dominant component. CcEO caused complete suppression of A. flavus growth and AFB1 secretion at 0.7 and 0.6 µL/mL, respectively. The investigation on antifungal mode of action showed that CcEO inhibited fungal growth via abrogating ergosterol biosynthesis and triggered efflux of vital cellular ions. The inhibition of AFB1 biosynthesis was attributed to the inhibition of cellular methylglyoxal (MG) biosynthesis. In addition, CcEO showed remarkable antioxidant activity (IC50 = 10.564 µL/mL) against DPPH (2,2-diphenyl-1-picrylhydrazyl) radicals. Based on overall results, it can be concluded that the CcEO may be recommended as potential antifungal agent for protection of HRM from fungal infestation and AFB1 contamination.

Development of a protocol for the elimination of Cyrtanthus elatus virus-A from Narcissus tazetta by in vitro chemotherapy in combination with electrotherapy.

Narcissus (Narcissus tazetta) is a bulbous ornamental plant propagated vegetatively from bulbs. The Cyrtanthus elatus virus-A (CyEV-A) had been reported to cause a severe mosaic and yellow stripe disease in narcissus. Therefore, this study aimed to develop a protocol for the elimination of CyEV-A from infected bulblets by in vitro chemotherapy (30-50 mg/L ribavirin for 30 days) and electrotherapy (10-30 mA for 20 min), individually and in combination, to produce virus-free plants. The regenerated plants obtained from these treatments were screened for the absence of the CyEV-A by reverse-transcription polymerase chain reaction assays using a set of degenerate primers specific for a potyvirus coat protein gene. The results showed that in vitro chemotherapy (30 mg/L ribavirin for 30 days) alone produced 46.0 % (14/30) of virus-free plants, while electrotherapy (20 mA for 20 min) alone produced 40.0 % (12/30) of virus-free plants. In comparison, a combination of chemotherapy (30 mg/L ribavirin for 30 days) and electrotherapy (20 mA for 20 min) produced 50.0 % (15/30) of virus-free plants. The virus-free plants obtained from this combination treatment exhibited better growth and produced more bulbs compared to the other treatments and control. The protocol may be used for the control of the virus disease in narcissus.

Acupressure as an Adjunct to Pharmacological Treatment for Depression, Anxiety, and Stress in Patients with Knee Osteoarthritis.

BACKGROUND: Osteoarthritis is the most common type of arthritis. Depression, anxiety, and stress are associated with knee osteoarthritis. OBJECTIVES: The aim of the study was to check the effectiveness of acupressure therapy with pharmacological treatment on pain, depression, anxiety, and stress in patients with knee osteoarthritis and to assess the effect of pain improvement on psychological health. METHODS: Eligible 212 patients with knee osteoarthritis were divided into two groups (intervention and control group). The intervention group (n = 106) received acupressure therapy in combination with pharmacological treatment, whereas the control group (n = 106) continued pharmacological treatment only. Pain and psychological symptoms were measured using the visual analog scale and Depression Anxiety Stress Scale-21. Pearson's correlation was used to check the effect of pain improvement on psychological health. RESULTS: Patients of both groups reported severe pain initially. On analyzing the results after completion of the study, it was found that patients in the intervention group scored better on the pain scale (p < 0.001) and DASS-21 (p ≤ 0.0001). However, it may be noted that reduction in the DASS-21 score was not found to be significant for the control group (p = 0.08). Pearson's correlation coefficients value ranged from 0.231 to 0.412 for DASS-21 (p < 0.05). CONCLUSIONS: On analysis, it can be concluded that acupressure can be used as add-on therapy in combination with conventional treatment (pharmacological treatment), which may assist in pain reduction. The reduction in pain directly contributes to improvement in the physiological wellness among patients with knee osteoarthritis.

Elimination of Bean yellow mosaic virus from infected cormels of three cultivars of gladiolus using thermo-, electro- and chemotherapy.

Bean yellow mosaic virus (BYMV) is a prevalent virus and major threat to gladiolus cultivation the world over. In the gladiolus repository at CSIR-NBRI, Lucknow, several plants (82-88%) of three economically important cultivars were found infected by BYMV showing severe mosaic and stripe symptoms. Affected plants exhibit diminished quality and quantity of florets and corms, thus reducing their value. Attempts were made to eliminate BYMV from the infected gladiolus cormel explants in vitro through thermotherapy (37 °C for 30 days), chemotherapy (30 mg/L ribavirin for 30 days), and electrotherapy (30 mA for 20 min), either alone and in different combinations. The in vitro regenerated plants were free from BYMV infection when checked by RT-PCR using BYMV-specific primers. The combination of electro- and chemotherapies has given the best response as compared to other treatments. Among the individual therapies, electrotherapy (30 mA/20 min) was found to be the best for and production of BYMV-free gladiolus plants (44-46%) with moderate regeneration efficiency (54-58%) followed by chemotherapy and thermotherapy. However, the cormels obtained from a combination of electro- and chemotherapy treatment (30 mA/20 min + 30 mg/L) has given highest virus free (46-52%) and highest therapy efficiency indices (56%) as compared to other treatments. Further, these cormels showed better developed root systems and produced more cormels which were larger in size as compared to the other treatments and control when grown in tissue culture media.

Endophytic fungi isolated from oil-seed crop Jatropha curcas produces oil and exhibit antifungal activity.

Jatropha curcas L., a perennial plant grown in tropics and subtropics is popularly known for its potential as biofuel. The plant is reported to survive under varying environmental conditions having tolerance to stress and an ability to manage pest and diseases. The plant was explored for its endophytic fungi for use in crop protection. Endophytic fungi were isolated from leaf of Jatropha curcas, collected from New Delhi, India. Four isolates were identified as Colletotrichum truncatum, and other isolates were identified as Nigrospora oryzae, Fusarium proliferatum, Guignardia cammillae, Alternaria destruens, and Chaetomium sp. Dual plate culture bioassays and bioactivity assays of solvent extracts of fungal mycelia showed that isolates of Colletotrichum truncatum were effective against plant pathogenic fungi Fusarium oxysporum and Sclerotinia sclerotiorum. Isolate EF13 had highest activity against S. sclerotiorum. Extracts of active endophytic fungi were prepared and tested against S. sclerotiorum. Ethyl acetate and methanol extract of C. truncatum EF10 showed 71.7% and 70% growth inhibition, respectively. Hexane extracts of C. truncatum isolates EF9, EF10, and EF13 yielded oil and the oil from EF10 was similar to oil of the host plant, i.e., J. curcas.