Effects of “FIRST2ACT” Model on Knowledge and Practical Skills of Difficult Airway Management in Nurse Anesthesia Students: An Interventional Study

Introduction: An important part of anesthesia management is opening and maintaining the patient’s airway. Failure to establish and maintain a safe airway for patients during anesthesia is a life-threatening condition. Despite advances in science and technology, difficult airway management is far from ideal. Providing a simulated environment for critical situations seems to be the best way to better educate and prevent medical errors. This study aimed to compare the effect of the FIRST2ACT (Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trend) model on knowledge and practical skills of difficult airway management and respiratory accidents between the intervention and control groups.Methods: This study was a quasi-experimental intervention with before and after design. Sampling was done by census method and the participants were third and fourth-year nurse anesthesia students (n=62). The students were randomly allocated to an intervention group (n=31) educated and practicing based on the FIRST2ACT model and a control group (n=31). The intervention consisted of five stages: developing core knowledge, assessment, simulation, reflective review, and performance feedback, all based on the FIRST2ACT model. Theoretical and practical skills were examined in the participants. Data collection tools included a questionnaire and a checklist.Results: The results showed that after applying the FIRST2ACT model, the intervention group scored higher than the control group in both theoretical knowledge (17.87±1.43 vs. 12.67±1.35) and practical skills (134.28±3.21 vs. 81.58±8.55). This difference in results between the two groups was statistically significant (P˂0.001).Conclusion: It can be concluded that using this model was effective to improve the knowledge and practical skills of nurse anesthesia students in the field of difficult airway management and respiratory accidents during anesthesia

C-Terminal Domain Deletion Enhances the Protective Activity of cpa/cpb Loaded Solid Lipid Nanoparticles against Leishmania major in BALB/c Mice

Cutaneous leishmaniasis (CL) is the most common form of leishmaniasis with an annual incidence of approximately 2 million cases and is endemic in 88 countries, including Iran. CL's continued spread, along with rather ineffectual treatments and drug-resistant variants emergence has increased the need for advanced preventive strategies. We studied Type II cysteine proteinase (CPA) and Type I (CPB) with its C-terminal extension (CTE) as cocktail DNA vaccine against murine and canine leishmaniasis. However, adjuvants' success in enhancing immune responses to selected antigens led us to refocus our vaccine development programs. Herein, we discuss cationic solid lipid nanoparticles' (cSLN) ability to improve vaccine-induced protective efficacy against CL and subsequent lesion size and parasite load reduction in BALB/c mice. For this work, we evaluated five different conventional as well as novel parasite detection techniques, i.e., footpad imaging, footpad flowcytometry and lymph node flowcytometry for disease progression assessments. Vaccination with cSLN-cpa/cpb-CTE formulation showed highest parasite inhibition at 3-month post vaccination. Immunized mice showed reduced IL-5 level and significant IFN-ã increase, compared to control groups. We think our study represents a potential future and a major step forward in vaccine development against leishmaniasis

Amine functionalized benzene based hypercrosslinked polymer as an adsorbent for CO2/N2 adsorption

Abstract In this work, benzene based hypercrosslinked polymer (HCP) as an adsorbent was modified using amine group to enhance CO2 uptake capability and selectivity. Based on BET analysis result, the HCP and the modified HCP provide surface area of 806 (m2 g−1) and micropore volume of 453 (m2 g−1) and 0.19 (cm3 g−1) and 0.14 (cm3 g−1), respectively. The CO2 and N2 gases adsorption were performed in a laboratory scale reactor at a temperature between 298 and 328 K and pressure up to 9 bar. The experimental data were evaluated using isotherm, kinetic and thermodynamic models to identify the absorbent behavior. The maximum CO2 adsorption capacity at 298 K and 9 bar was obtained 301.67 (mg g−1) for HCP and 414.41 (mg g−1) for amine modified HCP. The CO2 adsorption thermodynamic parameters assessment including enthalpy changes, entropy changes, and Gibbs free energy changes at 298 K were resulted − 14.852 (kJ mol−1), − 0.024 (kJ mol−1 K−1), − 7.597 (kJ mol−1) for HCP and − 17.498 (kJ mol−1), − 0.029(kJ mol−1 K−1), − 8.9 (kJ mol−1) for amine functionalized HCP, respectively. Finally, the selectivity of the samples were calculated at a CO2/N2 composition of 15:85 (v/v) and 43% enhancement in adsorption selectivity at 298 K was obtained for amine modified HCP

Safety of Intravitreal Injection of Biosimilar of Aflibercept in Rabbit Eyes

Purpose. To assess the safety of biosimilar intravitreal aflibercept (CinnaGen Co., Iran) compared to the reference product (Eylea®; Bayer Schweiz AG, Zurich, Switzerland) in rabbit eyes through functional and histologic studies. Methods. Forty New Zealand albino rabbits were recruited to the study and were divided into four groups to be sacrificed at 48 hours, one, two, and four weeks after injections. In each group, five rabbits received 0.05 mL (2 mg) biosimilar aflibercept in the right eye and 0.05 mL saline in the left eye as the control, and in a similar manner, the remaining five rabbits received the reference drug in the right eye and saline in the left eye. All the rabbits underwent comprehensive ophthalmic examination and electroretinography (ERG) tests at baseline and also just before enucleation at the specific predefined time points. The enucleated eyes were prepared for retinal toxicity histological examination. Results. No retinal toxicity was observed based on histologic and ERG findings in all groups. Choroidal congestion was revealed after 1 week in an eye that was injected with biosimilar aflibercept, although the similar finding was detected in the contralateral eye which received saline. Also, one subject which received the reference drug showed chronic vitritis and lymphoplasmocytic reaction of the optic disc at week 4. The remaining subjects showed no histologic changes. Conclusion. The 2 mg intravitreal injection of biosimilar aflibercept (CinnaGen Co., Iran) was found to be nontoxic in rabbit eyes in the short-term period. Further studies are required to warrant the efficacy and safety profile of the drug in human subjects

Investigation of Factors Related to Stillbirth

The stillbirth rate is among the most important indicators of access to and quality of care during pregnancy. This study investigated the factors related to the stillbirth rate in the Yazd province, Iran. The current research is descriptive and cross-sectional and the results of Shahdieh city cohort study which was conducted on 4756 women were used. Data related to the history of stillbirth, demographic characteristics, fertility history and, various female diseases were extracted from the results of the cohort study. The result shows that 7.2% of studied women had a history of stillbirth. Among the multiple variables, predictor variables including education level, marriage age, age of the first conception, number of children, consanguineous marriage, Employment status, and diseases like diabetes, hypertension, and history of depression had a significant relationship with a history of stillbirth ( P  ≤ .05). The stillbirth rate in Shahedieh is high compared to the global stillbirth Rate, but it is comparable with the stillbirth Rate in Yazd province. Although Yazd province, as one of the industrial hubs of Iran, has relatively acceptable indicators of income, employment, and medical and health facilities and welfare compared to other provinces, this study showed that factors such as diabetes, hypertension, low level of women’s education, consanguineous marriage, and women’s employment status and social welfare can affect Stillbirth Rate

Flowcytometry analysis of the footpads.

<p>The bars represent the average percentage of GFP positive footpad cells ± SD of three mice per each group GFP fluorescence expression was significantly lower in the footpads of group 3 (*<i>p</i><0.05).</p

Antigen-specific IgG1 and IgG2a responses.

<p>Before and at week 9^th after challenge, blood samples were collected and pooled sera (diluted 1∶50) per each group was prepared. Antibody responses stimulated by rCPA (A, C) and rCPB or rCPB^-CTE (B, D) and SLA (E) showed the profile of CP-specific antibodies, induced before (n = 13) and after (n = 10) challenge. The data represent means±SD. Results are representative of two independent experiments, each performed in triplicate.</p

Cytokine production by lymph node (LN) cells from <i>L. major</i>-infected mice.

<p>Single-cell suspensions were prepared from the LN of three mice in the designated groups, before (n = 13) and 9 weeks after infection (n = 10). Cells cultured in triplicate for 5 days in the presence of recombinant antigens (10 µg/ml), soluble <i>Leishmania</i> antigen (SLA, 4 µg/well), Con A (as positive control) and RPMI (as negative control). Culture supernatants were assayed for levels of IFN-γ, before challenge (A), after challenge (B) and IL-5 (C) production by ELISA. There were no difference in Con A-induced cytokine production, among the groups. Each bar represents the mean ± SD for three mice per group (n = 3). Results are representative of two independent experiments, each performed in triplicate.</p

<i>L. major</i> burden of popliteal lymph nodes.

<p>(A) microtitration analysis: a limiting dilution analysis was performed 9 weeks after infection on the cells isolated from popliteal LN of 3 individual mice from each group and cultured in triplicate in Schneider's medium for 15 days at 26°C in serial 10-fold dilution. The wells were assessed microscopically for <i>L. major</i> growth, and the number of viable parasites was determined from the well with the highest dilution. The bar represents the average score±SD of three mice per group. Results are representative of at least two independent experiments and revealed a significant (*<i>p</i><0.05) decrease in G1, G3 of the vaccinated mice compared to the control groups. (B) flowcytometry analysis. 9 weeks post-infection, intracellular fluoresence of the lymph node cells (pool of lymph nodes of three mice from each group) was quantified by Partec PASIII flow cytometer. “*” reveals significantly decrease in group 1 and 3 compared to unvaccinated control groups (<i>p</i><0.05).</p

cSLN formulations and their characteristics.

<p>Nanoparticles were formulated from cetyl palmitate, cholesterol and DOTAP hydrochloride. Results represent mean±SD of three independent SLN preparations.</p