Magnetophoretic Intranasal Drug-loaded Magnetic Nano-aggregates as a Platform for Drug Delivery in Status Epilepticus.

BACKGROUND: Status epilepticus is associated with substantial morbidity and neuronal necrosis, and the duration of the seizure would affect its following complications. Eliminating the duration would have valuable outcomes; however, the presence of BBB is an obstacle. The purpose of the current study was to achieve a nose-to-brain magnetic drug delivery system to accelerate the onset of action, and to reduce the mucociliary clearance via implementing the magnetic field. MATERIALS AND METHODS: The drug-entrapped magnetic nanoaggregates were prepared via a 2-step method, synthesis of the magnetic nanoparticles and drug loading. Optimization of the variables, including ammonium hydroxide:water ratio, beta-cyclodextrin%, duration of the mixing time, amount of Pluronic, and drug:magnetic nanoaggregates mass ratio was performed according to particle size, PDI, zeta potential, release profile and entrapment efficiency. The efficacy of optimized formulation was assessed in the animal model. RESULTS: According to the analysis performed by the software, drug-to-nanoparticle ratio and the duration of mixing time were found to be significantly effective (p < 0.05) for entrapment efficiency and particle size distribution, respectively. The optimum formulation with an approximate average size of 581 nm and 61% entrapment efficiency was obtained, which released about 80% of its drug content within the first 20 minutes. The in vivo efficacy was significantly improved (p < 0.05) by administration of magnetic nanoaggregates in the presence of a simple external magnet placed on the glabellar region of the animals, compared to the control groups. CONCLUSION: This drug delivery system could be suggested as a fast-acting alternative for seizure cessation in status epilepticus emergencies.

Adaptive Support Ventilation Reduces the Incidence of Atelectasis in Patients Undergoing Coronary Artery Bypass Grafting: A Randomized Clinical Trial.

BACKGROUND: Pulmonary complications are common following cardiac surgery and can lead to increased morbidity, mortality, and healthcare costs. Atelectasis is the most common respiratory complication following cardiac surgery. One of the most important methods for reducing pulmonary complications is supportive care with protective ventilation strategies. In this study, we aimed to assess the effect of adaptive support ventilation (ASV) on atelectasis in patients undergoing cardiac surgery. METHODS: In this single-blind randomized clinical trial, 115 patients, undergoing coronary artery bypass grafting, were randomly allocated into 2 groups: 57 patients in the intervention and 58 patients in the control group. Patients in the intervention group were weaned with ASV, while patients in the control group were managed using synchronized intermittent mandatory ventilation (SIMV) and pressure support. The incidence of atelectasis, duration of mechanical ventilation, manual ventilator setting, arterial blood gas measurements, and length of hospital stay were compared between the groups. RESULTS: The incidence of atelectasis, number of changes in the manual ventilator setting, number of alarms, and length of hospital stay reduced in the intervention group. However, duration of mechanical ventilation and number of ABG measurements were not significantly different between the groups. CONCLUSIONS: The ASV mode could reduce the incidence of atelectasis and length of hospital stay. However, it did not reduce the duration of mechanical ventilation. It seems that ASV is not a superior mode for faster extubation.

High take-off of right coronary artery: an extremely rare case of RCA anomaly.

A 45-year-old man with a past history of aortic valve insufficiency presented with recently increasing chest discomfort. Coronary angiography revealed significant stenosis at the mid-portion of the left anterior descending artery and origin of the first obtuse marginal branch. The right coronary artery (RCA) was faintly seen to be free from significant stenosis. (Selective RCA angiography had not been possible.) At surgery while dissecting between the ascending aorta and the main pulmonary artery, the RCA ostium was incidentally found to be located approximately 10 cm above the aortic annulus and 5 cm above the sinotubular junction, between the medial curve of the ascending aorta and the main pulmonary artery. After coronary artery bypass grafts, we repaired the aortic valve and the RCA remained intact.