Medicine and Health Sciences Commons^™

Identifying Contributing Factors For Legal Placement Status In Involuntary Commitment And Voluntary Commitment In Child And Adolescent Psychiatry, Brianna R. Perry

Honors Undergraduate Theses

Background: Psychiatric hospitalization of children and adolescents can be carried out either voluntarily or involuntarily. The aim of this form of inpatient hospitalization is to provide treatment for those who cannot manage the symptoms of their mental illnesses on their own. However, psychiatric hospitalizations of children and adolescents are costly and could lead to outcomes such as worsened mental state in former patients and distrust of the system in caregivers. It is crucial to have a solid understanding of specific components that lead to the hospitalization.

Purpose: To identify potential trends in patient admission data through the analysis …

The Relationship Between Resistance Training On Depressive Symptoms, Coping Self-Efficacy, And Quality Of Life In Female College Students, Katherine B. Tran

Honors Undergraduate Theses

Background: Current studies have found a higher risk of depression, coping self-efficacy, and quality of life, specifically among female college students and predominantly pharmacotherapy or cognitive therapy intervention have been adopted to improve depression or depressive symptoms, however, current research suggests an alternative strategy, such as exercise, may be an effective approach. Understanding the relationship between exercise, such as resistance training (RT), and other psychosocial outcomes such as depressive symptoms, coping self-efficacy, and quality of life may show the potential of utilizing RT amongst this understudied population and can provide insight on alternative or supplemental treatment options for depression. Methods: …

Bioarchaeological Study Of Patterns Of Juvenile Oral Health In Ancient Peru, Nidhi S. Patel

Honors Undergraduate Theses

Dental caries have been identified for several centuries as a common pathology within individuals’ mouths, more specifically in the posterior teeth surfaces (Jesudass, Prabhu, Rajajee, & Sudheer, 2014). Although there have been modern procedures and preventative methods developed to help treat dental caries, in ancient times this was not always the case. The persistence of anterior teeth dental caries in juveniles is a unique pathology observed in Túcume that has not been studied yet. Through the analysis of skeletal samples, this research aims to study the specific case of the formation of anterior deciduous dental caries in juveniles located at …

How Hormonal Contraceptives Influence Injury In Female Athletes: A Systematic Review, Ashley V. Malvita

Honors Undergraduate Theses

Research indicates that female athletes have a higher risk of musculoskeletal injuries. Hormone fluctuations throughout the different periods of the menstruation cycle impacts the risk of injuries for women. Contraceptive use, most used in the form of an oral contraceptive pill, directly effects hormones and menstrual cycle related symptoms, with evidence of ameliorating some symptoms. Oral contraceptive use is suggested to influence musculoskeletal injuries in female athletes. However, there is little research and data that explores the direct relationship between oral contraceptive use and the injury rates of female athletes. Within this systematic review, five articles investigating this relationship fulfilled …

The Efficacy Of Vitamin D Supplementation In The Treatment Of Polycystic Ovary Syndrome, Paola N. Delacerda

Honors Undergraduate Theses

Polycystic ovary syndrome (PCOS) is a complex disorder commonly affecting women of reproductive age. Diagnostic criteria include abnormal menstrual cycles, elevated androgens, and cystic ovaries, although insulin resistance is also common. PCOS puts patients at an elevated risk for complications such as type 2 diabetes and cardiovascular disease, so proper management of this condition is essential. It has been found that vitamin D deficiency is prevalent among the PCOS patient population, therefore, this study aims to evaluate the efficacy of vitamin D supplementation as a treatment for PCOS. A meta-analysis was performed using six randomized, placebo-controlled trials that each examined …

Individual And Organizational Challenges To Implementing Prolonged Exposure Therapy In The Military Health System: A Systematic Review Of Client And Provider Perspectives, Paris R. Cloutier

Honors Undergraduate Theses

Military veterans and active-duty service members face high rates of posttraumatic stress disorder (PTSD), a chronic and debilitating condition that is comorbid with other negative psychological and social outcomes. PTSD symptomology in military careers is attributed to unique organizational factors and risks both during and post-deployment. Delivering modern, effective PTSD treatments derived from evidence-based research to the military population is a multi-faceted effort. Among these interventions, prolonged exposure therapy (PE) is a safe and effective trauma-focused treatment for veterans. To yield higher rates of PE success, common challenges faced by both military clients and their clinicians that may be impairing …

The Role Of Micrornas In Cellular Senescence, Inflammation, And Cancer Induced By Childhood Obesity, Sarah S. Siddiqi

Honors Undergraduate Theses

Childhood obesity has escalated into a major public health crisis with serious implications for long-term health. As obesity rates among children continue to rise globally, it is crucial to understand its effects on cellular aging and inflammation—key processes that underpin many metabolic diseases. Obesity not only directly contributes to various metabolic disorders but also disrupts fundamental cellular mechanisms, accelerating aging and fostering systemic inflammation. By examining the impact of obesity on cellular aging and chronic inflammation, as well as the regulatory role of microRNAs (miRNAs) in these pathways, we have been able to identify critical biomarkers and molecular mechanisms involved …

Peer Support To Enhance Safe Alcohol Use In University Students: A Quality Improvement Project, Kerri Reynolds

DNP Scholarly Projects

BACKGROUND: College is a period of transition to adulthood where many students experiment with alcohol consumption. Peer educators can bring access to evidence-based alcohol consumption education through student-centric strategies. This quality improvement project aimed to implement an evidence-based training program for college peer educators followed by the delivery of campus alcohol education in a six week period. Feasible ideas for sustainable college peer educator training were generated at this medium-sized public university. The impact of training on six peer educators’ self-reported professional leadership skills, knowledge, and confidence was measured.

METHODS: The Certified Peer Educator (CPE) training program (NASPA) was used …

Evaluating The Impact Of Simulation On Perceived Knowledge And Confidence Of New Graduate Nurses (Ngns) In Maternal-Newborn Care, Disa Seymour

DNP Scholarly Projects

Abstract

Background: Nursing education worldwide varies in duration and training process, with nurses often facing rapid immersion into patient care complexities when entering the workforce. While new nurses contribute significantly to the nursing community with contemporary knowledge, their transition to practice can be daunting, necessitating support for both competence and retention. As specialty care settings integrate more new graduate nurses (NGNs) to address workforce shortages, collaboration between leaders and educators becomes crucial. Simulation emerges as a vital tool in building confidence while learning, offering a safe space for skill development and growth of confidence.

Purpose: This project’s objective was to …

Optimizing The Assisted Living Experience: Integration Of Value-Based Care To Foster Augmented Resident-Centered Quality, Jennette Pietrzak

DNP Scholarly Projects

Background: Fee-for-Service models are quantity-focused reactive approaches and have historically been at the forefront of healthcare. Value-based models focus on proactive, resident-centered care that is aimed at quality care over quantity. Implementation of ValueBased Care models can positively impact healthcare and fiscal outcomes

Purpose: The quality improvement project aimed to develop, integrate, and implement a valuebased model in Memory Care as an alternative to traditional Fee-for-Service models. The project aimed to improve key performance indicators by reducing hospitalizations, emergency room visits, and falls following the implementation of Value-Based Care (VBC) models.

Method: Data metrics for hospitalizations, emergency room visits, and …

Scares: A Clinician Guide To Spinal Cord Awareness, Response, And Emergency Support Creation And Implantation Of Scares Protocol Among Hospitalist Advanced Practice Providers, Brittany Biega

DNP Scholarly Projects

While they are more common in patients with oncological disease and trauma, SCE still exist among patients without these comorbidities. Less has been established regarding care protocols in this population. The absence of standardized procedures has been linked to preventable, adverse patient outcomes, including cases of permanent damage due to delayed treatment. This project employs Lean Six Sigma methodologies and Johns Hopkins Evidence- Based Practice to devise a robust SCE protocol, aimed at standardizing care and improving patient outcomes. A multidisciplinary team including general medicine, neurology, neurosurgery, and neuroradiology developed “Spinal Emergency Management Guidelines” protocol, which was implemented within the …

Effectiveness Of Diversion Tube On Peripheral Blood Culture Contamination Rates From Intravenous Catheters In A Community Hospital Emergency Department, Anne Meginniss

DNP Scholarly Projects

BACKGROUND: Obtaining blood cultures is routine care for patients who are suspected to have sepsis. Contaminated blood cultures can lead to increased healthcare costs for patients suspected of sepsis. Reducing contaminated specimens could improve the quality of care delivered as well as increase patient satisfaction.

AIM: This quality improvement project aimed to reduce the number of contaminated blood cultures in a community hospital emergency department by using an initial specimen diversion tube to meet the new national benchmark of below 1% contamination rate.

METHODS: Twenty-seven diversion specimens were collected over an eight-week period via initial intravenous catheter insertion in a …

Impact Of Personal Continuous Glucose Monitor Use During Hospitalization On Rates Of Hypoglycemia And Provider Confidence, Rebecca Longo

DNP Scholarly Projects

Continuous Glucose Monitors (CGMs) are an essential tool for managing diabetes in the outpatient setting, helping individuals achieve glucose goals. However, CGMs are not currently FDA-approved for use in the hospital setting. Despite this limitation, many individuals continue using their personal CGM during hospitalization or begin using them prior to discharge if the care team believes the technology will support glucose management during and after leaving the hospital.

This project aimed to evaluate whether individuals using personal CGMs during hospitalization experienced less hypoglycemia and whether reviewing CGM data could improve provider confidence in insulin dosing. While initiating CGM use during …

Implementation Of An Electronic New Patient Intake Questionnaire (E-Npiq) In A Child Development Clinic: A Quality Improvement Project, Wilma Hyde

DNP Scholarly Projects

BACKGROUND: A rural academic medical center child development clinic in New Hampshire experienced high volumes and inefficient workflows, causing delays in care. With a referral rate at 5-fold capacity, the need to create an efficient intake process that allowed for triage and data collection was apparent.

PURPOSE: Institute an integrated electronic new patient intake questionnaire (e-NPIQ) to improve work efficiency.

METHODS: A literature review on barriers and enablers for patient uptake of electronic questionnaires guided best practices for workflow redesign. The project instituted an integrated e-NPIQ while simultaneously creating a standardized new patient intake process. A mixed methods approach analyzed …

Enhancing Safety Surveillance During Clinical Trials: The Development Of A Safety Data Review Handbook To Support Pharmacovigilance Clinicians, Lauren Wilson

DNP Scholarly Projects

Abstract

BACKGROUND: Pharmacovigilance (PV) Sciences include activities related to safety surveillance of pharmaceutical products, and is critical for developing safe and effective medications, vaccines and medical devices. Safety monitoring starts with preclinical research and continues through clinical trial and post marketing phases. PV scientists ensure patient safety during clinical trials through regular review and analysis of safety data. Regulations have become increasingly complex, leading to inadequately defined methods for reviewing large clinical trial safety datasets. Inconsistent safety data review (SDR) practices can result in delayed detection of adverse drug reactions (ADRs) or safety signals.

METHODS: This quality improvement project used …

Breast Tissue As A Local Drug Reservoir For Anticancer Therapy In Breast Cancer, Saniia Shchinar

Electronic Theses and Dissertations

Breast cancer, particularly the estrogen receptor-positive (ER+) subtype, remains a formidable challenge in oncology. Traditional oral therapies for ER-positive breast cancer, such as selective estrogen receptor modulators (SERMs) like Tamoxifen (TAM) and Toremifene (TOR), often encounter issues related to limited bioavailability, metabolic complications, and significant systemic side effects. These side effects include the risk of blood clots, hot flashes, vaginal dryness, menstrual cycle disruptions, and uterus cancer, which can hinder long-term adherence to preventive therapy. The exploration of local drug delivery into breast tissue presents a promising alternative to tackle these challenges. In this study, we explored the feasibility of …

Delivery Of Gemcitabine, Stearoyl Gemcitabine And Paclitaxel Through Plga Nanoparticles And Its Effect On The Desmoplasia Of Pancreatic Cancer Spheroids, Rishabh Bahl

Electronic Theses and Dissertations

Pancreatic cancer is one of the deadliest cancers to treat. The primary cause for the drug resistance is the dense extracellular matrix (ECM) that surrounds the tumor and restricts blood supply. Gemcitabine (GEM) and paclitaxel (PTX) are drugs that are clinically used in the treatment of pancreatic cancer. GEM, however, is rapidly metabolized by cytidine deaminase (CDA) and eliminated from the body, and paclitaxel is a substrate for P- glycoprotein (P-gp) efflux receptors. Drug delivery using nanoparticles has been reported to help improve drug half-lives and bypass efflux receptors. This thesis aims to encapsulate PTX in PLGA nanoparticles (PTX-NP) and …

Isolation, Molecular Characterization, And Epidemiological Analysis Of An Emerging Avian Metapneumovirus Subgroup B In Us Poultry, Sumit Jangra

Electronic Theses and Dissertations

Avian metapneumovirus (aMPV) is one the most economically important poultry respiratory pathogens belonging to the family Pneumoviridae and genus Metapneumovirus, which can affect both domestic and wild birds. aMPVs are classified into four subgroups (A, B, C, and D) based on the level of genetic variations and antigenic differences. aMPV causes turkey rhinotracheitis (TRT) and swollen head syndrome (SHS) in turkeys and chickens respectively. Recently, outbreaks of respiratory disease in meat-type birds and a significant decline in egg production with respiratory signs in breeders were reported from different states in the USA. Isolating aMPV is challenging as it is a …

Exploring Usability In Exercise Interventions: From Conceptualization To Measurement And Application, Anne Inger Mørtvedt

Dissertations, Master's Theses and Master's Reports

Exercise interventions hold promise for preventing and treating numerous conditions, diseases, and injuries. However, these interventions will only be effective if they are being used. Unfortunately, uptake and adherence to prescribed exercise and physical activity guidelines are insufficient. Some reasons for this include lack of knowledge, resources, flexibility, and enjoyment. Exercise program developers need to not only consider the effectiveness of the program during the development phase, but also involve end-users and receive feedback on program usability to determine likelihood of uptake and adoption. Usability testing can be used to detect barriers to use and implementation likelihood but has not …

Chemical Synthesis Of Sensitive Dna, Komal Chillar

Dissertations, Master's Theses and Master's Reports

Over the past decades, researchers have tried various chemical methods to synthesize modified oligodeoxynucleotides (ODNs, i.e. short segments of DNAs). Traditional ODN synthesis methods require strong basic, and nucleophilic conditions for the deprotection and cleavage of the ODN from the solid support. However, the sensitive ODNs containing labile functionalities are vulnerable to such harsh conditions. Sensitive ODNs have a wide range of applications in research and pharmaceuticals. To synthesize sensitive ODNs, researchers devised different strategies but no practical methods have been developed. To overcome these challenges, we developed alkyl Dim alkyl Dmoc technology. This innovative technology uses weakly basic and …

Continuous, Platform Purification Of Viral Products Using Aqueous Two-Phase Extraction, Natalie M. Nold

Dissertations, Master's Theses and Master's Reports

Cell and gene therapies, a ground-breaking class of drugs that can heal genetic diseases and cure cancer, often have treatment costs over $1 million. Most cell and gene therapies are delivered using virus-based delivery vectors, which are incredibly expensive to manufacture. Liquid chromatography is the favored method of viral vector purification since it is easily scalable and can be functionalized to purify by biospecificity, charge, hydrophobicity, or size. However, chromatography-based purification processes are highly expensive and usually only recover 20-50% of the viral vectors. There is currently no platform purification strategy for viral vectors due to differences in their surface …

Chemical Synthesis And Biological Application Of Sensitive Rna, Alexander T. Apostle

Dissertations, Master's Theses and Master's Reports

In the field of epigenetics - the dynamic collection of chemical modifications that overlay DNA/RNA - there is increasing interest in the potential for therapeutic and research-based utilization of the epitranscriptomics: those epigenetic modifications specific to RNA. Epitranscriptomics can give us a new approach to understanding and treating RNA viruses, like SARS-CoV-2. Given viruses are often found modified by human epitranscriptomic machinery, understanding how these modifications can modulate virulence is of high interest. We have shown that the N1-methyladensoine modification causes RNA synthesis termination in the SARS-CoV-2 replication complex, and thus may explain the differences in symptoms observed in individuals. …

Computational Analysis Of Vascular Aneurysms, Seyedmostafa Rezaeitaleshmahalleh

Dissertations, Master's Theses and Master's Reports

Vascular aneurysms, such as intracranial aneurysms (IAs) and abdominal aortic aneurysms (AAAs), pose significant health risks, particularly upon rupture. Disturbed hemodynamics, characterized by swirling flow patterns, can lead to cellular and structural changes that disrupt normal physiological processes and contribute to destructive vascular remodeling. Integrating hemodynamic analysis into clinical assessments of aneurysms has become crucial, especially through patient-specific computational fluid dynamics (CFD) simulations based on medical imaging. However, the complexity of CFD tools presents challenges in model creation and post-simulation analysis, limiting their accessibility to clinicians.
This project aimed to advance aneurysm management by exploring the role of intraluminal thrombus …

Multiplex Quantitative Polymerase Chain Reaction Assay For Mycoplasma Contamination, Pimthip Phasutha

Chulalongkorn University Theses and Dissertations (Chula ETD)

This study aims to develop multiplex qPCR to detect mycoplasma contamination. Firstly, the specific primers and probes for aligning with specific mycoplasma. were designed from conserved region called 23S rRNA, then, the designed primers and probes were verified their alignment with specific nucleotide of mycoplasma in Bioedit and checked the hairpin, self-complementary, and primer-dimer through Multi Primer Analyzer. After verification, the primers and probes do not have hairpin, self-complementary, and primer-dimer. Besides, the suitable temperature for annealing is 58oC. From the specificity test, it shows that the PCR product was detected at 254 bp which performed at the same size …

ปัจจัยนำของการเกิดภาวะกรดคั่งในเลือดจากสารคีโตนในผู้ป่วยโรคเบาหวานชนิดที่ 2 ที่ได้รับยาในกลุ่ม Sodium Glucose Co-Transporter 2 Inhibitors, อภิสรา เขียวประแดง

Chulalongkorn University Theses and Dissertations (Chula ETD)

วัตถุประสงค์: เพื่อหาปัจจัยนำ (Predisposing factors) ที่สัมพันธ์กับการเกิดภาวะกรดคั่งในเลือดจากสารคีโตน (Diabetic ketoacidosis; DKA) ในผู้ป่วยชาวไทยโรคเบาหวานชนิดที่ 2 ที่ใช้ยาในกลุ่ม Sodium glucose co-transporter 2 inhibitors (SGLT-2 inhibitors) วิธีการศึกษา: งานวิจัยนี้เป็นการศึกษาจากผลไปหาเหตุแบบเก็บข้อมูลย้อนหลังในหลายศูนย์ รวบรวมข้อมูลผู้ป่วยโรคเบาหวานชนิดที่ 2 ที่ได้รับยา SGLT-2 inhibitors ณ โรงพยาบาลจุฬาลงกรณ์ สภากาชาดไทยและโรงพยาบาลราชวิถี ช่วง 1 ตุลาคม 2557 ถึง 30 เมษายน 2567 ผลการศึกษา: กลุ่มตัวอย่างจำนวน 310 ราย แบ่งเป็นกลุ่มศึกษาคือผู้ป่วยที่เกิดภาวะ DKA 62 ราย (คิดเป็นความชุกของการเกิดภาวะ DKA ณ ช่วงเวลาที่ศึกษาเท่ากับร้อยละ 1.37) และกลุ่มควบคุมคือผู้ป่วยที่ไม่เกิดภาวะ DKA 248 ราย ส่วนปัจจัยนำที่มีความสัมพันธ์อย่างมีนัยสำคัญทางสถิติกับการเกิดภาวะ DKA ได้แก่ การติดเชื้อ (Adjusted OR = 28.31, P < 0.001) การปรับลดขนาดยาอินซูลินภายใน 1 เดือน (Adjusted OR = 5.58, P = < 0.001) และการมีประวัติภาวะ DKA ภายใน 1 ปี (Adjusted OR = 8.76, P = 0.038) สรุปผล: ปัจจัยที่มีผลต่อการเกิดภาวะ DKA ในผู้ป่วยโรคเบาหวานชนิดที่ 2 ที่ใช้ยา SGLT-2 inhibitors ได้แก่ การติดเชื้อ การปรับลดขนาดอินซูลินภายใน 1 เดือน และการมีประวัติภาวะ DKA ภายใน 1 ปี ผู้ป่วยที่มีปัจจัยดังกล่าวจึงควรได้รับการดูแลติดตามอย่างใกล้ชิด เพื่อช่วยลดความเสี่ยงในการเกิดภาวะ DKA และเพิ่มความปลอดภัยจากการใช้ยา SGLT-2 inhibitors

The Efficacy Of Plant-Produced Recombinant Insulin Like Growth Factor-1 (Igf-1) In Differentiation Of Mammalian Cell Lines, Kittinop Kittirotruji

Chulalongkorn University Theses and Dissertations (Chula ETD)

Insulin-like growth factor-1 (IGF-1) is a critical protein hormone with a structural resemblance to insulin, involved in regulating growth, cell proliferation, development, and survival, especially during childhood. IGF-1 exerts its biological effects through the IGF-1 receptor (IGF-1R), widely expressed across various cell types, and is key in the development of muscles, bones, and cartilage. The hormone's levels are influenced by age, nutrition, and hormonal status, peaking during adolescence and diminishing with age. Current medical applications of IGF-1 target conditions such as IGF-1 deficiency, excess growth hormone secretion, and metabolic disorders. To address production challenges, we utilized Molecular Pharming to produce …

The Impact Of N-Glycans On The Immune Response Of Plant-Produced Sars-Cov-2 Rbd-Fc Proteins, Theerakarn Srisangsung

Chulalongkorn University Theses and Dissertations (Chula ETD)

N-glycosylation is a crucial post-translational modification that significantly affects immune recognition. The plant-based platform, especially Nicotiana benthamiana, offers scalable and cost-effective production of therapeutic proteins with glycosylation patterns similar to mammalian cells. However, plant-specific N-glycans, such as α(1-3)-fucose and β(1-2)-xylose (XF), have the potential to trigger allergic reactions. This study investigates how various N-glycan structures on the RBD-Fc fusion protein influence the immune response in mice. The RBD-Fc fusion protein was used for vaccine formulation, produced in both wild-type (WT) and glycoengineered (∆XF) N. benthamiana plants. N-glycan analysis showed a predominance of mannose (Man) in RBD-Fc with an ER retention …

Cost-Effectiveness Analysis Of Pembrolizumab In High-Risk Early-Stage Triple-Negative Breast Cancer In Thailand, Thanapol Khuharatanachai

Chulalongkorn University Theses and Dissertations (Chula ETD)

Background: Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer with limited treatment options. Pembrolizumab, a programmed cell death protein 1 (PD-1) inhibitor, has demonstrated promising clinical benefits in treating early-stage TNBC. However, its high cost poses a significant barrier to its widespread adoption, especially in upper-middle-income countries like Thailand. This study aims to evaluate the cost-effectiveness and budget impact of pembrolizumab for the treatment of high-risk early-stage TNBC in Thailand. Methods: A Markov model was developed to simulate the health states and costs associated with pembrolizumab and standard chemotherapy. Transition probabilities and utility values were derived from …

Production And Characterization Of Monoclonal Antibodies Against Botulinum Toxin Produced In Nicotiana Benthamiana, Kornchanok Sangprasat

Chulalongkorn University Theses and Dissertations (Chula ETD)

Botulism is an uncommon but serious neurological condition caused by the botulinum toxin produced by the gram-positive bacterium named Clostridium botulinum. Common symptoms of botulism include muscle cramps, nausea, vomiting, diarrhea, difficulty swallowing, respiratory failure, muscle weakness, and potentially death. Currently, two types of antitoxin are used: equine-derived heptavalent antitoxin and human-derived immunoglobulin (BabyBIG®). However, treatment with heptavalent antitoxin may lead to hypersensitivity reactions, while BabyBIG®, which is produced in low yield, is used only for children. This research focuses on developing three anti-BoNT monoclonal antibodies (mAbs), 1B18, C25, and M2, which will be produced using Nicotiana benthamiana as a …

Characterization Of Plant Produced Vhh Antibodies Against Cobra Venom Toxins For Antivenom Therapy, Sarocha Vitayathikornnasak

Chulalongkorn University Theses and Dissertations (Chula ETD)

Cobra (Naja kaouthia) venom contains many toxins including α-neurotoxin (α-NTX) and phospholipase A2 (PLA2), which can cause neurodegeneration, respiratory failure, and even death. The conventional antivenom produced by animal immunization faces many challenges and limitations. Heavy-chain-only antibodies (HCAb), fusing VHH with human IgG Fc region, offer advantages in tissue penetration, antigen binding, and extended half-life. This research involved the construction and transient expression of two types of VHH-FC which are specific to α-Neurotoxin (VHH-αNTX-FC) and Phospholipase A2 (VHH-PLA2-FC) in Nicotiana benthamiana leaves. The recombinant HCAbs were incubated for up to six days to optimize expression levels followed by purification by …