Prosthetic knee joint infection due to Mycobacterium abscessus.

Infected total knee arthroplasty (TKA) due to Mycobacterium abscessus is very rare with only three such cases described in literature. Only one case was managed successfully, however, with a prolonged course of anti tubercular therapy. In this case report, we present an elderly lady with infected TKA after 2 years of the primary procedure. Although initially it grew different bacteriae, M. abscessus was isolated during the second debridement. She was successfully treated with total of 5 months of second line anti tubercular drugs with revision prosthesis performed during chemotherapy. Two years followup revealed satisfactory outcome with no relapse.

Effect of chemical penetration enhancer and iontophoresis on the in vitro percutaneous absorption enhancement of insulin through porcine epidermis.

The purpose of this study was to investigate the effect of chemical enhancers (fatty acids and limonene) and iontophoresis on the in vitro permeability enhancement of insulin through porcine epidermis. The following fatty acids were used: palmitic (C16:0), palmitoleic (C16:1), stearic (C18:0), oleic (C18:1), linoleic (C18:2), and linolenic (C18:3). Franz diffusion cells and the Scepter iontophoretic power source were used for the percutaneous absorption studies. Cathodal iontophoresis was performed at 0.2 mA/cm2 current density. Iontophoresis in combination with chemical enhancers synergistically increased (p<0.05) the in vitro permeability of insulin. Linolenic acid (C18:3) produced greater permeability of insulin through epidermis than did other fatty acids during passive (44.45 x 10(-4) cm/h) and iontophoretic (78.03 x 10(-4) cm/h) transport. Lispro insulin flux was significantly (p<0.05) greater through linolenic acid and limonene pretreated epidermis compared to untreated controls during both passive and iontophoretic transports. Using limonene as a penetration enhancer, a linear increase in the passive and iontophoretic flux of lispro insulin was observed with donor concentrations increasing from 100 IU/mL to 300 IU/mL. Iontophoretic flux through limonene-treated epidermis using 0.5 mA/cm2 current density and 300 IU/mL insulin donor solution was 45.63 IU/cm2/day. Using an iontophoretic patch size of 10 cm2, we would be able to deliver 50 IU of insulin within 3 h.

Iontophoretic enhancement of leuprolide acetate by fatty acids, limonene, and depilatory lotions through porcine epidermis.

The effect of chemical enhancers (e.g., fatty acids, limonene, depilatory lotions) and iontophoresis was investigated on the in vitro permeability of leuprolide acetate through porcine epidermis. Franz diffusion cells and Scepter iontophoretic power source were used for the percutaneous absorption studies. Anodal iontophoresis was performed at 0.2 mA/cm2 current density. Fatty acids used were palmitic (C16:0), palmitoleic (C16:1), stearic (C18:0), oleic (C18:1), linoleic (C18:2), and linolenic (C18:3) acids. The passive and iontophoretic flux were significantly (p < 0.05) greater through fatty acids-treated porcine epidermis in comparison to the control (untreated epidermis) for leuprolide acetate. The passive and iontophoretic permeability of leuprolide acetate increased with increasing number of cis double bonds. Among the fatty acids tested, linolenic acid (C18:3) exhibited the maximum permeability of leuprolide acetate during passive (51.42 x 10(-4) cm/hr) and iontophoretic (318.98 x 10(-4) cm/hr) transport. The passive and iontophoretic flux of leuprolide acetate were significantly (p < 0.05) greater through the limonene and depilatory lotion treated epidermis in comparison to their respective control. In conclusion, iontophoresis in combination with chemical enhancers synergistically increased (p < 0.05) the in vitro permeability of leuprolide acetate through porcine epidermis.

Passive and iontophoretic transport enhancement of insulin through porcine epidermis by depilatories: permeability and fourier transform infrared spectroscopy studies.

The effect of thioglycolate-based depilatory lotions was studied on the in vitro passive and iontophoretic permeability of insulin through porcine epidermis and biophysical changes in the stratum corneum (SC) lipids and proteins. The porcine epidermis and Franz diffusion cells modified for iontophoresis were used for the in vitro transport studies. Cathodal iontophoresis was performed at 0.2 mA/cm2 current density. Resistance of the control- and depilatory-lotion-treated epidermis was determined according to Ohm's law. Biophysical changes were studied on porcine SC before (control) and after treatment with the depilatory lotions using Fourier transform infrared (FT-IR) spectroscopy. Asymmetric (approximately 2915 cm(-1)) and symmetric approximately 2848 cm(-1)) Carbon-Hydrogen (C-H) stretching absorbances were studied to estimate the extent of lipid extraction. Fourier self-deconvolution and second derivative procedures were applied to amide I band (1700-1600 cm(-1)) in order to estimate quantitatively the changes in the secondary structure of the SC protein. The passive permeability of insulin was significantly (P <.05) increased through depilatory-lotion-treated (ie, Better Off, Marzena, and Sally Hansen) epidermis in comparison to control. Iontophoresis significantly enhanced (P <.05) the permeability of insulin through depilatory-pretreated epidermis in comparison with the control epidermis. Further, we were able to achieve the desired flux of insulin (5.25 U/cm2/d) through Better Off-treated epidermis using 0.2 mA/cm2 current density and 100 U/mL donor concentration of insulin. The SC treated with depilatory lotions showed a decrease in peak areas of C-H stretching absorbances in comparison with untreated SC. Depilatory lotion treatment also decreased (P <.05) the epidermal resistance in comparison with the control epidermis. The decrease in the alpha-helix conformation and the increase in the random and turn structures were observed in the SC proteins due to depilatory lotion treatment. The changes in the secondary structure of proteins and lipid extraction from the SC are suggested as the cause of the decrease in the epidermal resistance and the increase in the passive and iontophoretic permeability of insulin through depilatory-pretreated epidermis in comparison with the control epidermis.

Transepidermal transport enhancement of insulin by lipid extraction and iontophoresis.

PURPOSE: To study the effect of Ethyl acetate (EtAc), 1:1 ratio of EtAc and Ethanol (EtOH) and 2:1 ratio of chloroform (C) and methanol (M) on the extent of lipid extraction from the stratum corneum (SC) and in vitro passive and iontophoretic transport of insulin through porcine epidermis. METHODS: The porcine epidermis was pretreated for 40 min with the following solvents: 1) EtAc or EtAc:EtOH (1:1) and 2) C:M (2:1), which is a standard solvent combination for lipid extraction. Franz diffusion cells and Scepter iontophoretic power source were used for the transport studies. Cathodal iontophoresis was performed at 0.2 mA/cm2 current density. Fourier transform infrared spectroscopy (FTIR) studies were performed to assess the extent of lipid extraction. Thin layer chromatography (TLC) and gas chromatography (GC) were used to quantitate the different classes of lipid and identify the composition of the fatty acids, respectively, extracted by solvent(s) treatments. RESULTS: Insulin flux was found to be significantly (P < 0.05) greater through solvent pretreated epidermis compared to untreated controls during both passive and iontophoretic transport. Pretreatment with EtAc:EtOH (1:1) exhibited an insulin flux of 15.29 x 10(-8) nmoles/ cm2/h compared to 52.71 x 10(-8) nmoles/ cm2/h during passive and iontophoretic transport, respectively. The passive and iontophoretic flux of insulin through EtAc:EtOH (1:1) pretreated epidermis was significantly greater (P < 0.05) than EtAc treated epidermis. The SC treated with solvents showed a decrease in peak areas of C-H stretching absorbances in comparison to untreated SC. A greater percent decrease in peak areas was obtained by EtAc:EtOH(1:1), in comparison to EtAc alone. Epidermal resistance measurements revealed its strong correlation with the amount of lipids present in the epidermis. The lipids extracted consisted of six series of ceramides, fatty acids. triglycerides, cholesterol, cholesterol esters, cholesterol sulfate and phospholipids. CONCLUSIONS: The SC lipid extraction using suitable solvents followed by iontophoresis can synergistically enhance the transepidermal transport of insulin.