An assessment of knowledge and opinion of Nigerian physiotherapists on application of iontophoresis in the management of selected skin disorders and arthritis.

It is becoming increasingly important to improve knowledge of physiotherapists about iontophoresis since it involves topical medications. There is need to ascertain that physiotherapists have adequate knowledge of the procedure. The primary aim of this study was to determine the opinion and knowledge level of Nigerian physiotherapists about iontophoresis. One hundred and twenty-three (123) physiotherapists were purposively selected. A structured self-administered questionnaire was used for this study. The data were analyzed using descriptive statistics. The result showed that 40 (33.3%) physiotherapists were using iontophoresis as a treatment technique for skin ulcer, hyperhidrosis, and arthritis. Sixty-six (53.7%) of all the respondents chose galvanic (interrupted galvanic) current as the mode used for applying iontophoresis, 43 (35.0%) chose wrongly, faradic current as the current mode while 14 (11.3%) are ignorant of the correct current mode. The result showed variations in electrode placement for stimulation among physiotherapists- nerve root (12.2%), myotome (10.6%), trigger or acupuncture points (22.0%) while 12.2% indicated that they had no idea of appropriate electrodes placement. There was no significant difference in the mean percentage difference in the number of respondent who were correct in the type of current format being utilized for iontophoresis procedure and those who were wrong. Also, there was no significant difference in the mean percentage difference in the number of respondent who uses different methods of electrode placement. Most physiotherapists (62.6%) chose 1-15 minutes as the duration of application for iontophoresis while 31.7% chose their parameters based on patient's tolerance, experience and patient's condition. It was concluded that few physiotherapists in Nigeria have adequate knowledge about iontophoresis and very few are using iontophoresis as a treatment option.

Effect of iontophoresis on in vitro transdermal absorption of almotriptan.

The aim of the present work was to characterize the in vitro transdermal absorption of almotriptan through pig ear skin. The passive diffusion of almotriptan malate and its iontophoretic transport were investigated using current densities of 0.25 and 0.50mA/cm(2). In vitro iontophoresis experiments were conducted on diffusion cells with an agar bridge without background electrolytes in the donor compartment. Although both current densities applied produced a statistically significant increment with respect to passive permeation of almotriptan (p<0.01), that of 0.50mA/cm(2) proved to be the best experimental condition for increasing the transport of almotriptan across the skin. Under these experimental conditions, the transdermal flux of the drug increased 411-fold with respect to passive diffusion, reaching 264±24µg/cm(2)h (mean±SD). Based on these results, and taking into account the pharmacokinetics of almotriptan, therapeutic drug plasma levels for the management of migraine could be achieved via transdermal iontophoresis using a reasonably sized (around 7.2cm(2)) patch.

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.

Post-iontophoresis recovery of human skin impedance in vivo.

The objective of this study was to better understand the recovery of human skin impedance following iontophoresis in vivo. Volunteers were subjected to a 15-min period of iontophoresis in the presence of aqueous solutions of either NaCl, KCl, CaCl(2) or MgCl(2) at 133 mM. Subsequently, the low-frequency impedance (at 1 Hz) recovery was followed for a further 30 min. Assuming direct proportionality between the reciprocal impedance and the ion concentration in the membrane, the experimental data were fitted to the appropriate solutions of Fick's second law of diffusion to derive characteristic diffusion parameters (D/L(2)), apparent diffusivities (D), diffusion pathlengths (L) and mobilities, and ion concentrations in the skin immediately post-iontophoresis. Ion fluxes out of the membrane after termination of current flow were also deduced. In general, recovery was relatively independent of the background electrolyte as previously reported, and the data were consistent with ion transport in predominantly aqueous pathways. Compared to its mobility in aqueous solution, however, the apparent Cl- mobility in the skin was smaller, presumably due to the fact that, under normal physiological conditions, the human skin barrier supports a net negative charge. In parallel, the initial "release" of Na+ and K+ from the skin post-iontophoresis was faster than that of Ca(2+) and Mg(2+), the latter cations of higher charge density being able to associate more strongly, it seems, with the negatively-charged skin. The simple physicochemical analysis of the data presented serves to emphasize that a decrease in skin impedance is not a manifestation of damage to the barrier--rather, it is a natural response to the relevant electrical potential and ion concentration gradients involved.

Valores de referencia de electrólitos en el sudor en una población infantil del Hospital Pediátrico Docente ”Juan Manuel Márquez” / Values of electrolyte reference in the sweat in an infantile population of Educational Pediatric Hospital

Se estudiaron 266 niños de uno y otro sexos, para obtener los valores de referencia de los electrólitos en el sudor por el método de la iontoforesis con pilocarpina modificado. Del total de niños, 151 eran del sexo masculino y 115 del sexo femenino, en las edades comprendidas entre 6 meses y 14 años, provenientes de las áreas de hospitalización y consulta externa, portadores de enfermedades respiratorias y/o digestivas sin criterios clínicos, radiológicos ni genéticos de fibrosis quística. Con los datos obtenidos se realizó el estudio estadístico y se establecieron los valores de referencia para los cloruros y para el ion sodio, que resultaron de 9,0 - 43 y de 8,0 - 38,0 mmol/L, respectivamente. Se compararon los resultados obtenidos con los reportados por otros autores y no se encontraron diferencias significativas(AU)

Endothelial dysfunction and the expression of endothelial nitric oxide synthetase in diabetic neuropathy, vascular disease, and foot ulceration.

We studied endothelial-mediated microvascular blood flow in neuropathic diabetic patients to determine the association between endothelial regulation of the microcirculation and the expression of endothelial constitutive nitric oxide synthetase (ecNOS) in the skin. Vasodilation on the dorsal foot in response to heating and iontophoresis of acetylcholine (endothelium-dependent) and sodium nitroprusside (endothelium-independent) were measured using single-point laser Doppler and laser Doppler imaging in diabetic patients with neuropathy (DN), with neuropathy and vascular disease (DI), with Charcot arthropathy (DA), and without complications (D), and in healthy control subjects (C). The response to heat was reduced in the DN (321 [21-629] percentage of increase over the baseline, median [interquartile range]) and DI (225 [122-470]) groups but was preserved in the DA (895 [359-1,229]), D (699 [466-1,029]), and C (810 [440-1,064], P < 0.0001) groups. The endothelial-mediated response to acetylcholine was reduced in the DN (17 [11-25]), DA (22 [2-34]), and DI (13 [2-30]) groups compared with the D (47 [24-58]) and C (44 [31-70], P < 0.001) groups. The non-endothelial-mediated response to sodium nitroprusside was also reduced in the DI (4 [0-18]), DN (17 [9-26]), and DA (21 [11-31]) groups compared with the D (37 [19-41]) and C (44 [26-67], P < 0.0001) groups. There was a significant reduction in vasodilation in the DI group compared with all other groups (P < 0.0001). Full thickness skin biopsies from the dorsum of the foot of 15 DN, 10 DI, and 11 C study subjects were immunostained with antiserum to human ecNOS, the functional endothelial marker GLUT1, and the anatomical endothelial marker von Willebrand factor. The staining intensity of ecNOS was reduced in both diabetic groups. No differences were found among the three groups in the staining intensity of von Willebrand factor and GLUT1. We conclude that the endothelium-dependent and endothelium-independent vasodilations are impaired in diabetic patients predisposed to foot ulceration and that neuropathy is the main factor associated with this abnormality. Reduced expression of ecNOS may be a major contributing factor for endothelial dysfunction. These data provide support for a close association of neuropathy and microcirculation in the pathogenesis of foot ulceration.

Fibrosis quística

La fibrosis quística es una enfermedad que se hereda de forma autosómica recesiva; se caracteriza por anormalidad en el trasporte de electrolitos por parte de las células epiteliales a nivel sistémico y en especial en glándulas exocrinas. Para su diagnóstico se requiere la sospecha clínica, antecedente familiar, iontoforesis con valores mayores 60mq/L. El tratamiento integral busca mejorar la calidad de vida de estos pacientes. A continuación se presenta un caso atendido en el Servicio de Neumología del Hospital de La Misericordia.

Iontoforesis en el diagnóstico de fibrosis quística

La fibrosis quística es un desorden autosómico recesivo en el cual se compromete el transporte del cloro a través de las células epiteliales de diferentes órganos. Las manifestaciones son diversas, ya que se pueden afectar diferentes órganos. La prueba del sudor o iontoforesis continúa siendo uno de los exámenes más específicos e importantes para el diagnóstico de fibrosis quística. Esta prueba debe ser realizada en todo niño que presente un enfermedad pulmonar recurrente, infecciones a repetición, manifestaciones obstructivas bronquiales, enfermedad hepática, pólipos nasales, pancreatitis o malabsorción. Es importante tener en cuenta las implicaciones que tiene un diagnóstico oportuno en el niño; mientras más temprano se sospeche y se compruebe el diagnóstico, mejor calidad de vida se le podrá brindar al paciente.

Fibrosis quística en el Hospital de la Misericordia: diagnóstico tardío, un hecho común

La fibrosis quística es una enfermedad de presentación ocasional, causa de neumopatía crónica y cuya sobrevida se puede mejorar si se hace el diagnóstico oportunamente. Presentamos una revisión de 29 casos de fibrosis quística en el Hospital de la Misericordia, Universitario Pediátrico de Santa Fe de Bogotá, en la cual queremos resaltar el bajo índice de sospecha en la comunidad médica general, lo que demoró el diagnóstico y el inicio del tratamiento en estos pacientes. Una parte importante de los diagnóstico se hicieron por autopsia, pero es destacar que el diagnóstico fue más rápido una vez se sospechó la enfermedad. Nuestra revisión mostró los siguientes resultados: 65 por ciento de hombres, con una distribución mayor en el grupo de edad de 1 a 23 meses. Los síntomas y signos respiratorios eran mayores que los digestivos. 62 por ciento se diagnosticaron con iotonforesis y 44.8 por ciento por necropsia. El promedio de edad al diagnóstico fue de 15.1 meses y desde el inicio de los síntomas hasta la confirmación del diagnóstico, el tiempo promedio fue de 17.6 meses (edad promedio total de 28.9 meses). Se concluye que debemos sospechar con mayor frecuencia la fibrosis quística como causa de enfermedad pulmonar crónica en nuestro medio.

Iontophoresis. A novel drug administration for extraction of deciduous teeth. A clinical evaluation.

Iontophoresis has a wide range of application in dentistry, one of which is to produce a non invasive technique of analgesia. With the avoidance of needle, in this technique better patient management and good doctor-patient relationship can be built. This study provides an insight into the comparative evaluation of 2%, 4% and 6% lignocaine hydrochloride (plain) in providing analgesia iontophoretically while extraction of deciduous teeth. Patient satisfaction was seen when higher drug concentration and longer duration of iontophoresis was applied.

[The treatment of neuralgiform facial pains with the combined therapy of transcutaneous electric nerve stimulation (TENS) and the iontophoresis of nonsteroidal antiphlogistics]. / Die Behandlung neuralgiformer Gesichtsschmerzen mit der Kombinationstherapie von transcutaner elektrischer Nervenstimulation (TENS) und Iontophorese nichtsteroidaler Antiphlogistika.

In a prospective study, 46 patients suffering from facial pain were treated by transcutaneous electrical nerve stimulation (TENS). In case of insufficient pain relief the combined use of TENS and iontophoresis of non-steroidal antiphlogistics was employed. Benzydamine was applied to the anode and diclofenac to the cathode instead of the contact gel, reducing average pain intensity to a marked 18%, compared to 81% to 63% by TENS only. Furthermore, the consumption of analgetics declined considerably with combined therapy. Severe side effects could not be registered. Therefore, this new combined therapy must be considered to be an alternative treatment before using systemic medication.