Gram-negative bacilli causing infective endocarditis (IE) is rare, even in intravenous drug users. This case report underscores several clinically important aspects of Delftia acidovorans IE: the organism's ability to cause rapid destruction of normal native valves and to cause embolic occlusion of large arteries and its resistance to all aminoglycosides. CASE REPORT In November 2010, a 30-year-old male, with a history of intravenous drug use (IDU), hepatitis C, and posttraumatic stress disorder, presented to the Lexington Veterans Affairs Medical Center (VAMC) with a 2-to 3-week history of malaise and right knee pain. The patient reported having a fever for 2 days prior to presentation, with a temperature of 103°F (noted at home). He was in his usual state of health until a month prior to presentation, when he developed right knee pain, which was first observed when he jogged for exercise. The pain progressively worsened, and he stopped jogging 2 weeks prior to presentation. One week prior to presentation, the patient went to the VAMC emergency room and was diagnosed with a viral illness; flu PCR was negative, and he was instructed to follow up with his primary care physician. No anti-infective medication was given. On the day of hospitalization, he returned to the VAMC emergency department with increased pain in his right leg, fever, and a painful red lesion on the ring finger of his left hand. Upon physical examination, his temperature was 104°F and he was found to have a new grade 3/6 diastolic murmur (not previously noted in his clinic records), diminished pedal pulse and posterior tibial pulse in his right leg, without knee effusion, and a tender erythematous nodule on the 4th digit of his left hand. The patient's laboratory studies were unremarkable. His human immunodeficiency virus test and urine drug screening were both negative. Blood cultures were drawn, and vancomycin and piperacillin-tazobactam (2 days) were started empirically. The echocardiogram demonstrated a severe aortic insufficiency with aortic valve vegetation of 1.0 by 1.4 cm. An arteriogram of his right leg showed occlusions in the right posterior tibial artery and right peroneal artery.The patient's social history was only remarkable for past IDU. He stated that he was in a drug rehabilitation facility for 6 weeks prior to the onset of symptoms but confessed to occasional relapses in his IDU behavior. The patient admitted using the water from the bathroom and kitchen faucets to prepare his drugs for injection. He denied smoking and drinking alcohol regularly.The patient became afebrile on antibiotics in 48 h. He was evaluated by cardiothoracic surgery and, on the third hospital day, was transferred to the adjacent University of Kentucky Hospital (UKH) where he underwent successful aortic valve replacement.Two sets of blood cultures at VAMC and a culture of tissue from the patient's aortic valve at UKH grew a Gram-negative bacillus. The Gram-negative bacillus was identified as Delftia acidovorans, resistant to all aminoglycosides. His anti...

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Introduction The current work aimed to formulate a novel chitosan-based finasteride nanosystem (FNS-NS) for skin delivery to optimize the drug availability in skin for a longer time and enhance ex vivo performance of finasteride against androgenic alopecia. Methods Both undecorated and chitosan decorated FNS-NSs were synthesized by a high energy emulsification technique. All the prepared nanosystems were further subjected to physicochemical characterizations like pH, viscosity, encapsulation efficiency, surface morphology and in vitro drug release behavior. The influence of the nanosystem on the drug permeation and retention in rat skin was examined using Franz diffusion cell apparatus. Results The droplet size of developed nanosystems ranged from 41 to 864 nm with a low polydispersity index. The zeta potential of the nanosystems was between -10 mV and +56 mV. This chitosan decorated nanosystem exhibited controlled drug release, ie about 78–97% in 24 h. Among all the nanosystems, our chitosan decorated formulation (F5) had low drug permeation (16.35 µg/cm 2 ) and higher drug retention (10.81 µg/cm 2 ). Conclusion The abovementioned results demonstrate satisfactory in vitro drug release, skin retention profiles and ex vivo performance with chitosan decorated FNS-NS (F5). This optimized formulation could increase drug availability in skin and could become a promising carrier for topical delivery to treat androgenic alopecia.

This study aimed at developing the microwave-treated, physically cross-linked polymer blend film, optimizing the microwave treatment time, and testing for physicochemical attributes and wound healing potential in diabetic animals. Microwave-treated and untreated films were prepared by the solution casting method and characterized for various attributes required by a wound healing platform. The optimized formulation was tested for skin regeneration potential in the diabetes-induced open-incision animal model. The results indicated that the optimized polymer film formulation (MB-3) has significantly enhanced physicochemical properties such as high moisture adsorption (154.6 ± 4.23%), decreased the water vapor transmission rate (WVTR) value of (53.0 ± 2.8 g/m2/h) and water vapor permeability (WVP) value (1.74 ± 0.08 g mm/h/m2), delayed erosion (18.69 ± 4.74%), high water uptake, smooth and homogenous surface morphology, higher tensile strength (56.84 ± 1.19 MPa), and increased glass transition temperature and enthalpy (through polymer hydrophilic functional groups depicting efficient cross-linking). The in vivo data on day 16 of post-wounding indicated that the wound healing occurred faster with significantly increased percent re-epithelialization and enhanced collagen deposition with optimized MB-3 film application compared with the untreated group. The study concluded that the microwave-treated polymer blend films have sufficiently enhanced physical properties, making them an effective candidate for ameliorating the diabetic wound healing process and hastening skin tissue regeneration.

Diabetes, one of the global metabolic disorders, is often associated with delayed wound healing due to the elevated level of free radicals at the wound site, which hampers skin regeneration. This study aimed at developing a curcumin-loaded self-emulsifying drug delivery system (SEDDS) for diabetic wound healing and skin tissue regeneration. For this purpose, various curcumin-loaded SEDDS formulations were prepared and optimized. Then, the SEDDS formulations were characterized by the emulsion droplet size, surface charge, drug content/entrapment efficiency, drug release, and stability. In vitro, the formulations were assessed for the cellular uptake, cytotoxicity, cell migration, and inhibition of the intracellular ROS production in the NIH3T3 fibroblasts. In vivo, the formulations’ wound healing and skin regeneration potential were evaluated on the induced diabetic rats. The results indicated that, after being dispersed in the aqueous medium, the optimized SEDDS formulation was readily emulsified and formed a homogenous dispersion with a droplet size of 37.29 ± 3.47 nm, surface charge of −20.75 ± 0.07 mV, and PDI value of less than 0.3. The drug content in the optimized formulation was found to be 70.51% ± 2.31%, with an encapsulation efficiency of 87.36% ± 0.61%. The SEDDS showed a delayed drug release pattern compared to the pure drug solution, and the drug release rate followed the Fickian diffusion kinetically. In the cell culture, the formulations showed lower cytotoxicity, higher cellular uptake, and increased ROS production inhibition, and promoted the cell migration in the scratch assay compared to the pure drug. The in vivo data indicated that the curcumin-loaded SEDDS-treated diabetic rats had significantly faster-wound healing and re-epithelialization compared with the untreated and pure drug-treated groups. Our findings in this work suggest that the curcumin-loaded SEDDS might have great potential in facilitating diabetic wound healing and skin tissue regeneration.