Innovative uses for zinc in dermatology.

Severe zinc deficiency states, such as acrodermatitis enteropathica, are associated with a variety of skin manifestations, such as perioral, acral, and perineal dermatitis. These syndromes can be reversed with systemic zinc repletion. In addition to skin pathologies that are clearly zinc-dependent, many dermatologic conditions (eg, dandruff, acne, and diaper rash) have been associated and treated with zinc. Success rates for treatment with zinc vary greatly depending on the disease, mode of administration, and precise zinc preparation used. With the exception of systemic zinc deficiency states, there is little evidence that convincingly demonstrates the efficacy of zinc as a reliable first-line treatment for most dermatologic conditions. However, zinc may be considered as an adjunctive treatment modality. Further research is needed to establish the indications for zinc treatment in dermatology, optimal mode of zinc delivery, and best type of zinc compound to be used.

Zinc homeostatic proteins in the CNS are regulated by crosstalk between extracellular and intracellular zinc.

Release of Zn(2+) from presynaptic glutamatergic terminals has long been considered the principle challenge necessitating the existence of zinc homeostatic proteins (ZHP) in the mammalian nervous system. It is now known that neural cells also possess an intracellular zinc pool, termed here [Zn(2+)](i), which functions in a cell signaling context. A major challenge is characterizing the interaction of these two populations of zinc ions. To assess the relationship of this Zn(2+) pool to cellular ZHP production, we employed immunofluorescence and immunoblot analysis to compare the expression of ZHP's ZnT-1 and MT-I/II in olfactory bulb and hippocampus of wild-type and ZnT-3 KO mice, which lack synaptic Zn(2+). In both areas, the respective distribution and concentration of ZnT-1 and MT-I/II were identical in ZnT-3 KO and control animals. We subsequently examined ZHP content in ZnT-3 KO and WT mice treated with a membrane-permeable Zn(2+) chelator. In both olfactory bulb and hippocampus of the KO mice, the ZHP content was significantly reduced 15 h after chelation of [Zn(2+)](i) compared to WT controls. Our findings support the conclusion that ZHP expression is regulated by crosstalk between synaptic and intracellular pools of Zn(2+).

A potential role for imatinib and other small molecule tyrosine kinase inhibitors in the treatment of systemic and localized sclerosis.

Small molecule tyrosine kinase (TK) inhibitor, such as imatinib, is well established in the treatment of malignancy. Oral administration, high efficacy, and an excellent safety profile have made imatinib a drug of choice for several malignancies and benign conditions. Recent progress in the understanding of several benign conditions has led to the use of TK inhibitors in the treatment of hypereosinophilic syndrome and mastocytosis. Systemic sclerosis (SS) is a recalcitrant disease featuring multiorgan fibrosis and dysfunction. Molecular and biological evidence point to a central role for platelet-derived growth factor receptor, a TK-associated entity, in the pathogenesis of SS. The ability of several TK inhibitors, namely imatinib, to abrogate the activation of platelet-derived growth factor receptor-TK may entail their use in the treatment of SS and possibly more limited forms of sclerosis. Several human studies aiming to examine the use of imatinib in the treatment of SS are currently underway.

Nonattendance in obstetrics and gynecology patients.

BACKGROUND: Nonattendance for obstetrics and gynecology (OB/GYN) appointments disrupts medical care and leads to misuse of valuable resources. We investigated factors associated with nonattendance in an outpatient OB/GYN clinic. METHODS: Nonattendance was examined for a period of 1 year in first-time visitors of an ambulatory OB/GYN clinic. The effects of age, population sector, the treating physician, waiting time, and timing of the appointment on the proportions of nonattendance were assessed. Chi(2) tests and logistic regression were used for simple and multiple regression models. RESULTS: A total of 8,883 visits were included (median age 36 years). The proportion of nonattendance was 30.1%: 19.9% among rural Jewish, 30.5% in urban Jewish, and 36% in Bedouins (p < 0.001). Nonattendance increased from 26.6% among those waiting up to 1 week to 32.3% among those who waited more than 15 days (p < 0.001) and decreased with age (p < 0.001). A multiple logistic regression model demonstrated that age, population sector and waiting time for an appointment were significantly associated with nonattendance. CONCLUSION: Nonattendance in OB/GYN patients is independently associated with age, population sector and waiting time for an appointment. It is suggested that various solutions should be carefully introduced assessed regarding routine patient scheduling in OB/GYN clinics.

Intervention program to reduce waiting time of a dermatological visit: managed overbooking and service centralization as effective management tools.

BACKGROUND: Long waiting times are an impediment of dermatological patient care world-wide, resulting in significant disruption of clinical care and frustration among carers and patients. OBJECTIVE: To reduce waiting times for dermatological appointments. METHODS: A focus group including dermatologists and management personnel reviewed the scheduling process, mapped potential problems and proposed a comprehensive intervention program. The two major approaches taken in the intervention program were revision of the scheduling process by managed overbooking of patient appointments and centralization of the dermatological service into a centralized dermatological clinic. RESULTS: Following the intervention program, the average waiting time for dermatological appointments decreased from 29.3 to 6.8 days. The number of scheduled appointments per 6 months rose from 17,007 to 20,433. Non-attendance proportion (no-show) decreased from 33% to 28%. Dermatologist work-hours were without significant change. CONCLUSIONS: Waiting lists for dermatological consultations were substantially shortened by managed overbooking of patient appointments and centralization of the service.