Use of saliva for assessment of stress and its effect on the immune system prior to gross anatomy practical examinations.

The objective of this study was to determine the longitudinal effects of a series of stressful gross anatomy tests on the immune system. Thirty-six freshman occupational therapy students completed a written stress evaluation survey, and saliva samples were obtained at baseline and prior to each of three timed-practical gross anatomy tests. Cortisol, secretory IgA (sIgA), and IL-12 concentrations were measured within the salivary samples by enzyme-linked immunosorbent assay. The total scores from the stress surveys were used as markers for environmental stress. Data were compiled for each student at baseline and prior to each examination and were compared by repeated-measures MANOVA and Pearson's correlation test. Following normalization for protein concentration and flow rate, the concentrations of IL-2, IL-6, IL-12, and sIgA progressively increased from baseline to the third test. Cortisol concentrations, following normalization for flow rate, were highest prior to the first test and became significantly reduced prior to second and third test. Prior to second and third test, salivary concentrations of IL-6, IL-2, IL-12, and sIgA were significantly correlated (P < 0.05). In contrast, prior to third test, there was a negative correlation between salivary concentrations of cortisol and IL-12 (P < 0.05). Progressive increases in salivary sIgA, IL-6, IL-2, and IL-12 concentrations from the first to the third test coincident to decreased salivary cortisol suggest that the initial examination stressors precede significant effects on the immune system. These data suggest that there may be latent effects of examination stress on the immune system and that saliva can be used to predict these effects.

Should preclinical typodonts be disinfected prior to grading?

This is a report of a unique finding in a preclinical laboratory that may be a potential dental school health hazard. Visual inspection (conducted in April 2008 by a preclinical crown and bridge course coordinator) of typodonts used by second-year students at the University of Mississippi School of Dentistry found that fourteen out of thirty-nine had black spots on the undersurface of the cheek shroud and/or plastic gingiva. The spots were cultured by the Medical Center's Department of Microbiology and described only as being mold/fungus typical of that which frequently grows in warm, moist, southern environments. Although indoor molds are common, about 5 percent of the general population will develop some type of mild allergic airway problem from molds over their lifetime. Mold on typodonts is unsightly, indicates failure of students to recognize the value of cleanliness in the dental environment, and may be a potential health hazard for some individuals. Cleaning and drying procedures for typodonts were implemented. The transfer of items between students and instructors during preclinical courses provides many opportunities for the spread of potentially harmful microorganisms/viruses. As a minimal level of personal protection, it is suggested that instructors wear disposable gloves and face masks and exercise hand washing between handling student instruments and typodonts. This problem has not been previously mentioned in the literature and merits further investigation/discussion.

Pharmacokinetics of palifermin administered as the standard dose and as a collapsed dose in patients with hematologic malignancies.

STUDY OBJECTIVE: To assess the pharmacokinetic profile of palifermin after intravenous dosing with either a collapsed dose of 180 microg/kg/day for 1 day or a standard dose of 60 microg/kg/day for 3 days, before and after myeloablative chemoradiotherapy and peripheral blood progenitor cell (PBPC) transplantation. DESIGN: Prospective, open-label pharmacokinetic study. SETTING: University-affiliated hematology and oncology center. PATIENTS: Twenty-five adult patients with hematologic malignancies receiving myeloablative therapy; 13 were in the standard-dose group, and 12 were in the collapsed-dose group. INTERVENTION: Patients received total-body irradiation (study days -8 to -5), etoposide (day -4), cyclophosphamide (day -2), and PBPC transplantation (day 0). Standard-dose palifermin was administered on days -11, -10, -9, 0, 1, and 2; collapsed-dose palifermin was administered on days -11 and 0. MEASUREMENTS AND MAIN RESULTS: Baseline demographic and clinical characteristics were recorded. Blood samples were obtained for pharmacokinetic assessment, presence of palifermin antibodies, and routine chemistry and hematology panels. Adverse events were documented daily. For both dosing groups, palifermin concentrations declined rapidly (>or= 98%) in the first 30 minutes and increased slightly between 1 and 4 hours after dosing, with a terminal decay phase. For standard-dose palifermin, mean values for area under the serum concentration-time curve (AUC) were within 15% between doses 1 and 3 and within 1% between doses 1 and 4. For collapsed-dose palifermin, mean AUC values and other pharmacokinetic parameters were within 2% between doses 1 and 2. Mean AUC on days -11 and 0 were approximately 4-fold higher for collapseddose palifermin than for standard-dose palifermin. Both dosing regimens were well tolerated. CONCLUSIONS: Our results were consistent with approximately dose-linear pharmacokinetics for the two dosing regimens, with no observed accumulation. A randomized, controlled study is warranted to assess the safety and efficacy of collapsed-dose palifermin, which may provide a more convenient administration schedule.