. Various surfaces were also sampled with cotton-tip swabs. The filters of the air conditioning system in the surgical room were replaced and samples culture tested. The central supply rooms that housed equipment used in cardiac surgery operations were all inspected for visible signs of mold contamination or damage that might lead to mold growth. Routine scheduled maintenance and replacement protocols for equipment and air filters were reviewed.
None of the patients undergoing surgical operation during the same period developed infection of the surgical site due to Aspergillus spp. and the results of environmental samples tested 17 days later were negative. In two of the tested samples hyphomycetes classified as Cladodosporium spp. grew on the 17th day, however these were considered as laboratory contamination. These positive samples derived from a storage area in the surgical room. No further isolation of fungi was noted from the plates, which were kept for one month after the environmental sampling inoculation. Additionally, a subsequent investigation was performed on the ICU staff using nasal cultures for possible nasal colonization with Aspergillus spp., also giving negative culture test results.
Aspergillus mediastinitis has been defined by the US Centers for Disease Control and Prevention as the presence of a positive culture result from a mediastinal sample plus one of the following: (a) fever of over 38°C, or (b) chest pain or sternal instability with purulent effusion in the mediastinum or positive culture results from surgically obtained samples or blood. In a recently published review Pasqualotto et al. summarized cases of Aspergillus mediastinitis reported in the literature, all in patients who had undergone surgery (four with deep sternal wound infections, two with heart transplantation, two with aortitis, one with patch infection after repaired Fallot tetralogy and two patients who were immunocompetent who were affected during an outbreak of aspergillosis related to a contaminated ventilation system in the operating room). The authors considered immunocompromised individuals with defects in alveolar macrophage and neutrophil function as patients at risk (that is, patients undergoing chemotherapy, bone marrow recipients, solid-organ transplants, or patients with congenital or acquired immune disorders). The automatically drained exudate from the surgical wound in our patient, who was feverish, supported the diagnosis of mediastinitis, despite the absence of confirmatory signs from his thorax CT scan. However our patient was low risk for Aspergillus spp. infection development, since he did not fulfill the traditional criteria of immunosuppression (malignancy, chemotherapy or radiotherapy, neutropenia, systematic or immunosuppressive diseases, or systematic steroid treatment). Although our patient had received a short course (7 days) of treatment with steroids (50 mg twice a day) during a septic episode, it is highly unlikely that this resulted in a permanent altered host response. According to Pasqualotto et al. the most important and crucial point for the diagnosis of Aspergillus mediastinitis in patients undergoing cardiac surgery with destructive wound infections and samples that give negative culture test results is a high clinical suspicion. A potential immunomodulatory factor in our case could be the prolonged prostacyclin use. Recent experimental data support an immunosuppressive role for prostacyclin, through impaired regulation of phagocytosis, bacterial killing, and inflammatory mediator production, but the extrapolation of these findings to the clinical setting remains highly speculative.
Environmental investigations did not reveal the source of contamination in our patient's case. Despite the lack of an air sampler, a thorough investigation was performed without identification an environmental source. This finding argues against an ongoing source of contamination and is in line with the absence of new cases of infections with Aspergillus among patients undergoing surgery within our hospital. Nevertheless, a point source not yet identified cannot be excluded. However, based on previous reports of outbreaks through the ventilation system of the operating theater, the air conditioning filters of the cardiac surgery room were replaced immediately after the identification of the infection. No renovation or construction procedures were being performed at our hospital during this time period. Direct inoculation from our patient's flora could be a possible source, but the common practice of our ICU department consists of testing of bronchial cultures (biweekly) as well as urine and stool cultures (weekly), and this would have revealed such a previous colonization. Pre-existing colonization of bronchial secretions with Aspergillus spp. and chronic lung disease have been demonstrated as risk factors in a case-control study of sternal wound infections, but this was not the case for our patient. To the best of our knowledge, there is no recommendation issued for prophylaxis against Aspergillus infections in immunocompetent hosts. Interestingly, our patient had received a 15-day caspofungin course as pre-emptive treatment for invasive candidiasis based on colonization of urine and bronchial cultures by Candida spp. in conjunction to additional risk factors (prolonged ICU stay, administration of broad spectrum antibiotics, central line placement, mechanical ventilation and total parenteral nutrition administration) [15, 16]. The treatment course was terminated 10 days pre-operatively and no selection of fungi resistant to caspofungin was seen on routine surveillance cultures.
Aspergillus mediastinitis mainly affects patients undergoing cardiosurgery operations with predisposing factors, and is unusual in patients who are immunocompetent. The identification of the source of Aspergillus spp. is often difficult, and there are no guidelines for the administration of pre-emptive therapy in this population. Our patient could be added to the series of Pasqualotto and Denning as a third immunocompetent patient with post-operative Aspergillus spp. mediastinitis.
GD, IT, GT and GP analyzed and interpreted data from our patient with regard to ICU admission, surgical procedure and microbiology. JCP performed the histological examination of the myocardium and the lung, and SO and AA were major contributors to the writing of the manuscript. All authors read and approved the final manuscript.Datar Genetics Ltd has joined hands with Apollo Hospitals to provide Precision Oncology, a cancer management technique which brings down pain and lowers costs. The partnership envisages the integration of molecular and genetic analysis in the diagnosis, treatment and monitoring of cancers. The collaboration shall further explore leveraging technology to introduce precision matching for organ/bone marrow transplants.
Dr. K Hariprasad, Group President, Apollo Hospitals said, " Precision diagnosis gives patients the best chance to fight cancer upfront, save costs, reduce suffering and reduce time to productivity.. This in turn shall enable us to realize our long standing vision of delivering better clinical outcomes from bench to bedside. This alliance is further validation of Apollo Hospital's commitment to research driven health care."
Also speaking on the occasion, Rajan Datar, Managing Director, Datar Genetics, said “It is inevitable that genetics will be the main stay of all aspects of the war on cancer. India will lead this intellectual revolution and Datar Genetics is determined to make it successful. The collaboration with Apollo Hospitals marks the fundamental shift from a ‘West-facing’ and ‘West-dependent’ perspective in high technology in healthcare to a self-confident research initiative in India."
The strategic partnership is the first of its kind in India and will pave the way for rapid integration of molecular and genetic analysis as standard treatment options in cancer treatment for better outcomes and quality of life for patients as well as create an India centric model for high technology relevant for theEffects of phosphate buffer in parenteral drugs on particle formation from glass vials.

The characteristics of inorganic particles generated in glass vials filled with phosphate buffer solutions were investigated. During storage, particles were visually detected in the phosphate buffer solution in particular glass vials which pass compendial tests of containers for injectable drugs. These particles were considered to be different from ordinal glass delamination, which has been reported in a number of papers because the particles were mainly composed of Al, P and O, but not Si. The formation of the particles accelerated at higher storage temperatures. Among the surface treatments tested for the glass vials, sulfur treatment showed a protective effect on the particle formation in the vials, whereas the SiO(2) coating did not have any protective effects. It was found that the elution ratio of Al and Si in the solution stored in the glass vials after the heating was similar to the ratio of Al and Si in borosilicate glass. However, the Al concentration decreased during storage (5°C, 6 months), and consequently, particle formation was observed in the solution. Adding citrate, which is a chelating agent for Al, effectively suppressed the particle formation in the heated solution. When 50 ppb and higher concentrations of Al ion were added to the phosphate buffer solution, the formation of white particles containing Al, P and O was detected. It is suggested that a phosphate buffer solution in a borosilicate glass vial has the ability to form particles due to interactions with the Al that is eluted from the glass during storage.Arts and Humanities Grants supports organizations in Maine that present stories and cultural expressions of the state, its communities, and its people.
A partnership between the Maine Humanities Council and the Maine Arts Commission, these grants support innovative community projects that have both arts and humanities components.
Must include both arts and humanities components.<reponame>hect1c/martina-blog
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