Chih-Hung Ku has completed his study from Harvard School of Public Health (HSPH) with a master degree in Environmental Epidemiology, and a doctoral degree:

major in occupational epidemiology, and minors in biostatistics and bioaerosols in 1999, and a Visiting Scholar at the HSPH in 2004. He is a Faculty of the Kainan

University, Taoyuan City, Taiwan and an Adjunct Faculty of the School of Public Health, National Defense Medical Center, and Taipei City, Taiwan. He has published

more than 47 papers in reputed journals and has been serving as an Editorial Board Member of the Disease Markers.

Cardiac surgery site infection (SSI) is a nosocomial infection. We conducted a prospective study to assess the risk factors for

SSI at the Taipei Veterans General Hospital (TVGH), Taipei city, Taiwan, from July 1999 to August 2000. This study was

approved by the Institutional Review Board. Patients who had undergone cardiac surgery were invited to enroll in the study.

42 potential risk factors for SSI were classified into three stages: 22 in preoperative, 20 in intraoperative, and 2 in postoperative.

42 factors were reduced to 34 after the collinearity diagnostic analysis. Multiple logistic regression analysis using a generalized

logit model was used to assess associations of interest. A total of 471 cardiac surgery patients were enrolled in the study. SSI

incidence rates were 2.5 episodes per 1,000 person-days for the sternum and 3.6 episodes per 1,000 person-days for the leg.

After adjustment for covariates, we found that age, gender, New York Heart Association (NYHA), creatinin, and duration of

surgery were significantly associated with sternal SSI; whereas age, peripheral arterial occlusive disease (PAOD), and length of

stay in the recovery room were significantly associated with leg SSI. We concluded that in addition to patients’ characteristics

(age, gender) and health situations (heart and kidney function, PAOD), the significant findings for duration of surgery and

length of stay in the recovery room confirmed our concern that time is an important parameter in studying risk factors for SSI.

Further study might focus on the relation between infectious agents cultured from wounds and air sampling.

Mahboob Quershi is presently the Associate Dean for Research and Professor of Microbiology and Immunology Toruo University Nevada and also associated with

Unviersity of the Ryukyus, Japan.

RSV bronchiolitis and pneumonia is a common cause of pediatric hospitalization in the USA and all over the world. Severity

of RSV pneumonia is exacerbated in the premature neonates and those with congenital cardiopulmonary pathologies.

Additionally, adults with hematopoietic malignancies and particularly those receiving stem cell transplants often become

predisposed to RSV pneumonia. Breakouts of RSV-pneumonia in community often pre-herald those at the nosocomial

settings. Attempts to minimize the incidence frequencies and severity of these nosocomial events require multifactorial

approach including screening of staff and visitors, screening on admission, visitor restriction, compliance monitoring and

finally use of personal protective equipment which yet generates variable results. Prophylactic use of monoclonal antibody

palivizumab has been reported with variable responses. RSV and other respiratory viral infections among stem cell transplant

recipients are commonly encountered after allogenic transplant, which often poses a significant challenge for patient recovery

and transplant survival. Prospective studies confirming the efficacy of Ribavarin use in these patients preventing progression

to life threatening pneumonia are yet to be properly done. Thus, it leaves the scope for prospective studies utilizing alternate

therapeutic approaches. Osteopontin (OPN) is an immunomodulatory molecule originally reported to be involved with

osteogenesis and only later have been implicated in modulating immune response polarizing the response towards a Th1 type.

Recently, several research groups in the USA and other countries have reported immune-modulatory effects of OPN in RSV

infections. RSV-infected infants develop a hyperactive airway (Th2 bias) response which has been shown to be prevented in

experimental animal models by prophylactic administration of OPN. It is yet to be established whether prophylactic use of

OPN in nosocomial setting has a similar effect in preventing progression to severe pneumonia and minimize mortality. Use of

OPN in combination with the existing multifactorial approaches may prove wise and worthwhile to prevent the untimely death

of the RSV-infected neonates, as well as those immunosuppressed hematopoietic stem cell recipients.