Introduction: As has happened in other emerging respiratory pandemics, demand for N95 filtering facemask respirators (FFRs) has far exceeded their manufacturing production and availability in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. One of the proposed strategies for mitigating the massive demand for N95 FFRs is their reuse after a process of decontamination that allows the inactivation of any potentially infectious material on their surfaces. This article aims to summarize all of the available evidence on the different decontamination methods that might allow disposable N95 FFRs to be reused, with emphasis on decontamination from SARS-CoV-2. Methods: We performed a systematic review of the literature in order to identify studies reporting outcomes of at least 1 decontamination method for inactivating or removing any potentially infectious material from the surface of N95 FFRs, specifically addressing issues related to reduction of the microbial threat (including SARS-CoV-2 when available), maintaining the function of N95 FFRs and a lack of residual toxicity. Results: We identified a total of 15 studies reporting on the different decontamination methods that might allow disposable N95 FFRs to be reused, including small-scale energetic methods and disinfecting solutions/ spray/wipes. Among these decontamination methods, ultraviolet germicidal irradiation and vaporized hydrogen peroxide seem to be the most promising decontamination methods for N95 FFRs, based on their biocidal efficacy, filtration performance, fitting characteristics, and residual chemical toxicity, as well as other practical aspects such as the equipment required for their implementation and the maximum number of decontamination cycles. Conclusions: Although all the methods for the decontamination and reuse of N95 FFRs have advantages and disadvantages, ultraviolet germicidal irradiation and vaporized hydrogen peroxide seem to be the most promising methods.

Among patients undergoing heart transplantation, Aspergillus is the opportunistic pathogen with the highest attributable mortality. The median time of onset from transplantation for invasive pulmonary aspergillosis (IPA) was 46 days, but the median time to first positive culture result was 104 days among patients with Aspergillus colonization but no invasive disease. Most patients with IPA presented with fever and cough within the first 90 days of transplantation and with single or multiple pulmonary nodules. None of the heart transplant recipients with either IPA or invasive extrapulmonary aspergillosis (IEPA) had associated neutropenia. Human leukocyte antigen A1 locus was found significantly more frequently among patients colonized with Aspergillus than among patients with IPA (P<.006) or IEPA (P<.001). Even in the absence of neutropenia, IPA should be suspected for heart transplant recipients who have fever and respiratory symptoms within the first 3 months of transplantation, have a positive result of culture of respiratory secretions, and have abnormal radiological findings (particularly nodules).

ResumenEl síndrome febril agudo se refiere a un conjunto de enfermedades que cursan con fiebre en el contexto de exposición en áreas tropicales y que constituyen un motivo de consulta frecuente en el servicio de urgencias. Este artículo revisa el enfoque clínico del síndrome febril agudo en Colombia y de las enfermedades más prevalentes o graves que lo causan. Se presenta el enfoque sindromático y se establece una revisión sucinta de los síntomas principales, signos de alarma, tratamiento, prevención y notificación en el sistema de vigilancia en salud pública.Palabras clave: Síndrome febril agudo; Malaria; Dengue; Virus chikungunya; Hepatitis; Fiebre amarilla; Infecciones por rickettsia; Leptospirosis; Absceso hepático; Fiebre hemorrágica ébola Clinical approach to acute febrile syndome in Colombia AbstractAcute febrile syndrome refers to a group of diseases with fever as a main symptom, in a context of living in or having been exposed to tropical climates. It is a frequent cause for consultation in the emergency room. This paper reviews the clinical approach to acute febrile syndrome and the most prevalent or severe causes. We present the syndromatic approach to the patient and a short review of the main symptoms, alarm signs, treatment, prevention and notification to the public health surveillance system of the most frequent causes.Keywords: Acute febrile syndrome; Malaria; Dengue; Chikungunya virus; Hepatitis; Yellow fever; Rickettsia infections; Leptospirosis; Liver abscess; Hemorrhagic fever ebola IntroducciónColombia es un país ubicado en el trópico y endémico para distintas enfermedades febriles agudas de origen infeccioso, de las cuales, en el caso de malaria se puede realizar un diagnóstico oportuno y rápido, no así en las otras causas de sín-drome febril no palúdico, por lo que quedan sin diagnóstico etiológico claro. A pesar del intento de la OMS por generar algoritmos diagnósticos y terapéuticos en la enfermedad febril aguda, todavía existe mucha confusión acerca del enfoque y manejo del paciente con fiebre sin foco aparente en el servicio de urgencias y, más aún, en su seguimiento hospitalario e incluso ambulatorio 1-3 .Se define síndrome febril agudo (SFA) como el estado mór-bido con inicio repentino de fiebre, de menos de 7 días de evolución, en pacientes entre 5 y 65 años, en los cuales no se hayan identificado signos ni síntomas relacionados con un foco infeccioso aparente 4 . Actualmente, en Colombia existen más de 60 enfermedades infectocontagiosas consideradas de interés en salud pública, con un comportamiento endemoepidémico en más del 85% del territorio nacional, que se manifiestan a través de SFA 5 . Debido a la diversidad de enfermedades causantes y a la posibilidad de que el cuadro corresponda a un caso de malaria, dengue, rickettiosis u otras enfermedades potencialmente letales y de importancia en salud pública, es muy importante para el médico colombiano tener la capacidad de abordar los casos para garantizar una atención apropiada y una selección de las pruebas diagnósticas apropiadas...

No abstract

Data with respect to the epidemiological situation of fungal diseases in Colombia is scarce. Thus, the aim of this study is to estimate the burden of fungal infections. A population projection for 2017 from the Colombian Department for National Statistics was used, as well as official information from the Ministry of Health and National Institute of Health. A bibliographical search for Colombian data on mycotic diseases and population at risk (chronic obstructive pulmonary disease, HIV infection/AIDS, cancer, and transplant patients) was done. The Colombian population for 2017 was estimated at 49,291,609 inhabitants, and the estimated number of fungal infections for Colombia in 2017 was between 753,523 and 757,928, with nearly 600,000 cases of candidiasis, 130,000 cases of aspergillosis, and 16,000 cases of opportunistic infection in HIV, affecting around 1.5% of the population. In conclusion, fungal infections represent an important burden of disease for the Colombian population. Different clinical, epidemiological, and developmental scenarios can be observed in which fungal infections occur in Colombia.

The identification of aberrant cellular pathways and dysfunctional molecules important in neoplastic transformation has begun to provide us with a number of targets for drug development. It is likely that many of these agents will be incorporated into our existing treatment strategies that include cytotoxic agents. Sorafenib, a multi-kinase inhibitor has been approved in the United States for the treatment of renal cell carcinoma as well as hepatocellular cancer. Its potential role in hematological malignancies, particularly acute myeloid leukemia (AML) is under evaluation. Here we describe the biological pathways in AML that are the potential targets of sorafenib action and discuss the early clinical data with the agent in solid tumors and AML.

No abstract

Candidemia is associated with a high mortality rate. Age and shock increase mortality, while the use of fluconazole was shown to be a protective factor. A higher resistance rate with new breakpoints was noted.