Indigenous communities in Colombia: A cultural and holistic view of cancer management.

Cancer is one of the most burdening global health challenges. Indigenous communities are at high risk for worse healthcare outcomes because of inequalities in the incidence, prevalence, and mortality of oncological diseases, that arise from socioeconomic, racial, cultural, religious beliefs, and ethnic factors. Their perception about themselves is closely related to what affects their territory, making them possess a profound rooted feeling with their surroundings, and intense spiritual believes. Consequently, the disease process is linked to physical and emotional imbalances and alterations in their territory. Researchers from the United States, Canada, New Zealand, and Australia have worked diligently to learn about barriers to cancer management among these populations. Unfortunately, robust cancer data is lacking for most of the world's Indigenous, leading to obstacles in information systems and consequently, inequities in healthcare with the perpetuation of the problem. Therefore, a better understanding of cancer as a global health problem is required. Our study aims to propose a holistic and culturally adapted framework to improve cancer health services and outcomes among Indigenous peoples in Colombia.

Advancing pediatric palliative care in a low-middle income country: an implementation study, a challenging but not impossible task.

BACKGROUND: The disparities in access to pediatric palliative care and pain management in Latin America remains an unaddressed global health issue. Efforts to improve the development of Palliative Care (PC) provision have traditionally targeted services for adults, leaving the pediatric population unaddressed. Examples of such services are scarce and should be portrayed in scientific literature to inform decision-makers and service providers on models of care available to tackle the burden of Pediatric Palliative Care (PPC) in Low-and middle-income countries (LMIC). The purpose of this study is to describe the implementation of a pediatric palliative care program, "Taking Care of You" (TCY), in a tertiary care, university hospital in Cali, Colombia. METHODS: A program's database was built with children between 0 to 18 years old and their families, from year 2017 to 2019. Descriptive analysis was carried out to evaluate the impact of the program and service delivery. A theory-based method was directed to describe the PPC program, according to the implementation of self-designed taxonomy, mapping theoretical levels and domains. Clinical outcomes in patients were included in the analysis. RESULTS: Since 2017 the program has provided PPC services to 1.965 children. Most of them had an oncologic diagnosis and were referred from hospitalization services (53%). The number of ambulatory patients increased by 80% every trimester between 2017 and 2018. A 50% increase was reported in hospitalization, emergency, and intensive care units during the same time period. CONCLUSIONS: The program addressed a gap in the provision of PPC to children in Cali. It shows effective strategies used to implement a PPC program and how the referral times, coordination of care, communication with other hospital services were improved while providing compassionate/holistic care to children with life-limiting and threatening diseases and in end-of-life. The implementation of this program has required the onset of specific strategies and arrangements to promote awareness and education proving it a hard task, yet not impossible.

Latent tuberculosis infection in patients with autoimmune diseases treated with Infliximab and Etanercept / Infección latente por tuberculosis en pacientes con enfermedades autoinmunes que reciben tratamiento con Infliximab y Etanercept

Introduction: Latent tuberculosis infection (LTI) in patients receiving biological therapies is a reality, but this has not been studied in depth in Colombia. Objective: To determine the prevalence of LTI in patients with autoimmune diseases receiving treatment with Infliximab / Etanercept in a referral health center in Cali, Colombia, between the years 2011-2017. Methodology: A retrospective observational study was conducted. We reviewed the 'Registry of patients exposed to tumor necrosis factor-alpha (TNF-α) antagonist drugs in Fundación Valle del Lili'. Patients diagnosed with a chronic inflammatory disease were included who received treatment with Infliximab, Etanercept, or both and followed at least two years. Design: Retrospective observational study. We reviewed the 'Registry of patients exposed to tumor necrosis factor alpha (TNF-α) antagonist drugs in Fundación Valle del Lili'. Patients diagnosed with a chronic inflammatory disease were included who received treatment with Infliximab, Etanercept or both and followed at least a period of 2 years. Results: We included 82 patients; the median age was 47.5 years (IQR=28-60 years), 76% were female, 2% had intimate contact with tuberculosis, 15% were older than 65 years. The 56% had a diagnosis of rheumatoid arthritis as an indication of therapy, and 2% presented infection by hepatitis C virus. The median PPD was 12 mm (IQR=10-17 mm). The prevalence was 3.8% for LTI. Conclusion: The conversion to LTI shows an important prevalence, so it is convenient to perform a routine follow-up of patients receiving therapies with Infliximab and Etanercept.

Introducción: La infección latente por tuberculosis (ILTB) en pacientes que reciben terapias biológicas es una realidad, pero esto no ha sido estudiado a profundidad en Colombia. Objectivo: Determinar la prevalencia de ILTB en pacientes con enfermedades autoinmunes que reciben tratamiento con Infliximab/Etanercept en una institución de salud de referencia de Cali, Colombia, entre los años 2011-2017. Metodología: Se realizó un estudio observacional retrospectivo. Se revisó el 'Registro de pacientes expuestos a fármacos antagonistas del factor de necrosis tumoral alfa (anti TNF-α) en la Fundación Valle del Lili entre los años 2011 y 2017'. Se incluyeron pacientes con diagnóstico de una enfermedad inflamatoria crónica quienes recibieron tratamiento con Infliximab, Etanercept o ambos y con seguimiento al menos un periodo de 2 años. Resultados: Se incluyeron 82 pacientes; la mediana de edad fue 47,5 años RIC (28-60 años), el 76% fue de sexo femenino, el 2% tuvo contacto íntimo con TB, el 15% era mayor de 65 años. El 56% tenía diagnóstico de artritis reumatoide como indicación de terapia y el 2% presentaba infección por HCV. La mediana de PPD fue 12 mm RIC (10-17 mm). La prevalencia fue del 3,8% para ILTB. Conclusiones: La conversión a ILTB muestra una prevalencia importante, por lo que resulta conveniente la realización de un seguimiento rutinario a los pacientes que reciben terapias con Infliximab y Etanercept.