Partial Genetic Deletion of Klotho Aggravates Cardiac Calcium Mishandling in Acute Kidney Injury.

Acute kidney injury (AKI) is associated with an elevated risk of cardiovascular major events and mortality. The pathophysiological mechanisms underlying the complex cardiorenal network interaction remain unresolved. It is known that the presence of AKI and its evolution are significantly associated with an alteration in the anti-aging factor klotho expression. However, it is unknown whether a klotho deficiency might aggravate cardiac damage after AKI. We examined intracellular calcium (Ca2+) handling in native ventricular isolated cardiomyocytes from wild-type (+/+) and heterozygous hypomorphic mice for the klotho gene (+/kl) in which an overdose of folic acid was administered to induce AKI. Twenty-four hours after AKI induction, cardiomyocyte contraction was decreased in mice with the partial deletion of klotho expression (heterozygous hypomorphic klotho named +/kl). This was accompanied by alterations in Ca2+ transients during systole and an impairment of sarco/endoplasmic reticulum Ca2+-ATPase (SERCA2a) function in +/kl mice after AKI induction. Moreover, Ca2+ spark frequency and the incidence of Ca2+ pro-arrhythmic events were greater in cardiomyocytes from heterozygous hypomorphic klotho compared to wild-type mice after AKI. A decrease in klotho expression plays a role in cardiorenal damage aggravating cardiac Ca2+ mishandling after an AKI, providing the basis for future targeted approaches directed to control klotho expression as novel therapeutic strategies to reduce the cardiac burden that affects AKI patients.

Using photovoice to promote diabetes self-management in Latino patients.

Innovative, patient-centered interventions that employ novel educational methods are needed to address the burden of diabetes in the growing Latino population. Objective of this study was to assess the acceptability, feasibility, and perceived utility of photovoice in a diabetes self-management intervention for Latinos. Thirty-seven adults with diabetes attended a church-based self-management education program that included a photovoice exercise where participants were asked to take photographs to illustrate their successes and challenges in diabetes management. Participants discussed their photographs in the group classes and evaluated the exercise in an exit survey. Photographs and discussion notes were analyzed for prevalent themes. We measured participant participation in the photovoice activity, content of photographs, themes of the discussions that were prompted by the photographs in class, and participants' satisfaction with the photovoice exercise. Of the 37 participants, 70% took photos and 65% shared them in class. Photos depicted family, social gatherings, diet, exercise, the neighborhood, diabetes supplies and medications, and home life. Almost all the group discussions involved aspects of social support, including giving advice, empathizing, or providing motivation for self-care to one another. Eighty-six percent reported learning how to better manage their diabetes from others' photos; 93% noted sharing photos made them feel connected to the group. In a diabetes self-management education program, photovoice was well received by Latino adults and provided a vehicle to receive and provide social support in self-care. This trial was registered at clinicaltrials.gov with identifier NCT01288300.

Factors Impacting Adherence to Diabetes Medication Among Urban, Low Income Mexican-Americans with Diabetes.

Mexican-Americans carry a high burden of type 2 diabetes and are disproportionately affected by diabetes related mortality and morbidity. Poor adherence to medication is an important barrier to achieving metabolic control and contributes to adverse health outcomes and health disparities. Little is known about barriers and facilitators to medication adherence among Mexican-Americans with diabetes. This is a qualitative study of semi-structured interviews with a sample of 27 adults (25 Mexican-Americans and 2 Latinos of other origin) with self-reported type 2 diabetes who were recruited as part of a church-based, randomized controlled trial for diabetes self-management education in a low-income, immigrant neighborhood of Chicago. Face-to-face, in-depth interviews were conducted (one in English and 26 in Spanish), audio-recorded, transcribed verbatim, and professionally translated. Systematic qualitative methods were used to analyze interviews. All 27 participants were Latino, and 25 were of Mexican descent. Participants' mean age was 57 years, 81% were female, 69% had an annual income less than $20,000 and 48% had no health insurance. Mean A1C level was 8.6% and mean systolic blood pressure was 125 mmHg. The majority of participants (85%) reported using oral diabetes medication and 35% reported taking insulin. 76% reported being affiliated with one of the two partnering catholic churches based in the South Lawndale neighborhood of Chicago, also known as Little Village. Concerns regarding effectiveness and negative impact of diabetes medication were prevalent and expressed by 13 (48%) of 27 participants. Dissatisfaction with ineffective provider communication and not being able to pay for medication were other important barriers to adherence and were expressed by 7% and 11% of participants, respectively. Family support, for example, family members assisting in organizing medications in boxes and reminding participants to take them, was reported by 15% of participants and emerged as an important facilitator to medication adherence. There is a gap in research on factors influencing adherence to diabetes medication among Mexican-Americans. Our study suggests that concerns regarding negative impact of diabetes medication and concerns regarding effectiveness are prevalent barriers to adherence. These barriers can be addressed through educational efforts targeting patients and clinicians by specifically including content on beliefs that lead to poor adherence in diabetes self-management interventions for patients and continuing medical education for providers and by developing interventions that engage family members as a support system for medication adherence.

Bacteriologia en sinusitis aguda y cronica / Bacteriology in acute and chronic sinusitis

Se determinaron estadististicamente los germenes que con mayor frecuencia se ven involucrados en sinusitis aguda y cronica en nuestro medio, asi como la flora normal del seno maxilar y del meato medio en pacientes sin antecedentes de sinusitis, practicando cultivos para aerobios, anaerobios y hongos. Se encontraron tanto en sinusitis aguda como en cronica germenes anaerobios, principalmente el estafilocococo aureus, coagulas positivo. Los germenes anaerobios se obtuvieron solamente en sinusitis cronica en las muestras tomadas de mucosa. En el estudio de la flora normal se aislaron solamente germenes aerobios, predominando el estafilococo epidermides y estafilococo aureus, coagulasa positivo.