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Census data reveal that suburban communities are becoming increasingly diverse. Once considered affluent and predictable places, American suburbs are now confronting increasing poverty rates as well as ethnic, racial and linguistic diversity. Currently, more than half of US Latinos live in the suburbs. Schools and public institutions such as museums are challenged to provide programming that meets the needs of Latinos, who are disproportionately poor (Ackerman and Tazi 2015:3). Promoting school readiness among Latino children is an important effort in maximizing the potential and educational attainment of this growing population.In one suburban community, a school-museum collaboration resulted in a bilingual parent-child program promoting school readiness and social inclusion for Latino families. Arte Juntos/Art Together engaged parents and children using art and culture-based activities that developed observation skills, creativity, critical thinking, vocabulary, and aesthetic appreciation. Celebrating diverse perspectives and self-expression, the program provided access to museums as enriching spaces for informal learning, personal empowerment and social inclusion.

Background and Aims Typical Hemolytic Uremic Syndrome (HUS) is a thrombotic microangiopathy (TMA) characterized by the triad of acute renal failure, hemolytic anemia and thrombocytopenia. TMAs are classified into: Inherited or primary acquired (atypical HUS), secondary or infection associated. Infection with Shiga-toxin–producing Escherichia coli (E. coli), mainly of serotype O157:H7, is the most common cause of typical HUS, but other serotypes have been rarely associated such as Enteroagregative Escherichia coli (EAEC) serotype O104:H4. Method Case Report Results We report a case of a 51-years-old male with past medical history of arterial hypertension (treated with Perindopril) and IgGk Multiple Myeloma (MM) diagnosed 10 years prior submitted to two bone marrow autotransplants (9 and 4 years prior) and multiple chemotherapy agents including Carfilzomib-Pomalidomide-Dexamethasone (last cycle 4 days before the onset of symptoms). One week after returning from a trip to Brazil, he was admitted to the emergency department with a two-day history of non-bloody diarrhea (4-5 liquid stools per day) and asthenia, with similar positive familiar epidemiology. He denied abdominal pain, fever, nausea or vomiting. At physical examination, he was hypertensive (177/90 mmHg), anuric (12,5 ml/h), dehydrated and apyretic. Abdominal palpation was painless and there were no signs of peritoneal irritation. Laboratory tests showed hemoglobin 10.5 g/dl, new onset thrombocytopenia (261 000/uL » 21 000/uL), kidney disfunction (serum creatinine (sCr) 0.74 mg/dL to 9 mg/dL and serum urea (sU) 41 mg/dL to 260 mg/dL), hyperkaliemia (6 mEq/L) and metabolic acidosis (pH 7,39 and bicarbonate 18.4 mEq/L). LDH was 1949 U/L, C-reactive protein 30.6 mg/L, procalcitonin 3.77 ng/mL, haptoglobin <0.07 g/L and with normal complement levels (C3 and C4). Schistocytes were present in peripheral blood smear. The diagnosis of Acute Kidney Injury related with TMA was established and the patient was transferred to the Nephrology ward and urgent hemodialysis was started. Exhaustive study was performed showing normal renal ultrasound, non-nephrotic proteinuria (1.6 g/g), urinalysis showed leukocyturia and erythrocyturia. Autoimmune study including PR3-ANCA, MPO-ANCA, anti-GBM antibody, Anti-dsDNA antibody, anti-beta 2-glycoprotein I antibodies, anticardiolipin antibodies, anti-ADAMTS13 antibodies and ADAMTS13 activity, as well as study of complement C5, C'3, C'4, factor B, H and I, anti-factor H ac, AH 50 and CH50b were unremarkable. Blood and urine culture and antistreptolysin O titers were negative. Specific stool cultures for E. coli O157, Shigella, Salmonella, Yersinia and Campylobacter were negative. Stool evaluation for parasites were also negative. Viral serology for HIV, HBV, HCV and Plasmodium tests were negative. PCR stool was required due to high suspicion of E.coli infection. The suspicion of a Carfilzomib induced TMA was also raised, while molecular techniques results were awaited. MM was stable and treatment was held until recovery of kidney function. During hospitalization the patient recovered diuresis and creatinine decreased. On the 11th day of hospitalization, he was discharged but still depended on hemodialysis. Finally, stool PCR techniques identified aatA and aggR genes associated with EAEC O104:H4 allowing the diagnosis of acquired infectious HUS rather than drug-related TMA. One week after discharge, the dialysis was stopped due to sCr 3 mg/dL. Four months later, he resumed Carfilzomib and kidney function remained stable with sCr 0.9 mg/dL, despite sustained proteinuria of 1.2 g. Conclusion The authors emphasize the importance of considering other causes of TMA when E.coli O157 infection is excluded, namely drug-related causes (as Carfilzomib) or less frequent infectious agents such as EAEC O104:H4. This case reveals the importance of requesting PCR in the stool even when the E.coli test is negative. This is of particular relevance in immunosuppressed patients. This diagnosis allowed continuing MM treatment.

Background and Aims The incidence of nephrolithiasis has risen in recent years, largely due to changes in diet and lifestyle. An association between nephrolithiasis and risk of cardiovascular disease has been described, including atherosclerosis. The underlying mechanisms linking the two conditions are not well understood, making it important to study the role of exercise and nutritional habits. This study aims to examine the incidence of cardiovascular comorbidities in patients with nephrolithiasis, considering demographic information and the timeline of disease diagnosis and follow-up. Conditions such as dyslipidemia, myocardial infarction, stroke, and metabolic syndrome are of particular interest in this population. Method We retrospectively analysed consecutive patients that were referred to our tertiary medical center nephrolithiasis clinic between 2021 and 2023. The demographic information collected included gender, age at first nephrolithiasis diagnosis, current age, and family history. The cardiovascular conditions analysed included metabolic syndrome, hypertension, diabetes, gout, smoking, stroke, and dyslipidemia. Additionally, renal function (GFR-EPI) was also taken into account. Appropriate tests for continuous and categorical variables were applied, recurring to SPSS v21.0. Results A total of 84 patients were included in the study. Of these, 51.2% (n=43) were women with a median age of 52 years (IQR: 13-83) and a median age of first nephrolithiasis diagnosis of 34 years (IQR: 9-75). The analysed comorbidities showed a high incidence of hypertension (n=35, 41.7%), obesity (n=33, 40.7%), dyslipidemia (n=50, 61%), and metabolic syndrome (n=20, 23.8%). Family history was identified in 37.3% (n=31) of patients, with a significant difference for men, where 64.5% (n=20) had a positive family history (p-value 0.033). The results showed a relationship between increased body mass index and younger age of first nephrolithiasis diagnosis (p-value 0.012) and lower renal function at diagnosis (p-value 0.005). Conclusion The diagnosis of nephrolithiasis requires a change in the patient's diet and lifestyle, not only because of the risk of recurrence, but also because these patients are at a higher risk of developing serious cardiovascular events. This study highlights the high incidence of these comorbidities and underscores the importance of both the patient and the nephrologist being diligent in addressing these issues to achieve better kidney and overall health outcomes.