BackgroundProtozoan parasites of the genus Leishmania are responsible for leishmaniasis, a neglected tropical disease affecting millions worldwide. Visceral leishmaniasis (VL), caused by Leishmania donovani, is the most severe form of leishmaniasis with high rates of mortality if left untreated. Current treatments include pentavalent antimonials and amphotericin B. However, high toxicity and emergence of resistance hinder the success of these options. Miltefosine (HePC) is the first oral treatment available for leishmaniasis. While treatment with HePC has proven effective, higher tolerance to the drug has been observed, and experimental resistance is easily developed in an in vitro environment. Several studies, including ours, have revealed that HePC resistance has a multi-factorial origin and this work aims to shed light on this complex mechanism.Methods2D-DIGE quantitative proteomics comparing the soluble proteomes of sensitive and HePC resistant L. donovani lines identified a protein of interest tentatively involved in drug resistance. To test this link, we employed a gain-of-function approach followed by mutagenesis analysis. Functional studies were complemented with flow cytometry to measure HePC incorporation and cell death.ResultsWe identified a mitochondrial HSP70 (HSPA9B) downregulated in HePC-resistant L. donovani promastigotes. The overexpression of HSPA9B in WT lines confers an increased sensitivity to HePC, regardless of whether the expression is ectopic or integrative. Moreover, the increased sensitivity to HePC is specific to the HSPA9B overexpression since dominant negative mutant lines were able to restore HePC susceptibility to WT values. Interestingly, the augmented susceptibility to HePC did not correlate with an increased HePC uptake. Leishmania donovani promastigotes overexpressing HSPA9B were subjected to different environmental stimuli. Our data suggest that HSPA9B is capable of protecting cells from stressful conditions such as low pH and high temperature. This phenotype was further corroborated in axenic amastigotes overexpressing HSPA9B.ConclusionsThe results from this study provide evidence to support the involvement of a mitochondrial HSP70 (HSPA9B) in experimental HePC resistance, a mechanism that is not yet fully understood, and reveal potential fundamental roles of HSPA9B in the biology of Leishmania. Overall, our findings are relevant for current and future antileishmanial chemotherapy strategies.Electronic supplementary materialThe online version of this article (doi:10.1186/s13071-016-1904-8) contains supplementary material, which is available to authorized users.

Background Over 41 million people in the United States speak Spanish as their primary language, of which 16 million have limited English proficiency (LEP). It is well-established that language barriers contribute to health disparities and that the use of ad-hoc interpretation by untrained family members results in substandard care. We developed a novel interpreter training program for medical students to serve as in-person interpreters at a charitable, resident continuity clinic so as to overcome the language barrier in the delivery of healthcare to LEP patients. Methods The Medical Student Interpreter Training Program (MSITP) consists of three steps. First, fluent Spanish-speaking students shadowed a licensed interpreter. Second, students took a standardized phone exam to demonstrate language proficiency. Finally, students completed a three-hour training on the methodology and ethics of interpreting conducted by the Department of Interpreter Services. Results Pre- and post-tests were administered to assess students’ familiarity with the Interpreter Code of Ethics and interpreter skills. Familiarity with the Interpreter Code of Ethics increased significantly with all students reporting feeling comfortable (47%) or very comfortable (53%) after training. The pre- and post-tests included free response questions, which were administered to assess competence in the methodology and ethics of interpreting. The cohort’s aggregate score increased by 35% after the training (Wilcoxon signed rank z-score = 2.53; p = .01). Conclusions Implementing the MSITP resulted in an increased number of trained, Spanish-speaking interpreters available to provide their services to LEP patients at an affiliated charitable clinic and throughout the university hospital. Unlike other program models which are time and resource-intensive, this program is replicable and easily managed by volunteers. The MSITP is an effective model for training students as medical interpreters to ensure the delivery of quality healthcare for LEP patients.

Introduction: The Hiatt Residency in Global Health Equity program at Brigham and Women's Hospital partnered with Loyola University Medical Center and the Stritch School of Medicine to build and share an innovative global health dinner curriculum (GHDC) based on the methodologies of transformative learning theory. This educational approach encourages trainees to critically analyze their frame of reference and has the potential to create practitioners equipped to advance health equity. Methods: The GHDC explored broad global health (GH) topics through facilitated discussions with faculty and an experienced guest discussant over dinner. Medical students and internal medicine residents attended sessions based on their availability and interest. Participants completed surveys before and after every dinner. Comprehensive post-curriculum surveys were collected after participants had been involved for at least 1 year. Results: In 2017-2018, 98% of the 37 participants preferred the dinner-style learning session to a didactic-style lecture (97% of the 37 participants in 2018-2019). Eighty-five percent (2017-2018) agreed or strongly agreed that dinners provided them with new knowledge on a GH topic (92% in 2018-2019). Seventy-two percent (2017-2018) agreed that the dinner introduced them to a new potential mentor in GH (66% in 2018-2019). Discussion: The GHDC has been particularly successful in introducing participants to unfamiliar areas of medicine and new mentors. A second strength is its accessibility to medical students and residents. Its dependence on local resources allows versatility and customization; however, this trait also makes it difficult to prepackage the curriculum for interested institutions.