To evaluate the dynamics of regulatory T cells (Tregs) during tegumentary leishmaniasis, we assessed peripheral blood and biopsies from 54 patients. Patients with cutaneous leishmaniasis (CL) had a decreased proportion of Tregs in the peripheral blood, but the proportion was higher in the biopsies of lesions. During treatment of CL, circulating Tregs increased reaching normal proportions, whereas antigen-specific interferon-γ responses diminished. By contrast, circulating Tregs from mucosal leishmaniasis patients failed to normalize during treatment. C-C chemokine receptor type 5 was expressed on a large proportion of Tregs at the site of infection. These results demonstrate increased Tregs at the site of infection, possibly homing from the peripheral circulation.

Objetivo: Describir conceptos, experiencias y perspectivas que alumnos del último año de medicina en una universidad peruana tienen respecto al Profesionalismo Médico. Material y Métodos: Se aplicó una encuesta a alumnos que cursaban la rotación clínica final de su último (7º) año de estudios en la Facultad de Medicina de la Universidad Peruana Cayetano Heredia, durante el año 2015. Resultados: El porcentaje de respuestas fue 90,5%. Las tres respuestas más comunes fueron ética (51,2%), buena comunicación médico-paciente (43%) y conocimientos (41,9%). El 81,4 % de los estudiantes estuvo “de acuerdo” o “muy de acuerdo” con el hecho de que profesionalismo puede ser aprendido y enseñado. El contacto con modelos positivos del personal docente de la Facultad (4,26/5,00) fue considerado el método más útil para el aprendizaje sobre profesionalismo médico, en tanto que sólo el 25,6% consideró adecuado el número de actividades dedicadas a la enseñanza del tema. Conclusiones: Los Internos de medicina consideran a la ética, una buena relación médico-paciente, conocimiento, respeto y responsabilidad como principales atributos del profesionalismo médico. Percibieron que su concepto de profesionalismo fue más influenciado por modelos positivos que por actividades académicas formales.

Background Human T-cell lymphotropic virus (HTLV-1) is a retrovirus endemic in Latin America, Africa, and Asia. Increasing numbers are being reported in the United States. HTLV-1 causes Adult T-cell Leukemia/Lymphoma (ATL) in 3–5% of HTLV-1 carriers, usually only after a prolonged latent period. Co-infection with the nematode Strongyloides stercoralis (SS) is associated with early onset of ATL. The exact mechanism by which SS accelerates ATL development in HTLV-1 subjects is not understood. CADM1 has been recently identified as a surface marker of HTLV-1 infected cells; CD7 is a probable marker of early cell transformation. We hypothesize that previous SS infection will increase the proportion of infected T cells (CADM1+) and lead to transformation of infected cells (CADM1+CD7low) in HTLV-1 subjects.Methods In this pilot study, we tested seven subjects that were diagnosed with HTLV-1 between 2006 and 2008 and actively followed up at the HTLV-1 Cohort Clinic at the Tropical Medicine Institute in Lima, Peru. Five had previous SS infection. We performed surface flow cytometry staining of peripheral blood mononuclear cells with monoclonal antibodies against CADM1, CD7, CD4, and CD3. Current SS infection was ruled out by the Baermann technique in a stool sample.ResultsAverage age was 53 years (range 30–79). Average time since diagnosis of HTLV-1 was 10 years (range 9–11). One 30-year-old patient with prior SS infection was diagnosed with ATL and hospitalized in the ICU at the time of follow-up and excluded from group comparison. There was a trend for higher proportions of CADM1+ T-cells in subjects with previous SS co-infection compared with those without SS (median 16.20% vs. 9.55%, P = 0.13, Mann–Whitney). The proportion of PBMCs that were CADM1+CD7− was also increased in some of those with previous SS (Figure 1).Conclusion Our pilot data suggest that SS co-infection is associated with prolonged effects on HTLV-1 infection. We noted trends towards increased numbers of HTLV-1 infected cells (CADM1+) and a predisposition towards malignant transformation (CADM1+CD7low). Further studies are needed to confirm this observation and to determine whether CADM1 and CD7 expression may be useful as a screening tool to monitor HTLV-1 subjects at high risk of developing ATL.Figure 1.Representative flow cytometry.Disclosures All authors: No reported disclosures.

Interpretation: Preliminary results suggest that there is a lack of communication between doctors and parents in the Pediatric Emergency Unit. This study also demonstrated incomplete parental knowledge of bacterial meningitis, which could in turn affect parent's ability to identify appropriate prevention and treatment methods for their children.Abstract #: 1.029_INF

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