No subject
Thu Jul 7 11:54:55 BRT 2011
need for dose adjustment. But we should be very careful with kidney
functions.
Is there any information on the mechanism of renal lesion? Tubular?
Best regards,
Carlos.
2011/7/11 Jaime Soto <jaime.soto at prodderma.com>
> Dear all,****
>
> ** **
>
> I received some days ago a specific question regarding miltefosine use in
> patients with renal impairment. I delay my answer asking to other people
> because this is not an easy answer; this is the conclusion:****
>
> ** **
>
> =93Miltefosine is mildly nephrotoxic [Soto. CID 2004; 38:1266=9672] in
> leishmaniasis patients with normal renal function, Whether or not
> miltefosine would further diminish renal function in renally-impaired
> patients is not known. If renal function is already very low, however, a
> further effect on renal function might not be seen. ****
>
> ** **
>
> My personal view would be to not lower dosing because of a possible adver=
se
> effect on the kidneys, specially because, in the specific case, full dose
> could mean the difference between improving and failure.****
>
> ** **
>
> Regards from Bolivia,****
>
> ** **
>
> Jaime soto ****
>
> ****
>
> ** **
>
> *De:* leish-l-bounces at lineu.icb.usp.br [mailto:
> leish-l-bounces at lineu.icb.usp.br] *En nombre de *Carlos Costa
> *Enviado el:* domingo, 10 de julio de 2011 05:44 p.m.
> *Para:* Jennie Blackwell
> *CC:* Leish-L
> *Asunto:* SPAM-LOW: Re: [Leish-l] miltefosine for diffuse leishmaniasis**=
*
> *
>
> ** **
>
> Hi Jennie,****
>
> ** **
>
> Thanks for the drug information. Now, I have to check the permission for
> its use in Brazil and how to justify its use to the public system in orde=
r
> to be acquired by the government. Meanwhile, we are looking for miltefosi=
ne,
> paramomycin, and alternative therapies.****
>
> ** **
>
> But if the immunosuppression is species specific do you think that a
> general stimulation would reverse it? Does anyone knows which is the
> mechanism behind the DCL induced immunosuppression? Parasite or host or
> both? ****
>
> ** **
>
> Cheers,****
>
> ** **
>
> Carlos.****
>
> 2011/7/7 Jennie Blackwell <jmb37 at cam.ac.uk>****
>
> Hello Carlos****
>
> ** **
>
> My memory from late 80s was that these patients responded well to
> interferon-gamma treatment. With all the moves to make drugs more afforda=
ble
> for disease endemic countries, has it not been possible to consider this
> option?****
>
> ** **
>
> In psoriasis they use creams with Vitamin D. Has anyone ever tried this f=
or
> DCL?****
>
> ** **
>
> I'm sure this is going to elicit a round of responses - but you know I'm
> not a clinician so I would just be interested to know!****
>
> ** **
>
> Cheers, Jennie
>
> Jenefer M. Blackwell****
>
> TICHR, CCHR, UWA****
>
> Phone: +61 8 94897910****
>
> From my iPhone****
>
>
> On 07/07/2011, at 3:04, Carlos Costa <chncosta at gmail.com> wrote:****
>
> Dear all,****
>
> ** **
>
> Maria Cleudimar has cutaneous diffuse leishmaniasis due to *Leishmania
> amazonensis*. She used to be a long time patient form Dr. Jackson Costa,
> in the countryside of Maranh=E3o State, Brazil, since she was 10 years ol=
d,
> after a disease that started when she was just five. Now, she is under my
> and Dorcas care, at the age of 30, living in the city of Teresina.****
>
> ** **
>
> Her long time DCL does not respond to the treatment antimonium anymore.
> Although we still prescribe liposomal amphotericin B at very low dose
> (3mg/kg/once a week), her situation is deteriorating progressively, her
> renal function does not allow any additional dosing since creatinine is
> presently above 3mg/dL, and previous biopsy had shown tubular damage
> apparently secondary to the drug, without evidence of amyloidosis. We tri=
ed
> several combinations of different drugs, without success. Her situation
> worsened a lot during her recent pregnancy (the baby is eight months old
> now).****
>
> ** **
>
> Our hope now stands only in miltefosine, for oral chronic use, but the dr=
ug
> is not licensed or available in Brazil yet (to my knowledge).****
>
> ** **
>
> With her permission I attached some of her pictures, hoping to sensitize
> critical people in order to help me to get miltefosine and the permission
> for prescription in Brazil (or any other oral drug with promising efficac=
y,
> and without nephrotoxicity, if known). Moreover, we need to know about th=
e
> dose adjustment for the renal impairment, and how long the drug could saf=
ely
> be used.****
>
> ** **
>
> One picture shows her face before treatment, and another after the
> pregnancy, with the baby. One shows the situation of her thighs, another =
the
> calf of the leg and the last one the infiltration of the palate.****
>
> ** **
>
> Hoping a little from friends, my kindest regards,****
>
> ** **
>
> Carlos.****
>
> ** **
>
> PS. Please understand that the pictures are allowed not for publication o=
r
> public presentation. Cleudimar permission is restricted to this forum.***=
*
>
> ** **
>
>
> --
> *Carlos H. N. Costa, MD, DSc.*****
>
> *President*****
>
> *Sociedade Brasileira de Medicina Tropical *****
>
> *(Brazilian Society of Tropical Medicine)*****
>
> *Instituto de Doen=E7as Tropicais Natan Portella
> Universidade Federal do Piau=ED*****
>
> *Rua Artur de Vasconcelos 151-Sul*****
>
> *64049-750 Teresina-PI
> Brazil
> Telephones: +55 86 3221-3413 (work); +55 86 8838-3303 (mobile).
> *
> Aviso: As informa=E7=F5es contidas nesta mensagem s=E3o CONFIDENCIAIS, pr=
otegidas
> pelo sigilo legal, por direitos autorais e destinadas exclusivamente =E0
> pessoa ou organiza=E7=E3o para a qual a mensagem foi destinada.
> Warning: This message is meant only for the intended recipient of the
> transmission. It is forbidden any unauthorized use, alteration,
> reproduction and distribution. If you are not the correct recipient, plea=
se
> notify us immediately by return e-mail and delete this message from your
> system. ****
>
> ** **
>
> <cleu antes grav 13jan09.jpg>****
>
> <cleu e nene.jpg>****
>
> <cleu santada recorte.jpg>****
>
> <cleu panturrilhas.jpg>****
>
> <cleu palato.jpg>****
>
> _______________________________________________
> Leish-l mailing list
> Leish-l at lineu.icb.usp.br
> http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/leish-l****
>
>
>
>
> --
> *Carlos H. N. Costa, MD, DSc.*****
>
> *President*****
>
> *Sociedade Brasileira de Medicina Tropical *****
>
> *(Brazilian Society of Tropical Medicine)*****
>
> *Instituto de Doen=E7as Tropicais Natan Portella
> Universidade Federal do Piau=ED*****
>
> *Rua Artur de Vasconcelos 151-Sul*****
>
> *64049-750 Teresina-PI
> Brazil
> Telephones: +55 86 3221-3413 (work); +55 86 8838-3303 (mobile).
> *
> Aviso: As informa=E7=F5es contidas nesta mensagem s=E3o CONFIDENCIAIS, pr=
otegidas
> pelo sigilo legal, por direitos autorais e destinadas exclusivamente =E0
> pessoa ou organiza=E7=E3o para a qual a mensagem foi destinada.
> Warning: This message is meant only for the intended recipient of the
> transmission. It is forbidden any unauthorized use, alteration,
> reproduction and distribution. If you are not the correct recipient, plea=
se
> notify us immediately by return e-mail and delete this message from your
> system. ****
>
> ** **
>
> ** **
>
> __________ Informaci=F3n de ESET NOD32 Antivirus, versi=F3n de la base de
> firmas de virus 6280 (20110709) __________****
>
> ** **
>
> ESET NOD32 Antivirus ha comprobado este mensaje.****
>
> ** **
>
> http://www.eset.com****
>
> ** **
>
> __________ Informaci=F3n de ESET NOD32 Antivirus, versi=F3n de la base de
> firmas de virus 6284 (20110711) __________****
>
> ** **
>
> ESET NOD32 Antivirus ha comprobado este mensaje.****
>
> ** **
>
> http://www.eset.com****
>
--=20
*Carlos H. N. Costa, MD, DSc.*
*President*
*Sociedade Brasileira de Medicina Tropical *
***(Brazilian Society of Tropical Medicine)*
*Instituto de Doen=E7as Tropicais Natan Portella
Universidade Federal do Piau=ED*
*Rua Artur de Vasconcelos 151-Sul*
*64049-750 Teresina-PI
Brazil
Telephones: +55 86 3221-3413 (work); +55 86 8838-3303 (mobile).
*
Aviso: As informa=E7=F5es contidas nesta mensagem s=E3o CONFIDENCIAIS, prot=
egidas
pelo sigilo legal, por direitos autorais e destinadas exclusivamente =E0
pessoa ou organiza=E7=E3o para a qual a mensagem foi destinada.
Warning: This message is meant only for the intended recipient of the
transmission. It is forbidden any unauthorized use, alteration,
reproduction and distribution. If you are not the correct recipient, please
notify us immediately by return e-mail and delete this message from your
system.
--20cf301eeb1b05424104a7d0ea21
Content-Type: text/html; charset=windows-1252
Content-Transfer-Encoding: quoted-printable
<font color=3D"#000000"><font size=3D"4"><font face=3D"verdana,sans-serif">=
Thanks, Jaime.</font></font></font><div><font color=3D"#000000"><font size=
=3D"4"><font face=3D"verdana,sans-serif"><br></font></font></font></div><di=
v><font color=3D"#000000"><font size=3D"4"><font face=3D"verdana,sans-serif=
">From your review the drug is not eliminated by the kidneys, so there is n=
o need for dose adjustment. But we should be very careful with kidney funct=
ions.</font></font></font></div>
<div><font color=3D"#000000"><font size=3D"4"><font face=3D"verdana,sans-se=
rif"><br></font></font></font></div><div><font color=3D"#000000"><font size=
=3D"4"><font face=3D"verdana,sans-serif">Is there any information on the me=
chanism of renal lesion? Tubular?</font></font></font></div>
<div><font color=3D"#000000"><font size=3D"4"><font face=3D"verdana,sans-se=
rif"><br></font></font></font></div><div><font color=3D"#000000"><font size=
=3D"4"><font face=3D"verdana,sans-serif">Best regards,</font></font></font>=
</div><div>
<font color=3D"#000000"><font size=3D"4"><font face=3D"verdana,sans-serif">=
<br></font></font></font></div><div><font color=3D"#000000"><font size=3D"4=
"><font face=3D"verdana,sans-serif">Carlos.<br></font></font></font><br><di=
v class=3D"gmail_quote">
2011/7/11 Jaime Soto <span dir=3D"ltr"><<a href=3D"mailto:jaime.soto at pro=
dderma.com">jaime.soto at prodderma.com</a>></span><br><blockquote class=3D=
"gmail_quote" style=3D"margin:0 0 0 .8ex;border-left:1px #ccc solid;padding=
-left:1ex;">
<div lang=3D"ES-CO" link=3D"blue" vlink=3D"purple"><div><p class=3D"MsoNorm=
al"><span lang=3D"EN-US" style=3D"font-size:11.0pt;color:#1F497D">Dear all,=
<u></u><u></u></span></p><p class=3D"MsoNormal"><span lang=3D"EN-US" style=
=3D"font-size:11.0pt;color:#1F497D"><u></u>=A0<u></u></span></p>
<p class=3D"MsoNormal"><span lang=3D"EN-US" style=3D"font-size:11.0pt;color=
:#1F497D">I received some days ago a specific question regarding miltefosin=
e use in patients with renal impairment. I delay my answer asking to other =
people because this is not an easy answer; this is the conclusion:<u></u><u=
></u></span></p>
<p class=3D"MsoNormal"><span lang=3D"EN-US" style=3D"font-size:11.0pt;color=
:#1F497D"><u></u>=A0<u></u></span></p><p class=3D"MsoNormal"><span lang=3D"=
EN-US" style=3D"font-size:10.0pt;color:#1F497D">=93Miltefosine is mildly ne=
phrotoxic [Soto. CID 2004; 38:1266=9672] in leishmaniasis patients with nor=
mal renal function, Whether or not miltefosine would further diminish renal=
function in renally-impaired patients is not known. If renal function is a=
lready very low, however, a further effect on renal function might not be s=
een. <u></u><u></u></span></p>
<p class=3D"MsoNormal"><span lang=3D"EN-US" style=3D"font-size:10.0pt;color=
:#1F497D"><u></u>=A0<u></u></span></p><p class=3D"MsoNormal"><span lang=3D"=
EN-US" style=3D"font-size:10.0pt;color:#1F497D">My personal view would be t=
o not lower dosing because of a possible adverse effect on the kidneys, spe=
cially because, in the specific case, full dose could mean the difference b=
etween improving and failure.<u></u><u></u></span></p>
<p class=3D"MsoNormal"><span lang=3D"EN-US" style=3D"font-size:10.0pt;color=
:#1F497D"><u></u>=A0<u></u></span></p><p class=3D"MsoNormal"><span lang=3D"=
EN-US" style=3D"font-size:10.0pt;color:#1F497D">Regards from Bolivia,<u></u=
><u></u></span></p>
<p class=3D"MsoNormal"><span lang=3D"EN-US" style=3D"font-size:10.0pt;color=
:#1F497D"><u></u>=A0<u></u></span></p><p class=3D"MsoNormal"><span lang=3D"=
EN-US" style=3D"font-size:10.0pt;color:#1F497D">Jaime soto </span><span lan=
g=3D"EN-US" style=3D"font-size:11.0pt;color:#1F497D"><u></u><u></u></span><=
/p>
<p class=3D"MsoNormal"><span lang=3D"EN-US" style=3D"font-size:11.0pt;color=
:#1F497D">=A0<u></u><u></u></span></p><p class=3D"MsoNormal"><span lang=3D"=
EN-US" style=3D"font-size:11.0pt;color:#1F497D"><u></u>=A0<u></u></span></p=
><div style=3D"border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0cm=
0cm 0cm">
<p class=3D"MsoNormal"><b><span lang=3D"ES" style=3D"font-size:10.0pt">De:<=
/span></b><span lang=3D"ES" style=3D"font-size:10.0pt"> <a href=3D"mailto:l=
eish-l-bounces at lineu.icb.usp.br" target=3D"_blank">leish-l-bounces at lineu.ic=
b.usp.br</a> [mailto:<a href=3D"mailto:leish-l-bounces at lineu.icb.usp.br" ta=
rget=3D"_blank">leish-l-bounces at lineu.icb.usp.br</a>] <b>En nombre de </b>C=
arlos Costa<br>
<b>Enviado el:</b> domingo, 10 de julio de 2011 05:44 p.m.<br><b>Para:</b> =
Jennie Blackwell<br><b>CC:</b> Leish-L<br><b>Asunto:</b> SPAM-LOW: Re: [Lei=
sh-l] miltefosine for diffuse leishmaniasis<u></u><u></u></span></p></div>
<p class=3D"MsoNormal"><u></u>=A0<u></u></p><p class=3D"MsoNormal">Hi Jenni=
e,<u></u><u></u></p><div><p class=3D"MsoNormal"><u></u>=A0<u></u></p></div>=
<div><p class=3D"MsoNormal">Thanks for the drug information. Now, I have to=
check the permission for its use in Brazil and how to justify its use to t=
he public system in order to be acquired by the government. Meanwhile, we a=
re looking for miltefosine, paramomycin, and alternative therapies.<u></u><=
u></u></p>
</div><div><p class=3D"MsoNormal"><u></u>=A0<u></u></p></div><div><p class=
=3D"MsoNormal">But if the immunosuppression is species specific do you thin=
k that a general stimulation would reverse it? Does anyone knows which is t=
he mechanism behind the DCL induced immunosuppression? Parasite or host or =
both?=A0<u></u><u></u></p>
</div><div><p class=3D"MsoNormal"><u></u>=A0<u></u></p></div><div><p class=
=3D"MsoNormal">Cheers,<u></u><u></u></p></div><div><p class=3D"MsoNormal"><=
u></u>=A0<u></u></p></div><div><p class=3D"MsoNormal" style=3D"margin-botto=
m:12.0pt">
Carlos.<u></u><u></u></p>
<div><p class=3D"MsoNormal">2011/7/7 Jennie Blackwell <<a href=3D"mailto=
:jmb37 at cam.ac.uk" target=3D"_blank">jmb37 at cam.ac.uk</a>><u></u><u></u></=
p><div><div><p class=3D"MsoNormal">Hello Carlos<u></u><u></u></p></div><div=
><p class=3D"MsoNormal">
<u></u>=A0<u></u></p></div><div><p class=3D"MsoNormal">My memory from late =
80s was that these patients responded well to interferon-gamma treatment. W=
ith all the moves to make drugs more affordable for disease endemic countri=
es, has it not been possible to consider this option?<u></u><u></u></p>
</div><div><p class=3D"MsoNormal"><u></u>=A0<u></u></p></div><div><p class=
=3D"MsoNormal">In psoriasis they use creams with Vitamin D. Has anyone ever=
tried this for DCL?<u></u><u></u></p></div><div><p class=3D"MsoNormal"><u>=
</u>=A0<u></u></p>
</div><div><p class=3D"MsoNormal">I'm sure this is going to elicit a ro=
und of responses - but you know I'm not a clinician so I would just be =
interested to know!<u></u><u></u></p></div><div><p class=3D"MsoNormal"><u><=
/u>=A0<u></u></p>
</div><div><p class=3D"MsoNormal">Cheers, Jennie=A0<br><br>Jenefer M. Black=
well<u></u><u></u></p><div><p class=3D"MsoNormal">TICHR, CCHR, UWA<u></u><u=
></u></p></div><div><p class=3D"MsoNormal">Phone: +61 8 94897910<u></u><u><=
/u></p>
</div><div><p class=3D"MsoNormal">From my iPhone<u></u><u></u></p></div></d=
iv><div><div><div><p class=3D"MsoNormal" style=3D"margin-bottom:12.0pt"><br=
>On 07/07/2011, at 3:04, Carlos Costa <<a href=3D"mailto:chncosta at gmail.=
com" target=3D"_blank">chncosta at gmail.com</a>> wrote:<u></u><u></u></p>
</div><blockquote style=3D"margin-top:5.0pt;margin-bottom:5.0pt"><div><p cl=
ass=3D"MsoNormal"><span style=3D"font-size:13.5pt;color:black">Dear all,</s=
pan><u></u><u></u></p><div><p class=3D"MsoNormal"><u></u>=A0<u></u></p></di=
v><div>
<p class=3D"MsoNormal"><span style=3D"font-size:13.5pt;color:black">Maria C=
leudimar has cutaneous diffuse leishmaniasis due to <i>Leishmania amazonens=
is</i>. She used to be a long time patient form Dr. Jackson Costa, in the c=
ountryside of Maranh=E3o State, Brazil, since she was 10 years old, after a=
disease that started when she was just five. Now, she is under my and Dorc=
as care, at the age of 30, living in the city of Teresina.</span><u></u><u>=
</u></p>
</div><div><p class=3D"MsoNormal"><u></u>=A0<u></u></p></div><div><p class=
=3D"MsoNormal"><span style=3D"font-size:13.5pt;color:black">Her long time D=
CL does not respond to the treatment antimonium anymore. Although we still =
prescribe liposomal amphotericin B at very low dose (3mg/kg/once a week), h=
er situation is deteriorating progressively, her renal function does not al=
low any additional dosing since creatinine is presently above 3mg/dL, and p=
revious biopsy had shown tubular damage apparently secondary to the drug, w=
ithout evidence of amyloidosis. We tried several combinations of different =
drugs, without success. Her situation worsened a lot during her recent preg=
nancy (the baby is eight months old now).</span><u></u><u></u></p>
</div><div><p class=3D"MsoNormal"><u></u>=A0<u></u></p></div><div><p class=
=3D"MsoNormal"><span style=3D"font-size:13.5pt;color:black">Our hope now st=
ands only in miltefosine, for oral chronic use, but the drug is not license=
d or available in Brazil yet (to my knowledge).</span><u></u><u></u></p>
</div><div><p class=3D"MsoNormal"><u></u>=A0<u></u></p></div><div><p class=
=3D"MsoNormal"><span style=3D"font-size:13.5pt;color:black">With her permis=
sion I attached some of her pictures, hoping to sensitize critical people i=
n order to help me to get miltefosine and the permission for prescription i=
n Brazil (or any other oral drug with promising efficacy, and without nephr=
otoxicity, if known). Moreover, we need to know about the dose adjustment f=
or the renal impairment, and how long the drug could safely be used.</span>=
<u></u><u></u></p>
</div><div><p class=3D"MsoNormal"><u></u>=A0<u></u></p></div><div><p class=
=3D"MsoNormal"><span style=3D"font-size:13.5pt;color:black">One picture sho=
ws her face before treatment, and another after the pregnancy, with the bab=
y. One shows the situation of her thighs, another the calf of the leg and t=
he last one the infiltration of the palate.</span><u></u><u></u></p>
</div><div><p class=3D"MsoNormal"><u></u>=A0<u></u></p></div><div><p class=
=3D"MsoNormal"><span style=3D"font-size:13.5pt;color:black">Hoping a little=
from friends, my kindest regards,</span><u></u><u></u></p></div><div><p cl=
ass=3D"MsoNormal">
<u></u>=A0<u></u></p></div><div><p class=3D"MsoNormal"><span style=3D"font-=
size:13.5pt;color:black">Carlos.</span><u></u><u></u></p></div><div><p clas=
s=3D"MsoNormal"><u></u>=A0<u></u></p></div><div><p class=3D"MsoNormal"><spa=
n style=3D"font-size:13.5pt;color:black">PS. Please understand that the pic=
tures are allowed not for publication or public presentation. Cleudimar per=
mission is restricted to this forum.</span><u></u><u></u></p>
</div><div><p class=3D"MsoNormal"><u></u>=A0<u></u></p></div><div><p class=
=3D"MsoNormal"><br>-- <br><b><span>Carlos H. N. Costa, MD, DSc.</span></b><=
u></u><u></u></p><div><p class=3D"MsoNormal"><b><span>President</span></b><=
u></u><u></u></p>
</div><div><p class=3D"MsoNormal"><b><span>Sociedade Brasileira de Medicina=
Tropical=A0</span></b><u></u><u></u></p></div><div><p class=3D"MsoNormal">=
<b><span>(Brazilian Society of Tropical Medicine)</span></b><u></u><u></u><=
/p>
</div><div><p class=3D"MsoNormal"><b><span>Instituto de Doen=E7as Tropicais=
Natan Portella<br>Universidade Federal do Piau=ED</span></b><u></u><u></u>=
</p><div><p class=3D"MsoNormal"><b><span>Rua Artur de Vasconcelos 151-Sul</=
span></b><u></u><u></u></p>
</div><div><p class=3D"MsoNormal"><b><span>64049-750 Teresina-PI<br>Brazil<=
br>Telephones: +55 86 3221-3413 (work); +55 86 8838-3303 (mobile).<br></spa=
n></b><span><br></span><span style=3D"font-size:10.0pt">Aviso: As informa=
=E7=F5es contidas nesta mensagem s=E3o CONFIDENCIAIS, protegidas pelo sigil=
o legal, por direitos autorais e destinadas exclusivamente =E0 pessoa ou or=
ganiza=E7=E3o para a qual a mensagem foi destinada.<br>
Warning: This message is meant only for the intended recipient of the trans=
mission.=A0 It is forbidden any unauthorized use, alteration, reproduction =
and distribution. If you are not the correct recipient, please notify us im=
mediately by return e-mail and delete this message from your system. </span=
><u></u><u></u></p>
</div></div><p class=3D"MsoNormal"><u></u>=A0<u></u></p></div></div></block=
quote></div></div><div><blockquote style=3D"margin-top:5.0pt;margin-bottom:=
5.0pt"><div><p class=3D"MsoNormal"><cleu antes grav 13jan09.jpg><u></=
u><u></u></p>
</div></blockquote><blockquote style=3D"margin-top:5.0pt;margin-bottom:5.0p=
t"><div><p class=3D"MsoNormal"><cleu e nene.jpg><u></u><u></u></p></d=
iv></blockquote><blockquote style=3D"margin-top:5.0pt;margin-bottom:5.0pt">=
<div>
<p class=3D"MsoNormal"><cleu santada recorte.jpg><u></u><u></u></p></=
div></blockquote><blockquote style=3D"margin-top:5.0pt;margin-bottom:5.0pt"=
><div><p class=3D"MsoNormal"><cleu panturrilhas.jpg><u></u><u></u></p=
>
</div>
</blockquote><blockquote style=3D"margin-top:5.0pt;margin-bottom:5.0pt"><di=
v><p class=3D"MsoNormal"><cleu palato.jpg><u></u><u></u></p></div></b=
lockquote><blockquote style=3D"margin-top:5.0pt;margin-bottom:5.0pt"><div><=
p class=3D"MsoNormal">
_______________________________________________<br>Leish-l mailing list<br>=
<a href=3D"mailto:Leish-l at lineu.icb.usp.br" target=3D"_blank">Leish-l at lineu=
.icb.usp.br</a><br><a href=3D"http://lineu.icb.usp.br/cgi-bin/mailman/listi=
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</div></blockquote></div></div></div><p class=3D"MsoNormal"><br><br clear=
=3D"all"><br>-- <br><b><span>Carlos H. N. Costa, MD, DSc.</span></b><u></u>=
<u></u></p><div><p class=3D"MsoNormal"><b><span>President</span></b><u></u>=
<u></u></p>
</div><div><p class=3D"MsoNormal"><b><span>Sociedade Brasileira de Medicina=
Tropical=A0</span></b><u></u><u></u></p></div><div><p class=3D"MsoNormal">=
<b><span>(Brazilian Society of Tropical Medicine)</span></b><u></u><u></u><=
/p>
</div><div><p class=3D"MsoNormal"><b><span>Instituto de Doen=E7as Tropicais=
Natan Portella<br>Universidade Federal do Piau=ED</span></b><u></u><u></u>=
</p><div><p class=3D"MsoNormal"><b><span>Rua Artur de Vasconcelos 151-Sul</=
span></b><u></u><u></u></p>
</div><div><p class=3D"MsoNormal"><b><span>64049-750 Teresina-PI<br>Brazil<=
br>Telephones: +55 86 3221-3413 (work); +55 86 8838-3303 (mobile).<br></spa=
n></b><span><br></span><span style=3D"font-size:10.0pt">Aviso: As informa=
=E7=F5es contidas nesta mensagem s=E3o CONFIDENCIAIS, protegidas pelo sigil=
o legal, por direitos autorais e destinadas exclusivamente =E0 pessoa ou or=
ganiza=E7=E3o para a qual a mensagem foi destinada.<br>
Warning: This message is meant only for the intended recipient of the trans=
mission.=A0 It is forbidden any unauthorized use, alteration, reproduction =
and distribution. If you are not the correct recipient, please notify us im=
mediately by return e-mail and delete this message from your system. </span=
><u></u><u></u></p>
</div></div><p class=3D"MsoNormal"><u></u>=A0<u></u></p></div><p class=3D"M=
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tivirus, versi=F3n de la base de firmas de virus 6280 (20110709) __________=
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1) __________<u></u><u></u></p><p class=3D"MsoNormal"><u></u>=A0<u></u></p>=
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</blockquote></div><br><br clear=3D"all"><br>-- <br><font face=3D"verdana, =
sans-serif"><b>Carlos H. N. Costa, MD, DSc.</b></font><div>
<font face=3D"verdana, sans-serif"><b>President</b></font></div><div><span =
style=3D"font-family:verdana, sans-serif"><b>Sociedade Brasileira de Medici=
na Tropical=A0</b></span></div><div><b><span style=3D"font-family:verdana, =
sans-serif"></span></b><span style=3D"font-family:verdana, sans-serif"><b>(=
Brazilian Society of Tropical Medicine)</b></span></div>
<div><font face=3D"verdana, sans-serif"><b>Instituto de Doen=E7as Tropicais=
Natan Portella<br>Universidade Federal do Piau=ED</b></font><div><font fac=
e=3D"verdana, sans-serif"><b>Rua Artur de Vasconcelos 151-Sul</b></font></d=
iv>
<div>
<font face=3D"verdana, sans-serif"><b>64049-750 Teresina-PI<br>Brazil<br>Te=
lephones: +55 86 3221-3413 (work); +55 86 8838-3303 (mobile).<br></b><br><s=
pan style=3D"font-size:x-small">Aviso: As informa=E7=F5es contidas nesta me=
nsagem s=E3o CONFIDENCIAIS, protegidas pelo sigilo legal, por direitos auto=
rais e destinadas exclusivamente =E0 pessoa ou organiza=E7=E3o para a qual =
a mensagem foi destinada.<br>
Warning: This message is meant only for the intended recipient of the trans=
mission.=A0 It is forbidden any unauthorized use, alteration, reproduction =
and distribution. If you are not the correct recipient, please notify us im=
mediately by return e-mail and delete this message from your system. </span=
></font></div>
</div><br>
</div>
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