[Leish-l] Thermotherapy
Chang, Kwang-Poo
KwangPoo.Chang at rosalindfranklin.edu
Fri Jun 17 18:40:07 BRT 2011
Dear Poonam,
Have you work on Leishmania in the clinical samples directly ?
Should you work with promastigotes grown from the clinical samples, how many samples have you isolated in culture for continuous passasge successfully ? Did you have clinical samples which gave you no growth or very limited growth and not subculturable ?
KP
________________________________
From: leish-l-bounces at lineu.icb.usp.br on behalf of poonam salotra
Sent: Fri 6/17/2011 6:24 AM
To: rreithinger at yahoo.co.uk; abhay.satoskar at osumc.edu; jdavid at hsph.harvard.edu; alan.magill at us.army.mil; Chang, Kwang-Poo
Cc: raj at cellabs.com.au; vishwamohan_katoch at yahoo.co.in; leish-l at lineu.icb.usp.br
Subject: Re: [Leish-l] Thermotherapy
Dear KP,
To answer your question about the HIV-CL patient located in India that we reported in Lancet 2011, this case was identified in Rajasthan state in Western India. We had identified the causative parasite as L tropica based on ITS1-PCR-RFLP analysis.
In all our studies with CL patients in Rajasthan, we found L tropica as the causative agent (Immunology, 2010; FEMS Imm.Med.Micro, 2009; AmJTropMedHyg 2007). Heat therapy introduced by Abhay in this region seems to be working very well.
Best regards
Poonam
.................................
Poonam Salotra, PhD
Deputy Director
Institute of Pathology (ICMR)
Safdarjung Hospital Campus
New Delhi-110029
India
Ph 91-11-26166124
Fax 91-11-26198401
________________________________
Date: Wed, 15 Jun 2011 13:57:29 +0100
From: rreithinger at yahoo.co.uk
To: Abhay.Satoskar at osumc.edu; jdavid at hsph.harvard.edu; ALAN.MAGILL at US.ARMY.MIL; KwangPoo.Chang at rosalindfranklin.edu
CC: raj at cellabs.com.au; vishwamohan_katoch at yahoo.co.in; leish-l at lineu.icb.usp.br
Subject: Re: [Leish-l] Thermotherapy
For one of the patients:
Lancet. <http://www.ncbi.nlm.nih.gov/pubmed/21315946> 2011 Feb 12;377(9765):610.
Heat, Oriental sore, and HIV.
Prasad N <http://www.ncbi.nlm.nih.gov/pubmed?term="Prasad N"[Author]> , Ghiya BC <http://www.ncbi.nlm.nih.gov/pubmed?term="Ghiya BC"[Author]> , Bumb RA <http://www.ncbi.nlm.nih.gov/pubmed?term="Bumb RA"[Author]> , Kaushal H <http://www.ncbi.nlm.nih.gov/pubmed?term="Kaushal H"[Author]> , Saboskar AA <http://www.ncbi.nlm.nih.gov/pubmed?term="Saboskar AA"[Author]> , Lezama-Davila CM <http://www.ncbi.nlm.nih.gov/pubmed?term="Lezama-Davila CM"[Author]> , Salotra P <http://www.ncbi.nlm.nih.gov/pubmed?term="Salotra P"[Author]> , Satoskar AR <http://www.ncbi.nlm.nih.gov/pubmed?term="Satoskar AR"[Author]> .
--- On Wed, 15/6/11, Chang, Kwang-Poo <KwangPoo.Chang at rosalindfranklin.edu> wrote:
From: Chang, Kwang-Poo <KwangPoo.Chang at rosalindfranklin.edu>
Subject: RE: Thermotherapy
To: "Satoskar, Abhay" <Abhay.Satoskar at osumc.edu>, "Richard Reithinger" <rreithinger at yahoo.co.uk>, "John David" <jdavid at hsph.harvard.edu>, "Alan J COL MIL USA MEDCOM WRAIRMagill" <ALAN.MAGILL at US.ARMY.MIL>
Cc: vishwamohan_katoch at yahoo.co.in, "Raj" <raj at cellabs.com.au>, leish-l at lineu.icb.usp.br
Date: Wednesday, 15 June, 2011, 13:41
Dear Abhay,
Where are your HIV-CL patients located in India ? Are these PKDL or CL caused by something else ?
KP
________________________________
From: Satoskar, Abhay [mailto:Abhay.Satoskar at osumc.edu]
Sent: Wed 6/15/2011 6:33 AM
To: Richard Reithinger; Chang, Kwang-Poo; John David; Alan J COL MIL USA MEDCOM WRAIRMagill
Cc: vishwamohan_katoch at yahoo.co.in; Raj; leish-l at lineu.icb.usp.br
Subject: RE: Thermotherapy
All,
I think there some interesting discussions here. I think its worth trying anesthetic cream for heat therapy. We will do that. As Richard indicated that the greatest advantage of RF therapy ( even if it need local anesthesia with lidocaine) is that in most patient just one treatment for 1 min is enough to induce complete clinical cure. More importantly, in India we had three HIV patients with CL who failed to respond to intralesional SSG even after their CD4+ T cell counts increasing to > 200 after starting HAART. These patients were treated with RF therapy which resulted in complete lesion healing in 5-6 weeks. The patients have remained disease free after 1.5 years. As we know treating CL in HIV patients can be difficult so I think we have an effective alternative.
Abhay
Abhay R Satoskar MD, PhD
Professor
Departments of Pathology and Microbiology
129 Hamilton Hall
1645 Neil Avenue
The Ohio State University
Columbus, Ohio
Tel: 614-366-3417
________________________________
From: Richard Reithinger [rreithinger at yahoo.co.uk]
Sent: Wednesday, June 15, 2011 4:02 AM
To: Kwang-PooChang; John David; Alan J COL MIL USA MEDCOM WRAIRMagill
Cc: Satoskar, Abhay; vishwamohan_katoch at yahoo.co.in; Raj; leish-l at lineu.icb.usp.br
Subject: Thermotherapy
All,
Agree with Alan: patients need at least intradermal anesthesia prior application of radiofrequency waves using the ThermoMed device; 50C is way to high for someone to endure for 5 min or so.
The reason the device appears to work better than other similar approaches is that the radiofrequencies yield a relatively homogenous/stable field where skin particles get excited, and in turn generate the heat; the heat (temperature) is then controlled by a thermistor embedded in the device. Following application of radiofrequency-generated heat, application of a topical antibiotic is recommended to avoid post-treatment secondary infections. From an operational point of view we also know that the ThermoMed device is more useful in situations where (i) you have lots of patients (i.e. economies of scale); (ii) patients with smaller lesions; and (iii) patient with lesions that are not located on joint or body areas that are difficult to access. Whilst a clear disadvantage of the device has been cost, the advantages have been that many patients only require one application session of radiofrequency-generated heat (i.e. patient lost to follow-up are not an issue) and that the device is portable (e.g. can be used in mobile-type of treatment service provision).
Having said, I second Tony Bryceson's comment, that there is scope for additional well-designed and carried out clinical trials looking at this approach, comparing it to IM/IV or IL SbV or other treatment modalities.
Richard Reithinger
--- On Wed, 8/6/11, Magill, Alan J COL MIL USA MEDCOM WRAIR <ALAN.MAGILL at US.ARMY.MIL> wrote:
From: Magill, Alan J COL MIL USA MEDCOM WRAIR <ALAN.MAGILL at US.ARMY.MIL>
Subject: Re: [Leish-l] inquiry
To: "Chang, Kwang-Poo" <KwangPoo.Chang at rosalindfranklin.edu>, "John David" <jdavid at hsph.harvard.edu>
Cc: "Satoskar, Abhay" <Abhay.Satoskar at osumc.edu>, "vishwamohan_katoch at yahoo.co.in" <vishwamohan_katoch at yahoo.co.in>, "Raj" <raj at cellabs.com.au>, "leish-l at lineu.icb.usp.br" <leish-l at lineu.icb.usp.br>
Date: Wednesday, 8 June, 2011, 20:45
John certainly knows well..
50C is not tolerable to human skin. All potential lesions to be treated need to be appropriately cleaned and anesthetized with intradermal and subQ injection of lidocaine. I have never tried the newer lidocaine creams such as EMLA, they might work as well. This can be somewhat rate limiting for multiple lesions as each lesion needs to be prepared, injected, and you need to wait about 10 plus minutes for the lidocaine to work.
Trying the Thermomed device on normal skin (try on yourself) will show that most people can only get to about 43 or 44 C before quickly removing the device from their skin.
Alan Magill
________________________________
From: leish-l-bounces at lineu.icb.usp.br <http://uk.mc256.mail.yahoo.com/mc/compose?to=leish-l-bounces@lineu.icb.usp.br> [leish-l-bounces at lineu.icb.usp.br <http://uk.mc256.mail.yahoo.com/mc/compose?to=leish-l-bounces@lineu.icb.usp.br> ] On Behalf Of Chang, Kwang-Poo [KwangPoo.Chang at rosalindfranklin.edu <http://uk.mc256.mail.yahoo.com/mc/compose?to=KwangPoo.Chang@rosalindfranklin.edu> ]
Sent: Monday, June 06, 2011 12:02 PM
To: John David
Cc: Satoskar, Abhay; vishwamohan_katoch at yahoo.co.in <http://uk.mc256.mail.yahoo.com/mc/compose?to=vishwamohan_katoch@yahoo.co.in> ; Raj; leish-l at lineu.icb.usp.br <http://uk.mc256.mail.yahoo.com/mc/compose?to=leish-l@lineu.icb.usp.br>
Subject: Re: [Leish-l] inquiry
Any chance to make it available for additional trials elsewhere ?
I recall your statement in our conversation about the advantage of this instrument over the heating lamp. That is to maintain the specific elevated temperature uniformly throughout the skin lesion for a sustained period. The 50 C must be the effective temperature that has been experimentally determined. It seems to be a tolerable temperature to human skin ? Dr. Sharma may comment on this medically as a dermatologist ?
KP
________________________________
From: John David [mailto:jdavid at hsph.harvard.edu <http://uk.mc256.mail.yahoo.com/mc/compose?to=jdavid@hsph.harvard.edu> ]
Sent: Sunday, June 05, 2011 11:18 PM
To: Chang, Kwang-Poo
Cc: Sharmanl; Satoskar, Abhay; Raj; Petr Volf; leish-l at lineu.icb.usp.br <http://uk.mc256.mail.yahoo.com/mc/compose?to=leish-l@lineu.icb.usp.br> ; hgoto at usp.br <http://uk.mc256.mail.yahoo.com/mc/compose?to=hgoto@usp.br> ; elfadil_abass at yahoo.com <http://uk.mc256.mail.yahoo.com/mc/compose?to=elfadil_abass@yahoo.com> ; vishwamohan_katoch at yahoo.co.in <http://uk.mc256.mail.yahoo.com/mc/compose?to=vishwamohan_katoch@yahoo.co.in>
Subject: Re: [Leish-l] inquiry
The Themomed instrument shown below can produce accurate 50 degrees C plus or minus 0.2 degrees temperature by radio wave.
from Themorsurgery Technologies. Picture below.
Two papers of a trial in Brazil and one in Afghanistan on CL below.
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