<table cellspacing="0" cellpadding="0" border="0" ><tr><td valign="top" style="font: inherit;"><p><font size="3">Dear Carlos</font></p><p><font size="3">Just adding as an afterthought</font><font size="3"><br></font></p><p><font size="3"><br></font></p><p><font size="3">whether the drug can be sent across from India through Leishmaniasis Research Society (India) to Brazil, I am willing to help</font></p><p><font size="3"><br></font></p><p><font size="3">Dr Shyam Sundar would know more about this logistics</font></p><p><font size="3">best wishes</font></p><p><font size="3">neeloo</font></p><p><br></p><br>--- On <b>Wed, 7/6/11, Carlos Costa <i><chncosta@gmail.com></i></b> wrote:<br><blockquote style="border-left: 2px solid rgb(16, 16, 255); margin-left: 5px; padding-left: 5px;"><br>From: Carlos Costa <chncosta@gmail.com><br>Subject: [Leish-l] miltefosine for diffuse leishmaniasis<br>To: "Leish-L" <Leish-l@lineu.icb.usp.br><br>Date:
Wednesday, July 6, 2011, 3:04 PM<br><br><div id="yiv276413658"><font color="#000000"><font size="4"><font face="verdana,sans-serif">Dear all,</font></font></font><div><font color="#000000"><font size="4"><font face="verdana,sans-serif"><br></font></font></font></div><div><font color="#000000"><font size="4"><font face="verdana,sans-serif">Maria Cleudimar has cutaneous diffuse leishmaniasis due to <i>Leishmania amazonensis</i>. She used to be a long time patient form Dr. Jackson Costa, in the countryside of Maranhão State, Brazil, since she was 10 years old, 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.</font></font></font></div>
<div><font color="#000000"><font size="4"><font face="verdana,sans-serif"><br></font></font></font></div><div><font color="#000000"><font size="4"><font face="verdana,sans-serif">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 tried several combinations of different drugs, without success. Her situation worsened a lot during her recent pregnancy (the baby is eight months old now).</font></font></font></div>
<div><font color="#000000"><font size="4"><font face="verdana,sans-serif"><br></font></font></font></div><div><font color="#000000"><font size="4"><font face="verdana,sans-serif">Our hope now stands only in miltefosine, for oral chronic use, but the drug is not licensed or available in Brazil yet (to my knowledge).</font></font></font></div>
<div><font color="#000000"><font size="4"><font face="verdana,sans-serif"><br></font></font></font></div><div><font color="#000000"><font size="4"><font face="verdana,sans-serif">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 efficacy, and without nephrotoxicity, if known). Moreover, we need to know about the dose adjustment for the renal impairment, and how long the drug could safely be used.</font></font></font></div>
<div><font color="#000000"><font size="4"><font face="verdana,sans-serif"><br></font></font></font></div><div><font color="#000000"><font size="4"><font face="verdana,sans-serif">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.</font></font></font></div>
<div><font color="#000000"><font size="4"><font face="verdana,sans-serif"><br></font></font></font></div><div><font color="#000000"><font size="4"><font face="verdana,sans-serif">Hoping a little from friends, my kindest regards,</font></font></font></div>
<div><font color="#000000"><font size="4"><font face="verdana,sans-serif"><br></font></font></font></div><div><font color="#000000"><font size="4"><font face="verdana,sans-serif">Carlos.</font></font></font></div><div><font color="#000000"><font size="4"><font face="verdana,sans-serif"><br>
</font></font></font></div><div><font color="#000000"><font size="4"><font face="verdana,sans-serif">PS. Please understand that the pictures are allowed not for publication or public presentation. Cleudimar permission is restricted to this forum.</font></font></font></div>
<div><font face="verdana, sans-serif"><span style="font-size:large;"><br>
</span></font></div><div><br>-- <br><font face="verdana, sans-serif"><b>Carlos H. N. Costa, MD, DSc.</b></font><div><font face="verdana, sans-serif"><b>President</b></font></div><div><span style="font-family:verdana, sans-serif;"><b>Sociedade Brasileira de Medicina Tropical </b></span></div>
<div><span style="font-family:verdana, sans-serif;"><b>(Brazilian Society of Tropical Medicine)</b></span></div><div><font face="verdana, sans-serif"><b>Instituto de Doenças Tropicais Natan Portella<br>
Universidade Federal do Piauí</b></font><div><font face="verdana, sans-serif"><b>Rua Artur de Vasconcelos 151-Sul</b></font></div><div><font face="verdana, sans-serif"><b>64049-750 Teresina-PI<br>Brazil<br>Telephones: +55 86 3221-3413 (work); +55 86 8838-3303 (mobile).<br>
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