<font color="#000000"><font size="4"><font face="verdana,sans-serif">Thanks for the article, KP. Congratulations to the team, specially the bright Sujoy. You are getting closer and closer. Cheers, Carlos.<br></font></font></font><br>
<div class="gmail_quote">2011/7/12 Chang, Kwang-Poo <span dir="ltr"><<a href="mailto:KwangPoo.Chang@rosalindfranklin.edu">KwangPoo.Chang@rosalindfranklin.edu</a>></span><br><blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex;">
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<p class="MsoNormal"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy">Dear Carlos,<u></u><u></u></span></font></p>
<p class="MsoNormal"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy"><u></u> <u></u></span></font></p>
<p class="MsoNormal"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy">Attached please find Sujoy Dutta’s
recent article, in which some publications on PDT clinical trials cited may be
useful to you ?<u></u><u></u></span></font></p>
<p class="MsoNormal"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy"><u></u> <u></u></span></font></p>
<p class="MsoNormal"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy">KP<u></u><u></u></span></font></p>
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<p class="MsoNormal"><b><font size="2" face="Tahoma"><span style="font-size:10.0pt;font-family:Tahoma;font-weight:bold">From:</span></font></b><font size="2" face="Tahoma"><span style="font-size:10.0pt;font-family:Tahoma">
<a href="mailto:leish-l-bounces@lineu.icb.usp.br" target="_blank">leish-l-bounces@lineu.icb.usp.br</a> [mailto:<a href="mailto:leish-l-bounces@lineu.icb.usp.br" target="_blank">leish-l-bounces@lineu.icb.usp.br</a>] <b><span style="font-weight:bold">On Behalf Of </span></b>Carlos Costa<br>
<b><span style="font-weight:bold">Sent:</span></b> Sunday, July 10, 2011 6:14
PM<br>
<b><span style="font-weight:bold">To:</span></b> Dr Mourad Mokni</span></font></p><font size="2" face="Tahoma"><div class="im"><br>
<b><span style="font-weight:bold">Cc:</span></b> Leish-L<br>
<b><span style="font-weight:bold">Subject:</span></b> Re: [Leish-l] miltefosine
for diffuse leishmaniasis</div></font><u></u><u></u><p></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt"><u></u> <u></u></span></font></p>
<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt">Dear Mourad,<u></u><u></u></span></font></p><div><div></div><div class="h5">
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt">I have tried once fluconazole without result. As you saw in my last
email, I am trying to locate some photodynamic therapy and imiquimoid aroun
here in <u></u><u></u>Brazil<u></u><u></u>.
But would you please clarify what is the action of photodynamic therapy? Have
you ever used imiquimoid for leishmaniasis?<u></u><u></u></span></font></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt">My warmest regards,<u></u><u></u></span></font></p>
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<p class="MsoNormal" style="margin-bottom:12.0pt"><font size="3" face="Times New Roman"><span style="font-size:12.0pt">Carlos.<u></u><u></u></span></font></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt">2011/7/8 Dr Mourad Mokni <<a href="mailto:mourad.mokni@rns.tn" target="_blank">mourad.mokni@rns.tn</a>><u></u><u></u></span></font></p>
<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt"><br>
Dear colleague,<br>
I understand your distress the patient presentation is disturbing. I agree that
Miltefosine would be the best choice even that it would not guarantee the
absence of relapse. These patients have surely an impaired immunologic response
against leishmaniasis and interferon could work. But it is surely more
expensive than miltefosine. Did you tried fluconazole , itraconazole and
topical imiquimod (which enhance IFN)? Do you have access to Photodynamic
therapy (PDT) ?. I hope you will have access to miltefosine it is the best drug
to try first.<br>
Best wishes<br>
<br>
Mourad MOKNI<br>
Professor of dermatology<br>
La <u></u><u></u>Rabta<u></u> <u></u>Hospital<u></u><u></u><br>
Rue Jabbari Bab Saadoun 1007<br>
<u></u><u></u>Tunis-<u></u> <u></u>Tunisia<u></u><u></u><u></u><u></u></span></font></p>
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At 21:04 06/07/2011, Carlos Costa wrote:<u></u><u></u></span></font></p>
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<p class="MsoNormal" style="margin-bottom:12.0pt"><font size="3" face="Times New Roman"><span style="font-size:12.0pt">Dear all,<br>
<br>
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 <u></u><u></u>Maranhão State<u></u>,
<u></u>Brazil<u></u><u></u>, 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 <u></u><u></u>Teresina<u></u><u></u>.<br>
<br>
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).<br>
<br>
Our hope now stands only in miltefosine, for oral chronic use, but the drug is
not licensed or available in <u></u><u></u>Brazil<u></u><u></u>
yet (to my knowledge).<br>
<br>
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 <u></u><u></u>Brazil<u></u><u></u>
(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.<br>
<br>
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.<br>
<br>
Hoping a little from friends, my kindest regards,<br>
<br>
Carlos.<br>
<br>
PS. Please understand that the pictures are allowed not for publication or
public presentation. Cleudimar permission is restricted to this forum.<br>
<br>
<br>
--<br>
Carlos H. N. Costa, MD, DSc.<br>
President<br>
Sociedade Brasileira de Medicina Tropical<br>
(Brazilian Society of Tropical Medicine)<br>
Instituto de Doenças Tropicais Natan Portella<br>
Universidade Federal do Piauí<br>
Rua Artur de Vasconcelos 151-Sul<br>
64049-750 Teresina-PI<br>
<u></u><u></u>Brazil<u></u><u></u><br>
Telephones: +55 86 3221-3413 (work); +55 86 8838-3303 (mobile).<br>
<br>
Aviso: As informações contidas nesta mensagem são CONFIDENCIAIS, protegidas
pelo sigilo legal, por direitos autorais e destinadas exclusivamente à pessoa
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<br>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt"><u></u> <u></u></span></font></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt"><br>
<br clear="all">
<br>
-- <br>
</span></font><b><font face="Verdana"><span style="font-family:Verdana;font-weight:bold">Carlos H. N. Costa, MD, DSc.</span></font></b><u></u><u></u></p>
<div>
<p class="MsoNormal"><b><font size="3" face="Verdana"><span style="font-size:12.0pt;font-family:Verdana;font-weight:bold">President</span></font></b><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><b><font size="3" face="Verdana"><span style="font-size:12.0pt;font-family:Verdana;font-weight:bold">Sociedade Brasileira de Medicina
Tropical </span></font></b><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><b><font size="3" face="Verdana"><span style="font-size:12.0pt;font-family:Verdana;font-weight:bold">(Brazilian Society of Tropical Medicine)</span></font></b><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><b><font size="3" face="Verdana"><span style="font-size:12.0pt;font-family:Verdana;font-weight:bold">Instituto de Doenças Tropicais Natan
Portella<br>
Universidade Federal do Piauí</span></font></b><u></u><u></u></p>
<div>
<p class="MsoNormal"><b><font size="3" face="Verdana"><span style="font-size:12.0pt;font-family:Verdana;font-weight:bold">Rua Artur de Vasconcelos 151-Sul</span></font></b><u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><b><font size="3" face="Verdana"><span style="font-size:12.0pt;font-family:Verdana;font-weight:bold">64049-750 Teresina-PI<br>
<u></u><u></u>Brazil<u></u><u></u><br>
Telephones: +55 86 3221-3413 (work); +55 86 8838-3303 (mobile).<br>
</span></font></b><font face="Verdana"><span style="font-family:Verdana"><br>
</span></font><font size="2" face="Verdana"><span style="font-size:10.0pt;font-family:Verdana">Aviso: As informações contidas nesta mensagem são CONFIDENCIAIS,
protegidas pelo sigilo legal, por direitos autorais e destinadas exclusivamente
à pessoa ou organização para a qual a mensagem foi destinada.<br>
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. </span></font><u></u><u></u></p>
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</div>
<p class="MsoNormal"><font size="3" face="Times New Roman"><span style="font-size:12.0pt"><u></u> <u></u></span></font></p>
</div>
</div></div></div>
</div>
</blockquote></div><br><br clear="all"><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><b><span style="font-family:verdana, sans-serif"></span></b><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>
</b><br><span style="font-size:x-small">Aviso: As informações contidas nesta mensagem são CONFIDENCIAIS, protegidas pelo sigilo legal, por direitos autorais e destinadas exclusivamente à pessoa ou organização para a qual a mensagem foi destinada.<br>
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. </span></font></div>
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