<table cellspacing="0" cellpadding="0" border="0" ><tr><td valign="top" style="font: inherit;">Dear Sharma,<br>Would you please send me your articles comparing the 2 routes and the effect on larger lesions if it is in the paper. All the best Ali<br><br>Dr Ali Khamesipour<br><br>--- On <b>Tue, 7/26/11, Sharmanl <i><nandlals@hotmail.com></i></b> wrote:<br><blockquote style="border-left: 2px solid rgb(16, 16, 255); margin-left: 5px; padding-left: 5px;"><br>From: Sharmanl <nandlals@hotmail.com><br>Subject: Re: [Leish-l] miltefosine for diffuse leishmaniasis<br>To: "Chang, Kwang-Poo" <KwangPoo.Chang@rosalindfranklin.edu>, "Carlos Costa" <chncosta@gmail.com><br>Cc: "Abhay Satoskar" <Abhay.Satoskar@osumc.edu>, Mark@lineu.icb.usp.br, "Berman" <Jbe9320457@aol.com>, dagobertosilveira@superig.com.br, "Sampaio" <rsampaio@unb.br>, "Dorcas Lamounier Costa" <dorcas.lc@gmail.com>, "Nawacki"
<mnawacki@paladinlabs.com>, jurbina@mac.com, generhedin@thermosurgery.com, "Leish-L" <Leish-l@lineu.icb.usp.br>, Josh@lineu.icb.usp.br, "Pierre BUFFET" <pierre.buffet@upmc.fr>, Raimunda@lineu.icb.usp.br, "Fabiana Alves" <fabipalves@gmail.com>, Fernando@lineu.icb.usp.br, robertobadaro768@gmail.com, "Shyam Sundarmail" <Drshyamsundar@hotmail.com>, joseanegodinho@yahoo.com.br, "Robert Vinson" <rvinson@paladinlabs.com>, "Koremblum" <fkorembl@paladinlabs.com><br>Date: Tuesday, July 26, 2011, 2:57 AM<br><br><div id="yiv243849689">
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<div><font face="Calibri">Dear Dr. KP</font></div>
<div><font face="Calibri">This is in relation to your query on tmt. of CL with
regard to Intra-lesional vs I/M route. We have carried out one comparative
study comparing the two modes and published it. Intralesional is surely
quite effective mode but in larger lesions it sometimes result in
cobble stoning of the healing. It surely provides higher concentration of drug
at the site. However, in larger lesions it may not infiltrate evenly in the
whole lesion by this route. We combined both routes and found that the
results were slightly better than only I/L route. Combination meaning give I/L
injection and also rest of the vial inject IM as well. </font></div>
<div><font face="Calibri">I am not sure whether this answers your query or not but
I thought it may be relevant in the present context.</font> </div>
<div><font face="Calibri">Thanks </font></div>
<div><font face="Calibri">NL Sharma</font></div></div>
<div style="FONT:10pt Tahoma;">
<div><br></div>
<div style="BACKGROUND:#f5f5f5;">
<div style=""><b>From:</b> <a rel="nofollow" title="KwangPoo.Chang@rosalindfranklin.edu" ymailto="mailto:KwangPoo.Chang@rosalindfranklin.edu" target="_blank" href="/mc/compose?to=KwangPoo.Chang@rosalindfranklin.edu">Chang, Kwang-Poo</a> </div>
<div><b>Sent:</b> Tuesday, July 26, 2011 12:28 AM</div>
<div><b>To:</b> <a rel="nofollow" title="mailto:chncosta@gmail.com
CTRL + Click to follow link" ymailto="mailto:chncosta@gmail.com" target="_blank" href="/mc/compose?to=chncosta@gmail.com">Carlos Costa</a> </div>
<div><b>Cc:</b> <a rel="nofollow" title="mailto:Jbe9320457@aol.com
CTRL + Click to follow link" ymailto="mailto:Jbe9320457@aol.com" target="_blank" href="/mc/compose?to=Jbe9320457@aol.com">Berman</a> ; <a rel="nofollow" title="Josh@lineu.icb.usp.br" ymailto="mailto:Josh@lineu.icb.usp.br" target="_blank" href="/mc/compose?to=Josh@lineu.icb.usp.br">Josh@lineu.icb.usp.br</a> ; <a rel="nofollow" title="Mark@lineu.icb.usp.br" ymailto="mailto:Mark@lineu.icb.usp.br" target="_blank" href="/mc/compose?to=Mark@lineu.icb.usp.br">Mark@lineu.icb.usp.br</a> ; <a rel="nofollow" title="jurbina@mac.com" ymailto="mailto:jurbina@mac.com" target="_blank" href="/mc/compose?to=jurbina@mac.com">jurbina@mac.com</a> ; <a rel="nofollow" title="pierre.buffet@upmc.fr" ymailto="mailto:pierre.buffet@upmc.fr" target="_blank" href="/mc/compose?to=pierre.buffet@upmc.fr">Pierre
BUFFET</a> ; <a rel="nofollow" title="fabipalves@gmail.com" ymailto="mailto:fabipalves@gmail.com" target="_blank" href="/mc/compose?to=fabipalves@gmail.com">Fabiana Alves</a> ; <a rel="nofollow" title="Drshyamsundar@hotmail.com" ymailto="mailto:Drshyamsundar@hotmail.com" target="_blank" href="/mc/compose?to=Drshyamsundar@hotmail.com">Shyam
Sundarmail</a> ; <a rel="nofollow" title="dorcas.lc@gmail.com" ymailto="mailto:dorcas.lc@gmail.com" target="_blank" href="/mc/compose?to=dorcas.lc@gmail.com">Dorcas Lamounier Costa</a> ; <a rel="nofollow" title="generhedin@thermosurgery.com" ymailto="mailto:generhedin@thermosurgery.com" target="_blank" href="/mc/compose?to=generhedin@thermosurgery.com">generhedin@thermosurgery.com</a> ; <a rel="nofollow" title="rvinson@paladinlabs.com" ymailto="mailto:rvinson@paladinlabs.com" target="_blank" href="/mc/compose?to=rvinson@paladinlabs.com">Robert
Vinson</a> ; <a rel="nofollow" title="Abhay.Satoskar@osumc.edu" ymailto="mailto:Abhay.Satoskar@osumc.edu" target="_blank" href="/mc/compose?to=Abhay.Satoskar@osumc.edu">Abhay Satoskar</a> ; <a rel="nofollow" title="mailto:dagobertosilveira@superig.com.br
CTRL + Click to follow link" ymailto="mailto:dagobertosilveira@superig.com.br" target="_blank" href="/mc/compose?to=dagobertosilveira@superig.com.br">dagobertosilveira@superig.com.br</a>
; <a rel="nofollow" title="Fernando@lineu.icb.usp.br" ymailto="mailto:Fernando@lineu.icb.usp.br" target="_blank" href="/mc/compose?to=Fernando@lineu.icb.usp.br">Fernando@lineu.icb.usp.br</a> ; <a rel="nofollow" title="Raimunda@lineu.icb.usp.br" ymailto="mailto:Raimunda@lineu.icb.usp.br" target="_blank" href="/mc/compose?to=Raimunda@lineu.icb.usp.br">Raimunda@lineu.icb.usp.br</a> ; <a rel="nofollow" title="joseanegodinho@yahoo.com.br" ymailto="mailto:joseanegodinho@yahoo.com.br" target="_blank" href="/mc/compose?to=joseanegodinho@yahoo.com.br">joseanegodinho@yahoo.com.br</a> ; <a rel="nofollow" title="mnawacki@paladinlabs.com" ymailto="mailto:mnawacki@paladinlabs.com" target="_blank" href="/mc/compose?to=mnawacki@paladinlabs.com">Nawacki</a> ; <a rel="nofollow" title="fkorembl@paladinlabs.com" ymailto="mailto:fkorembl@paladinlabs.com" target="_blank" href="/mc/compose?to=fkorembl@paladinlabs.com">Koremblum</a> ; <a rel="nofollow" title="rsampaio@unb.br"
ymailto="mailto:rsampaio@unb.br" target="_blank" href="/mc/compose?to=rsampaio@unb.br">Sampaio</a> ; <a rel="nofollow" title="robertobadaro768@gmail.com" ymailto="mailto:robertobadaro768@gmail.com" target="_blank" href="/mc/compose?to=robertobadaro768@gmail.com">robertobadaro768@gmail.com</a> ; <a rel="nofollow" title="Leish-l@lineu.icb.usp.br" ymailto="mailto:Leish-l@lineu.icb.usp.br" target="_blank" href="/mc/compose?to=Leish-l@lineu.icb.usp.br">Leish-L</a> </div>
<div><b>Subject:</b> Re: [Leish-l] miltefosine for diffuse
leishmaniasis</div></div></div>
<div><br></div>
<div class="yiv243849689Section1">
<p class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;">I am writing to ask for
your help with information and suggestion about treating cutaneous leishmaniasis
in
Panama .</span></font></p>
<p class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;"> </span></font></p>
<p class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;">I have only very
sketchy information about the case as follows:</span></font></p>
<p class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;"> </span></font></p>
<ol style="MARGIN-TOP:0pt;" type="1">
<li style="COLOR:navy;" class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;FONT-SIZE:10pt;">An American young man has 2 skin
lesions, one of which is on the abdomen. </span></font>
</li><li style="COLOR:navy;" class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;FONT-SIZE:10pt;">He was diagnosed to have cutaneous
leishmaniasis</span></font>
</li><li style="COLOR:navy;" class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;FONT-SIZE:10pt;">A course of 30-day intra-muscular
injection of pentavalent antimony is prescribed.</span></font>
</li></ol>
<p class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;"> </span></font></p>
<p class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;">I wonder about the
intramuscular instead of intra-lesion antimony treatment and also the duration
of the treatment for 30 days ?</span></font></p>
<p class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;"> </span></font></p>
<p class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;">Looking forward to
hearing from you at your earliest convenience.</span></font></p>
<p class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;"> </span></font></p>
<p class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;">KP</span></font></p>
<p class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;"> </span></font></p>
<div>
<div style="TEXT-ALIGN:center;" class="yiv243849689MsoNormal" align="center"><font size="3" face="Times New Roman"><span style="FONT-SIZE:12pt;">
<hr tabindex="-1" align="center" size="2" width="100%">
</span></font></div>
<p class="yiv243849689MsoNormal"><b><font size="2" face="Tahoma"><span style="FONT-FAMILY:Tahoma;FONT-SIZE:10pt;FONT-WEIGHT:bold;">From:</span></font></b><font size="2" face="Tahoma"><span style="FONT-FAMILY:Tahoma;FONT-SIZE:10pt;">
Carlos Costa
[mailto:chncosta@gmail.com] <br><b><span style="FONT-WEIGHT:bold;">Sent:</span></b> Tuesday, July 12, 2011 2:46
PM<br><b><span style="FONT-WEIGHT:bold;">To:</span></b> Chang,
Kwang-Poo<br><b><span style="FONT-WEIGHT:bold;">Cc:</span></b> <a rel="nofollow" ymailto="mailto:gzischke@thermosurgery.com" target="_blank" href="/mc/compose?to=gzischke@thermosurgery.com">gzischke@thermosurgery.com</a>; Abhay
Satoskar; John David; <a rel="nofollow" ymailto="mailto:generhedin@thermosurgery.com" target="_blank" href="/mc/compose?to=generhedin@thermosurgery.com">generhedin@thermosurgery.com</a>;
Josh Berman; <a rel="nofollow" ymailto="mailto:dagobertosilveira@superig.com.br" target="_blank" href="/mc/compose?to=dagobertosilveira@superig.com.br">dagobertosilveira@superig.com.br</a>;
Raimunda Sampaio; Dorcas Lamounier Costa; Mark Nawacki; <a rel="nofollow" ymailto="mailto:jurbina@mac.com" target="_blank" href="/mc/compose?to=jurbina@mac.com">jurbina@mac.com</a>; Pierre BUFFET; <a rel="nofollow" ymailto="mailto:joseanegodinho@yahoo.com.br" target="_blank" href="/mc/compose?to=joseanegodinho@yahoo.com.br">joseanegodinho@yahoo.com.br</a>;
Robert Vinson; Shyam Sundarmail; <a rel="nofollow" ymailto="mailto:robertobadaro768@gmail.com" target="_blank" href="/mc/compose?to=robertobadaro768@gmail.com">robertobadaro768@gmail.com</a>;
Leish-L; Fernando Koremblum; Fabiana Alves; Fabiana Alves<br><b><span style="FONT-WEIGHT:bold;">Subject:</span></b> Re: [Leish-l] miltefosine for
diffuse leishmaniasis</span></font></p></div>
<p class="yiv243849689MsoNormal"><font size="3" face="Times New Roman"><span style="FONT-SIZE:12pt;"> </span></font></p>
<p class="yiv243849689MsoNormal"><font color="black" size="4" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:13.5pt;">Hi
Gena,</span></font></p>
<div>
<p class="yiv243849689MsoNormal"><font size="3" face="Times New Roman"><span style="FONT-SIZE:12pt;"> </span></font></p></div>
<div>
<p class="yiv243849689MsoNormal"><font color="black" size="4" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:13.5pt;">Thanks a lot for
your offer. </span></font></p></div>
<div>
<p class="yiv243849689MsoNormal"><font size="3" face="Times New Roman"><span style="FONT-SIZE:12pt;"> </span></font></p></div>
<div>
<p class="yiv243849689MsoNormal"><font color="black" size="4" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:13.5pt;">Our purpose is to
work together with John and Abhay, who I know personally for a long time. May be
the experience here will lead to broader
application.</span></font></p></div>
<div>
<p class="yiv243849689MsoNormal"><font size="3" face="Times New Roman"><span style="FONT-SIZE:12pt;"> </span></font></p></div>
<div>
<p class="yiv243849689MsoNormal"><font color="black" size="4" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:13.5pt;">I am forwarding
your email to DNDi to see if they could help us in getting the machine into the
country, since they have expertise in this kind of humanitarian
treatment.</span></font></p></div>
<div>
<p class="yiv243849689MsoNormal"><font size="3" face="Times New Roman"><span style="FONT-SIZE:12pt;"> </span></font></p></div>
<div>
<p class="yiv243849689MsoNormal"><font color="black" size="4" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:13.5pt;">My best
regards,</span></font></p></div>
<div>
<p class="yiv243849689MsoNormal"><font size="3" face="Times New Roman"><span style="FONT-SIZE:12pt;"> </span></font></p></div>
<div>
<p class="yiv243849689MsoNormal"><font color="black" size="4" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:13.5pt;">Carlos. </span></font></p></div>
<div>
<p class="yiv243849689MsoNormal"><font size="3" face="Times New Roman"><span style="FONT-SIZE:12pt;"> </span></font></p>
<div>
<p class="yiv243849689MsoNormal"><font size="3" face="Times New Roman"><span style="FONT-SIZE:12pt;">2011/7/12 Chang, Kwang-Poo <<a rel="nofollow" ymailto="mailto:KwangPoo.Chang@rosalindfranklin.edu" target="_blank" href="/mc/compose?to=KwangPoo.Chang@rosalindfranklin.edu">KwangPoo.Chang@rosalindfranklin.edu</a>></span></font></p>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;">This is good to
try.</span></font></p>
<p style="" class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;"> </span></font></p>
<p style="" class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;">KP</span></font></p>
<p style="" class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;"> </span></font></p>
<div>
<div style="TEXT-ALIGN:center;" class="yiv243849689MsoNormal" align="center"><font size="3" face="Times New Roman"><span style="FONT-SIZE:12pt;">
<hr align="center" size="2" width="100%">
</span></font></div>
<p style="" class="yiv243849689MsoNormal"><b><font size="2" face="Tahoma"><span style="FONT-FAMILY:Tahoma;FONT-SIZE:10pt;FONT-WEIGHT:bold;">From:</span></font></b><font size="2" face="Tahoma"><span style="FONT-FAMILY:Tahoma;FONT-SIZE:10pt;"> <a rel="nofollow" ymailto="mailto:gzischke@thermosurgery.com" target="_blank" href="/mc/compose?to=gzischke@thermosurgery.com">gzischke@thermosurgery.com</a> [mailto:<a rel="nofollow" ymailto="mailto:gzischke@thermosurgery.com" target="_blank" href="/mc/compose?to=gzischke@thermosurgery.com">gzischke@thermosurgery.com</a>] <br><b><span style="FONT-WEIGHT:bold;">Sent:</span></b> Tuesday, July 12, 2011 12:47
PM<br><b><span style="FONT-WEIGHT:bold;">To:</span></b>
Carlos Costa ; Abhay Satoskar; John David; <a rel="nofollow" ymailto="mailto:generhedin@thermosurgery.com" target="_blank" href="/mc/compose?to=generhedin@thermosurgery.com">generhedin@thermosurgery.com</a><br><b><span style="FONT-WEIGHT:bold;">Cc:</span></b> Josh Berman; <a rel="nofollow" ymailto="mailto:dagobertosilveira@superig.com.br" target="_blank" href="/mc/compose?to=dagobertosilveira@superig.com.br">dagobertosilveira@superig.com.br</a>; Raimunda Sampaio; Dorcas
Lamounier Costa; Mark Nawacki; <a rel="nofollow" ymailto="mailto:jurbina@mac.com" target="_blank" href="/mc/compose?to=jurbina@mac.com">jurbina@mac.com</a>; Pierre BUFFET; <a rel="nofollow" ymailto="mailto:joseanegodinho@yahoo.com.br" target="_blank" href="/mc/compose?to=joseanegodinho@yahoo.com.br">joseanegodinho@yahoo.com.br</a>; Robert Vinson; Shyam Sundarmail;
<a rel="nofollow" ymailto="mailto:robertobadaro768@gmail.com" target="_blank" href="/mc/compose?to=robertobadaro768@gmail.com">robertobadaro768@gmail.com</a>; Leish-L; Fernando Koremblum;
Chang, Kwang-Poo<br><b><span style="FONT-WEIGHT:bold;">Subject:</span></b> RE:
[Leish-l] miltefosine for diffuse
leishmaniasis</span></font></p></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font size="3" face="Times New Roman"><span style="FONT-SIZE:12pt;"> </span></font></p>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;">Dear Dr.
Costas,</span></font></p></div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;">Thermosurgery is
committed to the research and treatment of leishmaniasis. We are pleased
to work with you and assist your patients. We can lend you an instrument
to use in your program. Our biggest hurdle is getting the equipment into
the country. If you work with an NGO or government agency that can assist
us in the importation that would be helpful.
</span></font></p></div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;">Lets discuss the
logistics to see if it is feasible to get you the equipment. I would
suggest that you work with Dr David and Dr Satoskar on the recommended treatment
protocol. </span></font></p></div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;">We would want to
receive documentation regarding the use of the equipment and a paper so that we
can educate others on the value of this treatment.
</span></font></p></div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;"> </span></font></p></div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;">Warm
regards,</span></font></p></div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;">gena</span></font></p></div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;"> </span></font></p></div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;"> </span></font></p></div>
<div>
<p style="MARGIN-BOTTOM:12pt;" class="yiv243849689MsoNormal"><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;">Gena
Zischke<br>Business Development<br>Thermosurgery Technologies, Inc.<br>2901
W. Indian School
Rd.<br>
Phoenix , AZ
85017<br>Phone: (602)
264-7300<br><br><br>The information in this communication is confidential. It is
intended solely for the addressee. Access to this communication by anyone else
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error, please notify us immediately by return email, and destroy this
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Thermosurgery Technologies, Inc.<br><br><br>Fax: (602)
248-3809</span></font></p></div>
<blockquote style="BORDER-BOTTOM:medium none;BORDER-LEFT:blue 1pt solid;PADDING-BOTTOM:0pt;MARGIN-TOP:5pt;PADDING-LEFT:4pt;PADDING-RIGHT:0pt;MARGIN-BOTTOM:5pt;MARGIN-LEFT:3.95pt;BORDER-TOP:medium none;BORDER-RIGHT:medium none;PADDING-TOP:0pt;">
<div>
<p style="MARGIN-BOTTOM:12pt;" class="yiv243849689MsoNormal"><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;">-------- Original
Message --------<br>Subject: Re: [Leish-l] miltefosine for diffuse
leishmaniasis<br>From: Carlos Costa
<<a rel="nofollow" ymailto="mailto:chncosta@gmail.com" target="_blank" href="/mc/compose?to=chncosta@gmail.com">chncosta@gmail.com</a>><br>Date: Sun, July 10, 2011 4:23
pm<br>To: "Chang, Kwang-Poo" <<a rel="nofollow" target="_blank" href="http://KwangPoo.Chang@rosalindfranklin.edu">KwangPoo.Chang@rosalindfranklin.edu</a>><br>Cc: Josh Berman
<<a rel="nofollow" ymailto="mailto:Jbe9320457@aol.com" target="_blank" href="/mc/compose?to=Jbe9320457@aol.com">Jbe9320457@aol.com</a>>, <a rel="nofollow" ymailto="mailto:dagobertosilveira@superig.com.br" target="_blank" href="/mc/compose?to=dagobertosilveira@superig.com.br">dagobertosilveira@superig.com.br</a>,<br>Raimunda Sampaio <<a rel="nofollow" ymailto="mailto:rsampaio@unb.br" target="_blank" href="/mc/compose?to=rsampaio@unb.br">rsampaio@unb.br</a>>, Dorcas
Lamounier Costa<br><<a rel="nofollow" target="_blank" href="http://dorcas.lc@gmail.com">dorcas.lc@gmail.com</a>>, Mark Nawacki <<a rel="nofollow" ymailto="mailto:mnawacki@paladinlabs.com" target="_blank" href="/mc/compose?to=mnawacki@paladinlabs.com">mnawacki@paladinlabs.com</a>>,<br><a rel="nofollow" ymailto="mailto:jurbina@mac.com" target="_blank" href="/mc/compose?to=jurbina@mac.com">jurbina@mac.com</a>, Pierre BUFFET
<<a rel="nofollow" ymailto="mailto:pierre.buffet@upmc.fr" target="_blank" href="/mc/compose?to=pierre.buffet@upmc.fr">pierre.buffet@upmc.fr</a>>,<br><a rel="nofollow" ymailto="mailto:joseanegodinho@yahoo.com.br" target="_blank" href="/mc/compose?to=joseanegodinho@yahoo.com.br">joseanegodinho@yahoo.com.br</a>, Robert Vinson <<a rel="nofollow" ymailto="mailto:rvinson@paladinlabs.com" target="_blank" href="/mc/compose?to=rvinson@paladinlabs.com">rvinson@paladinlabs.com</a>>,<br>Shyam Sundarmail <<a rel="nofollow" ymailto="mailto:Drshyamsundar@hotmail.com" target="_blank" href="/mc/compose?to=Drshyamsundar@hotmail.com">Drshyamsundar@hotmail.com</a>>,<br><a rel="nofollow" ymailto="mailto:robertobadaro768@gmail.com" target="_blank" href="/mc/compose?to=robertobadaro768@gmail.com">robertobadaro768@gmail.com</a>, Leish-L <<a rel="nofollow" ymailto="mailto:Leish-l@lineu.icb.usp.br" target="_blank"
href="/mc/compose?to=Leish-l@lineu.icb.usp.br">Leish-l@lineu.icb.usp.br</a>>, Fernando<br>Koremblum <<a rel="nofollow" ymailto="mailto:fkorembl@paladinlabs.com" target="_blank" href="/mc/compose?to=fkorembl@paladinlabs.com">fkorembl@paladinlabs.com</a>><br><br>KP, do you have any idea
about prices? Please send me the brand name to see if I can easily import
them. Best wishes to Jean, Carlos</span></font></p>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;">2011/7/10 Chang,
Kwang-Poo <<a rel="nofollow" ymailto="mailto:KwangPoo.Chang@rosalindfranklin.edu" target="_blank" href="/mc/compose?to=KwangPoo.Chang@rosalindfranklin.edu">KwangPoo.Chang@rosalindfranklin.edu</a>></span></font></p>
<div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;">Carlos will
undoubtedly go with those, which are clinically acceptable and feasible for
the sake of expediency. </span></font></p></div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;"> </span></font></p></div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;">In a separate
message, the causative agent was said to have been identified as L
amazonensis. Thermosensitivity of this species has been well-documented,
suggestive of thermotherapy. There is already the suggestion of hot bath.
One-use heat pad/heat wrap available over-the-counter in the
USA drug stores is just as
innocuous to consider as some topical ointments
suggested.</span></font></p></div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;"> </span></font></p></div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY:Arial;COLOR:navy;FONT-SIZE:10pt;">KP</span></font></p></div>
<div>
<div style="TEXT-ALIGN:center;" class="yiv243849689MsoNormal" align="center"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;">
<hr align="center" size="2" width="100%">
</span></font></div>
<div>
<p style="" class="yiv243849689MsoNormal"><b><font color="black" size="2" face="Tahoma"><span style="FONT-FAMILY:Tahoma;COLOR:black;FONT-SIZE:10pt;FONT-WEIGHT:bold;">From:</span></font></b><font color="black" size="2" face="Tahoma"><span style="FONT-FAMILY:Tahoma;COLOR:black;FONT-SIZE:10pt;"> <a rel="nofollow" ymailto="mailto:leish-l-bounces@lineu.icb.usp.br" target="_blank" href="/mc/compose?to=leish-l-bounces@lineu.icb.usp.br">leish-l-bounces@lineu.icb.usp.br</a> [mailto:<a rel="nofollow" ymailto="mailto:leish-l-bounces@lineu.icb.usp.br" target="_blank" href="/mc/compose?to=leish-l-bounces@lineu.icb.usp.br">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> Saturday, July 09, 2011 10:07
AM</span></font></p></div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="2" face="Tahoma"><span style="FONT-FAMILY:Tahoma;COLOR:black;FONT-SIZE:10pt;"><br><b><span style="FONT-WEIGHT:bold;">To:</span></b> Leish-L<br><b><span style="FONT-WEIGHT:bold;">Cc:</span></b> Josh Berman; <a rel="nofollow" ymailto="mailto:dagobertosilveira@superig.com.br" target="_blank" href="/mc/compose?to=dagobertosilveira@superig.com.br">dagobertosilveira@superig.com.br</a>; Dorcas Lamounier Costa; <a rel="nofollow" ymailto="mailto:jurbina@mac.com" target="_blank" href="/mc/compose?to=jurbina@mac.com">jurbina@mac.com</a>; Pierre
BUFFET; Robert Vinson; Raimunda Sampaio; Shyam Sundarmail; <a rel="nofollow" ymailto="mailto:robertobadaro768@gmail.com" target="_blank" href="/mc/compose?to=robertobadaro768@gmail.com">robertobadaro768@gmail.com</a>; Mark Nawacki; Fernando
Koremblum; <a rel="nofollow" ymailto="mailto:joseanegodinho@yahoo.com.br" target="_blank" href="/mc/compose?to=joseanegodinho@yahoo.com.br">joseanegodinho@yahoo.com.br</a></span></font></p></div>
<p style="" class="yiv243849689MsoNormal"><b><font color="black" size="2" face="Tahoma"><span style="FONT-FAMILY:Tahoma;COLOR:black;FONT-SIZE:10pt;FONT-WEIGHT:bold;">Subject:</span></font></b><font color="black" size="2" face="Tahoma"><span style="FONT-FAMILY:Tahoma;COLOR:black;FONT-SIZE:10pt;"> Re: [Leish-l]
miltefosine for diffuse leishmaniasis</span></font></p></div>
<div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;"> </span></font></p></div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="4" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:13.5pt;">Dear
friends,</span></font></p></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;"> </span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="4" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:13.5pt;">This is really a
such touching and motivated community, and leish-l is proving to be an
excellent tool for solving the leishmaniasis toughest problems throughout the
world. The word "together" sounds really powerful in such a
cases.</span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;"> </span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="4" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:13.5pt;">What os showing
up from these kind emails is a face of science coming not only from the bench,
the hospitals, the field, but a science coming straight from the
heart.</span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;"> </span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="5" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:18pt;">Let me summarize
some of the lessons and suggestions. Please correct me if I skip
some.</span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;"> </span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="5" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:18pt;">1) Hot bath -
Teresina is
very hot, and hot showers are rare here. However, we can easily provide her an
electric shower. Should it be a tube? How long the bath would
last?</span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;"> </span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="5" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:18pt;">2) BCG - one or
two shots. We will do it. Any hint about the intervals between the
shots?</span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;"> </span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="5" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:18pt;">3) Previous drug
therapy: ImunoglucanTM (cell wall of <i><span style="FONT-STYLE:italic;">Saccharomyces cerevisiae</span></i>), and
saquinavir, after her delivery (</span></font><font color="black" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;"><a rel="nofollow" target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed/18816190">Intracellular
survival of Leishmania species that cause visceral leishmaniasis is
significantly reduced by HIV-1 protease
inhibitors.</a>).</span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;"> </span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="5" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:18pt;">4) Besides
miltefosine we got a good hint where to find it (
Paladino ,
Canada ), which has excellent
temporary effect (Zerpa et al, 2006), we should
consider: </span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="5" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:18pt;">a) lower/corrected
doses of paramomycin (Bryceson) - we have also to find the drug outside
Brazil , since it is not
distributed/approved here; </span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="5" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:18pt;">b)
gamma-interferon (who produces/sells
it?).</span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="5" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:18pt;">c)
fluconazol/itraconazol/(voriconazol?).</span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="5" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:18pt;">d) amiodarone -
<i><span style="FONT-STYLE:italic;">in vitro</span></i> testing does not
sounds so good.</span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="5" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:18pt;">e) topic imiquimod
(IxiumTM cream) - apparently easy to find. concentration of
5%?</span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="5" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:18pt;">f) photodynamic
therapy - with Dr. Dagoberto Silveira, we are investigating where to do it
around.</span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="5" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:18pt;">g) immunotherapy
with suicide photo-inactivated <i><span style="FONT-STYLE:italic;">Leishmania</span></i> (KP
Chang).</span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;"> </span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="5" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:18pt;">Please check what
really seems reasonable. My feeling is that most of the suggestions can be
tried.</span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;"> </span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="5" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:18pt;">My warmest
regards,</span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;"> </span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="5" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:18pt;">Carlos.</span></font></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;"> </span></font></p></div></div>
<div>
<div style="MARGIN-BOTTOM:12pt;">
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;"> </span></font></p></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;">2011/7/8 Pierre BUFFET <<a rel="nofollow" ymailto="mailto:pierre.buffet@upmc.fr" target="_blank" href="/mc/compose?to=pierre.buffet@upmc.fr">pierre.buffet@upmc.fr</a>></span></font></p></div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;">Anthony,<br><br><br>because there are
only a few options left, would you consider at one point low dose pentamidine
(3 mg/kg every week or so, as you did in DCL patinets in
Ethiopia in
the 70s if I remember)? Could be used either to stabilize the situation before
starting on a coadministration, or as a maintenance after the
co-administration, in both cases with careful monitoring of kidney function
?<br><br>
Pierre<br><br><br> Anthony Bryceson
<<a rel="nofollow" ymailto="mailto:a.bryceson@doctors.org.uk" target="_blank" href="/mc/compose?to=a.bryceson@doctors.org.uk">a.bryceson@doctors.org.uk</a>> a
écrit :</span></font></p></div>
<div>
<div>
<blockquote style="BORDER-BOTTOM:medium none;BORDER-LEFT:windowtext 1pt solid;PADDING-BOTTOM:0pt;MARGIN:5pt 0pt 5pt 4.8pt;PADDING-LEFT:6pt;PADDING-RIGHT:0pt;BORDER-TOP:medium none;BORDER-RIGHT:medium none;PADDING-TOP:0pt;">
<div style="MARGIN-BOTTOM:12pt;">
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;"> </span></font></p></div>
<div style="MARGIN-BOTTOM:12pt;">
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;">Dear Carlos<br>As you are well aware
DCL is very difficult to treat. The big problem is that the defect in
specific CMI is more profound than that in VL and may never recover, in
contrast with the defect in VL which bounces back quickly.<br><br>To have
any chance of curing the patient, treatment should be monitored by
quantitative slit skin smears (as for splenic aspirates in VL) from multiple
pre-selected sites, every week or two weeks, and treatment continued until
negativity and for some weeks or months longer. When slit skin smears
become negative, hunt for any nodular or infiltrated lesions and take deep
biopsies and look for amastigotes there. Keep on hunting and smearing.
Sometimes, at the end of all this, evidence of CMI may appear, and cure
becomes a possibility. I am sure that the method of treating is more
important than the choice of drug - so long of course that the parasite is
susceptible to the drug.<br><br>Hannah Akuffo has sent you the abstract
relating to 3 patients treated by Sabawork Teklemariam in Addis Abeba. That
article details this approach.<br><br>Do you know the species of Leishmania
causing Maria's DCL, and its sensitivities? In Addis Abeba parasites were
cultured from two of the patients and sensitivities determined and
isobolograms drawn to look for synergy. The isolates were sensitive to
paromomycin and sodium stibogluconate was synergistic. It would be worth
while to make cultures before you start any new treatment and have the
isolate tested in this way. I expect that you have a lab that could do this;
if not, Simon Croft might be able to advise.<br><br>Miltefosine has been
very successful in a number of situations in South American CL and showed
promise for DCL, but patients relapsed despite prolonged
treatment.<br>1. Zerpa O, Ulrich M, Blanco B, et al. Diffuse cutaneous
leishmaniasis responds to miltefosine but then relapses. Br J Dermatol.
2007;156:1328-1335.<br><br>In a few patients with VL-HIV confection whom I
treated in
London , miltefosine worked well at first,
but the patients relpased while still on treatment and drug resistance was
supected but not tested. Miltefosine has a pharmacokinetic profile with a
long tail that might make it susceptible to the devlopment of resistance,
especially if the therapeutic window for a given isolate was narrow. So you
might want to think about adding a second drug to go with miltefosine from
the beginning. I am not sure what might be the best drug for combination;
perhaps Josh Berman might have an opinion. It is of course essential to
ensure contraception.<br><br>You could also consider the combination of
paromomycin and low dose SSG. In view of Maria's poor renal function you
might need to modify the dose of paromomycin and to monitor
function.<br><br>Robert Vinson is CEO of Paladin Labs, and would I am sure
help you locate miltefosine. <<a rel="nofollow" ymailto="mailto:rvinson@paladin-labs.com" target="_blank" href="/mc/compose?to=rvinson@paladin-labs.com">rvinson@paladin-labs.com</a>><br><br>Richard Chin is CEO of
One World Health, and would, I am equally sure, help you locate
paromomycin, should you consider that path. <a rel="nofollow" target="_blank" href="http://www.oneworldhealth.org/contact-us">http://www.oneworldhealth.org/contact-us</a> Phone: +1
415-421-4700 Fax: +1 415-421-4747<br><br>I wish you and Maria all the best
in this venture.<br>Anthony<br><br><br>Dear Jennie<br>Immunotherapy proved
rather disappointing in VL. It seems that the patient needs a decent immune
response in the first place to benefit from
immuno-boosting.<br>Sadly<br>Anthony<br><br><br>On 6 Jul 2011, at 20:04,
Carlos Costa
wrote:</span></font></p></div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;">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
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 .<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
Brazil 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
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.<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>
Brazil<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 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.<br><br><cleu antes grav
13jan09.jpg><cleu e nene.jpg><cleu santada
recorte.jpg><cleu panturrilhas.jpg><cleu
palato.jpg>_______________________________________________<br>Leish-l
mailing list<br><a rel="nofollow" ymailto="mailto:Leish-l@lineu.icb.usp.br" target="_blank" href="/mc/compose?to=Leish-l@lineu.icb.usp.br">Leish-l@lineu.icb.usp.br</a><br><a rel="nofollow" target="_blank" href="http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/leish-l">http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/leish-l</a></span></font></p></div>
<div style="MARGIN-BOTTOM:12pt;">
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;"> </span></font></p></div></blockquote>
<div style="MARGIN-BOTTOM:12pt;">
<p style="MARGIN-BOTTOM:12pt;" class="yiv243849689MsoNormal"><font color="black" size="3" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:12pt;"> </span></font></p></div></div></div></div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;"><br><br clear="all"><br>--
<br></span></font><b><font color="black" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-WEIGHT:bold;">Carlos H. N.
Costa, MD, DSc.</span></font></b></p></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><b><font color="black" size="3" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:12pt;FONT-WEIGHT:bold;">President</span></font></b></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><b><font color="black" size="3" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:12pt;FONT-WEIGHT:bold;">Sociedade
Brasileira de Medicina
Tropical </span></font></b></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><b><font color="black" size="3" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:12pt;FONT-WEIGHT:bold;">(Brazilian
Society of Tropical Medicine)</span></font></b></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><b><font color="black" size="3" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:12pt;FONT-WEIGHT:bold;">Instituto
de Doenças Tropicais Natan Portella<br>Universidade Federal do
Piauí</span></font></b></p></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><b><font color="black" size="3" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:12pt;FONT-WEIGHT:bold;">Rua
Artur de Vasconcelos 151-Sul</span></font></b></p></div></div>
<div>
<div>
<p style="" class="yiv243849689MsoNormal"><b><font color="black" size="3" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:12pt;FONT-WEIGHT:bold;">64049-750
Teresina-PI<br>
Brazil<br>Telephones: +55 86
3221-3413 (work); +55 86 8838-3303 (mobile).<br></span></font></b><font color="black" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;"><br></span></font><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;">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></p></div></div></div>
<div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR:black;FONT-SIZE:12pt;"> </span></font></p></div></div></div></div></div></div></div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;"><br><br clear="all"><br>-- <br><b><span style="FONT-WEIGHT:bold;">Carlos H. N. Costa,
MD, DSc.</span></b></span></font></p>
<div>
<p style="" class="yiv243849689MsoNormal"><b><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;FONT-WEIGHT:bold;">President</span></font></b></p></div>
<div>
<p style="" class="yiv243849689MsoNormal"><b><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;FONT-WEIGHT:bold;">Sociedade
Brasileira de Medicina Tropical </span></font></b></p></div>
<div>
<p style="" class="yiv243849689MsoNormal"><b><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;FONT-WEIGHT:bold;">(Brazilian
Society of Tropical Medicine)</span></font></b></p></div>
<div>
<p style="" class="yiv243849689MsoNormal"><b><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;FONT-WEIGHT:bold;">Instituto
de Doenças Tropicais Natan Portella<br>Universidade Federal do
Piauí</span></font></b></p>
<div>
<p style="" class="yiv243849689MsoNormal"><b><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;FONT-WEIGHT:bold;">Rua
Artur de Vasconcelos 151-Sul</span></font></b></p></div>
<div>
<p style="" class="yiv243849689MsoNormal"><b><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;FONT-WEIGHT:bold;">64049-750
Teresina-PI<br>
Brazil<br>Telephones: +55 86
3221-3413 (work); +55 86 8838-3303 (mobile).<br></span></font></b><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;"><br>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></p></div></div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;"> </span></font></p>
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<hr align="center" size="2" width="100%">
</span></font></div>
<p style="" class="yiv243849689MsoNormal"><font color="black" size="2" face="Verdana"><span style="FONT-FAMILY:Verdana;COLOR:black;FONT-SIZE:10pt;">_______________________________________________<br>Leish-l
mailing list<br><a rel="nofollow" ymailto="mailto:Leish-l@lineu.icb.usp.br" target="_blank" href="/mc/compose?to=Leish-l@lineu.icb.usp.br">Leish-l@lineu.icb.usp.br</a><br><a rel="nofollow" target="_blank" href="http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/leish-l">http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/leish-l</a></span></font></p></div></blockquote></div></div></div></div></div>
<p class="yiv243849689MsoNormal"><font size="3" face="Times New Roman"><span style="FONT-SIZE:12pt;"><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></p>
<div>
<p class="yiv243849689MsoNormal"><b><font size="3" face="Verdana"><span style="FONT-FAMILY:Verdana;FONT-SIZE:12pt;FONT-WEIGHT:bold;">President</span></font></b></p></div>
<div>
<p class="yiv243849689MsoNormal"><b><font size="3" face="Verdana"><span style="FONT-FAMILY:Verdana;FONT-SIZE:12pt;FONT-WEIGHT:bold;">Sociedade
Brasileira de Medicina Tropical </span></font></b></p></div>
<div>
<p class="yiv243849689MsoNormal"><b><font size="3" face="Verdana"><span style="FONT-FAMILY:Verdana;FONT-SIZE:12pt;FONT-WEIGHT:bold;">(Brazilian
Society of Tropical Medicine)</span></font></b></p></div>
<div>
<p class="yiv243849689MsoNormal"><b><font size="3" face="Verdana"><span style="FONT-FAMILY:Verdana;FONT-SIZE:12pt;FONT-WEIGHT:bold;">Instituto de
Doenças Tropicais Natan Portella<br>Universidade Federal do
Piauí</span></font></b></p>
<div>
<p class="yiv243849689MsoNormal"><b><font size="3" face="Verdana"><span style="FONT-FAMILY:Verdana;FONT-SIZE:12pt;FONT-WEIGHT:bold;">Rua Artur de
Vasconcelos 151-Sul</span></font></b></p></div>
<div>
<p class="yiv243849689MsoNormal"><b><font size="3" face="Verdana"><span style="FONT-FAMILY:Verdana;FONT-SIZE:12pt;FONT-WEIGHT:bold;">64049-750
Teresina-PI<br>
Brazil<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-FAMILY:Verdana;FONT-SIZE:10pt;">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></p></div></div>
<p class="yiv243849689MsoNormal"><font size="3" face="Times New Roman"><span style="FONT-SIZE:12pt;"> </span></font></p></div></div>
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