<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<HTML xmlns="http://www.w3.org/TR/REC-html40" xmlns:v =
"urn:schemas-microsoft-com:vml" xmlns:o =
"urn:schemas-microsoft-com:office:office" xmlns:w =
"urn:schemas-microsoft-com:office:word" xmlns:st1 =
"urn:schemas-microsoft-com:office:smarttags"><HEAD>
<META content="text/html; charset=iso-8859-1" http-equiv=Content-Type>
<META name=GENERATOR content="MSHTML 8.00.6001.19088"><!--[if !mso]>
<STYLE>
v\:* {behavior:url(#default#VML);}
o\:* {behavior:url(#default#VML);}
w\:* {behavior:url(#default#VML);}
.shape {behavior:url(#default#VML);}
</STYLE>
<![endif]--><o:SmartTagType name="PostalCode"
namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:SmartTagType><o:SmartTagType
name="country-region"
namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:SmartTagType><o:SmartTagType
name="Street"
namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:SmartTagType><o:SmartTagType
name="State"
namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:SmartTagType><o:SmartTagType
name="City"
namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:SmartTagType><o:SmartTagType
name="place"
namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:SmartTagType><o:SmartTagType
name="address"
namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:SmartTagType><o:SmartTagType
name="PersonName"
namespaceuri="urn:schemas-microsoft-com:office:smarttags"></o:SmartTagType><!--[if !mso]>
<STYLE>
st1\:*{behavior:url(#default#ieooui) }
</STYLE>
<![endif]-->
<STYLE>
<!--
/* Font Definitions */
@font-face
{font-family:Tahoma;
panose-1:2 11 6 4 3 5 4 4 2 4;}
@font-face
{font-family:Verdana;
panose-1:2 11 6 4 3 5 4 4 2 4;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{margin:0pt;
margin-bottom:.0001pt;
font-size:12.0pt;
font-family:"Times New Roman";}
a:link, span.MsoHyperlink
{color:blue;
text-decoration:underline;}
a:visited, span.MsoHyperlinkFollowed
{color:blue;
text-decoration:underline;}
span.EmailStyle17
{mso-style-type:personal-reply;
font-family:Arial;
color:navy;}
@page Section1
{size:612.0pt 792.0pt;
margin:72.0pt 72.0pt 72.0pt 72.0pt;}
div.Section1
{page:Section1;}
/* List Definitions */
@list l0
{mso-list-id:712849748;
mso-list-type:hybrid;
mso-list-template-ids:1324011672 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;}
@list l0:level1
{mso-level-tab-stop:36.0pt;
mso-level-number-position:left;
text-indent:-18.0pt;}
ol
{margin-bottom:0pt;}
ul
{margin-bottom:0pt;}
-->
</STYLE>
</HEAD>
<BODY lang=EN-US link=blue vLink=blue>
<DIV dir=ltr align=left><SPAN class=367464611-26072011><FONT color=#0000ff
face=Arial>Dear KP,</FONT></SPAN></DIV>
<DIV dir=ltr align=left><SPAN class=367464611-26072011><FONT color=#0000ff
face=Arial></FONT></SPAN> </DIV>
<DIV dir=ltr align=left><SPAN class=367464611-26072011><FONT color=#0000ff
face=Arial>My brother got leishmaniasis while working for the Panama Canal
back in the 70's. </FONT></SPAN></DIV>
<DIV dir=ltr align=left><SPAN class=367464611-26072011><FONT color=#0000ff
face=Arial>He could not get pentavalent antimony at the time so I sent him some
Glucantime from Brasil.</FONT></SPAN></DIV>
<DIV dir=ltr align=left><SPAN class=367464611-26072011><FONT color=#0000ff
face=Arial>He had a 10 day IM treatment (5 ml b.i.d.) and responded
well.</FONT></SPAN></DIV>
<DIV dir=ltr align=left><SPAN class=367464611-26072011><FONT color=#0000ff
face=Arial></FONT></SPAN> </DIV>
<DIV dir=ltr align=left><SPAN class=367464611-26072011><FONT color=#0000ff
face=Arial>I hope this helps</FONT></SPAN></DIV>
<DIV dir=ltr align=left><SPAN class=367464611-26072011><FONT color=#0000ff
face=Arial></FONT></SPAN> </DIV>
<DIV dir=ltr align=left><SPAN class=367464611-26072011><FONT color=#0000ff
face=Arial>Jorge</FONT></SPAN></DIV>
<DIV><FONT color=#0000ff face=Arial></FONT> </DIV>
<DIV align=left>
<DIV align=left><FONT size=2 face=Arial>Jorge R. Arias Ph.D.</FONT></DIV>
<DIV align=left><FONT size=2 face=Arial>Disease Carrying Insects Program
Supervisor</FONT></DIV>
<DIV align=left><FONT size=2 face=Arial>(703) 246-8474</FONT></DIV></DIV>
<DIV> </DIV><BR>
<DIV dir=ltr lang=en-us class=OutlookMessageHeader align=left>
<HR tabIndex=-1>
<FONT size=2 face=Tahoma><B>From:</B> leish-l-bounces@lineu.icb.usp.br
[mailto:leish-l-bounces@lineu.icb.usp.br] <B>On Behalf Of </B>Chang,
Kwang-Poo<BR><B>Sent:</B> Monday, July 25, 2011 2:59 PM<BR><B>To:</B> Carlos
Costa<BR><B>Cc:</B> Berman; Josh@lineu.icb.usp.br; Mark@lineu.icb.usp.br;
jurbina@mac.com; Pierre BUFFET; Fabiana Alves; Shyam Sundarmail; Dorcas
Lamounier Costa; generhedin@thermosurgery.com; Robert Vinson; Abhay Satoskar;
dagobertosilveira@superig.com.br; Fernando@lineu.icb.usp.br;
Raimunda@lineu.icb.usp.br; joseanegodinho@yahoo.com.br; Nawacki; Koremblum;
Sampaio; robertobadaro768@gmail.com; Leish-L<BR><B>Subject:</B> Re: [Leish-l]
miltefosine for diffuse leishmaniasis<BR></FONT><BR></DIV>
<DIV></DIV>
<DIV class=Section1>
<P class=MsoNormal><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 <st1:country-region w:st="on"><st1:place
w:st="on">Panama</st1:place></st1:country-region>.<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT color=navy size=2 face=Arial><SPAN
style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal><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:<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT color=navy size=2 face=Arial><SPAN
style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt"><o:p> </o:p></SPAN></FONT></P>
<OL style="MARGIN-TOP: 0pt" type=1>
<LI style="COLOR: navy; mso-list: l0 level1 lfo1" class=MsoNormal><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. <o:p></o:p></SPAN></FONT>
<LI style="COLOR: navy; mso-list: l0 level1 lfo1" class=MsoNormal><FONT
color=navy size=2 face=Arial><SPAN
style="FONT-FAMILY: Arial; FONT-SIZE: 10pt">He was diagnosed to have cutaneous
leishmaniasis<o:p></o:p></SPAN></FONT>
<LI style="COLOR: navy; mso-list: l0 level1 lfo1" class=MsoNormal><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.<o:p></o:p></SPAN></FONT>
</LI></OL>
<P class=MsoNormal><FONT color=navy size=2 face=Arial><SPAN
style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal><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 ?<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT color=navy size=2 face=Arial><SPAN
style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal><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.<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT color=navy size=2 face=Arial><SPAN
style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT color=navy size=2 face=Arial><SPAN
style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt">KP<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT color=navy size=2 face=Arial><SPAN
style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt"><o:p> </o:p></SPAN></FONT></P>
<DIV>
<DIV style="TEXT-ALIGN: center" class=MsoNormal 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=MsoNormal><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">
<st1:PersonName w:st="on">Carlos Costa</st1:PersonName>
[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>
gzischke@thermosurgery.com; Abhay Satoskar; John David;
generhedin@thermosurgery.com; Josh Berman; dagobertosilveira@superig.com.br;
Raimunda Sampaio; Dorcas Lamounier Costa; Mark Nawacki; jurbina@mac.com; Pierre
BUFFET; joseanegodinho@yahoo.com.br; Robert Vinson; Shyam Sundarmail;
robertobadaro768@gmail.com; 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><o:p></o:p></P></DIV>
<P class=MsoNormal><FONT size=3 face="Times New Roman"><SPAN
style="FONT-SIZE: 12pt"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT color=black size=4 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; COLOR: black; FONT-SIZE: 13.5pt">Hi
Gena,</SPAN></FONT><o:p></o:p></P>
<DIV>
<P class=MsoNormal><FONT size=3 face="Times New Roman"><SPAN
style="FONT-SIZE: 12pt"><o:p> </o:p></SPAN></FONT></P></DIV>
<DIV>
<P class=MsoNormal><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><o:p></o:p></P></DIV>
<DIV>
<P class=MsoNormal><FONT size=3 face="Times New Roman"><SPAN
style="FONT-SIZE: 12pt"><o:p> </o:p></SPAN></FONT></P></DIV>
<DIV>
<P class=MsoNormal><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><o:p></o:p></P></DIV>
<DIV>
<P class=MsoNormal><FONT size=3 face="Times New Roman"><SPAN
style="FONT-SIZE: 12pt"><o:p> </o:p></SPAN></FONT></P></DIV>
<DIV>
<P class=MsoNormal><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><o:p></o:p></P></DIV>
<DIV>
<P class=MsoNormal><FONT size=3 face="Times New Roman"><SPAN
style="FONT-SIZE: 12pt"><o:p> </o:p></SPAN></FONT></P></DIV>
<DIV>
<P class=MsoNormal><FONT color=black size=4 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; COLOR: black; FONT-SIZE: 13.5pt">My best
regards,</SPAN></FONT><o:p></o:p></P></DIV>
<DIV>
<P class=MsoNormal><FONT size=3 face="Times New Roman"><SPAN
style="FONT-SIZE: 12pt"><o:p> </o:p></SPAN></FONT></P></DIV>
<DIV>
<P class=MsoNormal><FONT color=black size=4 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; COLOR: black; FONT-SIZE: 13.5pt">Carlos. </SPAN></FONT><o:p></o:p></P></DIV>
<DIV>
<P class=MsoNormal><FONT size=3 face="Times New Roman"><SPAN
style="FONT-SIZE: 12pt"><o:p> </o:p></SPAN></FONT></P>
<DIV>
<P class=MsoNormal><FONT size=3 face="Times New Roman"><SPAN
style="FONT-SIZE: 12pt">2011/7/12 Chang, Kwang-Poo <<A
href="mailto:KwangPoo.Chang@rosalindfranklin.edu">KwangPoo.Chang@rosalindfranklin.edu</A>><o:p></o:p></SPAN></FONT></P>
<DIV vlink="blue" link="blue">
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=navy size=2 face=Arial><SPAN
style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt">This is good to
try.</SPAN></FONT><o:p></o:p></P>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=navy size=2 face=Arial><SPAN
style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt"> </SPAN></FONT><o:p></o:p></P>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=navy size=2 face=Arial><SPAN
style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt">KP</SPAN></FONT><o:p></o:p></P>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=navy size=2 face=Arial><SPAN
style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt"> </SPAN></FONT><o:p></o:p></P>
<DIV>
<DIV style="TEXT-ALIGN: center" class=MsoNormal 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="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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
href="mailto:gzischke@thermosurgery.com"
target=_blank>gzischke@thermosurgery.com</A> [mailto:<A
href="mailto:gzischke@thermosurgery.com"
target=_blank>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> <st1:PersonName
w:st="on">Carlos Costa</st1:PersonName>; Abhay Satoskar; John David; <A
href="mailto:generhedin@thermosurgery.com"
target=_blank>generhedin@thermosurgery.com</A><BR><B><SPAN
style="FONT-WEIGHT: bold">Cc:</SPAN></B> Josh Berman; <A
href="mailto:dagobertosilveira@superig.com.br"
target=_blank>dagobertosilveira@superig.com.br</A>; Raimunda Sampaio; Dorcas
Lamounier Costa; Mark Nawacki; <A href="mailto:jurbina@mac.com"
target=_blank>jurbina@mac.com</A>; Pierre BUFFET; <A
href="mailto:joseanegodinho@yahoo.com.br"
target=_blank>joseanegodinho@yahoo.com.br</A>; Robert Vinson; Shyam Sundarmail;
<A href="mailto:robertobadaro768@gmail.com"
target=_blank>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><o:p></o:p></P></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT size=3 face="Times New Roman"><SPAN
style="FONT-SIZE: 12pt"> <o:p></o:p></SPAN></FONT></P>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=2 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; COLOR: black; FONT-SIZE: 10pt">Dear Dr.
Costas,</SPAN></FONT><o:p></o:p></P></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=2 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; COLOR: black; FONT-SIZE: 10pt"> </SPAN></FONT><o:p></o:p></P></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=2 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; COLOR: black; FONT-SIZE: 10pt">Warm
regards,</SPAN></FONT><o:p></o:p></P></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=2 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; COLOR: black; FONT-SIZE: 10pt">gena</SPAN></FONT><o:p></o:p></P></DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=2 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; COLOR: black; FONT-SIZE: 10pt"> </SPAN></FONT><o:p></o:p></P></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=2 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; COLOR: black; FONT-SIZE: 10pt"> </SPAN></FONT><o:p></o:p></P></DIV>
<DIV>
<P style="MARGIN-BOTTOM: 12pt; mso-margin-top-alt: auto" class=MsoNormal><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
<st1:Street w:st="on"><st1:address w:st="on">W. Indian School
Rd.</st1:address></st1:Street><BR><st1:place w:st="on"><st1:City
w:st="on">Phoenix</st1:City>, <st1:State w:st="on">AZ</st1:State>
<st1:PostalCode w:st="on">85017</st1:PostalCode></st1:place><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
is unauthorized. If you are not the intended recipient, any disclosure, copying,
distribution or any action taken or omitted to be taken in reliance on it, is
prohibited and may be unlawful. If you have received this communication in
error, please notify us immediately by return email, and destroy this
communication and all copies thereof, including all attachments. Thank you.
Thermosurgery Technologies, Inc.<BR><BR><BR>Fax: (602)
248-3809</SPAN></FONT><o:p></o:p></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; mso-margin-top-alt: auto" class=MsoNormal><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: <st1:PersonName w:st="on">Carlos Costa</st1:PersonName>
<<A href="mailto:chncosta@gmail.com"
target=_blank>chncosta@gmail.com</A>><BR>Date: Sun, July 10, 2011 4:23
pm<BR>To: "Chang, Kwang-Poo" <<A
href="http://KwangPoo.Chang@rosalindfranklin.edu"
target=_blank>KwangPoo.Chang@rosalindfranklin.edu</A>><BR>Cc: Josh Berman
<<A href="mailto:Jbe9320457@aol.com"
target=_blank>Jbe9320457@aol.com</A>>, <A
href="mailto:dagobertosilveira@superig.com.br"
target=_blank>dagobertosilveira@superig.com.br</A>,<BR>Raimunda Sampaio <<A
href="mailto:rsampaio@unb.br" target=_blank>rsampaio@unb.br</A>>, Dorcas
Lamounier Costa<BR><<A href="http://dorcas.lc@gmail.com"
target=_blank>dorcas.lc@gmail.com</A>>, Mark Nawacki <<A
href="mailto:mnawacki@paladinlabs.com"
target=_blank>mnawacki@paladinlabs.com</A>>,<BR><A
href="mailto:jurbina@mac.com" target=_blank>jurbina@mac.com</A>, Pierre BUFFET
<<A href="mailto:pierre.buffet@upmc.fr"
target=_blank>pierre.buffet@upmc.fr</A>>,<BR><A
href="mailto:joseanegodinho@yahoo.com.br"
target=_blank>joseanegodinho@yahoo.com.br</A>, Robert Vinson <<A
href="mailto:rvinson@paladinlabs.com"
target=_blank>rvinson@paladinlabs.com</A>>,<BR>Shyam Sundarmail <<A
href="mailto:Drshyamsundar@hotmail.com"
target=_blank>Drshyamsundar@hotmail.com</A>>,<BR><A
href="mailto:robertobadaro768@gmail.com"
target=_blank>robertobadaro768@gmail.com</A>, Leish-L <<A
href="mailto:Leish-l@lineu.icb.usp.br"
target=_blank>Leish-l@lineu.icb.usp.br</A>>, Fernando<BR>Koremblum <<A
href="mailto:fkorembl@paladinlabs.com"
target=_blank>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><o:p></o:p></P>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=2 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; COLOR: black; FONT-SIZE: 10pt">2011/7/10 Chang,
Kwang-Poo <<A href="mailto:KwangPoo.Chang@rosalindfranklin.edu"
target=_blank>KwangPoo.Chang@rosalindfranklin.edu</A>></SPAN></FONT><o:p></o:p></P>
<DIV vlink="blue" link="blue">
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=navy size=2 face=Arial><SPAN
style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt"> </SPAN></FONT><o:p></o:p></P></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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
<st1:country-region w:st="on"><st1:place
w:st="on">USA</st1:place></st1:country-region> drug stores is just as
innocuous to consider as some topical ointments
suggested.</SPAN></FONT><o:p></o:p></P></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=navy size=2 face=Arial><SPAN
style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt"> </SPAN></FONT><o:p></o:p></P></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=navy size=2 face=Arial><SPAN
style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt">KP</SPAN></FONT><o:p></o:p></P></DIV>
<DIV>
<DIV style="TEXT-ALIGN: center" class=MsoNormal 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="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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
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><st1:PersonName
w:st="on">Carlos Costa</st1:PersonName><BR><B><SPAN
style="FONT-WEIGHT: bold">Sent:</SPAN></B> Saturday, July 09, 2011 10:07
AM</SPAN></FONT><o:p></o:p></P></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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
href="mailto:dagobertosilveira@superig.com.br"
target=_blank>dagobertosilveira@superig.com.br</A>; Dorcas Lamounier Costa; <A
href="mailto:jurbina@mac.com" target=_blank>jurbina@mac.com</A>; Pierre
BUFFET; Robert Vinson; Raimunda Sampaio; Shyam Sundarmail; <A
href="mailto:robertobadaro768@gmail.com"
target=_blank>robertobadaro768@gmail.com</A>; Mark Nawacki; Fernando
Koremblum; <A href="mailto:joseanegodinho@yahoo.com.br"
target=_blank>joseanegodinho@yahoo.com.br</A></SPAN></FONT><o:p></o:p></P></DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV>
<DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=3 face="Times New Roman"><SPAN
style="COLOR: black; FONT-SIZE: 12pt"> </SPAN></FONT><o:p></o:p></P></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=4 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; COLOR: black; FONT-SIZE: 13.5pt">Dear
friends,</SPAN></FONT><o:p></o:p></P></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=3 face="Times New Roman"><SPAN
style="COLOR: black; FONT-SIZE: 12pt"> </SPAN></FONT><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=3 face="Times New Roman"><SPAN
style="COLOR: black; FONT-SIZE: 12pt"> </SPAN></FONT><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=3 face="Times New Roman"><SPAN
style="COLOR: black; FONT-SIZE: 12pt"> </SPAN></FONT><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=3 face="Times New Roman"><SPAN
style="COLOR: black; FONT-SIZE: 12pt"> </SPAN></FONT><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=5 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; COLOR: black; FONT-SIZE: 18pt">1) Hot bath -
<st1:City w:st="on"><st1:place w:st="on">Teresina</st1:place></st1:City> 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><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=3 face="Times New Roman"><SPAN
style="COLOR: black; FONT-SIZE: 12pt"> </SPAN></FONT><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=3 face="Times New Roman"><SPAN
style="COLOR: black; FONT-SIZE: 12pt"> </SPAN></FONT><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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
href="http://www.ncbi.nlm.nih.gov/pubmed/18816190" target=_blank>Intracellular
survival of Leishmania species that cause visceral leishmaniasis is
significantly reduced by HIV-1 protease
inhibitors.</A>).</SPAN></FONT><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=3 face="Times New Roman"><SPAN
style="COLOR: black; FONT-SIZE: 12pt"> </SPAN></FONT><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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 (<st1:place
w:st="on"><st1:City w:st="on">Paladino</st1:City>, <st1:country-region
w:st="on">Canada</st1:country-region></st1:place>), which has excellent
temporary effect (Zerpa et al, 2006), we should
consider: </SPAN></FONT><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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
<st1:country-region w:st="on"><st1:place
w:st="on">Brazil</st1:place></st1:country-region>, since it is not
distributed/approved here; </SPAN></FONT><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=5 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; COLOR: black; FONT-SIZE: 18pt">c)
fluconazol/itraconazol/(voriconazol?).</SPAN></FONT><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=3 face="Times New Roman"><SPAN
style="COLOR: black; FONT-SIZE: 12pt"> </SPAN></FONT><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=3 face="Times New Roman"><SPAN
style="COLOR: black; FONT-SIZE: 12pt"> </SPAN></FONT><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=5 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; COLOR: black; FONT-SIZE: 18pt">My warmest
regards,</SPAN></FONT><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=3 face="Times New Roman"><SPAN
style="COLOR: black; FONT-SIZE: 12pt"> </SPAN></FONT><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=5 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; COLOR: black; FONT-SIZE: 18pt">Carlos.</SPAN></FONT><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=3 face="Times New Roman"><SPAN
style="COLOR: black; FONT-SIZE: 12pt"> </SPAN></FONT><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV style="MARGIN-BOTTOM: 12pt">
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=3 face="Times New Roman"><SPAN
style="COLOR: black; FONT-SIZE: 12pt"> </SPAN></FONT><o:p></o:p></P></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=3 face="Times New Roman"><SPAN
style="COLOR: black; FONT-SIZE: 12pt">2011/7/8 Pierre BUFFET <<A
href="mailto:pierre.buffet@upmc.fr"
target=_blank>pierre.buffet@upmc.fr</A>></SPAN></FONT><o:p></o:p></P></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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 <st1:country-region
w:st="on"><st1:place w:st="on">Ethiopia</st1:place></st1:country-region> 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><st1:City w:st="on"><st1:place
w:st="on">Pierre</st1:place></st1:City><BR><BR><BR> Anthony Bryceson
<<A href="mailto:a.bryceson@doctors.org.uk"
target=_blank>a.bryceson@doctors.org.uk</A>> a
écrit :</SPAN></FONT><o:p></o:p></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="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=3 face="Times New Roman"><SPAN
style="COLOR: black; FONT-SIZE: 12pt"> </SPAN></FONT><o:p></o:p></P></DIV>
<DIV style="MARGIN-BOTTOM: 12pt">
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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 <st1:City w:st="on"><st1:place
w:st="on">London</st1:place></st1:City>, 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 href="mailto:rvinson@paladin-labs.com"
target=_blank>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
href="http://www.oneworldhealth.org/contact-us"
target=_blank>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,
<st1:PersonName w:st="on">Carlos Costa</st1:PersonName>
wrote:</SPAN></FONT><o:p></o:p></P></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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
<st1:place w:st="on"><st1:City w:st="on">Maranhão State</st1:City>,
<st1:country-region w:st="on">Brazil</st1:country-region></st1:place>, 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 <st1:City w:st="on"><st1:place
w:st="on">Teresina</st1:place></st1:City>.<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 <st1:country-region w:st="on"><st1:place
w:st="on">Brazil</st1:place></st1:country-region> 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 <st1:country-region
w:st="on"><st1:place w:st="on">Brazil</st1:place></st1:country-region> (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><st1:country-region
w:st="on"><st1:place
w:st="on">Brazil</st1:place></st1:country-region><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 href="mailto:Leish-l@lineu.icb.usp.br"
target=_blank>Leish-l@lineu.icb.usp.br</A><BR><A
href="http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/leish-l"
target=_blank>http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/leish-l</A></SPAN></FONT><o:p></o:p></P></DIV>
<DIV style="MARGIN-BOTTOM: 12pt">
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=3 face="Times New Roman"><SPAN
style="COLOR: black; FONT-SIZE: 12pt"> </SPAN></FONT><o:p></o:p></P></DIV></BLOCKQUOTE>
<DIV style="MARGIN-BOTTOM: 12pt">
<P style="MARGIN-BOTTOM: 12pt; mso-margin-top-alt: auto" class=MsoNormal><FONT
color=black size=3 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; COLOR: black; FONT-SIZE: 12pt"> </SPAN></FONT><o:p></o:p></P></DIV></DIV></DIV></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV></DIV>
<DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><st1:country-region w:st="on"><st1:place
w:st="on">Brazil</st1:place></st1:country-region><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><o:p></o:p></P></DIV></DIV></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=3 face="Times New Roman"><SPAN
style="COLOR: black; FONT-SIZE: 12pt"> </SPAN></FONT><o:p></o:p></P></DIV></DIV></DIV></DIV></DIV></DIV></DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><o:p></o:p></P></DIV>
<DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><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><st1:country-region w:st="on"><st1:place
w:st="on">Brazil</st1:place></st1:country-region><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><o:p></o:p></P></DIV></DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=2 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; COLOR: black; FONT-SIZE: 10pt"> </SPAN></FONT><o:p></o:p></P>
<DIV style="TEXT-ALIGN: center" class=MsoNormal align=center><FONT color=black
size=2 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; COLOR: black; FONT-SIZE: 10pt">
<HR align=center SIZE=2 width="100%">
</SPAN></FONT></DIV>
<P style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto"
class=MsoNormal><FONT color=black size=2 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; COLOR: black; FONT-SIZE: 10pt">_______________________________________________<BR>Leish-l
mailing list<BR><A href="mailto:Leish-l@lineu.icb.usp.br"
target=_blank>Leish-l@lineu.icb.usp.br</A><BR><A
href="http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/leish-l"
target=_blank>http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/leish-l</A></SPAN></FONT><o:p></o:p></P></DIV></BLOCKQUOTE></DIV></DIV></DIV></DIV></DIV>
<P class=MsoNormal><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><o:p></o:p></P>
<DIV>
<P class=MsoNormal><B><FONT size=3 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; FONT-SIZE: 12pt; FONT-WEIGHT: bold">President</SPAN></FONT></B><o:p></o:p></P></DIV>
<DIV>
<P class=MsoNormal><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><o:p></o:p></P></DIV>
<DIV>
<P class=MsoNormal><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><o:p></o:p></P></DIV>
<DIV>
<P class=MsoNormal><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><o:p></o:p></P>
<DIV>
<P class=MsoNormal><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><o:p></o:p></P></DIV>
<DIV>
<P class=MsoNormal><B><FONT size=3 face=Verdana><SPAN
style="FONT-FAMILY: Verdana; FONT-SIZE: 12pt; FONT-WEIGHT: bold">64049-750
Teresina-PI<BR><st1:country-region w:st="on"><st1:place
w:st="on">Brazil</st1:place></st1:country-region><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><o:p></o:p></P></DIV></DIV>
<P class=MsoNormal><FONT size=3 face="Times New Roman"><SPAN
style="FONT-SIZE: 12pt"><o:p> </o:p></SPAN></FONT></P></DIV></DIV></BODY></HTML>