<html 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" xmlns="http://www.w3.org/TR/REC-html40">
<head>
<meta http-equiv=Content-Type content="text/html; charset=iso-8859-1">
<meta name=Generator content="Microsoft Word 11 (filtered medium)">
<!--[if !mso]>
<style id=owaTempEditStyle>
v\:* {behavior:url(#default#VML);}
o\:* {behavior:url(#default#VML);}
w\:* {behavior:url(#default#VML);}
.shape {behavior:url(#default#VML);}
</style>
<![endif]--><o:SmartTagType
namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="country-region"/>
<o:SmartTagType namespaceuri="urn:schemas-microsoft-com:office:smarttags"
name="PlaceType"/>
<o:SmartTagType namespaceuri="urn:schemas-microsoft-com:office:smarttags"
name="PostalCode"/>
<o:SmartTagType namespaceuri="urn:schemas-microsoft-com:office:smarttags"
name="State"/>
<o:SmartTagType namespaceuri="urn:schemas-microsoft-com:office:smarttags"
name="City"/>
<o:SmartTagType namespaceuri="urn:schemas-microsoft-com:office:smarttags"
name="Street"/>
<o:SmartTagType namespaceuri="urn:schemas-microsoft-com:office:smarttags"
name="address"/>
<o:SmartTagType namespaceuri="urn:schemas-microsoft-com:office:smarttags"
name="PlaceName"/>
<o:SmartTagType namespaceuri="urn:schemas-microsoft-com:office:smarttags"
name="place"/>
<o:SmartTagType namespaceuri="urn:schemas-microsoft-com:office:smarttags"
name="PersonName"/>
<!--[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;}
p
{margin:0pt;
margin-bottom:.0001pt;
font-size:12.0pt;
font-family:"Times New Roman";}
span.emailstyle17
{font-family:Arial;
color:navy;}
span.EmailStyle19
{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:1541472939;
mso-list-template-ids:-261972526;}
ol
{margin-bottom:0pt;}
ul
{margin-bottom:0pt;}
-->
</style>
</head>
<body lang=EN-US link=blue vlink=blue ocsi=x>
<div class=Section1>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Dear Abhay,<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Do you know someone in <st1:country-region
w:st="on"><st1:place w:st="on">Panama</st1:place></st1:country-region> who has
the RFH equipment to carry out the heat treatment ? I do believe in it and
said so in my previous messages.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>KP<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<div>
<div class=MsoNormal align=center style='text-align:center'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'>
<hr size=2 width="100%" align=center tabindex=-1>
</span></font></div>
<p class=MsoNormal><b><font size=2 face=Tahoma><span style='font-size:10.0pt;
font-family:Tahoma;font-weight:bold'>From:</span></font></b><font size=2
face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma'> Satoskar, Abhay
[mailto:Abhay.Satoskar@osumc.edu] <br>
<b><span style='font-weight:bold'>Sent:</span></b> Tuesday, July 26, 2011 5:35
AM<br>
<b><span style='font-weight:bold'>To:</span></b> Chang, Kwang-Poo; <st1:PersonName
w:st="on">Carlos Costa</st1:PersonName><br>
<b><span style='font-weight:bold'>Cc:</span></b> gzischke@thermosurgery.com;
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:
12.0pt'><o:p> </o:p></span></font></p>
<div>
<div>
<p class=MsoNormal><font size=2 color=black face=Tahoma><span style='font-size:
10.0pt;font-family:Tahoma;color:black'>KP<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=black face=Tahoma><span style='font-size:
10.0pt;font-family:Tahoma;color:black'>My suggestion would be RFH
treatment<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=black face=Tahoma><span style='font-size:
10.0pt;font-family:Tahoma;color:black'>of intralesional antimony twice a
week upto 6 doses<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=black face=Tahoma><span style='font-size:
10.0pt;font-family:Tahoma;color:black'>This works in L.tropica CL<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=black face=Tahoma><span style='font-size:
10.0pt;font-family:Tahoma;color:black'>abhay<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=black face=Tahoma><span style='font-size:
10.0pt;font-family:Tahoma;color:black'> <o:p></o:p></span></font></p>
</div>
<div>
<div>
<p class=MsoNormal><font size=2 color=black face=Tahoma><span style='font-size:
10.0pt;font-family:Tahoma;color:black'>Abhay R Satoskar MD, PhD<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=black face=Tahoma><span style='font-size:
10.0pt;font-family:Tahoma;color:black'>Professor<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=black face=Tahoma><span style='font-size:
10.0pt;font-family:Tahoma;color:black'>Departments of Pathology and
Microbiology<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=black face=Tahoma><span style='font-size:
10.0pt;font-family:Tahoma;color:black'>129 <st1:City w:st="on"><st1:place
w:st="on">Hamilton</st1:place></st1:City> Hall<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><st1:Street w:st="on"><st1:address w:st="on"><font size=2
color=black face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma;
color:black'>1645 Neil Avenue</span></font></st1:address></st1:Street><font
size=2 color=black face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma;
color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=black face=Tahoma><span style='font-size:
10.0pt;font-family:Tahoma;color:black'>The <st1:place w:st="on"><st1:PlaceName
w:st="on">Ohio</st1:PlaceName> <st1:PlaceType w:st="on">State</st1:PlaceType> <st1:PlaceType
w:st="on">University</st1:PlaceType></st1:place><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><st1:place w:st="on"><st1:City w:st="on"><font size=2
color=black face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma;
color:black'>Columbus</span></font></st1:City><font size=2 color=black
face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma;color:black'>, <st1:State
w:st="on">Ohio</st1:State></span></font></st1:place><font size=2 color=black
face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma;color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=black face=Tahoma><span style='font-size:
10.0pt;font-family:Tahoma;color:black'>Tel: 614-366-3417<o:p></o:p></span></font></p>
</div>
</div>
<div>
<p class=MsoNormal><font size=2 color=black face=Tahoma><span style='font-size:
10.0pt;font-family:Tahoma;color:black'> <o:p></o:p></span></font></p>
</div>
<div id=divRpF61649>
<div class=MsoNormal align=center style='text-align:center'><font size=2
color=black face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma;
color:black'>
<hr size=2 width="100%" align=center tabindex=-1>
</span></font></div>
<p class=MsoNormal style='margin-bottom:12.0pt'><b><font size=2 color=black
face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma;color:black;
font-weight:bold'>From:</span></font></b><font size=2 color=black face=Tahoma><span
style='font-size:10.0pt;font-family:Tahoma;color:black'> Chang, Kwang-Poo
[KwangPoo.Chang@rosalindfranklin.edu]<br>
<b><span style='font-weight:bold'>Sent:</span></b> Monday, July 25, 2011 2:58
PM<br>
<b><span style='font-weight:bold'>To:</span></b> <st1:PersonName w:st="on">Carlos
Costa</st1:PersonName><br>
<b><span style='font-weight:bold'>Cc:</span></b> gzischke@thermosurgery.com;
Satoskar, Abhay; 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<o:p></o:p></span></font></p>
</div>
<div>
<div>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>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>.</span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>I have only very sketchy information about
the case as follows:</span></font><font color=black><span style='color:black'><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
<ol style='margin-top:0pt' start=1 type=1>
<li class=MsoNormal style='color:navy;mso-list:l0 level1 lfo1'><font size=2
color=navy face=Arial><span style='font-size:10.0pt;font-family:Arial'>An
American young man has 2 skin lesions, one of which is on the abdomen. </span></font><o:p></o:p></li>
<li class=MsoNormal style='color:navy;mso-list:l0 level1 lfo1'><font size=2
color=navy face=Arial><span style='font-size:10.0pt;font-family:Arial'>He
was diagnosed to have cutaneous leishmaniasis</span></font> <o:p></o:p></li>
<li class=MsoNormal style='color:navy;mso-list:l0 level1 lfo1'><font size=2
color=navy face=Arial><span style='font-size:10.0pt;font-family:Arial'>A
course of 30-day intra-muscular injection of pentavalent antimony is
prescribed.</span></font> <o:p></o:p></li>
</ol>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>I wonder about the intramuscular instead
of intra-lesion antimony treatment and also the duration of the treatment for
30 days ?</span></font><font color=black><span style='color:black'><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Looking forward to hearing from you at
your earliest convenience.</span></font><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>KP</span></font><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
<div>
<div class=MsoNormal align=center style='text-align:center'><font size=3
color=black face="Times New Roman"><span style='font-size:12.0pt;color:black'>
<hr size=2 width="100%" align=center tabindex=-1>
</span></font></div>
<p class=MsoNormal><b><font size=2 color=black face=Tahoma><span
style='font-size:10.0pt;font-family:Tahoma;color:black;font-weight:bold'>From:</span></font></b><font
size=2 color=black face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma;
color:black'> <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><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
</div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=4 color=black face=Verdana><span
style='font-size:13.5pt;font-family:Verdana;color:black'>Hi Gena,</span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=4 color=black face=Verdana><span
style='font-size:13.5pt;font-family:Verdana;color:black'>Thanks a lot for your
offer. </span></font><font color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=4 color=black face=Verdana><span
style='font-size:13.5pt;font-family:Verdana;color:black'>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><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=4 color=black face=Verdana><span
style='font-size:13.5pt;font-family:Verdana;color:black'>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><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=4 color=black face=Verdana><span
style='font-size:13.5pt;font-family:Verdana;color:black'>My best regards,</span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=4 color=black face=Verdana><span
style='font-size:13.5pt;font-family:Verdana;color:black'>Carlos. </span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'>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>
<div>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>This is good to try.</span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>KP</span></font><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
<div>
<div class=MsoNormal align=center style='text-align:center'><font size=3
color=black face="Times New Roman"><span style='font-size:12.0pt;color:black'>
<hr size=2 width="100%" align=center>
</span></font></div>
<p class=MsoNormal><b><font size=2 color=black face=Tahoma><span
style='font-size:10.0pt;font-family:Tahoma;color:black;font-weight:bold'>From:</span></font></b><font
size=2 color=black face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma;
color:black'> <a href="mailto:gzischke@thermosurgery.com">gzischke@thermosurgery.com</a>
[mailto:<a href="mailto: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> <st1:PersonName w:st="on">Carlos
Costa</st1:PersonName>; Abhay Satoskar; John David; <a
href="mailto:generhedin@thermosurgery.com">generhedin@thermosurgery.com</a><br>
<b><span style='font-weight:bold'>Cc:</span></b> Josh Berman; <a
href="mailto:dagobertosilveira@superig.com.br">dagobertosilveira@superig.com.br</a>;
Raimunda Sampaio; Dorcas Lamounier Costa; Mark Nawacki; <a
href="mailto:jurbina@mac.com">jurbina@mac.com</a>; Pierre BUFFET; <a
href="mailto:joseanegodinho@yahoo.com.br">joseanegodinho@yahoo.com.br</a>;
Robert Vinson; Shyam Sundarmail; <a href="mailto: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><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
<div>
<div>
<p class=MsoNormal><font size=2 color=black face=Verdana><span
style='font-size:10.0pt;font-family:Verdana;color:black'>Dear Dr. Costas,</span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=black face=Verdana><span
style='font-size:10.0pt;font-family:Verdana;color:black'>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><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=black face=Verdana><span
style='font-size:10.0pt;font-family:Verdana;color:black'>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><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=black face=Verdana><span
style='font-size:10.0pt;font-family:Verdana;color:black'>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><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=black face=Verdana><span
style='font-size:10.0pt;font-family:Verdana;color:black'>Warm regards,</span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=black face=Verdana><span
style='font-size:10.0pt;font-family:Verdana;color:black'>gena</span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal style='margin-bottom:12.0pt'><font size=2 color=black
face=Verdana><span style='font-size:10.0pt;font-family:Verdana;color:black'>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><font color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<blockquote style='border:none;border-left:solid blue 1.0pt;padding:0pt 0pt 0pt 4.0pt;
margin-left:3.95pt;margin-top:5.0pt;margin-bottom:5.0pt'>
<div>
<p class=MsoNormal style='margin-bottom:12.0pt'><font size=2 color=black
face=Verdana><span style='font-size:10.0pt;font-family:Verdana;color:black'>--------
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">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">Jbe9320457@aol.com</a>>,
<a href="mailto:dagobertosilveira@superig.com.br">dagobertosilveira@superig.com.br</a>,<br>
Raimunda Sampaio <<a href="mailto:rsampaio@unb.br">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">mnawacki@paladinlabs.com</a>>,<br>
<a href="mailto:jurbina@mac.com">jurbina@mac.com</a>, Pierre BUFFET <<a
href="mailto:pierre.buffet@upmc.fr">pierre.buffet@upmc.fr</a>>,<br>
<a href="mailto:joseanegodinho@yahoo.com.br">joseanegodinho@yahoo.com.br</a>,
Robert Vinson <<a href="mailto:rvinson@paladinlabs.com">rvinson@paladinlabs.com</a>>,<br>
Shyam Sundarmail <<a href="mailto:Drshyamsundar@hotmail.com">Drshyamsundar@hotmail.com</a>>,<br>
<a href="mailto:robertobadaro768@gmail.com">robertobadaro768@gmail.com</a>,
Leish-L <<a href="mailto:Leish-l@lineu.icb.usp.br">Leish-l@lineu.icb.usp.br</a>>,
Fernando<br>
Koremblum <<a href="mailto: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><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
<div>
<p class=MsoNormal><font size=2 color=black face=Verdana><span
style='font-size:10.0pt;font-family:Verdana;color:black'>2011/7/10 Chang,
Kwang-Poo <<a href="mailto:KwangPoo.Chang@rosalindfranklin.edu">KwangPoo.Chang@rosalindfranklin.edu</a>></span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
<div>
<div>
<div>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Carlos will undoubtedly go with those,
which are clinically acceptable and feasible for the sake of expediency. </span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>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><font color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>KP</span></font><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<div class=MsoNormal align=center style='text-align:center'><font size=3
color=black face="Times New Roman"><span style='font-size:12.0pt;color:black'>
<hr size=2 width="100%" align=center>
</span></font></div>
<div>
<p class=MsoNormal><b><font size=2 color=black face=Tahoma><span
style='font-size:10.0pt;font-family:Tahoma;color:black;font-weight:bold'>From:</span></font></b><font
size=2 color=black face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma;
color:black'> <a href="mailto:leish-l-bounces@lineu.icb.usp.br">leish-l-bounces@lineu.icb.usp.br</a>
[mailto:<a href="mailto: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><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><font color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=black face=Tahoma><span style='font-size:
10.0pt;font-family:Tahoma;color:black'><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">dagobertosilveira@superig.com.br</a>;
Dorcas Lamounier Costa; <a href="mailto:jurbina@mac.com">jurbina@mac.com</a>;
Pierre BUFFET; Robert Vinson; Raimunda Sampaio; Shyam Sundarmail; <a
href="mailto:robertobadaro768@gmail.com">robertobadaro768@gmail.com</a>; Mark
Nawacki; Fernando Koremblum; <a href="mailto:joseanegodinho@yahoo.com.br">joseanegodinho@yahoo.com.br</a></span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<p class=MsoNormal><b><font size=2 color=black face=Tahoma><span
style='font-size:10.0pt;font-family:Tahoma;color:black;font-weight:bold'>Subject:</span></font></b><font
size=2 color=black face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma;
color:black'> Re: [Leish-l] miltefosine for diffuse leishmaniasis</span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=4 color=black face=Verdana><span
style='font-size:13.5pt;font-family:Verdana;color:black'>Dear friends,</span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=4 color=black face=Verdana><span
style='font-size:13.5pt;font-family:Verdana;color:black'>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><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=4 color=black face=Verdana><span
style='font-size:13.5pt;font-family:Verdana;color:black'>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><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=5 color=black face=Verdana><span
style='font-size:18.0pt;font-family:Verdana;color:black'>Let me summarize some
of the lessons and suggestions. Please correct me if I skip some.</span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=5 color=black face=Verdana><span
style='font-size:18.0pt;font-family:Verdana;color:black'>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><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=5 color=black face=Verdana><span
style='font-size:18.0pt;font-family:Verdana;color:black'>2) BCG - one or two
shots. We will do it. Any hint about the intervals between the shots?</span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=5 color=black face=Verdana><span
style='font-size:18.0pt;font-family:Verdana;color:black'>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><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=5 color=black face=Verdana><span
style='font-size:18.0pt;font-family:Verdana;color:black'>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><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=5 color=black face=Verdana><span
style='font-size:18.0pt;font-family:Verdana;color:black'>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><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=5 color=black face=Verdana><span
style='font-size:18.0pt;font-family:Verdana;color:black'>b) gamma-interferon
(who produces/sells it?).</span></font><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=5 color=black face=Verdana><span
style='font-size:18.0pt;font-family:Verdana;color:black'>c)
fluconazol/itraconazol/(voriconazol?).</span></font><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=5 color=black face=Verdana><span
style='font-size:18.0pt;font-family:Verdana;color:black'>d) amiodarone - <i><span
style='font-style:italic'>in vitro</span></i> testing does not sounds so good.</span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=5 color=black face=Verdana><span
style='font-size:18.0pt;font-family:Verdana;color:black'>e) topic imiquimod
(IxiumTM cream) - apparently easy to find. concentration of 5%?</span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=5 color=black face=Verdana><span
style='font-size:18.0pt;font-family:Verdana;color:black'>f) photodynamic
therapy - with Dr. Dagoberto Silveira, we are investigating where to do it
around.</span></font><font color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=5 color=black face=Verdana><span
style='font-size:18.0pt;font-family:Verdana;color:black'>g) immunotherapy with
suicide photo-inactivated <i><span style='font-style:italic'>Leishmania</span></i>
(KP Chang).</span></font><font color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=5 color=black face=Verdana><span
style='font-size:18.0pt;font-family:Verdana;color:black'>Please check what
really seems reasonable. My feeling is that most of the suggestions can be
tried.</span></font><font color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=5 color=black face=Verdana><span
style='font-size:18.0pt;font-family:Verdana;color:black'>My warmest regards,</span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=5 color=black face=Verdana><span
style='font-size:18.0pt;font-family:Verdana;color:black'>Carlos.</span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
</div>
<div>
<div style='margin-bottom:12.0pt'>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
<div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'>2011/7/8 Pierre BUFFET <<a
href="mailto:pierre.buffet@upmc.fr">pierre.buffet@upmc.fr</a>><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'>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">a.bryceson@doctors.org.uk</a>>
a écrit :<o:p></o:p></span></font></p>
</div>
<div>
<div>
<blockquote style='border:none;border-left:solid windowtext 1.0pt;padding:0pt 0pt 0pt 6.0pt;
margin-left:4.8pt;margin-top:5.0pt;margin-right:0pt;margin-bottom:5.0pt'>
<div style='margin-bottom:12.0pt'>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
<div style='margin-bottom:12.0pt'>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'>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">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:<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'>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">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><o:p></o:p></span></font></p>
</div>
<div style='margin-bottom:12.0pt'>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
</blockquote>
<div style='margin-bottom:12.0pt'>
<p class=MsoNormal style='margin-bottom:12.0pt'><font size=3 color=black
face="Times New Roman"><span style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
</div>
</div>
</div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'><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><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<div>
<p class=MsoNormal><b><font size=3 color=black face=Verdana><span
style='font-size:12.0pt;font-family:Verdana;color:black;font-weight:bold'>President</span></font></b><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><b><font size=3 color=black face=Verdana><span
style='font-size:12.0pt;font-family:Verdana;color:black;font-weight:bold'>Sociedade
Brasileira de Medicina Tropical </span></font></b><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><b><font size=3 color=black face=Verdana><span
style='font-size:12.0pt;font-family:Verdana;color:black;font-weight:bold'>(Brazilian
Society of Tropical Medicine)</span></font></b><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><b><font size=3 color=black face=Verdana><span
style='font-size:12.0pt;font-family:Verdana;color:black;font-weight:bold'>Instituto
de Doenças Tropicais Natan Portella<br>
Universidade Federal do Piauí</span></font></b><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<div>
<p class=MsoNormal><b><font size=3 color=black face=Verdana><span
style='font-size:12.0pt;font-family:Verdana;color:black;font-weight:bold'>Rua
Artur de Vasconcelos 151-Sul</span></font></b><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<div>
<div>
<p class=MsoNormal><b><font size=3 color=black face=Verdana><span
style='font-size:12.0pt;font-family:Verdana;color:black;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 size=2 color=black face=Verdana><span style='font-size:
10.0pt;font-family:Verdana;color:black'>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><font color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
</div>
<div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<p class=MsoNormal><font size=2 color=black face=Verdana><span
style='font-size:10.0pt;font-family:Verdana;color:black'><br>
<br clear=all>
<br>
-- <br>
<b><span style='font-weight:bold'>Carlos H. N. Costa, MD, DSc.</span></b></span></font><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
<div>
<p class=MsoNormal><b><font size=2 color=black face=Verdana><span
style='font-size:10.0pt;font-family:Verdana;color:black;font-weight:bold'>President</span></font></b><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><b><font size=2 color=black face=Verdana><span
style='font-size:10.0pt;font-family:Verdana;color:black;font-weight:bold'>Sociedade
Brasileira de Medicina Tropical </span></font></b><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><b><font size=2 color=black face=Verdana><span
style='font-size:10.0pt;font-family:Verdana;color:black;font-weight:bold'>(Brazilian
Society of Tropical Medicine)</span></font></b><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><b><font size=2 color=black face=Verdana><span
style='font-size:10.0pt;font-family:Verdana;color:black;font-weight:bold'>Instituto
de Doenças Tropicais Natan Portella<br>
Universidade Federal do Piauí</span></font></b><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
<div>
<p class=MsoNormal><b><font size=2 color=black face=Verdana><span
style='font-size:10.0pt;font-family:Verdana;color:black;font-weight:bold'>Rua
Artur de Vasconcelos 151-Sul</span></font></b><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><b><font size=2 color=black face=Verdana><span
style='font-size:10.0pt;font-family:Verdana;color:black;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 size=2 color=black face=Verdana><span style='font-size:
10.0pt;font-family:Verdana;color:black'><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><font color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
<div class=MsoNormal align=center style='text-align:center'><font size=2
color=black face=Verdana><span style='font-size:10.0pt;font-family:Verdana;
color:black'>
<hr size=2 width="100%" align=center>
</span></font></div>
<p class=MsoNormal><font size=2 color=black face=Verdana><span
style='font-size:10.0pt;font-family:Verdana;color:black'>_______________________________________________<br>
Leish-l mailing list<br>
<a href="mailto:Leish-l@lineu.icb.usp.br">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><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
</blockquote>
</div>
</div>
</div>
</div>
</div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'><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><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
<div>
<p class=MsoNormal><b><font size=3 color=black face=Verdana><span
style='font-size:12.0pt;font-family:Verdana;color:black;font-weight:bold'>President</span></font></b><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><b><font size=3 color=black face=Verdana><span
style='font-size:12.0pt;font-family:Verdana;color:black;font-weight:bold'>Sociedade
Brasileira de Medicina Tropical </span></font></b><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><b><font size=3 color=black face=Verdana><span
style='font-size:12.0pt;font-family:Verdana;color:black;font-weight:bold'>(Brazilian
Society of Tropical Medicine)</span></font></b><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><b><font size=3 color=black face=Verdana><span
style='font-size:12.0pt;font-family:Verdana;color:black;font-weight:bold'>Instituto
de Doenças Tropicais Natan Portella<br>
Universidade Federal do Piauí</span></font></b><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
<div>
<p class=MsoNormal><b><font size=3 color=black face=Verdana><span
style='font-size:12.0pt;font-family:Verdana;color:black;font-weight:bold'>Rua
Artur de Vasconcelos 151-Sul</span></font></b><font color=black><span
style='color:black'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><b><font size=3 color=black face=Verdana><span
style='font-size:12.0pt;font-family:Verdana;color:black;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 size=2 color=black face=Verdana><span style='font-size:
10.0pt;font-family:Verdana;color:black'>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><font
color=black><span style='color:black'><o:p></o:p></span></font></p>
</div>
</div>
<p class=MsoNormal><font size=3 color=black face="Times New Roman"><span
style='font-size:12.0pt;color:black'> <o:p></o:p></span></font></p>
</div>
</div>
</div>
</div>
</div>
</body>
</html>