<div><font class="Apple-style-span" face="verdana, sans-serif" size="4">Dear all</font><span class="Apple-style-span" style="font-family: verdana, sans-serif; font-size: large; "> those who are following and helping the patient Mrs. Cleudimar with diffuse leishmaniasis, in Brazil,</span></div>
<div><font class="Apple-style-span" face="verdana, sans-serif" size="4"><br></font></div><div><font class="Apple-style-span" face="verdana, sans-serif" size="4">She is clinically stable both in respect to leishmaniasis and to the renal failure, but has not started the treatment yet.</font></div>
<div><font class="Apple-style-span" face="verdana, sans-serif" size="4"><br></font></div><div><font class="Apple-style-span" face="verdana, sans-serif" size="4">According to many suggestions, mostly from Dr. Anthony Bryceson, but also from so many others, the protocol has been set as:</font></div>
<div><font class="Apple-style-span" face="verdana, sans-serif" size="4"><br></font></div><div><font class="Apple-style-span" face="verdana, sans-serif" size="4">1. To combine miltefosine with paramomycin for prolonged therapy.</font></div>
<div><font class="Apple-style-span" face="verdana, sans-serif" size="4">2. To use heat therapy as adjuvant by: a) heating by radiofrequency and b) using sauna.</font></div><div><font class="Apple-style-span" face="verdana, sans-serif" size="4"><br>
</font></div><div><font class="Apple-style-span" face="verdana, sans-serif" size="4">We already received miltefosine, gently donated by Paladin (with the help pf Fernando Koreblum, and others), shipped from Germany by Daniella Schreiner, from Germany, and from Ivan Velez, from Colombia. (However, just for three months - we will need much more for a prolonged therapy).</font></div>
<div><font class="Apple-style-span" face="verdana, sans-serif" size="4"><br></font></div><div><font class="Apple-style-span" face="verdana, sans-serif" size="4">After the contact with the Institute of One Health (Richard Chin, Raj Shankar Ghosh, Philippe Desjeux among so many) the batch of paramomycin will be produced this November by Gland Pharma and gently shipped from India to Brazil by </font><span class="Apple-style-span" style="font-family: verdana, sans-serif; font-size: large; ">Pritu Dalaria</span><span class="Apple-style-span" style="font-family: verdana, sans-serif; font-size: large; ">.</span></div>
<div><span class="Apple-style-span" style="font-family: verdana, sans-serif; font-size: large; "><br></span></div><div><span class="Apple-style-span" style="font-family: verdana, sans-serif; font-size: large; ">Thermosurgery Technologies already sent the instrument and it is ready to use. Hopefully, we will start tomorrow. The mediation by John David an</span><font class="Apple-style-span" size="4" face="verdana, sans-serif">d <span class="Apple-style-span" style="background-color: rgb(255, 255, 255); ">Gena Zischke was decisive. I found in the internet a portable sauna which I already bought with the help of donations from the participants of the Meeting of Applied Research in Leishmaniasis, in Uberaba, Brazil, and from Rotary Club, Teresina, Brazil.</span></font></div>
<div><font class="Apple-style-span" size="4" face="verdana, sans-serif"><span class="Apple-style-span" style="background-color: rgb(255, 255, 255); "><br></span></font></div><div><font class="Apple-style-span" size="4" face="verdana, sans-serif"><span class="Apple-style-span" style="background-color: rgb(255, 255, 255); ">The Brazilian Government with the actions led by Dr. Jarbas Barbosa has strongly supported this salvage therapy, and which has been decisive to get the drugs and equipment in Brazil.</span></font></div>
<div><font class="Apple-style-span" size="4" face="verdana, sans-serif"><span class="Apple-style-span" style="background-color: rgb(255, 255, 255); "><br></span></font></div><div><font class="Apple-style-span" size="4" face="verdana, sans-serif"><span class="Apple-style-span" style="background-color: rgb(255, 255, 255); ">After everything is set, let's cross fingers for the good luck of Mrs Cleudimar.</span></font></div>
<div><font class="Apple-style-span" size="4" face="verdana, sans-serif"><span class="Apple-style-span" style="background-color: rgb(255, 255, 255); "><br></span></font></div><div><font class="Apple-style-span" size="4" face="verdana, sans-serif"><span class="Apple-style-span" style="background-color: rgb(255, 255, 255); ">How decisive Leish-L has shown to be. Looks like a new important route, outside the formal paths, that should be explored more frequently for humanitarian actions.</span></font></div>
<div><font class="Apple-style-span" face="verdana, sans-serif" size="4"><br></font></div><div><font class="Apple-style-span" face="verdana, sans-serif" size="4">Best wishes and thanks to all,</font></div><div><font class="Apple-style-span" face="verdana, sans-serif" size="4"><br>
</font></div><div><font class="Apple-style-span" face="verdana, sans-serif" size="4">Carlos.</font></div><div><font class="Apple-style-span" face="verdana, sans-serif" size="4"><br></font></div><div><font class="Apple-style-span" face="verdana, sans-serif" size="4"><br>
</font><div><div><br></div>-- <br><div style="text-align:center"><span style="font-family:verdana, sans-serif"><b>Carlos H. N. Costa, MD, DSc.</b></span></div><div style="text-align:center"><span style="font-family:verdana, sans-serif"><b>Sociedade Brasileira de Medicina Tropical </b></span></div>
<div style="text-align:center"><b><span style="font-family:verdana, sans-serif"></span></b><span style="font-family:verdana, sans-serif"><b>(Brazilian Society of Tropical Medicine)</b></span></div><div style="text-align:center">
<span style="font-family:verdana, sans-serif"><b>President</b></span></div><div style="text-align:center"><span style="font-family:verdana, sans-serif"><b><br></b></span></div><div style="text-align:center"><span style="font-family:verdana, sans-serif"><b>Universidade Federal do Piauí</b></span></div>
<div><div style="text-align:center"><span style="font-family:verdana, sans-serif"><b>Instituto de Doenças Tropicais Natan Portella</b></span></div><div style="text-align:center"><font face="verdana, sans-serif"><b>Rua Artur de Vasconcelos 151-Sul</b></font></div>
<div><div style="text-align:center"><span style="font-family:verdana, sans-serif"><b>64001-450 Teresina-PI</b></span></div><font face="verdana, sans-serif"><div style="text-align:center"><b>Brazil</b></div><b><div style="text-align:center">
<span style="font-weight:normal"><b>Telephones: +55 86 3221-3413 (work); +55 86 8838-3303 (mobile).</b></span></div></b><div style="text-align:center"><br></div><span style="font-size:x-small"><div style="text-align:center">
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