<font color="#000000"><font><font face="verdana,sans-serif">Who knows what is the present legal situation of miltefosine in Brazil? <br></font></font></font><br><div class="gmail_quote">2012/4/17 Marco Tulio Antonio Garciazapata <span dir="ltr"><<a href="mailto:mctulianglobal@gmail.com">mctulianglobal@gmail.com</a>></span><br>
<blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex"><font size="3" face="Times New Roman">
</font><p style="margin:0cm 0cm 0pt;text-align:justify;line-height:normal" class="MsoNormal"><span lang="EN-US"><font size="3"><font face="Calibri">Kleber,</font></font></span></p><font size="3" face="Times New Roman">
</font><p style="margin:0cm 0cm 0pt;text-align:justify;line-height:normal" class="MsoNormal"><span lang="EN-US"><font size="3" face="Calibri"> </font></span></p><font size="3" face="Times New Roman">
</font><p style="background:white;margin:0cm 0cm 0pt;text-align:justify;line-height:normal" class="MsoNormal"><font face="Calibri"><font size="3"><span><span style="color:rgb(51,51,51)" lang="EN">Through</span></span><span style="color:rgb(51,51,51)" lang="EN"> <span>cyber</span> <span>and</span> by <span>courtesy
of</span> <strong><span>Jenny</span> <span>F</span> <span>Laskarzewsky</span></strong>, Pharm. </span><span><span style="color:rgb(51,51,51)" lang="EN-US">D</span></span><span style="color:rgb(51,51,51)" lang="EN-US">,
BCPS</span> </font><span style="color:rgb(51,51,51);font-size:8pt" lang="EN-US">(Clinical
Pharmacist at San Ramon Regional Medical Center / </span><span><span style="color:rgb(51,51,51);font-size:8pt" lang="EN">San Francisco Bay</span></span><span style="color:rgb(51,51,51);font-size:8pt" lang="EN"> <span>Region</span>,
United States) </span><font size="3"><span><span style="color:rgb(51,51,51)" lang="EN">have just received</span></span><span style="color:rgb(51,51,51)" lang="EN"> <span>another</span> <span>information that</span> <span>may</span> <span>be of interest</span> </span><span lang="EN-US">an
unrandomized trial <span style="background:aqua">"Treatment
of Bolivian mucosal leishmaniasis with miltefosine"</span> </span></font><span style="font-size:8pt" lang="EN-US">(<b><span style="color:rgb(0,51,204)">Soto J, et al Clinical Infectious Diseases.
2007;44(3);350)</span></b></span><span lang="EN-US"><font size="3"> concluded that the cure rate for
<font color="#3333ff" size="6"><strong>miltefosine</strong></font> </font></span><span style="font-size:8pt" lang="EN-US">(<b><span style="color:rgb(0,51,204)">2.5 mg/kg/day
(Max=150 mg/day) for 28 days</span></b>) </span><span lang="EN-US"><font size="3">was equivalent
to parenteral Amphotericin B, with its toxicity profile is far superior to that
of amphotericin B.<span> </span></font></span></font></p><div class="im"><font size="3" face="Times New Roman">
</font><p style="margin:0cm 0cm 0pt;text-align:center;line-height:normal" class="MsoNormal" align="center"><span lang="EN-US"><font size="3" face="Calibri"> </font></span></p><font size="3" face="Times New Roman">
</font><p style="margin:0cm 0cm 0pt;text-align:center;line-height:normal" class="MsoNormal" align="center"><span lang="EN-US"><font size="3"><font face="Calibri"><strong>Prof. Marco Tulio A Garcia-Zapata, MD, PhD</strong></font></font></span></p>
<font size="3" face="Times New Roman">
</font><p style="margin:0cm 0cm 0pt;text-align:center;line-height:normal" class="MsoNormal" align="center"><span style="font-size:8pt" lang="EN-US"><font face="Calibri">Medical
Tropicalist / Head Professor / Principal Researcher</font></span></p><font size="3" face="Times New Roman">
</font><p style="margin:0cm 0cm 0pt;text-align:center;line-height:normal" class="MsoNormal" align="center"><span style="font-size:8pt" lang="EN-US"><font face="Calibri">Tropical
Medicine & Dermatology Department (DMTD)</font></span></p><font size="3" face="Times New Roman">
</font><p style="margin:0cm 0cm 0pt;text-align:center;line-height:normal" class="MsoNormal" align="center"><span style="font-size:8pt" lang="EN-US"><font face="Calibri">Center
for Studies and Research in (Re)Emerging Diseases (NUPEREME)</font></span></p><font size="3" face="Times New Roman">
</font><p style="margin:0cm 0cm 0pt;text-align:center;line-height:normal" class="MsoNormal" align="center"><span style="font-size:8pt" lang="EN-US"><font face="Calibri">Reference
Sentry for International and Travel Medicine (USCREMIVI)</font></span></p><font size="3" face="Times New Roman">
</font><p style="margin:0cm 0cm 0pt;text-align:center;line-height:normal" class="MsoNormal" align="center"><span style="font-size:8pt" lang="EN-US"><font face="Calibri"> </font></span></p><font size="3" face="Times New Roman">
</font><p style="margin:0cm 0cm 0pt;text-align:center;line-height:normal" class="MsoNormal" align="center"><span style="font-size:8pt"><font face="Calibri">Caixa Postal 12911
- Setor Leste Vila Nova</font></span></p><font size="3" face="Times New Roman">
</font><p style="margin:0cm 0cm 0pt;text-align:center;line-height:normal" class="MsoNormal" align="center"><span style="font-size:8pt" lang="EN-US"><font face="Calibri">Goiania
- GO, 74643-970, Brazil</font></span></p><font size="3" face="Times New Roman">
</font><p style="margin:0cm 0cm 0pt;text-align:center;line-height:normal" class="MsoNormal" align="center"><span style="font-size:8pt" lang="EN-US"><font face="Calibri">Phone(=<a href="tel:62%293269-8219" value="+16232698219" target="_blank">62)3269-8219</a>,
Fax <a href="tel:%28%2B62%293521-1839" value="+6235211839" target="_blank">(+62)3521-1839</a></font></span></p><font size="3" face="Times New Roman">
</font><p style="margin:0cm 0cm 0pt;text-align:center;line-height:normal" class="MsoNormal" align="center"><span style="font-size:8pt"><font face="Calibri">E-mail:
<a href="mailto:nupereme@gmail.com" target="_blank">nupereme@gmail.com</a> </font></span></p><font size="3" face="Times New Roman">
</font><div style="margin:0cm 0cm 0pt;text-align:center;line-height:normal" class="MsoNormal" align="center"><span style="font-size:8pt"><font face="Calibri"><a href="mailto:medicinadeviagem.hc.hdt@gmail.com" target="_blank">medicinadeviagem.hc.hdt@gmail.com</a> </font></span></div>
<div style="margin:0cm 0cm 0pt;text-align:center;line-height:normal" class="MsoNormal" align="center"><span style="font-size:8pt"><font face="Calibri"><a href="mailto:mctulianglobal@gmail.com" target="_blank">mctulianglobal@gmail.com</a> </font></span></div>
</div><p style="text-align:center"><font size="3" face="Times New Roman">
</font><br><font size="6">***************</font><br></p><div class="im"><div class="gmail_quote">2012/4/15 Marco Tulio Antonio Garciazapata <span dir="ltr"><<a href="mailto:mctulianglobal@gmail.com" target="_blank">mctulianglobal@gmail.com</a>></span><br>
</div></div><blockquote style="margin:0px 0px 0px 0.8ex;padding-left:1ex;border-left-color:rgb(204,204,204);border-left-width:1px;border-left-style:solid" class="gmail_quote"><div class="im"><div>Kleber,</div><div> </div>
<div><span>Your case</span> <span>can be</span> <span>a</span> <span>"</span><span>Record"</span> <span>in the literature.</span> W<span>e have to</span> <span>offer some kind of</span> <span>solution and</span> <span>quickly.</span> Due<span> we do not</span> <span>have much experience</span> <span>in the treatment</span> <span>of leishmaniasis</span> <span>in the elderly population</span><span>.</span> <span>Worried</span><span>, I</span><span> found that</span> <span>there are</span> <span>few studies</span> <span>that deal with</span> <span>the issue</span><span>.</span></div>
<span></span><div><br> <span>It is well</span> <span>known</span> <span>effectiveness</span> <span>in the treatment</span> <span>of leishmaniasis</span><span>,</span> <span>in general, with</span> <span>the group of</span> <span>antimonial</span> <span>drugs</span> <span>and /</span> <span>or</span> <span>derivatives</span> <span>of amphotericin B</span><span>,</span> <span>but without</span> <span>doubt,</span> <span>are very</span> <span>toxic and</span> <span>not recommended</span> <span>in these patients</span><span>.</span></div>
<span></span><div><br> <span>In the treatment of</span> <span>invasive fungal infections</span> <span>in the elderly</span> <font size="1"><span>(</span><span>Aging and</span> <span>infectious diseases</span><span>, 15 August, CID</span> <span>2001:33</span><span>)</span></font><span><font size="1">,</font> <strong>lipid formulations of</strong></span><strong> <span>amphotericin</span> <span>B</span></strong> <font size="1"><span>(</span><span>liposome/"Ambisome"</span><span>,</span> <span>lipid complex/"Abelcet" and</span> <span>colloidal dispersion</span> <span>B/"Amphotec" or "Amphocil"</span><span>)</span><span>,</span></font> <span>would be</span> the drugs <span>recommended</span><span>,</span> <span>but at</span> <span>high cost</span><span>,</span> <span>are not</span> <span>the</span> <span>choice</span><span>.</span> E<span>xpected</span> <span>in the coming</span> <span>years, the</span> goianan <span>pharmaceutical industry</span> <span>available at the</span> national<span> market</span> <span>such</span> <span>formulations</span> <span>result of</span> <span>promising</span> <span>studies</span> <span>in nanotechnology</span> <span>made by</span> <span>Faculty of Pharmacy /</span> <span>Federal University of Goias, Brazil</span><span>.</span></div>
<span></span></div><div><br> <span>In this case</span> <span>the recommendation</span> <span>is to use</span> <span><strong><font size="4">alternative drug</font></strong></span><span>, in spite</span> <span>of being</span> <span>less toxic and</span> <span>less effective,</span> <span>can be</span> <span>invaluable</span> <span>in such</span> <span>patients.</span> <font color="#3333ff"><strong><span>"</span><span>Primum non</span> <span>nocere"!!!</span></strong></font> <span>Draws</span> <span>attention to</span> <span>the</span> <span>subject with</span> <span>very little experience</span> <span>using</span> <span><strong><font size="4">MILTEFOSINE</font></strong></span><span>, the 1st</span> <span>anti</span><span>-</span><span>leishmania</span> <span>drugs</span> <span>more effective</span> <span>oral</span> <font size="1"><span>(Expert</span> <span>Review of</span> <span>Anti</span><span>-</span><span>infective</span> <span>Therapy</span><span>, April</span> <span>2006</span><span>,</span> <span>Vol</span> <span>4</span><span>, No. 2</span><span>, Pages</span> <span>177-185</span><span>)</span></font>. <span>But</span> <span>I found</span> <span>a review</span> <span>in this sense</span> <font size="1"><span>(Am.</span> <span>J.</span> <span>Trop</span><span>.</span> <span>Hyg</span><span>.</span><span>,</span> <span>78 (5)</span><span>,</span> <span>2008</span><span>, p</span><span>.</span> <span>745-749</span><span>)</span></font> <span>and mainly a report</span> <span>of</span> <span>three</span> <span>cases in the</span> "<span>Triangulo Mineiro"</span> <span>-</span> <span>MG</span><span>, Brazil,</span> of unforgettable <span>Prof.</span> <span>Aluizio Prata (RIP)</span> <span>who along with</span> <span>Mario</span> <span>Leon</span> <font size="1"><span>(</span><span>Rev.</span> <span>Inst</span><span>.</span> <span>Trop.</span> <span>S.</span> <span>Paulo</span><span>, May-</span><span>June,</span> <span>200,</span> <span>46</span> <span>(</span><span>3</span><span>)</span> <span>:175</span><span>-</span><span>177</span><span>)</span></font> <span>successfully used</span><span>,</span> <strong><font color="#3333ff" size="4">AZITHROMYCIN</font></strong> <span>(500</span> <span>mg/dia/10</span> <span>days</span> <span>oral) in</span> <span>patients aged</span> <span>76-80</span> <span>years of age.</span><div class="im">
<br>
<br> <span>Hopefully</span> <span>this information can</span> <span>help you</span><span>.</span></div></div><div class="im"><div><span></span> </div><div><span>Best regards,</span></div><div><span></span> </div>
<div style="text-align:center"><span><strong>Prof. Marco Tulio A Garcia-Zapata, MD, PhD</strong></span></div><div style="text-align:center"><span><font size="1"><strong>Medical Tropicalist / Head Professor / Principal Researcher</strong></font></span></div>
<div style="text-align:center"><span><font size="1">Tropical Medicine & Dermatology Department (DMTD)</font></span></div><div style="text-align:center"><span><font size="1"><span>Center for Studies</span> <span>and Research in</span> (Re)Emerging Diseases (NUPEREME)</font></span></div>
</div><div style="text-align:center"><span><font size="1">Reference Sentry Unit for International and Travel Medicine (USCREMIVI)</font></span></div><div style="text-align:center"><span><font size="1">Teaching Hospital / Tropical Pathology & Public Health Institute (IPTSP)</font></span></div>
</blockquote><div style="text-align:center"><font size="1">Federal University of Goias, Brazil (<span>UFG)</span></font></div><div class="HOEnZb"><div class="h5"><blockquote style="margin:0px 0px 0px 0.8ex;padding-left:1ex;border-left-color:rgb(204,204,204);border-left-width:1px;border-left-style:solid" class="gmail_quote">
<div style="text-align:center"><span><font size="1"></font></span> </div><div style="text-align:center">
<span><font size="1">Caixa Postal 12911 - Setor Leste Vila Nova</font></span></div><div style="text-align:center"><span><font size="1">Goiania - GO, 74643-970, Brazil</font></span></div><div style="text-align:center"><span><font size="1">Phone(=<a href="tel:62%293269-8219" value="+16232698219" target="_blank">62)3269-8219</a>, Fax <a href="tel:%28%2B62%293521-1839" value="+6235211839" target="_blank">(+62)3521-1839</a></font></span></div>
<div style="text-align:center"><span><font size="1">E-mail: <a href="mailto:nupereme@gmail.com" target="_blank">nupereme@gmail.com</a> </font></span></div><div style="text-align:center"><span><font size="1"><a href="mailto:medicinadeviagem.hc.hdt@gmail.com" target="_blank">medicinadeviagem.hc.hdt@gmail.com</a></font></span></div>
<div style="text-align:center"><span><font size="1"> <a href="mailto:mctulianglobal@gmail.com" target="_blank">mctulianglobal@gmail.com</a></font></span></div><div style="text-align:center"><span><font size="1"></font></span> </div>
<div>
<span></span> </div><div><span></span> </div><div><br><br></div><div class="gmail_quote">2012/4/9 Kleber Luz <span dir="ltr"><<a href="mailto:klebergluz@gmail.com" target="_blank">klebergluz@gmail.com</a>></span><br>
<blockquote style="margin:0px 0px 0px 0.8ex;padding-left:1ex;border-left-color:rgb(204,204,204);border-left-width:1px;border-left-style:solid" class="gmail_quote"><div><div>
Hello every body! Today i had done a diagnose of VL in a patient 92 y old, test fast test was positive and the bone marrow aspireted was positive with a lot of leishmanias. Does anyone had a patient like this. He was HIV negative.<span><font color="#888888"><br clear="all">
<br>-- <br>Prof.Adjunto III - Kleber Giovanni Luz - DEPARTAMENTO DE INFECTOLOGIA/UFRN/HOSPITAL GISELDA TRIGUEIRO<br>
Rua Cônego Monte, 110 - QUINTAS<br>CEP 59037-170<br>NATAL-RN<br><b>FONE (FAX): <a value="+18432151603">(84) - 3215-1603</a><br>FONE: <a value="+18432327948">(84) - 3232-7948</a><br>CEL: (84) - 9193 - 6208</b><br> <div style="display:inline">
</div><br>
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<br></blockquote></div><br><br clear="all"><div><br></div>-- <br><div style="text-align:left"><span style="font-family:verdana,sans-serif">Carlos H. N. Costa, MD, DSc.</span></div><div style="text-align:left"><span style="font-family:verdana,sans-serif">Sociedade Brasileira de Medicina Tropical </span></div>
<div style="text-align:left"><span style="font-family:verdana,sans-serif"></span><span style="font-family:verdana,sans-serif">(Brazilian Society of Tropical Medicine)</span></div><div style="text-align:left"><span style="font-family:verdana,sans-serif">President</span></div>
<div style="text-align:left"><span style="font-family:verdana,sans-serif"><br></span></div><div style="text-align:left"><span style="font-family:verdana,sans-serif">Universidade Federal do Piauí</span></div><div><div style="text-align:left">
<span style="font-family:verdana,sans-serif">Instituto de Doenças Tropicais Natan Portella</span></div><div style="text-align:left"><font face="verdana, sans-serif">Rua Artur de Vasconcelos 151-Sul</font></div><div><div style="text-align:left">
<span style="font-family:verdana,sans-serif">64001-450 Teresina-PI</span></div><font face="verdana, sans-serif"><div style="text-align:left">Brazil</div><div style="text-align:left">Telephones: +55 86 3222-4377 (W), <div style="text-align:center;display:inline!important">
<div style="text-align:center;display:inline!important">+55 86 3221-3062 (W), </div></div><div style="text-align:center;display:inline!important">+55 86 3237-1075 (R). </div></div><div style="text-align:left"><br></div><div style="text-align:left">
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