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</o:shapelayout></xml><![endif]--></head><body lang=PT-BR link=blue vlink=purple><div class=WordSection1><p class=MsoNormal><span style='font-size:14.0pt;font-family:"Calibri","sans-serif"'>Dear Marco Tulio and Kleber and colleagues<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:14.0pt;font-family:"Calibri","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:14.0pt;font-family:"Calibri","sans-serif"'>Regarding the work of Soto with miltefosine, 2007, I believe that this has serious methodological errors, such opinions are published on this Article - Mucosal leishmaniasis and miltefosine Tuon FF, Amato VS Clin Infect Dis. 2007 Jun 1, 44 (11) :1525-6; author reply 1526-7. I suggest that a patient would be possibility for this low-dose liposomal amphotericin as 2mg/kg, for longer time than usual.<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:14.0pt;font-family:"Calibri","sans-serif"'>Best regards<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:14.0pt;font-family:"Calibri","sans-serif"'>Valdir Amato<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:14.0pt;font-family:"Calibri","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>De:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> tropmed-l-bounces@lineu.icb.usp.br [mailto:tropmed-l-bounces@lineu.icb.usp.br] <b>Em nome de </b>Carlos Costa<br><b>Enviada em:</b> sábado, 21 de abril de 2012 08:36<br><b>Para:</b> Marco Tulio Antonio Garciazapata<br><b>Cc:</b> tropmed-L@lineu.icb.usp.br<br><b>Assunto:</b> Re: [Tropmed-l] LV patiente 92y old<o:p></o:p></span></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal style='margin-bottom:12.0pt'><span style='font-family:"Verdana","sans-serif";color:black'>Who knows what is the present legal situation of miltefosine in Brazil? </span><o:p></o:p></p><div><p class=MsoNormal>2012/4/17 Marco Tulio Antonio Garciazapata <<a href="mailto:mctulianglobal@gmail.com">mctulianglobal@gmail.com</a>><o:p></o:p></p><p class=MsoNormal style='text-align:justify'><span lang=EN-US style='font-family:"Calibri","sans-serif"'>Kleber,</span><o:p></o:p></p><p class=MsoNormal style='text-align:justify'><span lang=EN-US style='font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p><p class=MsoNormal style='text-align:justify;background:white'><span lang=EN style='font-family:"Calibri","sans-serif";color:#333333'>Through cyber and by courtesy of <strong><span style='font-family:"Calibri","sans-serif"'>Jenny F Laskarzewsky</span></strong>, Pharm. </span><span lang=EN-US style='font-family:"Calibri","sans-serif";color:#333333'>D, BCPS</span><span lang=EN-US style='font-family:"Calibri","sans-serif"'> </span><span lang=EN-US style='font-size:8.0pt;font-family:"Calibri","sans-serif";color:#333333'>(Clinical Pharmacist at San Ramon Regional Medical Center / </span><span lang=EN style='font-size:8.0pt;font-family:"Calibri","sans-serif";color:#333333'>San Francisco Bay Region, United States) </span><span lang=EN style='font-family:"Calibri","sans-serif";color:#333333'>have just received another information that may be of interest </span><span lang=EN-US style='font-family:"Calibri","sans-serif"'>an unrandomized trial <span style='background:aqua'>"Treatment of Bolivian mucosal leishmaniasis with miltefosine"</span> </span><span lang=EN-US style='font-size:8.0pt;font-family:"Calibri","sans-serif"'>(<b><span style='color:#0033CC'>Soto J, et al Clinical Infectious Diseases. 2007;44(3);350)</span></b></span><span lang=EN-US style='font-family:"Calibri","sans-serif"'> concluded that the cure rate for </span><strong><span lang=EN-US style='font-size:24.0pt;font-family:"Calibri","sans-serif";color:#3333FF'>miltefosine</span></strong><span lang=EN-US style='font-family:"Calibri","sans-serif"'> </span><span lang=EN-US style='font-size:8.0pt;font-family:"Calibri","sans-serif"'>(<b><span style='color:#0033CC'>2.5 mg/kg/day (Max=150 mg/day) for 28 days</span></b>) </span><span lang=EN-US style='font-family:"Calibri","sans-serif"'>was equivalent to parenteral Amphotericin B, with its toxicity profile is far superior to that of amphotericin B. </span><o:p></o:p></p><div><p class=MsoNormal align=center style='text-align:center'><span lang=EN-US style='font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><strong><span lang=EN-US style='font-family:"Calibri","sans-serif"'>Prof. Marco Tulio A Garcia-Zapata, MD, PhD</span></strong><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span lang=EN-US style='font-size:8.0pt;font-family:"Calibri","sans-serif"'>Medical Tropicalist / Head Professor / Principal Researcher</span><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span lang=EN-US style='font-size:8.0pt;font-family:"Calibri","sans-serif"'>Tropical Medicine & Dermatology Department (DMTD)</span><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span lang=EN-US style='font-size:8.0pt;font-family:"Calibri","sans-serif"'>Center for Studies and Research in (Re)Emerging Diseases (NUPEREME)</span><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span lang=EN-US style='font-size:8.0pt;font-family:"Calibri","sans-serif"'>Reference Sentry for International and Travel Medicine (USCREMIVI)</span><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span lang=EN-US style='font-size:8.0pt;font-family:"Calibri","sans-serif"'> </span><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span style='font-size:8.0pt;font-family:"Calibri","sans-serif"'>Caixa Postal 12911 - Setor Leste Vila Nova</span><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span lang=EN-US style='font-size:8.0pt;font-family:"Calibri","sans-serif"'>Goiania - GO, 74643-970, Brazil</span><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span lang=EN-US style='font-size:8.0pt;font-family:"Calibri","sans-serif"'>Phone(=<a href="tel:62%293269-8219" target="_blank">62)3269-8219</a>, Fax <a href="tel:%28%2B62%293521-1839" target="_blank">(+62)3521-1839</a></span><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span style='font-size:8.0pt;font-family:"Calibri","sans-serif"'>E-mail: <a href="mailto:nupereme@gmail.com" target="_blank">nupereme@gmail.com</a> </span><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span style='font-size:8.0pt;font-family:"Calibri","sans-serif"'><a href="mailto:medicinadeviagem.hc.hdt@gmail.com" target="_blank">medicinadeviagem.hc.hdt@gmail.com</a> </span><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span style='font-size:8.0pt;font-family:"Calibri","sans-serif"'><a href="mailto:mctulianglobal@gmail.com" target="_blank">mctulianglobal@gmail.com</a> </span><o:p></o:p></p></div><p align=center style='text-align:center'><br><span style='font-size:24.0pt'>***************</span><o:p></o:p></p><div><div><p class=MsoNormal>2012/4/15 Marco Tulio Antonio Garciazapata <<a href="mailto:mctulianglobal@gmail.com" target="_blank">mctulianglobal@gmail.com</a>><o:p></o:p></p></div></div><blockquote style='border:none;border-left:solid #CCCCCC 1.0pt;padding:0cm 0cm 0cm 6.0pt;margin-left:4.8pt;margin-right:0cm'><div><div><p class=MsoNormal>Kleber,<o:p></o:p></p></div><div><p class=MsoNormal> <o:p></o:p></p></div><div><p class=MsoNormal>Your case can be a "Record" in the literature. We have to offer some kind of solution and quickly. Due we do not have much experience in the treatment of leishmaniasis in the elderly population. Worried, I found that there are few studies that deal with the issue.<o:p></o:p></p></div><div><p class=MsoNormal><br> It is well known effectiveness in the treatment of leishmaniasis, in general, with the group of antimonial drugs and / or derivatives of amphotericin B, but without doubt, are very toxic and not recommended in these patients.<o:p></o:p></p></div><div><p class=MsoNormal><br> In the treatment of invasive fungal infections in the elderly <span style='font-size:7.5pt'>(Aging and infectious diseases, 15 August, CID 2001:33),</span> <strong>lipid formulations of amphotericin B</strong> <span style='font-size:7.5pt'>(liposome/"Ambisome", lipid complex/"Abelcet" and colloidal dispersion B/"Amphotec" or "Amphocil"),</span> would be the drugs recommended, but at high cost, are not the choice. Expected in the coming years, the goianan pharmaceutical industry available at the national market such formulations result of promising studies in nanotechnology made by Faculty of Pharmacy / Federal University of Goias, Brazil.<o:p></o:p></p></div></div><div><p class=MsoNormal><br> In this case the recommendation is to use <strong><span style='font-size:13.5pt'>alternative drug</span></strong>, in spite of being less toxic and less effective, can be invaluable in such patients. <strong><span style='color:#3333FF'>"Primum non nocere"!!!</span></strong> Draws attention to the subject with very little experience using <strong><span style='font-size:13.5pt'>MILTEFOSINE</span></strong>, the 1st anti-leishmania drugs more effective oral <span style='font-size:7.5pt'>(Expert Review of Anti-infective Therapy, April 2006, Vol 4, No. 2, Pages 177-185)</span>. But I found a review in this sense <span style='font-size:7.5pt'>(Am. J. Trop. Hyg., 78 (5), 2008, p. 745-749)</span> and mainly a report of three cases in the "Triangulo Mineiro" - MG, Brazil, of unforgettable Prof. Aluizio Prata (RIP) who along with Mario Leon <span style='font-size:7.5pt'>(Rev. Inst. Trop. S. Paulo, May-June, 200, 46 (3) :175-177)</span> successfully used, <strong><span style='font-size:13.5pt;color:#3333FF'>AZITHROMYCIN</span></strong> (500 mg/dia/10 days oral) in patients aged 76-80 years of age.<o:p></o:p></p><div><p class=MsoNormal><br><br>Hopefully this information can help you.<o:p></o:p></p></div></div><div><div><p class=MsoNormal> <o:p></o:p></p></div><div><p class=MsoNormal>Best regards,<o:p></o:p></p></div><div><p class=MsoNormal> <o:p></o:p></p></div><p class=MsoNormal align=center style='text-align:center'><strong>Prof. Marco Tulio A Garcia-Zapata, MD, PhD</strong><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><strong><span style='font-size:7.5pt'>Medical Tropicalist / Head Professor / Principal Researcher</span></strong><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>Tropical Medicine & Dermatology Department (DMTD)</span><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>Center for Studies and Research in (Re)Emerging Diseases (NUPEREME)</span><o:p></o:p></p></div><p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>Reference Sentry Unit for International and Travel Medicine (USCREMIVI)</span><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>Teaching Hospital / Tropical Pathology & Public Health Institute (IPTSP)</span><o:p></o:p></p></blockquote><p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>Federal University of Goias, Brazil (UFG)</span><o:p></o:p></p><div><div><blockquote style='border:none;border-left:solid #CCCCCC 1.0pt;padding:0cm 0cm 0cm 6.0pt;margin-left:4.8pt;margin-right:0cm'><p class=MsoNormal align=center style='text-align:center'> <o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>Caixa Postal 12911 - Setor Leste Vila Nova</span><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>Goiania - GO, 74643-970, Brazil</span><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>Phone(=<a href="tel:62%293269-8219" target="_blank">62)3269-8219</a>, Fax <a href="tel:%28%2B62%293521-1839" target="_blank">(+62)3521-1839</a></span><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>E-mail: <a href="mailto:nupereme@gmail.com" target="_blank">nupereme@gmail.com</a> </span><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'><a href="mailto:medicinadeviagem.hc.hdt@gmail.com" target="_blank">medicinadeviagem.hc.hdt@gmail.com</a></span><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'> <a href="mailto:mctulianglobal@gmail.com" target="_blank">mctulianglobal@gmail.com</a></span><o:p></o:p></p><p class=MsoNormal align=center style='text-align:center'> <o:p></o:p></p><div><p class=MsoNormal> <o:p></o:p></p></div><div><p class=MsoNormal> <o:p></o:p></p></div><div><p class=MsoNormal style='margin-bottom:12.0pt'><o:p> </o:p></p></div><div><p class=MsoNormal>2012/4/9 Kleber Luz <<a href="mailto:klebergluz@gmail.com" target="_blank">klebergluz@gmail.com</a>><o:p></o:p></p><div><div><p class=MsoNormal>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 style='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): (84) - 3215-1603<br>FONE: (84) - 3232-7948<br>CEL: (84) - 9193 - 6208</b><br> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:12.0pt'><o:p> </o:p></p></div></div><div><p class=MsoNormal style='margin-bottom:12.0pt'>_______________________________________________<br>TropMed-L mailing list<br><a href="mailto:TropMed-L@lineu.icb.usp.br" target="_blank">TropMed-L@lineu.icb.usp.br</a><br><a href="http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/tropmed-l" target="_blank">http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/tropmed-l</a><o:p></o:p></p></div></div><p class=MsoNormal><o:p> </o:p></p></blockquote><p class=MsoNormal><o:p> </o:p></p></div></div><p class=MsoNormal style='margin-bottom:12.0pt'><br>_______________________________________________<br>TropMed-L mailing list<br><a href="mailto:TropMed-L@lineu.icb.usp.br">TropMed-L@lineu.icb.usp.br</a><br><a href="http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/tropmed-l" target="_blank">http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/tropmed-l</a><o:p></o:p></p></div><p class=MsoNormal><br><br clear=all><o:p></o:p></p><div><p class=MsoNormal><o:p> </o:p></p></div><p class=MsoNormal>-- <o:p></o:p></p><p class=MsoNormal><span style='font-family:"Verdana","sans-serif"'>Carlos H. N. Costa, MD, DSc.</span><o:p></o:p></p><p class=MsoNormal><span style='font-family:"Verdana","sans-serif"'>Sociedade Brasileira de Medicina Tropical </span><o:p></o:p></p><p class=MsoNormal><span style='font-family:"Verdana","sans-serif"'>(Brazilian Society of Tropical Medicine)</span><o:p></o:p></p><p class=MsoNormal><span style='font-family:"Verdana","sans-serif"'>President</span><o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><span style='font-family:"Verdana","sans-serif"'>Universidade Federal do Piauí</span><o:p></o:p></p><div><p class=MsoNormal><span style='font-family:"Verdana","sans-serif"'>Instituto de Doenças Tropicais Natan Portella</span><o:p></o:p></p><p class=MsoNormal><span style='font-family:"Verdana","sans-serif"'>Rua Artur de Vasconcelos 151-Sul</span><o:p></o:p></p><div><p class=MsoNormal><span style='font-family:"Verdana","sans-serif"'>64001-450 Teresina-PI</span><o:p></o:p></p><p class=MsoNormal><span style='font-family:"Verdana","sans-serif"'>Brazil<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Verdana","sans-serif"'>Telephones: +55 86 3222-4377 (W), <o:p></o:p></span></p><p class=MsoNormal align=center style='text-align:center'><span style='font-family:"Verdana","sans-serif"'>+55 86 3221-3062 (W), <o:p></o:p></span></p><p class=MsoNormal align=center style='text-align:center'><span style='font-family:"Verdana","sans-serif"'>+55 86 3237-1075 (R). <o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Verdana","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Verdana","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Verdana","sans-serif"'>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.<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Verdana","sans-serif"'>Warning: This message is meant only for the intended recipient of the transmission. 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