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Santo Domingo, Dominican Republic

Isa R.I.,Instituto Dermatologico Y Cirugia Of Piel | Amaya B.Y.,Instituto Dermatologico Y Cirugia Of Piel | Pimentel M.I.,Instituto Dermatologico Y Cirugia Of Piel | Arenas R.,Mycology | And 2 more authors.
Medicina Cutanea Ibero-Latino-Americana | Year: 2014

Introduction: For tinea capitis, «comma hairs» and «corkscrew hairs» have been described as dermoscopic patterns by some authors; others have reported small groups of patients diagnosed with tinea capitis with positive dermoscopy; however, there is no data about the sensitivity of dermoscopy in the diagnosis of tinea capitis. We sought to report the results of dermoscopy in a large group of patients with tinea capitis in order to stablish the specificity of dermoscopic examination. Material and methods: Fourty three patients with tinea capitis were evaluated clinically and with dermoscopy during a 2 months period in 2011. Direct examination with potassium hydroxide and culture was performed to all patients. Results: Direct examination with potassium hydroxide was positive in all cases and 17 had culture positive for Trichophyton tonsurans, Microsporum canis or Microsporum audouinii. Thirty one patients had positive dermoscopy. «Comma hairs» were found in the seven patients in whom Microsporum canis or Microsporum audouinii were confirmed by culture and in six of the 10 patients in whom Trichophyton tonsurans was isolated.«Corkscrew hairs» were found in three patients with Microsporum canis or Microsporum audouinii and in three patients with Tricophyton tonsurans infection. Comment: «Comma hairs» are not specific for Microsporum or Trichophyton and «corkscrew hairs» are not specific for Trichophyton soudanense, they can be found in other species of Trichophyton and Microsporum. A limitation in our study is the lack of positive cultures in a considerable percentage of potassium hydroxide (KOH) direct examination positive patients. Further studies are needed.

Myers J.E.,Columbia University | Taylor B.S.,Columbia University | Taylor B.S.,University of Texas Health Science Center at San Antonio | Rojas Fermin R.A.,Dominican HIV AIDS Cohort Study | And 11 more authors.
AIDS Research and Human Retroviruses | Year: 2012

Emergence of HIV resistance is a concerning consequence of global scale-up of antiretroviral therapy (ART). To date, there is no published information about HIV resistance from the Dominican Republic. The study's aim was to determine the prevalence of transmitted drug resistance (TDR) to reverse transcriptase and protease inhibitors in a sample of chronically HIV-1-infected patients in one clinic in Santo Domingo. The data are presented in the context of a review of the TDR literature from Latin America and the Caribbean. Genotype testing was successfully performed on 103 treatment-naive adults planning to initiate antiretroviral therapy; the World Health Organization (WHO) list of surveillance drug resistance mutations (SDRM) was used to determine the presence of TDR mutations. WHO SDRM were identified in eight patients (7.8%); none had received sdNVP. There were no significant differences in epidemiologic or clinical variables between those with or without WHO SDRM. The prevalence of WHO SDRM was 1.0% and 6.8% for nucleoside reverse transcriptase inhibitors and nonnucleoside reverse transcriptase inhibitors, respectively. No WHO SDRMs for protease inhibitors were identified. Among 12 studies of TDR in the region with a sample size of at least 100 subjects, the reported prevalence of SDRM ranged from 2.8% to 8.1%. The most commonly identified SDRM was K103N. This information adds to our understanding of the epidemiology of TDR in the region and the possible role such mutations could play in undermining first-line treatment. Ongoing surveillance is clearly needed to better understand the TDR phenomenon in the Caribbean. © Copyright 2012, Mary Ann Liebert, Inc. 2012.

Brito M.O.,University of Illinois at Chicago | Lerebours L.,Clinica de Familia | Volquez C.,Instituto Dermatologico Y Cirugia Of Piel | Basora E.,Clinica de Familia | And 8 more authors.
PLoS ONE | Year: 2015

Background: Voluntary Medical Male Circumcision (VMMC) is an effective strategy to reduce the risk of HIV infection. Studies conducted in the Dominican Republic (DR) suggest that acceptability of VMMC among men may be as high as 67%. The goal of this clinical trial was to assess the acceptability, uptake and safety for VMMC services in two areas of high HIV prevalence in the country. Methods: This was a single-arm, non-randomized, pragmatic clinical trial. Study personnel received background information about the risks and benefits of VMMC and practical training on the surgical technique. A native speaking research assistant administered a questionnaire of demographics, sexual practices and knowledge about VMMC. One week after the surgery, participants returned for wound inspection and to answer questions about their post-surgical experience. Results: 539 men consented for the study. Fifty seven were excluded from participation for medical or anatomical reasons and 28 decided not to have the procedure after providing consent. A total of 454 men were circumcised using the Forceps Guided Method Under Local Anesthesia. The rate of adverse events (AE) was 4.4% (20% moderate, 80% mild). There were no serious AEs and all complications resolved promptly with treatment. Eighty eight percent of clients reported being "very satisfied" and 12% were "somewhat satisfied" with the outcome at the one-week postoperative visit. Conclusions: Recruitment and uptake were satisfactory. Client satisfaction with VMMC was high and the rate of AEs was low. Roll out of VMMC in targeted areas of the DR is feasible and should be considered.

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