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Papers by Juan Carlos Jorge

The surgical reconfiguration of the genitalia is still a standard intervention in the management ... more The surgical reconfiguration of the genitalia is still a standard intervention in the management of human intersexuality. In this paper, we present a case study of an adolescent with hypospadias who had required multiple surgeries to illustrate the latest thinking of biomedical knowledge and intersex knowledge on genital surgeries. We noticed that cosmetic criteria will not be sufficient to justify surgical interventions for the management of intersexuality and its variants, which will allow for further questioning and discussion about the management and optimal treatment of medical conditions associated with human intersexuality beyond genital appearance. We conclude that a greater appreciation for the aesthetic of genital variations will, possibly, impose a new frontier to intersex surgeries.

Journal of Clinical and Translational Science

OBJECTIVES/GOALS: The clinical management of differences of sex development (DSDs) aims to guaran... more OBJECTIVES/GOALS: The clinical management of differences of sex development (DSDs) aims to guarantee best practices in medical care while addressing concerns related to non-reversible surgeries. Rhetorical analysis was conducted to study the balance between science policy and patient advocacy related to DSD surgeries as depicted in medical education materials METHODS/STUDY POPULATION: Unrestricted transcripts of two educational videos and text from all chapters of a handbook addressed to medical learners and faculty by the Association of American Medical Colleges (AAMC) were submitted to automated word cloud analysis (NVivo, QSR International®). Words with a weighted percentage > 0.19% from total words of a given source were defined as words of frequent use and were selected for further analysis after exclusion of words as conjunctions, prepositions, pronouns, or conversational fillers. Words sharing noun, adjective and adverb forms were coded and weighed as a single word follow...

Frontiers in Pediatrics, 2020

Background and Objective:Mild hypospadias is a birth congenital condition characterized by the re... more Background and Objective:Mild hypospadias is a birth congenital condition characterized by the relocation of the male urethral meatus from its typical anatomical position near the tip of the glans penis, to a lower ventral position up to the brim of the glans corona, which can also be accompanied by foreskin ventral deficiency. For the most part, a limited number of cases have known etiology. We have followed a high-throughput proteomics approach to study the proteome in mild hypospadias patients.Methods:Foreskin samples from patients with mild hypospadias were collected during urethroplasty, while control samples were collected during elective circumcision (n= 5/group). A high-throughput, quantitative proteomics approach based on multiplexed peptide stable isotope labeling (SIL) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis was used to ascertain protein abundance changes in hypospadias patients when compared to control samples.Results:A total of 4,815 prote...

Journal of Clinical and Translational Science, 2021

This study presents an individualized coaching approach tailored to the stages of proximity of pr... more This study presents an individualized coaching approach tailored to the stages of proximity of promising scientists interested in becoming independently funded researchers in the context of a minority-serving institution. This strategy defined the participant's stage of proximity by their number of first-author publications in peer-reviewed journals and their track record in submitting research grants. We argue that coaching tailored by stages is an asset to maintain the enthusiasm, persistence, and positive attitude of promising scientists as they try to reach independent investigator status. Furthermore, this valuable educational approach supports the development of management and leadership skills in defined scientific domains.

confidence and adherence was analyzed using logistic regression analysis controlling for age, gen... more confidence and adherence was analyzed using logistic regression analysis controlling for age, gender, ethnicity, education, and number of health conditions. RESULTS/ANTICIPATED RESULTS: The survey had a 60% response rate. The mean age of respondents was 72, and 42% were male. We found no significant association between number of visits and either confidence about usage (OR= 1.07, 95% CI 0.95–1.20) or medication adherence (OR= 1.01, 95% CI 0.90–1.13). We similarly found no significant association between number of providers and either confidence about usage (OR= 1.03, 95% CI 0.90–1.18) or medication adherence (OR= 1.05, 95% CI 0.93–1.20). Lower confidence about medication use was less likely among males (OR= 0.60, 95% CI 0.44–0.80), those with more education (OR= 0.29, 95% CI 0.20–0.42) or more comorbidities (OR= 0.89, 95% CI 0.82–0.96) and more likely with increasing age (OR= 1.06, 95% CI 1.04–1.08). Nonadherence was more likely among Indians (OR= 1.62, 95% CI 1.06–2.48) and those w...

The constant breakdown and restructuring of the medico-legal power over diverses identities is em... more The constant breakdown and restructuring of the medico-legal power over diverses identities is emphasized by the changes in gender-related diagnostic categories in each edition of the Diagnostic and Statistical Manual of Mental Disorders (1952-2013) as proposed by psychiatrists in the United States as well as by the Court’s arbitrary use of cases to determine socio-sexual identities in certain people.

Salud mental, 2019

Introduction. There is a wide range of possible combinations in relation to sex at birth, gender ... more Introduction. There is a wide range of possible combinations in relation to sex at birth, gender identity, and sexual orientations. Specific medical and psychological treatment needs may also vary depending on these combinations. Objective. In order to promote interventions that focus on the perceived needs of those directly involved, the aim of the present case study is to describe the clinical and life experiences of a 43-year old transgender woman with cryptorchidism and examine the interplay between this relative common testicular problem at birth, gender identity, and sexual orientation formation processes from her own perspective. Method. An in-depth interview was conducted at a specialized care centre in Mexico City, Mexico. The interview was audio recorded and transcribed for a content analysis. Results. The case under analysis was assigned to the male sex and identified herself as a transgender woman and lesbian. Although it is not possible to conclude that her gender ident...

Sonography, 2018

IntroductionThis study aims to establish objective anatomical criteria to obtain accurate and rel... more IntroductionThis study aims to establish objective anatomical criteria to obtain accurate and reliable measurements of the right liver lobe (RLL) length by ultrasound while considering sex and anthropometry of the patient.MethodsThirty‐three (n = 33) adult participants underwent two‐dimensional (2D) and panoramic (PAN) ultrasound imaging of the RLL in the anterior axillary region. Each measurement was performed in the standard oblique plane and in a tested craniocaudal (CC) plane by two independent observers. Pearson analysis was conducted to evaluate correlation between measurements and intraclass correlation coefficient for inter‐rater reliability. Two‐tail paired t test was used to compare groups. Statistical significance was attained at p < 0.05.ResultsThe proposed CC 2D RLL length was 13.0 ± 1.5 cm for women and 14.1 ± 1.3 cm for men whereas PAN RLL size was 13.7 ± 1.8 cm for women and 15.0 ± 1.1 cm for men. A strong correlation between the proposed 2D CC measurement of the ...

Journal of Diagnostic Medical Sonography, 2015

The liver is one of the principal organs in the body and is involved in over 500 physiological fu... more The liver is one of the principal organs in the body and is involved in over 500 physiological functions related to metabolism, digestion, immunity, and storage of nutrients. Given that there are a number of approaches to measure liver length through diagnostic 2D sonography, this work was undertaken to determine the most accurate measurement of this organ. Cadaveric specimens (n = 21) were employed to assess measurements in the midclavicular line (MCL) and the midaxillary line (MAL). Each measurement was calculated in anteroposterior (AP) and craniocaudal (CC) planes. In addition, in situ measurements were obtained by accessing the organ through the anterior thoracoabdominal wall. Statistical differences were detected between MCL and MAL measurements ( P < .05), and a positive correlation between MAL CC and in situ anterior measurements were noted (r = 0.97). Liver size, as assessed through in situ measurements, varied as a funtion of BMI and waist circumference ( P < .05). I...

Frontiers in Pediatrics, 2016

Hypospadias is a male congenital condition where the opening of the urethral meatus is not locate... more Hypospadias is a male congenital condition where the opening of the urethral meatus is not located in the typical anatomical position. It has been a challenge for empirical studies to ascertain the level of concordance of opinion among parents and urologists with regard to surgical outcomes according to hypospadias severity.

The West Indian medical journal, 2011

Little is known about anabolic androgenic steroids (AAS) misuse in the Caribbean region in spite ... more Little is known about anabolic androgenic steroids (AAS) misuse in the Caribbean region in spite of increased popularity among athletes and adolescents. The present study examines the usage of AAS among competitive athletes in Puerto Rico. Doping test results of competitive athletes obtained by random sampling out of competition during the 2000-2009 period were analysed. Doping tests were executed by the Centre for Sports, Health and Exercise Sciences (Albergue Olímpico, Salinas, Puerto Rico). A total of 550 athletes were monitored during 2000-2009. Information was collected with regard to competitive sport, gender and AAS compounds whenever a positive test result was encountered. From the total sample of monitored cases during the past decade, 5.4% showed adverse analytical findings. Anabolic androgenic steroids misuse was detected among male (62%) and female (38%) athletes. Weightlifting showed the greatest percentage of positive AAS doping test results (70% of total cases) and st...

Journal of Clinical and Translational Science

OBJECTIVES/GOALS: Although there is ample evidence that environmental contaminants impact reprodu... more OBJECTIVES/GOALS: Although there is ample evidence that environmental contaminants impact reproductive health, the exact mechanisms of action, for the most part, remains unclear. We sought to determine whether known contaminants in Puerto Rico can contribute to the selection of a bioassay to add granularity to geospatial contamination data at the cellular level. METHODS/STUDY POPULATION: A PubMed literature search was conducted: Puerto Rico AND Vieques AND Environmental Contaminants AND Heavy Metals OR Phthalates OR Metals OR PCB OR Air Pollution OR CVOC . Additional inclusion criteria were free full text, English language and year of publication between 2000 to 2022 (n = 244 studies). References that were not related to Puerto Rico and environmental contaminants in air, soil, water, or vegetation were excluded. A second PubMed literature search was conducted to determine whether a clinical link has been established between contaminant exposure and the male reproductive system. Sear...

Introduction. In spite of significant changes in the management policies of intersexuality, clini... more Introduction. In spite of significant changes in the management policies of intersexuality, clinical evidence show that not all pubertal or adult individuals live according to the assigned sex during infancy. Aim. The purpose of this study was to analyze the clinical management of an individual diagnosed as a female pseudohermaphrodite with congenital adrenal hyperplasia (CAH) simple virilizing form four decades ago but who currently lives as a monogamous heterosexual male. Methods. We studied the clinical files spanning from 1965 to 1991 of an intersex individual. In addition, we conducted a magnetic resonance imaging (MRI) study of the abdominoplevic cavity and a series of interviews using the oral history method. Main Outcome Measures. Our analysis is based on the clinical evidence that led to the CAH diagnosis in the 1960s in light of recent clinical testing to confirm such diagnosis. Results. Analysis of reported values for 17-ketosteroids, 17-hydroxycorticosteroids, from 24-ho...

Fonseca, Journal of Communication, 2021

Tomando como eje la representación de personas que encarnaban enfermedades congénitas visibles, e... more Tomando como eje la representación de personas que encarnaban enfermedades congénitas visibles, examinamos los intereses particulares que estas imágenes han suscitado desde el siglo XVI, desde la Medicina y la Historia del Arte. Mediante diferentes tipos de medios visuales –tratados médicos, pintura y cine–, estudiamos los valores que revelan según los contextos en los que se crearon y publicaron. Como enfoque metodológico, planteamos un análisis transdisciplinar, centrándonos en personas a las que la medicina contemporánea habría asignado diagnósticos de origen genético-cromosómico. ¿Quiénes y en qué contextos se encargaron estas representaciones? ¿A qué función estaban destinadas? ¿Qué intereses tienen quienes las crean? ¿Qué papel tienen las personas representadas? Los grabados en tratados médicos en los siglos XVI y XVII muestran representaciones para la comprensión científica del cuerpo expuesto, tipifican el sujeto y no se otorga relevancia personal. En la pintura y el cine, a...

Frontiers in Pediatrics, 2020

Background & Objective: Hypospadias, characterized by the displacement of the opening of the uret... more Background & Objective: Hypospadias, characterized by the displacement of the opening of the urethra at any point in the medial-ventral side of the penis, is classified upon severity as mild (Type I) and severe (Type II and Type III) hypospadias. Hypospadias' etiology is idiopathic in the majority of cases, and underlying causes seem of multifactorial origin. Studies regarding genetic variants support this notion. It is unknown whether downstream gene products fit this profile. This study evaluated the metabolome of hypospadias by using the emerging technology of metabolomics in the search for distinct cellular processes associated with hypospadias' etiology according to the severity of this congenital urogenital condition. Methods: Foreskin samples were collected during urethroplasty from boys with Type I, II, and III hypospadias or undergoing elective circumcision (N = 28) between 5 and 28 months of age. Samples were processed and submitted to gas chromatography-mass spectrometry (GC/MS). MetaboloAnalyst (http://www.metaboanalyst.ca/) online platform was used for bioinformatic analyses. Results: Thirty-five metabolites across experimental groups were identified by GC/MS. Principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA) showed that the metabolome of Type II and Type III hypospadias patients differs from the metabolome of Type I hypospadias and control patients. Of those 35, 10 amino acids were found in significantly low concentrations in severe hypospadias: aspartate, glutamate, glycine, isoleucine, leucine, lysine, methionine, phenylalanine, proline, and tyrosine. A high concentration of the amino acid lysine was detected in mild hypospadias. Conclusions: The observed downregulation of specific amino acids in severe hypospadias provides alternative routes for future research aiming to identify disrupted networks and pathways while considering the severity of hypospadias.

Journal of Urology and Nephrology Open Access, 2016

Journal of Urology and Nephrology Open Access Open Access Research Article estimates that less th... more Journal of Urology and Nephrology Open Access Open Access Research Article estimates that less than a quarter of congenital conditions are produced by known factors such as chromosomal variations, mutant genes, or environmental agents [3]. Hypospadias is not the exception; only a small proportion of cases have been linked to specific genes or environmental contaminants [4]. The twohit hypothesis proposes that genetic susceptibility linked to environmental exposure increases hypospadias risk [5-6]. It has been long recognized that age of the mother is one of the factors that defines a high-risk pregnancy in terms of reaching a healthy full-term pregnancy but also in terms of the potentiated risk for having a child with a congenital condition [7]. In fact, age of the mother (> 40years of age) is associated to hypospadias risk [8-13]. In this study, we revisited the reported association between

The Journal of Neuroscience, 1997

The modulation of the pyloric rhythm of the stomatogastric ganglion of the crab,Cancer borealis,b... more The modulation of the pyloric rhythm of the stomatogastric ganglion of the crab,Cancer borealis,by crustacean cardioactive peptide (CCAP) is described. CCAP activated pyloric rhythms in most silent preparations, and altered the phase relationships of pyloric motor neuron firing in all preparations. In CCAP, the pyloric rhythms were characterized by long lateral pyloric (LP) neuron bursts of action potentials. The threshold for CCAP action was ∼10−10M, with increasing effects at higher CCAP concentrations. The changes in motor pattern evoked by CCAP produced significant changes in LP-innervated muscle movement. These movements were additionally potentiated by CCAP applications to isolated nerve–muscle preparations. Thus, enhanced motor neuron firing and increase of the gain of the neuromuscular junctions are likely to operate coordinately in response to hormonally released CCAP. High CCAP concentrations sometimes resulted in modification of the normal 1:1 alternation between the pylo...

Frontiers in pharmacology, 2017

Latua pubiflora (Griseb) Phil. Is a native shrub of the Solanaceae family that grows freely in so... more Latua pubiflora (Griseb) Phil. Is a native shrub of the Solanaceae family that grows freely in southern Chile and is employed among Mapuche aboriginals to induce sedative effects and hallucinations in religious or medicine rituals since prehispanic times. In this work, the pentobarbital-induced sleeping test and the elevated plus maze test were employed to test the behavioral effects of extracts of this plant in mice. The psychopharmacological evaluation of L. pubiflora extracts in mice determined that both alkaloid-enriched as well as the non-alkaloid extracts produced an increase of sleeping time and alteration of motor activity in mice at 150 mg/Kg. The alkaloid extract exhibited anxiolytic effects in the elevated plus maze test, which was counteracted by flumazenil. In addition, the alkaloid extract from L. pubiflora decreased [(3)H]-flunitrazepam binding on rat cortical membranes. In this study we have identified 18 tropane alkaloids (peaks 1-4, 8-13, 15-18, 21, 23, 24, and 28)...

Journal of Pediatric Urology, 2017

Background: Caudal and penile blocks are the most popular regional anesthetic techniques used in ... more Background: Caudal and penile blocks are the most popular regional anesthetic techniques used in infants and children undergoing urological surgery. A recent report has suggested that penile venous pooling resulting from caudal blocks could affect surgical outcomes after hypospadias surgeries. We report our experience in patients with distal hypospadias undergoing repair with caudal vs penile block. Methods: A retrospective clinical database was constructed for patients who underwent distal hypospadias repair at our sponsoring institutions for the time period 2008-13 (n=192). All surgeries were performed by the same surgeon (MPB). Collected data included: hypospadias classification (glanular, coronal, sub-coronal), chordee status, perioperative anesthesia (caudal vs penile), and assessment of postoperative complications (fistula and meatal stenosis). Results: The mean age for distal hypospadias repair was 11 months with mean f/u of 3 years. Close to 50% of the sample underwent caudal or penile anesthesia block for post-op pain control (n= 91 vs. 101, respectively). Thirteen cases (6%) required further interventions; where 11 patients had urethral fistulas and 2 patients had meatal stenosis. Most patients with urethral fistula underwent caudal anesthesia (n=9/11). Risk ratio analysis for all distal hypospadias cases revealed that there is a higher risk of developing complications in patients who underwent caudal anesthesia vs patients who underwent penile block. (Risk Ratio = 3.47 [95% CI 0.99-12.24]) Conclusion: Our distal hypospadias repair complication rate (6%) compares to contemporary series. We found that caudal anesthesia was associated with a higher risk of fistula formation after undergoing distal hypospadias repair. Further studies are required to elucidate whether regional anesthetic techniques should be adjusted according to severity of the condition.

Cuicuilco, 2011

Lecciones médicas sobre la variante sexual: los hermafroditas del siglo xvi y los intersexuales d... more Lecciones médicas sobre la variante sexual: los hermafroditas del siglo xvi y los intersexuales del siglo XXI

The surgical reconfiguration of the genitalia is still a standard intervention in the management ... more The surgical reconfiguration of the genitalia is still a standard intervention in the management of human intersexuality. In this paper, we present a case study of an adolescent with hypospadias who had required multiple surgeries to illustrate the latest thinking of biomedical knowledge and intersex knowledge on genital surgeries. We noticed that cosmetic criteria will not be sufficient to justify surgical interventions for the management of intersexuality and its variants, which will allow for further questioning and discussion about the management and optimal treatment of medical conditions associated with human intersexuality beyond genital appearance. We conclude that a greater appreciation for the aesthetic of genital variations will, possibly, impose a new frontier to intersex surgeries.

Journal of Clinical and Translational Science

OBJECTIVES/GOALS: The clinical management of differences of sex development (DSDs) aims to guaran... more OBJECTIVES/GOALS: The clinical management of differences of sex development (DSDs) aims to guarantee best practices in medical care while addressing concerns related to non-reversible surgeries. Rhetorical analysis was conducted to study the balance between science policy and patient advocacy related to DSD surgeries as depicted in medical education materials METHODS/STUDY POPULATION: Unrestricted transcripts of two educational videos and text from all chapters of a handbook addressed to medical learners and faculty by the Association of American Medical Colleges (AAMC) were submitted to automated word cloud analysis (NVivo, QSR International®). Words with a weighted percentage > 0.19% from total words of a given source were defined as words of frequent use and were selected for further analysis after exclusion of words as conjunctions, prepositions, pronouns, or conversational fillers. Words sharing noun, adjective and adverb forms were coded and weighed as a single word follow...

Frontiers in Pediatrics, 2020

Background and Objective:Mild hypospadias is a birth congenital condition characterized by the re... more Background and Objective:Mild hypospadias is a birth congenital condition characterized by the relocation of the male urethral meatus from its typical anatomical position near the tip of the glans penis, to a lower ventral position up to the brim of the glans corona, which can also be accompanied by foreskin ventral deficiency. For the most part, a limited number of cases have known etiology. We have followed a high-throughput proteomics approach to study the proteome in mild hypospadias patients.Methods:Foreskin samples from patients with mild hypospadias were collected during urethroplasty, while control samples were collected during elective circumcision (n= 5/group). A high-throughput, quantitative proteomics approach based on multiplexed peptide stable isotope labeling (SIL) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis was used to ascertain protein abundance changes in hypospadias patients when compared to control samples.Results:A total of 4,815 prote...

Journal of Clinical and Translational Science, 2021

This study presents an individualized coaching approach tailored to the stages of proximity of pr... more This study presents an individualized coaching approach tailored to the stages of proximity of promising scientists interested in becoming independently funded researchers in the context of a minority-serving institution. This strategy defined the participant's stage of proximity by their number of first-author publications in peer-reviewed journals and their track record in submitting research grants. We argue that coaching tailored by stages is an asset to maintain the enthusiasm, persistence, and positive attitude of promising scientists as they try to reach independent investigator status. Furthermore, this valuable educational approach supports the development of management and leadership skills in defined scientific domains.

confidence and adherence was analyzed using logistic regression analysis controlling for age, gen... more confidence and adherence was analyzed using logistic regression analysis controlling for age, gender, ethnicity, education, and number of health conditions. RESULTS/ANTICIPATED RESULTS: The survey had a 60% response rate. The mean age of respondents was 72, and 42% were male. We found no significant association between number of visits and either confidence about usage (OR= 1.07, 95% CI 0.95–1.20) or medication adherence (OR= 1.01, 95% CI 0.90–1.13). We similarly found no significant association between number of providers and either confidence about usage (OR= 1.03, 95% CI 0.90–1.18) or medication adherence (OR= 1.05, 95% CI 0.93–1.20). Lower confidence about medication use was less likely among males (OR= 0.60, 95% CI 0.44–0.80), those with more education (OR= 0.29, 95% CI 0.20–0.42) or more comorbidities (OR= 0.89, 95% CI 0.82–0.96) and more likely with increasing age (OR= 1.06, 95% CI 1.04–1.08). Nonadherence was more likely among Indians (OR= 1.62, 95% CI 1.06–2.48) and those w...

The constant breakdown and restructuring of the medico-legal power over diverses identities is em... more The constant breakdown and restructuring of the medico-legal power over diverses identities is emphasized by the changes in gender-related diagnostic categories in each edition of the Diagnostic and Statistical Manual of Mental Disorders (1952-2013) as proposed by psychiatrists in the United States as well as by the Court’s arbitrary use of cases to determine socio-sexual identities in certain people.

Salud mental, 2019

Introduction. There is a wide range of possible combinations in relation to sex at birth, gender ... more Introduction. There is a wide range of possible combinations in relation to sex at birth, gender identity, and sexual orientations. Specific medical and psychological treatment needs may also vary depending on these combinations. Objective. In order to promote interventions that focus on the perceived needs of those directly involved, the aim of the present case study is to describe the clinical and life experiences of a 43-year old transgender woman with cryptorchidism and examine the interplay between this relative common testicular problem at birth, gender identity, and sexual orientation formation processes from her own perspective. Method. An in-depth interview was conducted at a specialized care centre in Mexico City, Mexico. The interview was audio recorded and transcribed for a content analysis. Results. The case under analysis was assigned to the male sex and identified herself as a transgender woman and lesbian. Although it is not possible to conclude that her gender ident...

Sonography, 2018

IntroductionThis study aims to establish objective anatomical criteria to obtain accurate and rel... more IntroductionThis study aims to establish objective anatomical criteria to obtain accurate and reliable measurements of the right liver lobe (RLL) length by ultrasound while considering sex and anthropometry of the patient.MethodsThirty‐three (n = 33) adult participants underwent two‐dimensional (2D) and panoramic (PAN) ultrasound imaging of the RLL in the anterior axillary region. Each measurement was performed in the standard oblique plane and in a tested craniocaudal (CC) plane by two independent observers. Pearson analysis was conducted to evaluate correlation between measurements and intraclass correlation coefficient for inter‐rater reliability. Two‐tail paired t test was used to compare groups. Statistical significance was attained at p < 0.05.ResultsThe proposed CC 2D RLL length was 13.0 ± 1.5 cm for women and 14.1 ± 1.3 cm for men whereas PAN RLL size was 13.7 ± 1.8 cm for women and 15.0 ± 1.1 cm for men. A strong correlation between the proposed 2D CC measurement of the ...

Journal of Diagnostic Medical Sonography, 2015

The liver is one of the principal organs in the body and is involved in over 500 physiological fu... more The liver is one of the principal organs in the body and is involved in over 500 physiological functions related to metabolism, digestion, immunity, and storage of nutrients. Given that there are a number of approaches to measure liver length through diagnostic 2D sonography, this work was undertaken to determine the most accurate measurement of this organ. Cadaveric specimens (n = 21) were employed to assess measurements in the midclavicular line (MCL) and the midaxillary line (MAL). Each measurement was calculated in anteroposterior (AP) and craniocaudal (CC) planes. In addition, in situ measurements were obtained by accessing the organ through the anterior thoracoabdominal wall. Statistical differences were detected between MCL and MAL measurements ( P < .05), and a positive correlation between MAL CC and in situ anterior measurements were noted (r = 0.97). Liver size, as assessed through in situ measurements, varied as a funtion of BMI and waist circumference ( P < .05). I...

Frontiers in Pediatrics, 2016

Hypospadias is a male congenital condition where the opening of the urethral meatus is not locate... more Hypospadias is a male congenital condition where the opening of the urethral meatus is not located in the typical anatomical position. It has been a challenge for empirical studies to ascertain the level of concordance of opinion among parents and urologists with regard to surgical outcomes according to hypospadias severity.

The West Indian medical journal, 2011

Little is known about anabolic androgenic steroids (AAS) misuse in the Caribbean region in spite ... more Little is known about anabolic androgenic steroids (AAS) misuse in the Caribbean region in spite of increased popularity among athletes and adolescents. The present study examines the usage of AAS among competitive athletes in Puerto Rico. Doping test results of competitive athletes obtained by random sampling out of competition during the 2000-2009 period were analysed. Doping tests were executed by the Centre for Sports, Health and Exercise Sciences (Albergue Olímpico, Salinas, Puerto Rico). A total of 550 athletes were monitored during 2000-2009. Information was collected with regard to competitive sport, gender and AAS compounds whenever a positive test result was encountered. From the total sample of monitored cases during the past decade, 5.4% showed adverse analytical findings. Anabolic androgenic steroids misuse was detected among male (62%) and female (38%) athletes. Weightlifting showed the greatest percentage of positive AAS doping test results (70% of total cases) and st...

Journal of Clinical and Translational Science

OBJECTIVES/GOALS: Although there is ample evidence that environmental contaminants impact reprodu... more OBJECTIVES/GOALS: Although there is ample evidence that environmental contaminants impact reproductive health, the exact mechanisms of action, for the most part, remains unclear. We sought to determine whether known contaminants in Puerto Rico can contribute to the selection of a bioassay to add granularity to geospatial contamination data at the cellular level. METHODS/STUDY POPULATION: A PubMed literature search was conducted: Puerto Rico AND Vieques AND Environmental Contaminants AND Heavy Metals OR Phthalates OR Metals OR PCB OR Air Pollution OR CVOC . Additional inclusion criteria were free full text, English language and year of publication between 2000 to 2022 (n = 244 studies). References that were not related to Puerto Rico and environmental contaminants in air, soil, water, or vegetation were excluded. A second PubMed literature search was conducted to determine whether a clinical link has been established between contaminant exposure and the male reproductive system. Sear...

Introduction. In spite of significant changes in the management policies of intersexuality, clini... more Introduction. In spite of significant changes in the management policies of intersexuality, clinical evidence show that not all pubertal or adult individuals live according to the assigned sex during infancy. Aim. The purpose of this study was to analyze the clinical management of an individual diagnosed as a female pseudohermaphrodite with congenital adrenal hyperplasia (CAH) simple virilizing form four decades ago but who currently lives as a monogamous heterosexual male. Methods. We studied the clinical files spanning from 1965 to 1991 of an intersex individual. In addition, we conducted a magnetic resonance imaging (MRI) study of the abdominoplevic cavity and a series of interviews using the oral history method. Main Outcome Measures. Our analysis is based on the clinical evidence that led to the CAH diagnosis in the 1960s in light of recent clinical testing to confirm such diagnosis. Results. Analysis of reported values for 17-ketosteroids, 17-hydroxycorticosteroids, from 24-ho...

Fonseca, Journal of Communication, 2021

Tomando como eje la representación de personas que encarnaban enfermedades congénitas visibles, e... more Tomando como eje la representación de personas que encarnaban enfermedades congénitas visibles, examinamos los intereses particulares que estas imágenes han suscitado desde el siglo XVI, desde la Medicina y la Historia del Arte. Mediante diferentes tipos de medios visuales –tratados médicos, pintura y cine–, estudiamos los valores que revelan según los contextos en los que se crearon y publicaron. Como enfoque metodológico, planteamos un análisis transdisciplinar, centrándonos en personas a las que la medicina contemporánea habría asignado diagnósticos de origen genético-cromosómico. ¿Quiénes y en qué contextos se encargaron estas representaciones? ¿A qué función estaban destinadas? ¿Qué intereses tienen quienes las crean? ¿Qué papel tienen las personas representadas? Los grabados en tratados médicos en los siglos XVI y XVII muestran representaciones para la comprensión científica del cuerpo expuesto, tipifican el sujeto y no se otorga relevancia personal. En la pintura y el cine, a...

Frontiers in Pediatrics, 2020

Background & Objective: Hypospadias, characterized by the displacement of the opening of the uret... more Background & Objective: Hypospadias, characterized by the displacement of the opening of the urethra at any point in the medial-ventral side of the penis, is classified upon severity as mild (Type I) and severe (Type II and Type III) hypospadias. Hypospadias' etiology is idiopathic in the majority of cases, and underlying causes seem of multifactorial origin. Studies regarding genetic variants support this notion. It is unknown whether downstream gene products fit this profile. This study evaluated the metabolome of hypospadias by using the emerging technology of metabolomics in the search for distinct cellular processes associated with hypospadias' etiology according to the severity of this congenital urogenital condition. Methods: Foreskin samples were collected during urethroplasty from boys with Type I, II, and III hypospadias or undergoing elective circumcision (N = 28) between 5 and 28 months of age. Samples were processed and submitted to gas chromatography-mass spectrometry (GC/MS). MetaboloAnalyst (http://www.metaboanalyst.ca/) online platform was used for bioinformatic analyses. Results: Thirty-five metabolites across experimental groups were identified by GC/MS. Principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA) showed that the metabolome of Type II and Type III hypospadias patients differs from the metabolome of Type I hypospadias and control patients. Of those 35, 10 amino acids were found in significantly low concentrations in severe hypospadias: aspartate, glutamate, glycine, isoleucine, leucine, lysine, methionine, phenylalanine, proline, and tyrosine. A high concentration of the amino acid lysine was detected in mild hypospadias. Conclusions: The observed downregulation of specific amino acids in severe hypospadias provides alternative routes for future research aiming to identify disrupted networks and pathways while considering the severity of hypospadias.

Journal of Urology and Nephrology Open Access, 2016

Journal of Urology and Nephrology Open Access Open Access Research Article estimates that less th... more Journal of Urology and Nephrology Open Access Open Access Research Article estimates that less than a quarter of congenital conditions are produced by known factors such as chromosomal variations, mutant genes, or environmental agents [3]. Hypospadias is not the exception; only a small proportion of cases have been linked to specific genes or environmental contaminants [4]. The twohit hypothesis proposes that genetic susceptibility linked to environmental exposure increases hypospadias risk [5-6]. It has been long recognized that age of the mother is one of the factors that defines a high-risk pregnancy in terms of reaching a healthy full-term pregnancy but also in terms of the potentiated risk for having a child with a congenital condition [7]. In fact, age of the mother (> 40years of age) is associated to hypospadias risk [8-13]. In this study, we revisited the reported association between

The Journal of Neuroscience, 1997

The modulation of the pyloric rhythm of the stomatogastric ganglion of the crab,Cancer borealis,b... more The modulation of the pyloric rhythm of the stomatogastric ganglion of the crab,Cancer borealis,by crustacean cardioactive peptide (CCAP) is described. CCAP activated pyloric rhythms in most silent preparations, and altered the phase relationships of pyloric motor neuron firing in all preparations. In CCAP, the pyloric rhythms were characterized by long lateral pyloric (LP) neuron bursts of action potentials. The threshold for CCAP action was ∼10−10M, with increasing effects at higher CCAP concentrations. The changes in motor pattern evoked by CCAP produced significant changes in LP-innervated muscle movement. These movements were additionally potentiated by CCAP applications to isolated nerve–muscle preparations. Thus, enhanced motor neuron firing and increase of the gain of the neuromuscular junctions are likely to operate coordinately in response to hormonally released CCAP. High CCAP concentrations sometimes resulted in modification of the normal 1:1 alternation between the pylo...

Frontiers in pharmacology, 2017

Latua pubiflora (Griseb) Phil. Is a native shrub of the Solanaceae family that grows freely in so... more Latua pubiflora (Griseb) Phil. Is a native shrub of the Solanaceae family that grows freely in southern Chile and is employed among Mapuche aboriginals to induce sedative effects and hallucinations in religious or medicine rituals since prehispanic times. In this work, the pentobarbital-induced sleeping test and the elevated plus maze test were employed to test the behavioral effects of extracts of this plant in mice. The psychopharmacological evaluation of L. pubiflora extracts in mice determined that both alkaloid-enriched as well as the non-alkaloid extracts produced an increase of sleeping time and alteration of motor activity in mice at 150 mg/Kg. The alkaloid extract exhibited anxiolytic effects in the elevated plus maze test, which was counteracted by flumazenil. In addition, the alkaloid extract from L. pubiflora decreased [(3)H]-flunitrazepam binding on rat cortical membranes. In this study we have identified 18 tropane alkaloids (peaks 1-4, 8-13, 15-18, 21, 23, 24, and 28)...

Journal of Pediatric Urology, 2017

Background: Caudal and penile blocks are the most popular regional anesthetic techniques used in ... more Background: Caudal and penile blocks are the most popular regional anesthetic techniques used in infants and children undergoing urological surgery. A recent report has suggested that penile venous pooling resulting from caudal blocks could affect surgical outcomes after hypospadias surgeries. We report our experience in patients with distal hypospadias undergoing repair with caudal vs penile block. Methods: A retrospective clinical database was constructed for patients who underwent distal hypospadias repair at our sponsoring institutions for the time period 2008-13 (n=192). All surgeries were performed by the same surgeon (MPB). Collected data included: hypospadias classification (glanular, coronal, sub-coronal), chordee status, perioperative anesthesia (caudal vs penile), and assessment of postoperative complications (fistula and meatal stenosis). Results: The mean age for distal hypospadias repair was 11 months with mean f/u of 3 years. Close to 50% of the sample underwent caudal or penile anesthesia block for post-op pain control (n= 91 vs. 101, respectively). Thirteen cases (6%) required further interventions; where 11 patients had urethral fistulas and 2 patients had meatal stenosis. Most patients with urethral fistula underwent caudal anesthesia (n=9/11). Risk ratio analysis for all distal hypospadias cases revealed that there is a higher risk of developing complications in patients who underwent caudal anesthesia vs patients who underwent penile block. (Risk Ratio = 3.47 [95% CI 0.99-12.24]) Conclusion: Our distal hypospadias repair complication rate (6%) compares to contemporary series. We found that caudal anesthesia was associated with a higher risk of fistula formation after undergoing distal hypospadias repair. Further studies are required to elucidate whether regional anesthetic techniques should be adjusted according to severity of the condition.

Cuicuilco, 2011

Lecciones médicas sobre la variante sexual: los hermafroditas del siglo xvi y los intersexuales d... more Lecciones médicas sobre la variante sexual: los hermafroditas del siglo xvi y los intersexuales del siglo XXI