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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.
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ABSTRACTDeeply rooted on human rights principles, there is a growing international agreement to prohibit non-consensual medical interventions to intersex persons. In contrast, medical protocols for intersex care in the United States are guided by clinical wisdom and guidelines that are not legally binding. But as the medical profession is called to respect and to champion the right to health within human rights principles, expert opinion in the United States has become unsettled when confronted with current standards of intersex care. In this study, we tracked the human rights arguments by international institutions that effectively impacted clinical standards for the care of intersex persons around the globe during this decade, and we studied the use of rhetoric by key policy stakeholders that seek to uphold intersex medical care in the United States to these international standards. We conclude that the medical establishment in the United States does not meet international standards of human rights as it enforces an outdated definition of 'sex'.
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Trastornos del Desarrollo Sexual , Trastornos del Desarrollo Sexual/terapia , Disentimientos y Disputas , Derechos Humanos , Humanos , Políticas , Estados UnidosRESUMEN
The craniocaudal (CC) length of the right lobe of the liver (RLL), liver texture, size of the main portal vein, and hemodynamics of the hepatic artery, were sonographically evaluated in female diabetic and non-diabetic patients. A One-way ANOVA, a Tukey's post-hoc test, and a Kruskal-Wallis with post-hoc Dunn's test, were employed. Non-symptomatic differences in liver anatomy were detected among non-controlled type 2 diabetes patients. They exhibited the longest CC length of the RLL (p = 0.04) as well as an enlarged main portal vein (p = 0.04). Hepatic artery resistive index (RI) was higher among controlled type 2 diabetes patients (p = 0.04). These differences were not attributed to fatty infiltration. Non-controlled type 2 diabetes patients exhibited significantly higher alanine aminotransferase, lower high-density lipoprotein cholesterol, and higher triglyceride levels, than in non-type 2 diabetes patients. Longitudinal sonography may provide valuable diagnostic information in the management of type 2 diabetes.
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Abstract 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 identity or sexual orientation is related to her antecedent of cryptorchidism, as she reflected on her related negative experiences, she concluded that her gender identity and sexual orientation trajectories, as well as her life in general, would have been completely different if there were no clinical interventions in her early development. Discussion and conclusion The present case could have been benefited from not receiving early treatment for her cryptorchidism. There is an urgent need for the development of standardized protocols or algorithms for physical and mental health care professionals, which focus on supportive guidance rather than adjustment to parental and medical expectations.
Resumen Este artículo presenta la historia clínica y de vida de una mujer transexual con criptorquidia al nacer. Nuestro objetivo es presentar un estudio de caso en que la identidad transgénero y la criptorquidia, una condición testicular común en niños e identidades trans, podrían cumplir un papel en los procesos de formación de identidad de género. La interacción entre la identidad de género y la orientación sexual también se presenta como entrevistas semiestructuradas destinadas a recopilar datos sobre intervenciones clínicas tempranas según lo informado por la persona. Abogamos por un algoritmo psicológico que abarque la comunicación interprofesional específicamente diseñada para las personas con diferencias de sexo/género, centrándose en la orientación de apoyo en lugar de ajustarse a las expectativas médicas y de los padres.
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OBJECTIVE: Cryptorchidism is an abnormality of the male genitourinary tract in which one or both testes fail to descend into the scrotum. The American Urological Association (AUA) clinical guidelines for the evaluation and treatment of cryptorchidism were recently published. We reviewed our experience with the evaluation and management of our patients and examined our findings with respect to the AUA and European Association of Urology (EAU) guidelines. METHODS: Data were obtained from pediatric patients who underwent a surgical intervention for an undescended testis from 2007 through 2017 at HIMA Hospital and the University Pediatric Hospital (both in Puerto Rico); all the surgeries were performed by the same surgeon. A total of 754 patients were identified; 142 patients were excluded due to lack of follow-up data (N = 612). The data obtained included age, testes locations, radiologic and surgical findings, and postoperative results. RESULTS: At their initial evaluations, a large proportion of the patients (46.4%) came accompanied with radiographic imaging. These findings were consistent with those of the physical examination in 58.5% of the patients and with the surgical findings in 63.1% (sensitivity 77.9%, specificity 45.8%). Our data showed that the median referral age was 24 months, which suggests that there was a significant delay in diagnosis. At the time of surgery, the average age of the patients who required an orchiectomy was 3.93 years, while those who underwent an orchiopexy had an average age of 3.28 years. CONCLUSION: Our data reveal that, despite its lack of usefulness, radiologic imaging continues to be included in the diagnostic workups of children newly identified with cryptorchidism in Puerto Rico. In addition, and contrary to the guidelines, there tends to be a significant delay in treatment with surgical intervention. It is important to continue to educate our referring physicians on the AUA and EUA guidelines in order to create awareness and encourage the proper diagnostic and treatment approach for cryptorchidism.
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Criptorquidismo/cirugía , Orquiectomía/estadística & datos numéricos , Orquidopexia/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Factores de Edad , Preescolar , Criptorquidismo/diagnóstico , Diagnóstico Tardío , Estudios de Seguimiento , Humanos , Masculino , Guías de Práctica Clínica como Asunto , Puerto Rico , Sensibilidad y EspecificidadRESUMEN
BACKGROUND & OBJECTIVES: Hypospadias is characterized by a displacement of the urethral opening in males that can change from the typical position within the glans penis to a subcoronal position (Type I), to anywhere along the ventral shaft (Type II), to penoscrotal, scrotal, or perineal positions (Type III). We and others have previously reported that age of the mother (≥ 40 years old) is a risk factor for having a child with hypospadias, but there is a scarcity of reports on whether such risk is higher for having a child with the mild (Type I) or the more severe forms (Types II and III). In addition, we aimed to assess the timing of hypospadias repair according to severity. METHODS: Parents of children with hypospadias were interviewed by using a series of questionnaires (n = 128 cases). Severity was confirmed in the clinic and age of the mother was self-reported. Number of surgeries, age of child by the first and the last intervention was also assessed. Ordered logistic regression and the Brant test were employed to calculate risk between mild (Type I) and severe cases (Types II and III), and the assumption of proportional odds, respectively. The Mann-Whitney U Test was used to compare number of surgeries and age by the last repair between mild and severe cases. One-way ANOVA was employed to compare age of the child at the time of first surgery across severities (Types I - III). RESULTS: Women ≥ 40 years of age are 3.89 times [95% CI: 1.20-12.64] at a higher risk for having a child with the more severe forms of the condition than younger women. Repair of Type I was accomplished with 1 intervention whereas more severe cases required 1 - 4 (2 ± 0.5) surgical interventions. The timing for hypospadias repair of Type I cases occurred at an average age of 16.2 ± 4.88 months, of Type II cases occurred at an average age of 20.3 ± 8.15 months whereas the average age of the first hypospadias repair among Type III cases was 12.68 ± 2.52 months. Number of surgeries according to severity (p ≤ 0.0018, z-ratio = 2.91) and age difference for the timing of last repair (p ≤ 0.045, z-ratio = 1.69) were statistically different, but not the age difference for the first repair. CONCLUSIONS: Increased maternal age is associated with the most severe forms of hypospadias. There is room for improvement for the timing of hypospadias repair according to severity.
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OBJECTIVE: The aim was to determine the distribution pattern of hypospadias cases across a well-defined geographic space. MATERIALS AND METHODS: The dataset for this study was produced by the Birth Defects Prevention and Surveillance System of the Department of Health of Puerto Rico (BDSS-PR), which linked the information of male newborns of the Puerto Rico Birth Cohort dataset (PRBC; n=92,285) from 2007 to 2010. A population-based case-control study was conducted to determine prevalence trend and to estimate the potential effects of maternal age, paternal age, birth-related variables, and health insurance status on hypospadias. Two types of geographic information systems (GIS) methods (Anselin Local Moran's I and Getis-Ord G) were used to determine the spatial distribution of hypospadias prevalence. RESULTS: Birthweight (<2500 g), age of mother (40+years), and private health insurance were associated with hypospadias as confirmed with univariate and multivariate analyses at 95% CI. A cluster of hypospadias cases was detected in the north-central region of Puerto Rico with both GIS methods (p≤0.05). CONCLUSIONS: The clustering of hypospadias prevalence provides an opportunity to assess the underlying causes of the condition and their relationships with geographical space.
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Hipospadias/epidemiología , Adulto , Análisis por Conglomerados , Humanos , Lactante , Recién Nacido , Masculino , Prevalencia , Puerto Rico/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
AIM: The purpose of this study was to provide a quantitative assessment of female rat sexual behaviors after acute exposure to the A-ring reduced testosterone metabolite, androstanediol (3α-Diol), through the nucleus accumbens (NA) shell. MAIN OUTCOME MEASURES: Quantitative analyses of female rat sexual behaviors and assessment of protein levels for the enzyme glutamic acid decarboxylase isoform 67 (GAD67) and gephyrin, a protein that participates in the clustering of GABA-A receptors in postsynaptic cells, were accomplished. METHODS: Female rats were ovariectomized and primed with estrogen and progesterone to induce sexual behaviors. Females received a 3α-Diol infusion via guided cannula that aimed to the NA shell five minutes prior to a sexual encounter with a stud male. The following parameters were videotaped and measured in a frame by frame analysis: lordosis quotient (LQ), Lordosis rating (LR), frequency and duration of proceptive behaviors (hopping/darting and ear wiggling). Levels of GAD67 and gephyrin were obtained by Western blot analysis two or twenty-four hours after the sexual encounter. RESULTS: Acute exposure to 3α-Diol in the NA shell enhanced LR, ear wiggling, and hopping/darting but not LQ. Some of these behavioral effects were counteracted by co-infusion of 3α-Diol plus the GABAA-receptor antagonist GABAzine. A transient reduction of GAD67 levels in the NA shell was detected. CONCLUSIONS: The testosterone metabolite 3α-Diol enhances sexual proceptivity, but not receptivity, when infused into the NA shell directly. The GABAergic system may participate in the androgen-mediated enhancement of female rat sexual motivation.
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Androstano-3,17-diol/metabolismo , Dihidrotestosterona/metabolismo , Glutamato Descarboxilasa/metabolismo , Núcleo Accumbens/enzimología , Conducta Sexual Animal/fisiología , Testosterona/metabolismo , Animales , Femenino , Lordosis , Masculino , Motivación , Ratas , Ratas Sprague-Dawley , Receptores de GABA-A/efectos de los fármacos , Grabación de Cinta de VideoRESUMEN
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-hour urine samples during an 8-year period showed poor adrenal suppression in spite of adherence to treatment. A recent MRI study confirmed the presence of hyperplastic adrenal glands as well as the presence of a prepubertal uterus. Semistructured interviews with the individual confirmed a life history consistent with a male gender identity. CONCLUSIONS: Although the American Academy of Pediatrics recommends that XX intersex individuals with CAH should be assigned to the female sex, this practice harms some individuals as they may self-identify as males. In the absence of comorbid psychiatric factors, the discrepancy between infant sex assignment and gender identity later in life underlines the need for a reexamination of current standards of care for individuals diagnosed with CAH.
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Hiperplasia Suprarrenal Congénita/diagnóstico , Hiperplasia Suprarrenal Congénita/metabolismo , Trastornos del Desarrollo Sexual/diagnóstico , Trastornos del Desarrollo Sexual/metabolismo , Identidad de Género , 17-Hidroxicorticoesteroides/metabolismo , 17-Cetosteroides/metabolismo , Glándulas Suprarrenales/metabolismo , Hiperplasia Suprarrenal Congénita/clasificación , Adulto , Diagnóstico Diferencial , Trastornos del Desarrollo Sexual/clasificación , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Anamnesis , Persona de Mediana Edad , Puerto RicoRESUMEN
INTRODUCTION: Anabolic androgenic steroids (AAS) affect human female sexual behaviors. Animal models have been useful in uncovering the neural mechanisms governing changes in female sexual response upon AAS exposure. AIM: We quantify the sexual response of AAS-exposed gonadally intact female mice when paired with gonadally intact female or male pairs. METHODS: C57Bl/6 female mice were systemically exposed to the AAS 17alpha-methyltestosterone (7.5 mg/kg) for 17 days via a subcutaneous osmotic implant. On days 15-17, these females were allowed to mate with males or proestrus female partners in familiar and unfamiliar testing arenas for 10 minutes. MAIN OUTCOME MEASURES: The following behavioral responses were registered: parameters related to mounting behavior such as the frequency of mounts, attempts to mount, and the latency to the first mount, anogenital investigation, fights and escapes, rejections, pelvic thrusts, and lordotic responses. RESULTS: We found that males displayed a significant decrease in the frequency of mounts to AAS-exposed females, when compared with mating encounters with control females. We found no difference in the lordosis strength when control females were mounted by either a male or AAS-exposed females. However, females under androgen exposure attempted to mount control females, but not males, and their behavior was accompanied by significant increases in the number of fights, escapes, and rejections to the male. There were no differences between AAS-exposed females and males when the frequency of mounts and pelvic thrusts toward control females were compared. The lordotic quotient of control females was similar for either partner. CONCLUSIONS: Aside from showing a male-like pattern, AAS-exposed females displayed a higher frequency of anogenital investigations toward control females than males, and their latency to the first mount was as fast as that of males. Taken together, we conclude that the sex partner greatly influences the sexual response of AAS-exposed female mice.
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Agresión/efectos de los fármacos , Anabolizantes/administración & dosificación , Copulación/efectos de los fármacos , Preferencia en el Apareamiento Animal/efectos de los fármacos , Metiltestosterona/administración & dosificación , Anabolizantes/farmacología , Análisis de Varianza , Animales , Relación Dosis-Respuesta a Droga , Reacción de Fuga/efectos de los fármacos , Femenino , Masculino , Metiltestosterona/farmacología , Ratones , Ratones Endogámicos C57BLRESUMEN
The androgen 17alpha-methyltestosterone (17alpha-meT) is one of the most commonly abused anabolic androgenic steroids (AAS). We assessed the impact of 17alpha-meT after bilateral infusion into the dorsomedial hypothalamus (DMH) in female anxiety. A paradoxical effect in Vogel conflict test (VCT) behavior was noted: while AAS infusion induced an increase in the latency to display the appetitive reaction of the task, it also increased the number of punished responses. No changes in elevated plus maze (EPM) behavior were noted. However, AAS infusion induced an increase in social interactions. Changes in social interactions were mimicked by muscimol infusion and counteracted by co-infusion of AAS plus the GABAA receptor (GABAA-R) antagonist GABAzine. A reduction of systolic blood pressure was registered after AAS infusion in the DMH. No changes in fluid intake or locomotor behaviors were noted. We conclude that the AAS 17alpha-meT modulates distinct anxiety domains in females through a fast-acting mechanism.
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Ansiolíticos/farmacología , Conducta Animal/efectos de los fármacos , Metiltestosterona/farmacología , Animales , Núcleo Hipotalámico Dorsomedial/efectos de los fármacos , Femenino , Relaciones Interpersonales , Muscimol/farmacología , Piridazinas/farmacología , Ratas , Ratas Sprague-Dawley , Factores SexualesRESUMEN
Three different behavioral tasks were used to study the role of the neurosteroid 5alpha -androstane-3alpha, 17beta-diol (3alphaDIOL) in affective components of behavior when infused into the basolateral amygdala (BLA) of both sexes. Female rats were ovariectomized; half received implants containing estradiol benzoate (OVX-EB), whereas the other half received empty implants (OVX). Male rats were gonadally intact. No differences were noted in male behavior according to the conditioned place preference (CPP) test, the modified Vogel conflict test (VCT), or the elevated plus maze (EPM) upon infusion of 3alphaDIOL. In contrast, 3alphaDIOL modulated CPP and VCT performance among female rats. Therefore, the authors propose that 3alphaDIOL modulates affect through the BLA via a sex-specific mechanism.
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Amígdala del Cerebelo/efectos de los fármacos , Condicionamiento Operante/efectos de los fármacos , Estradiol/análogos & derivados , Caracteres Sexuales , Conducta Espacial/efectos de los fármacos , Análisis de Varianza , Animales , Conducta Animal/efectos de los fármacos , Conducta Animal/fisiología , Estradiol/farmacología , Estrógenos/sangre , Estrógenos/farmacología , Conducta Exploratoria/efectos de los fármacos , Femenino , Agonistas del GABA/farmacología , Antagonistas del GABA/farmacología , Masculino , Aprendizaje por Laberinto/efectos de los fármacos , Actividad Motora/efectos de los fármacos , Muscimol/farmacología , Ovariectomía/métodos , Piridazinas/farmacología , Radioinmunoensayo/métodos , Ratas , Ratas Sprague-Dawley , Esteroides/farmacologíaRESUMEN
Neurotransmission mediated by gamma-aminobutyric acid type A (GABA(A)) receptors in the mammalian medial preoptic area (mPOA) plays a pivotal role in the expression of hormone-sensitive behaviors. Hand in hand with GABAergic control of reproduction, hormone treatments that activate gonadal steroid signaling pathways in gonadectomized rats are known to regulate the expression of specific GABA(A) receptor subunit mRNAs. While the effects of exogenous hormone treatments have been well documented, little information is available as to how GABA(A) receptor-mediated transmission in the mPOA is altered by endogenous changes in hormonal state in gonadally-intact adult animals or if those changes can be ascribed to hormone-dependent changes in receptor subunit composition. In the present study, we found that both the peak amplitudes of GABA(A) receptor-mediated synaptic currents in the mPOA, as well as the ability of the endogenous neurosteroids to modulate those currents, varied as a function of the estrous cycle. Moreover, we found that the degree of neurosteroid modulation was also significantly different between wild-type and the androgen-insensitive testicular feminization (Tfm) mutant male mice. Semiquantitative RT-PCR analysis performed to assess levels of GABA(A) receptor subunit mRNAs indicated that levels of specific subunits varied over the course of the estrous cycle and between wild-type and Tfm male mice. The variations in GABA(A) receptor expression and function in the mPOA that are associated with differences in gonadal steroid signaling may contribute to the dynamic nature of GABAergic control of neuroendocrine pathways.