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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INTRODUCTION: Explore influenza and Tdap immunization knowledge, attitudes, and practices among Hispanics patients attending prenatal care in a tertiary hospital in Puerto Rico as well as barriers encountered by patients regarding vaccination practices during pregnancy. METHODS: Descriptive study conducted at Adult District Hospital prenatal care clinics in the Medical Sciences Campus of Puerto Rico from September 2016 to June 2017. RESULTS: A total of 189 were recruited. Regarding Influenza vaccine: 75.6% were offered or oriented about Influenza vaccination, 51.8% had received the vaccine at least once (only 12.2% during current pregnancy) and, 57.1% reported receiving information about influenza infection risks in pregnancy, mainly from health care professionals and media. For Tdap only 20.6% of women were offered or oriented about the vaccine and 23.3% received the vaccine. 55.6% of patient had not been oriented about potential dangers of the pertussis infection; for the few oriented, health professionals were their predominant source. In terms of barriers, lack of information about vaccination and the effects/benefits during pregnancy were the most frequent. CONCLUSION: Our study identifies the existing gap of information regarding Influenza and Tdap vaccine. Physicians play a pivotal role in preventive care and new strategies are needed to optimize education to our patients.

INTRODUCTION: Ob/Gyn residency programs are not providing enough training time to pediatric gynecology education, and residents experience limited exposure in clinics. By graduation, most residents feel less than competent in managing pediatric evaluations. Multiple authors have published their concern and possible solutions to improve training during residency. Most interventions have been limited to independent study or simulations for technical skill development in pediatric pelvic examination. This study will integrate the individual solutions provided in the literature to develop a structured and interactive curriculum to achieve resident competence in all phases of the encounter. METHODS: A prospective pre-post cohort study to evaluate effects in knowledge, skills and attitudes (KAS) in 20 Ob/Gyn residents from University of Puerto Rico. The curriculum included 4 interactive, independent sessions of 60 minutes on bleeding patterns, pelvic pain, pelvic masses and vulvovaginal disease. Followed by a 120-minute workshop on examination, procedural and communication skills. To evaluate the areas, the data was collected in a pre and post tools for knowledge, skills and attitudes. RESULTS: Data was collected from 14 residents who completed the pre and post-tests. Descriptive statistics comparing all residents who responded pre and post-tests showed a 85% improvement in medical knowledge, 100% for procedural skills and 75% in attitudes. CONCLUSION: A short curriculum, with limited resources can be implemented in all interested programs. Providing more time and specific training in pediatric gynecology will improve KSA of Ob/Gyn residents leading to improvement in care for Ped/Gyn population. Study was limited by poor response of residents to web instruments.