Browse Health


Awards & Distinctions ?

Patients' Choice Award (2015)

Affiliations ?

Dr. Bernal is affiliated with 3 hospitals.

Hospital Affiliations



  • Duke University Hospital
    2301 Erwin Rd, Durham, NC 27710
    Top 50%
  • Temple University Hospital
    3401 N Broad St, Philadelphia, PA 19140
  • Durham Veterans Affairs Medical Center
    508 Fulton St, Durham, NC 27705
  • Publications & Research

    Dr. Bernal has contributed to 16 publications.
    Title Reinnervation of Urethral and Anal Sphincters with Femoral Motor Nerve to Pudendal Nerve Transfer.
    Date February 2012
    Journal Neurourology and Urodynamics

    Lower motor neuron damage to sacral roots or nerves can result in incontinence and a flaccid urinary bladder. We showed bladder reinnervation after transfer of coccygeal to sacral ventral roots, and genitofemoral nerves (L1, 2 origin) to pelvic nerves. This study assesses the feasibility of urethral and anal sphincter reinnervation using transfer of motor branches of the femoral nerve (L2-4 origin) to pudendal nerves (S1, 2 origin) that innervate the urethral and anal sphincters in a canine model.

    Title Evaluation of Chronic Pelvic Pain Syndrome in Men: is It Chronic Prostatitis?
    Date September 2009
    Journal Current Urology Reports

    Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is not well understood. The mechanisms involved in its pathophysiology have yet to be fully elucidated. Men with CP/CPPS suffer from symptoms that may not necessarily be linked to concurrent prostate involvement. Recent literature embraces the notion that symptoms may result from complex interactions, and studies have looked at other disease syndromes in an attempt to reveal the etiology of the disease. The title of this article suggests an organ-centric etiology to explain symptoms of patients with this disorder, but this does not seem to be the case. In an attempt to answer the question, this article examines possible etiologies for CP/CPPS in which the prostate may be involved and discusses evaluation strategies for patients with CP/CPPS. It seems, however, that instead of limiting our focus to the prostate, a multisystem approach to discovery and symptom control would further improve patient care.

    Title Ship in a Bottle: Rapid Extraction of Large Intravesical Foreign Bodies.
    Date April 2006
    Journal Urology

    Objects placed in the bladder often become encrusted with stone. Using a technique combining endoscopic visualization and a small open cystotomy, a large encrusted foreign body was successfully and safely removed. The combination of endoscopy and cystotomy is rapid, safe, and potentially applicable for the removal of large vesical calculi.

    Title Cost-benefit Analysis of Newborn Screening for Galactosemia in the Philippines.
    Date June 2005
    Journal The Southeast Asian Journal of Tropical Medicine and Public Health

    To determine the incidence of galactosemia (GAL) in the Philippines and to determine whether newborn screening for GAL is cost-beneficial from a societal perspective, cost-benefit analysis was performed. Newborn screening for GAL was done after the 24th hour of life using the Beutler test. Patients screened positive were recalled for confirmatory testing. Using incidence rates obtained from the different participating hospitals of the Philippine Newborn Screening Program (PNSP), the costs for the detection and treatment of GAL were compared to the expected benefits by preventing mental retardation, cataracts and other physical disabilities caused by the disorder that would lead to a loss of productivity for the individual. Sensitivity analyses for incidence and discount rates were also included. Of the 157,186 newborns screened by the PNSP since its inception in 1996, 8 screened positive results. Confirmatory testing of these patients showed that 2 had galactosemia. The incidence of galactosemia in this population therefore, is 1 in 106,006 (95% CI= 1:44,218 - 1:266,796). Projecting the figures to the actual birth rate (1.5M newborns/year), the total costs of the screening program amounted to $1.1M, while the total benefits amounted only to $0.2M, yielding net cost of $0.9M. A cost-benefit analysis of the screening program for galactosemia using the incidence 1 in 106,006 demonstrated that the costs of the program outweigh the benefits. The true incidence of galactosemia in the Philippine population may yield an incidence rate that will result in greater net benefits for the program.

    Title Identifying Obstacles to Viral Gene Therapy for Lung Cancer. Malignant Pleural Effusions As a Paradigm.
    Date May 2003
    Journal Methods in Molecular Medicine
    Title Soluble Coxsackievirus Adenovirus Receptor is a Putative Inhibitor of Adenoviral Gene Transfer in the Tumor Milieu.
    Date December 2002
    Journal Clinical Cancer Research : an Official Journal of the American Association for Cancer Research

    PURPOSE: Several barriers that collectively restrict gene delivery by viral vectors in vivo have been described. Previously, we identified soluble chondroitin sulfate-proteoglycans/glycosaminoglycans in malignant pleural effusions (MPEs) as inhibitors of retroviral vector transduction. Soluble components of MPE also inhibited adenoviral (Ad) gene transfer, and the factors were characteristically filterable, titrable, stable at 56 degrees C, and blocked the binding of Ad to target cells. Depleting immunoglobulin from MPE, partially reversed the block to Ad transduction, instigating a search for additional factors that bound Ad in MPE. EXPERIMENTAL DESIGN: Vector-protein interactions were identified after the resolution of MPE-components by SDS-PAGE. Viral overlays and immunoblots delineated significant interactions, and the potential relevance of those interactions was tested in transduction efficiency bioassays. RESULTS: Immunoglobulin is the predominant factor inhibiting Ad gene transfer in MPE. Albumin also interacted with Ad, although at predicted serum concentrations, it did not effect Ad transduction efficiency in vitro. Soluble coxsackievirus-Ad receptor (sCAR) was then identified in MPE. In a survey of 18 MPE, the mean concentration of sCAR was variable and estimated to be 3.51 +/- 5.02 ng/ml by ELISA. The impact of sCAR on transduction efficiency in this milieu was next assessed. Whereas immunodepletion of sCAR from MPE by affinity chromatography resulted in enhanced gene transfer within MPE, the inhibition of adenoviral gene transfer was not evident when the predicted concentrations of recombinant sCAR were added into the transduction medium. CONCLUSIONS: These studies indicate that, in addition to anti-Ad antibodies, other specific and nonspecific factors interact with viral vectors and may impair gene transfer in the tumor milieu. The presence of sCAR in MPE puts forward the notion that in certain contexts (e.g., within the extracellular matrix of solid tumors) the concentrations of secreted (or shed) CAR may be high enough to effectively compete with Ad gene delivery.

    Title Possible Role of Calmodulin in Excystation of Giardia Lamblia.
    Date December 1998
    Journal Parasitology Research

    The protozoan Giardia lamblia initiates infection when trophozoites emerge from a cyst in the hosts by the excystation process. Although this process is crucial to the initiation of infection by G. lamblia, little is known about its regulation. To study the possible involvement of calmodulin (CaM) in excystation we tested the effect of several CaM antagonists (TFP, W-7, and W-5) on this cellular function. Except for W-5 the rest of these compounds inhibited excystation. The protein kinase C inhibitor H-7 had no effect on excystation, suggesting that CaM antagonists acted by selectively inhibiting CaM. Furthermore, CaM was redistributed after the induction of excystation and there was an increase in its fluorescence and activity. These results suggest that a CaM-dependent process is involved in G. lamblia excystation.

    Title Antigens in Electron-dense Granules from Entamoeba Histolytica As Possible Markers for Pathogenicity.
    Date January 1991
    Journal Journal of Clinical Microbiology

    In vitro interaction of Entamoeba histolytica with collagen induces intracellular formation and release of electron-dense granules (EDG) and stimulation of collagenolytic activity. Purified EDG contain 1.66 U of collagenase per mg of protein. Thus, EDG may participate in tissue destruction during invasive amebiasis. Monoclonal antibodies (MAbs) L1.1 and L7.1 reacted specifically with EDG in enzyme-linked immunosorbent assay (ELISA) and immunofluorescence and immunoelectron microscopy. MAb L7.1 immunoprecipitated three polypeptides with molecular weights of 95,000, 68,000, and 28,000 from lysates of biosynthetically labeled E. histolytica. Both MAbs recognized the pathogenic E. histolytica axenic strains HM1:IMSS, HM38:IMSS, and HK-9 but failed to react in ELISA with Entamoeba moshkovskii, Entamoeba invadens, and E. histolytica-like Laredo. In addition, MAb L7.1 reacted with one E. histolytica isolate from a symptomatic patient but did not react with four of five isolates from asymptomatic patients. EDG antigens were detected by a MAb L7.1-based ELISA in E. histolytica-containing fecal samples from symptomatic, but not asymptomatic, individuals. These results suggest that the EDG antigen detected with MAb L7.1 may be differentially expressed in pathogenic and nonpathogenic E. histolytica.

    Title [giardiasis in Relation to Blood Group A].
    Date January 1988
    Journal Boletín Médico Del Hospital Infantil De México
    Title [does Giardia Lamblia Favor the Proliferation of Intestinal Bacteria?].
    Date January 1987
    Journal Boletín Médico Del Hospital Infantil De México
    Title [first Case of Ocular Linguatulosis in México].
    Date February 1986
    Journal Boletín Médico Del Hospital Infantil De México
    Title [lactose Absorption in Intestinal Parasitosis].
    Date December 1982
    Journal Boletín Médico Del Hospital Infantil De México
    Title [protein Absorption in Children with Giardiasis].
    Date July 1982
    Journal Boletín Médico Del Hospital Infantil De México

    With the object of investigating if Giardiasis interferes in the intestinal absorption of proteins, a study was made testing the absorption of gelatin in eleven. The determination of alpha-aminonitrogen, before giving gelatin, and the increase shown two hours later, was the criterion used to measure the capacity of absorption. Once the estimated basal had been carried out each of the children received tinidazol for three days, after which the large amount of gelatin was given once again so as to estimate any changes in the absorption, one the parasite had been eliminated. The results demonstrate that the presence of giardia in the intestine significantly restricts the absorption of the gelatin. We offer as proof the results of these findings in the growth of children who harbour this parasite.

    Title [height of Children with G. Lamblia and There Capacity to Absorb D-xylose].
    Date July 1976
    Journal Boletín Médico Del Hospital Infantil De México

    The investigation was carried out with the purpose of studying the capacity to absorb d-xylose in children with G. lamblia establishing also, whether or not their height was reduced. The study is included 25 school age children with giardiasis, pairing them according to sex and age with another 25 without intestinal parasitosis.

    Title [absorption of D-xylose in Intestinal Parasitic Diseases].
    Date May 1976
    Journal La Prensa Médica Mexicana

    In order to investigate the intestinal absorption in relation to parasitic diseases, 106 children were studied using the xylose test. All of them were attending a primary school. The height and weight were recorded, and the hemoblobin and hematocrit were estimated in each one. The examination of the stools shown one or more parasites in 57.6 per cent specimens. The E. histolytica, Hymenolepis nana and A. lumbricoides, were identified in 22.6, 21.7 and 20.7 per cent children, respectively; G lamblia was found in 10.4 per cent. Only the children with Giardia had a statistical difference in the absorption of xylose, with respect to those without parasites. At the same time height was low in comparison to a group of children with similar age and sex, selected among the 45 without parasitic diseases. Findings are discussed according to the pathogenic mechanism involved in giardiasis. Emphasis is done in the interplay of malnutrition and G. lamblia.

    Title [balantidium Coli Dysentery Syndrome in Children].
    Date January 1975
    Journal Boletín Médico Del Hospital Infantil De México

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