Case studies in adaptation: centring equity in global health education during the COVID-19 pandemic and beyond.

The COVID-19 pandemic disrupted all aspects of life globally and laid bare the pervasive inequities in access to education, employment, healthcare and economic security in both high-resource and low-resource settings. The global health field's brittle attempts of addressing global health inequities, through efforts that in some cases have evoked the colonialist forces implicated in shaping these disparities, have been further challenged by the pandemic. COVID-19 has forced global health leaders to reimagine their field through innovation such as shifting the application of global health to a local focus, collaborating with community organisations and exploring virtual education technologies. We present four case studies illustrating this promising movement towards a more sustainable, ethical and equitable model of global health education practice.Case 1: trainees from the Massachusetts General Hospital Center for Global Health partnered with the Board of Health of Holyoke, a majority Latinx city with high poverty levels, to respond to the COVID-19 pandemic through research and intervention. Case 2: Prevencasa, a community health organisation in Tijuana, Mexico, providing healthcare to local underserved communities, shifted its focus from hosting international trainees to developing a multidisciplinary training programme for Mexican healthcare professionals. Case 3: the Johns Hopkins Global Health Leadership Program adapted its curriculum into a hybrid online and in-person migrant health and human rights elective, collaborating with local organisations. Case 4: a US-based and a Latin American-based organisation collaborated to create a longitudinal, virtual urogynaecology training programme with hybrid simulation practice to increase accessibility of procedural-based training.

[Vaginal hysterectomy for the enlarged non-prolapse uterus using morcellation techniques and/or Deschamps needle: a retrospective cohort study]. / Histerectomía vaginal para úteros grandes y sin prolapso mediante morcelación y aguja de Deschamps.

OBJECTIVE: To compare surgical outcomes in women who underwent vaginal hysterectomy with enlarged (> 12 weeks size) and non-prolapsed uterus utilizing different morcellation techniques with or without concomitant Deschamps needle use to vaginal hysterectomy for prolapsed uterus. MATERIAL AND METHODS: Retrospective cohort study in women who underwent vaginal hysterectomy performed between January 2009 and June 2014 in the National Institute of Perinatology. The study group comprised 48 women who had vaginal hysterectomy with enlarged and non-prolapsed uterus in which were utilized different morcellation techniques with or without concomitant Deschamps needle use and 50 women who had vaginal hysterectomy for prolapsed uterus served as control. RESULTS: The groups had statistical difference in age, number of cesarean sections, body mass index (BMI), grade of prolapse (Point Cx and D with POPQ quantification system) and surgical prediagnosis (p < 0.001); mean uterus weight was 182.5 g and 106 g, respectively (p < 0.001), as well as for transverse and antero-posterior dimensions and realization of morcellation with or without use of Deschamps needle. Both groups had no statistical difference in preoperative hemoglobin, concomitant surgeries for incontinence and prolapsed, estimated blood loss, operation time, length of stay and complications. CONCLUSION: Vaginal hysterectomy utilizing different morcellation techniques with or without concomitant Deschamps needle use in women with enlarged and non-prolapsed uterus is safe, effective, and with similar complications to vaginal hysterectomies in prolapse uterus.

Clitoromegalia: quiste epidermoide de clítoris / Clitoromegaly: epidermal cyst of clitoris

Objetivo: Describir un caso de clitoromegalia en una mujer perimenopáusica. Lugar: Centro de Tercer Nivel de Atención. Intervenciones: Resonancia magnética, ultrasonido pélvico, marcadores tumorales, clitoroplastia con resección quirúrgica de quiste epidermoide. Resultados: Clitoroplastia más resección de tumor epidermoide con preservación de la anatomía y sensibilidad. Conclusión: Paciente femenina de 52 años, sin antecedentes de trauma pélvico, quien desarrolló un caso inusual de clitoromegalia sin dolor u otros síntomas, además de un notorio crecimiento tumoral en los últimos cuatro años en el cual la malignidad fue descartada. Hay pocos casos de quistes epidermoides en ausencia de trauma o mutilación de genitales reportados en la literatura; generalmente son solitarios, de crecimiento lento y asintomáticos, localizados usualmente en la piel, el cuello o el tronco del clítoris. El procedimiento realizado fue una clitoroplastia con resección del quiste epidermoide, en el cual se ha preservado tanto la anatomía como la sensibilidad sin complicaciones después de seis meses de seguimiento.

Objective: Describe a case of clitoromegaly in a perimenopausal female. Setting: Third Level Attention Center. Interventions: Magnetic resonance imaging, pelvic ultrasound, tumoral markers, clitoroplasty with surgical extirpation of epidermal cyst. Results: Clitoroplasty with surgical extirpation of epidermal cyst and preservation of the anatomy and sensitivity. Conclusions: A 52 years old female patient without history of pelvic trauma who developed an unusual case of clitoromegaly without pain nor any symptoms besides notorius tumor growing over past four years in which malignancy was discarded. There are very few epidermal cyst cases in the absence of trauma or genitalia mutilation reported in literature; they are usually solitary tumors, with slow growing and asymptomatic. Usually localized in clitoral scalp, neck or trunk. The performed procedure was a clitoroplasty with extirpation of an epidermal cyst, where has been well preserved the anatomy and sensitivity, without any complication after six months follow up.