Foreign body in the male urethra: case report

Cases of self-inserted foreign bodies into the lower urinary tract are uncommon. They are associated with a mental illness called polyembolokoilomania. The site, size and nature of the foreign body determines both the symptomatology and complications. A case of self-inserted needle into the penile urethra by a 15-year-old boy is presented. A plain X-ray of the pelvis revealed the needle. The needle was successfully removed by cystoscopy. Plane X-ray imaging and CT scan are essential to locate the site, size, and nature of the foreign body. Endoscopic approach is preferred in majority cases. Psychiatric counselling in the post-operative period is required to prevent further episodes of reinsertion of such foreign bodies.

A Girl and a Boy, Are a Bundle of Joy: A Rise in Gender-Equitable Fertility Preferences in India

Within the last decade, declining son preference in Asia has given rise to gender-equitable fertility preferences. These include daughter preference, gender indifference, and gender balance. Using five rounds of the India National Family Health Surveys, I investigate the sources of the trends in shifting parental preferences for the gender of their children. Over more than a quarter-century period (1992-1993 to 2019-2021), I find a significant decline in son preference from 40 to 18 percent and an increase in gender-equitable preferences among most subpopulations. Multivariate analysis shows that for all survey years, education and frequent exposure to television significantly increased the odds of gender-equitable preferences. In the last decade, community norms supporting women's employment are also associated with gender-equitable preferences. In addition, decomposition analysis shows that compared to compositional change, social norm change accounts for two-thirds of the rise in gender-equitable preferences. These findings suggest that rising norms of gender equality have the potential to dismantle gender-biased preferences in India.

Littre’s hernia: A Surgical dilemma. (Case Report)

Meckel’s diverticulum in a hernia sac is designated as a Littre’s hernia. It is an uncommon type of hernia. The diagnosis is invariably made at the time of surgery. Resection anastomosis of the adjacent segment of the small bowel with the diverticulum is a contentious issue. A case of Littre’s hernia is reported. A case of Littre’s hernia in a17 year old boy is reported to highlight the diagnostic and therapeutic issues confronting the attending surgeon. A short segment resection anastomosis of the small bowel along with the Meckel’s diverticulum was done. A herniorrhaphy was done with no complications. The diagnostic challenges and the dilemma of selecting the best option for removing the Meckel’s diverticulum and choice of hernia repair are discussed. Littre’s hernia is invariably diagnosed intraoperatively. A short segment resection anastomosis of the adjacent small bowel along with the Meckel’s diverticulum prevents complications arising due to the diverticulum. A herniorrhaphy for a young patient and the use of an absorbable mesh for other age groups is advisable.

Dermatofibrosarcoma Protuberans of the abdominal wall (Case Report)

Dermatofibrosarcoma protuberans is a uncommon tumour with enigmatic aetiology arising from the deeper layers of the skin usually involving the dermis and subcutaneous fat. It is an intermediate grade malignancy having a high incidence of local recurrence. Metastasis are rare. MRI of the part helps in assessing the extent of the lesion. Mohs micrographic surgery is the mainstay of treatment. Chemotherapy in the form of Imatinib mesylate and radiotherapy are indicated in recurrent cases.

Giant lipoma over the back

Lipoma is one of the most common soft tissue tumor arising from the mesenchyme. It is slow growing, encapsulated, and usually benign in nature. Tumors over the back, shoulder, and neck region have a high propensity to assume large size thereby getting redefined as a giant lipoma when they exceed 10 cm in width or weigh more than 1000 grams. MRI is the investigation of choice for evaluating giant lipomas. Fine needle aspiration cytology (FNAC) or frozen section may be pertinent in suspected cases of liposarcoma. Complete surgical incision is the treatment of choice. A case of a giant lipoma on the back of a 64-year-old lady is presented with a view to revisit conceptual understanding of the clinical evaluation, investigation, and management of giant lipomas.

Abdominal wall pseudocyst complicating incisional hernia repair

Background: Development of a pseudocyst after mesh repair of hernia is a rare complication. As a result, both diagnosis and management pose a great challenge to the attending surgeon. Therefore, the need to report such an uncommon complication and its management in order to create awareness of this distinct rare entity. Case report: A case of pseudocyst formation following a onlay mesh repair of incisional hernia is reported. Contrast-enhanced CT scan was diagnostic. It revealed a well formed cyst with no communication with the peritoneal cavity. Complete excision of the cyst was curative. Conclusion: Pseudocyst formation is a rare complication following mesh repair. Contrast enhanced CT scan is essential for confirming the diagnosis. Complete surgical resection of the cyst is the mainstay of surgical treatment.

Practising Pragmatism: The Framing of Gender Among Development Professionals in India

This article identifies the ways in which researchers and practitioners situated in different institutions engage with different systems of knowledge in their study of gender in the context of development, and the implications it has on how these professionals work together. Key informant interviews with 25 gender specialists from universities, research organizations, NGOs, UN agencies and donors undertaken in Delhi, India, are used as an illustration. The study finds that researchers/practitioners perceive that they study gender in dissimilar ways based on differences in academic training, professional roles and explicit affiliation with feminism. In practice, however, they have adopted ‘pragmatic’ ways to bridge the epistemological divide between the perspectives of ‘gender and development’ and ‘feminism’. These pragmatic practices are visible in the ways in which they work with the government, academia and donor organizations. I voice their need to traverse the quantitative–qualitative divide in order to strengthen our understanding of gender. The study demonstrates that researchers can negotiate epistemological differences for the sake of achieving the common goal of gender justice. This is important as the field of research on gender expands globally, with the emergence of new sites of knowledge production and emphasis on numerical evidence.

Challenges in Introducing New Contraceptive Methods: A Case Study of India

Increasing choice and introducing new contraceptive methods in the National Family Welfare Program in India could play a significant role in increasing adoption of contraception and meeting the unmet need of a large proportion of couples. However, inclusion of any new contraceptive method in India has to face many challenges at different steps: from clinical trials, administrative processes, acceptance in the national program, and reaching the intended beneficiaries. Having a good product is necessary but not sufficient for widespread accessibility, acceptance, and use. This article reviews the challenges based on the available policy documents, literature review, and discussions with senior program managers of the Ministry of Health and Family Welfare and development organizations. It concludes that comprehensive strategic planning is needed to address all possible barriers to ensure new contraceptive access at an affordable price by the beneficiaries it is intended for.

Mainstreaming of emergency contraception pill in India: challenges and opportunities

BACKGROUND

Emergency Contraception Pill (ECP) is an essential intervention to prevent unwanted pregnancies. However, its use has remained low due to various barriers including reservations among medical fraternity.

MATERIALS AND METHODS

This paper presents findings on barriers to ECP's easy access for potential users from (i) a cross-sectional survey of providers' attitudes, beliefs, and practices and interviews with key opinion leaders, (ii) three consultations organized by Population Council with policymakers and public health experts, and (iii) evidence from scientific literature.

RESULTS

The major barriers to easy access of ECP include misconceptions and reservations of providers (disapproval of ECP provision by CHWs, opposition to its being an OTC product, and myths, misconceptions, and moral judgments about its users) including influential gynecologists.

CONCLUSION

For mainstreaming ECP, the paper recommends educational campaign focusing on gynecologists and CHWs, relaxing restrictive policy on advertisement of ECP, involving press media and strengthening supply chain to ensure its regular supply to ASHA (CHW).

Medical barriers to emergency contraception: a cross-sectional survey of doctors in North India

BACKGROUND

Some medical doctors in India have publicly expressed opposition to making emergency contraceptive pills (ECPs) easily accessible, even though ECPs are included in the method mix of the Ministry of Health and Family Welfare program and as an over-the-counter (OTC) product. Such opposition affects access to ECPs by influencing policy, procurement, and distribution, besides stigmatizing the ECP user. This study was conducted to assess ECP knowledge, attitudes, and practices of doctors in North India.

METHODS

A cross-sectional survey of 83 doctors who provide ECPs, randomly selected from 3 cities in the state of Uttar Pradesh, was conducted in 2011. The quantitative data were complemented by 19 in-depth interviews with purposively selected senior gynecologists and other opinion leaders.

RESULTS

All surveyed physicians cited the correct dose and regimen for ECPs. However, the large majority of those surveyed believed that ECPs work by preventing implantation. (The best evidence currently indicates that ECPs do not work by preventing implantation.) Most doctors also believed incorrectly that ECPs have several contraindications and side effects. They also had strong reservations against OTC provision of ECPs by pharmacists and community health workers (CHWs) and negative attitudes toward ECP users, which serve as serious medical barriers to mainstreaming use of ECPs.

CONCLUSION

Physicians and their professional associations exert a strong influence on the operationalization of national contraceptive policies. Evidence-based advocacy and educational campaigns targeting doctors are needed to address and resolve their reservations about ECPs, particularly about its provision as an OTC product and its distribution by CHWs. Partnerships with medical associations can help reduce doctors' negative attitudes and create a conducive environment for influencing clinical practices. Such changes are needed to increase the availability and use of ECPs as part of a package of a full range of contraceptive method options to prevent unwanted pregnancy among the most vulnerable populations.