The Gendered Crisis: Livelihoods and Well-Being in India During COVID-19

This article studies the impact of the COVID-19 pandemic on the gendered dimensions of employment and mental health among urban informal-sector workers in Delhi, India. First, the study finds that men's employment declined by 84 percentage points during the pandemic relative to pre-pandemic employment, while their monthly earnings fell by 89 percent relative to the baseline mean. In contrast, women did not experience any significant impact on employment during pandemic. Second, the study documents very high levels of pandemic-induced mental stress, with wives reporting greater stress than husbands. Third, this gendered pattern in pandemic-induced mental stress is partly explained by men's employment losses, which affected wives more than husbands. In contrast, women staying employed during the pandemic is associated with worse mental health for them and their (unemployed) husbands. Fourth, pre-existing social networks are associated with higher mental stress for women, possibly due to the "home-based” nature of women's networks. HIGHLIGHTS In India, men suffered larger employment losses than women during the pandemic. Women reported greater mental stress than men, although both reported high stress. Men's employment losses affected their wives' mental health more than their own. Having many peers is correlated with worse stress for women, but not men. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Personal, Professional, and Educational Challenges Faced by the Postgraduate Residents of Gynecology and Obstetrics in Peshawar during Covid-19 Pandemic

Objectives: To find out the personal, professional, and educational challenges in training by the post-graduate residents of Obstetrics and Gynecology in the three tertiary care hospitals of Peshawar during the Covid-19 Pandemic. Method(s): This was a web-based cross-sectional study conducted among the postgraduate residents of Gynecology and Obstetrics in the three main teaching hospitals of Peshawar, from 1st April 2020 to 31st July 2020. A structured survey using Google forms was distributed among 98 postgraduate residents through emails and social media platforms. The challenges faced and their severity was assessed using the Likert Scale. Results were analyzed in Microsoft Excel. Result(s): Total number of participants was 98, with 99% being female. The mean age was 28.3+/-1.8 years. Their worst fear was of the family getting infected (86.7%). Their greatest challenge was the inability to practice social distancing due to the nature of their work (85%) amidst a lack of PPEs (51%). Their training suffered due to inadequate opportunities for elective surgeries (78%). Conclusion(s): Post-graduate residents in Gynaecology/Obstetrics faced substantial personal, professional, and educational challenges while training during the covid-19 pandemic.Copyright © 2023, Khyber Medical College. All rights reserved.

Adoption of online retail banking practices as a precautionary protective behavior during the Covid-19 Pandemic

BACKGROUND AND OBJECTIVES: Increase in online banking activities has been observed in the new normal of the Covid-19 pandemic. Previous studies argued that fraudsters tend to prey on unexpected events. This threat is also frightening online consumers of retail banking. Therefore, this study aimed to investigate how online retail banking users can be motivated enough to avoid online banking fraud threats while no compromise on health. METHODS: The population of the study is online banking customers in Pakistan. This study obtained data from 470 respondents who used online banking services by using questionnaires through an online survey. The structure Equation Modeling approach is used to investigate the relationship among study research variables. FINDINGS: Findings from a nationwide online survey confirmed the impact of the pandemic on consumer responses for online retail banking intention. Structure Equation Model results found that Perceived Vulnerability β = 0.24, Perceived Severity β = 0.31, and Response Efficacy β = 0.32 has significant impact on precautionary behavior. Surprisingly, Self-Efficacy was not significant to consumer precautionary behavior during the new normal of COVID-19. CONCLUSION: This study contributes to the literature on online banking and protection motivation theory. Results imply that bankers must invest in online banking and provide a secure environment that prioritizes the safety of the online transaction and create awareness to decrease the threat of fraud during the uncertain situation. The findings of this study particularly call for bankers, retailers' attention to online management of security systems. © 2021 IJHCUM. All rights reserved.

Spontaneous Splenic Rupture in a Patient with Active Sars-Cov-2 Infection

INTRODUCTION: Atraumatic splenic rupture (ASR) is an extremely rare but life-threatening event. Reported incidence ranges from 0.5% - 3.2% and mortality ranges from 12.2% to 20%. The most common predisposing pathologies to ASR are neoplastic and infectious, with the most common infection being mononucleosis. SARS-CoV-2 presents with a wide range of symptoms including cough and anosmia. Herein, we report a case of a patient with ASR and an active SARSCoV- 2 infection without any other predisposing factors. Given the wide range of complications associated with this novel infection, we believe SARS-CoV-2 may be the primary etiological factor in this case. DESCRIPTION: A 21-year-old man presented to Ruby Memorial Hospital with a chief complaint of acute onset severe left upper quadrant abdominal pain with no history of trauma. He had signs of peritonitis. The patient admitted to having a cough the prior week. A RT-PCR SARS-CoV-2 test was positive and rapid mononucleosis test was negative. Ultrasound showed free intra-peritoneal fluid and an irregular spleen. CT angiogram showed a grade 3 splenic subcapsular hematoma. The patient underwent exploratory laparotomy, which revealed a hemoperitoneum with a ruptured spleen. A splenectomy was performed. Three days post-splenectomy, he developed leukocytosis. A chest x-ray showed bibasilar opacities which was confirmed to be SARS-CoV-2 pneumonia. CBC with differentials did not show any evidence of hematological pathology. Streptococcus and legionella urine antigens were negative. Examination of the spleen showed no pathology or signs of malignancy;however, there was focal capsular disruption and hemorrhage. He was discharged nine days post-operation. DISCUSSION: To this author's knowledge, three other cases of ASR linked to SARS-CoV-2 infection are reported in the literature thus far. The average age of these three patients was 59, which is significantly higher than the patient in our case. SARS-CoV-2 has been shown to greatly increase the risk of thrombotic events, including DVT and PE. Formation of microthrombi may lead to splenic congestion. Our patient, due to his young age, lack of co-morbidities, and minimal abnormal histopathological findings, shows a potential novel complication of SARS-CoV-2 infection as no other etiology has been identified.

Use of Kidneys from Hepatitis C Nat Positive Donors for Uninfected Recipients: Early Results from a Rural Appalachian Kidney Transplant Program

Purpose: Increasing mismatch between kidneys available for transplant and the number of patients on the transplant wait list has led to research into novel sources of organs. One such source is kidneys from hepatitis C NAT positive deceased donors. This was previously deemed unforbidden territory due to the risk of disease transmission;however, with the development of direct-acting antiviral agents for effective treatment of Hepatitis C, this organ pool is now usable. Method(s): A retrospective analysis of outcomes of Hepatitis C NAT positive kidney transplants into Hepatitis C seronegative recipients was conducted at newly opened Appalachian transplant center. Due to insurance constraints, the criteria to initiate hepatitis C therapy was seroconversion to positive Hepatitis C PCR. Outcomes examined include median creatinine, glomerular filtration rate (GFR), liver function tests, recipient Hepatitis C seroconversion, concomitant Ebstein Barr virus (EBV), Cytomegalovirus (CMV) or polyoma hominis (BK) activation, morbidities and mortality. Result(s): Six transplants (of 15 total kidney transplants) from Hepatitis C NAT positive donors were performed in the first year of establishment. Male to female ratio was 2:1 and median patient age was 55.7 years (Range 42-73 years). Median follow-up was 10 months (Range 2-12 months). Diabetes and hypertensive nephrosclerosis were the most common causes of end stage renal disease at 40%. The average time on dialysis was 2.9 years (Range 1-6 years), the most common type being hemodialysis (67%) followed by peritoneal dialysis (33%). Average time on transplant waitlist was 5.57 months (Range 1.2-13.2 months). All patients seroconverted but with treatment, by 24 weeks all patients maintained undetectable viral loads. Patient survival rate was 83% with a death censored graft survival rate of 100%. One patient died due to respiratory failure from COVID-19 infection. Median creatinine and GFr were 1.96 mg/dL (Range 1.8 - 2.6 mg/dL) and 41.3 (Range 35.3 - 50) respectively. One case each of acute antibody and T cell mediated rejection was seen (6.7%), which were treated successfully. CMV, BK and EBV virus reactivation were seen in one patient each (6.7%). The most common complication was COVID-19 infection (50%) followed by neutropenia (33%). Conclusion(s): With the development of direct-acting antiviral agents offering complete cure of Hepatitis C, kidneys from Hepatitis C positive donors can be used for transplantation with excellent outcomes.

Successful Implementation of a Rural Appalachian Kidney Transplant Program, One Year Outcomes

Purpose: Kidney transplantation has become the optimal treatment for end stage renal disease (ESRD), allowing dialysis free survival. Despite widespread availability of transplant programs;rural patients have limited access to transplantation due to several barriers including increased travel time and financial burden. We report outcomes after establishment of a kidney transplant program serving rural West Virginia. Method(s): A retrospective review of the first 15 kidney transplants performed at a newly established Appalachian transplant program was conducted. Primary outcomes measured were graft survival and function. Other outcomes included graft rejection, patient survival and complications. Data related to patient demographics, etiology of ESRD, type of renal replacement therapy, time on transplant waitlist and average travel to transplant center were also collected. Result(s): The first 15 kidneys transplanted had an overall death censored graft survival rate of 100%. Median patient age was 53 (Range 31- 73 years) and a median follow-up of 6 months (Range 1-13 months). The average time on dialysis for this cohort was 4 years (n=13, Range 1-6 years) and average time on waitlist was 4.06 months (Range 0.4-13.2 months). The most common type of dialysis was hemodialysis (77%) followed by peritoneal dialysis (15%). Two patients were predialysis. Diabetes with hypertension (20%), IgA nephropathy (13%) and diabetes without hypertension (13%) were the most common causes of ESRD. Median graft creatinine was 1.51 mg/dL (Range 1.26 - 1.83 mg/dL) with a glomerular filtration rate (GFR) at 51.38 (Range 41.86-70) at one year. One patient developed acute antibody mediated rejection and one developed borderline T cell mediated rejection (13.3%), which were successfully treated with steroids, plasmapheresis and immune globulin therapy. Two patients died (13.3 %);one from acute respiratory failure following coronavirus (COVID-19) infection and one from cardiac arrest secondary to myocarditis (possible COVID-19). Patients experienced COVID-19 infection at a rate of 13.3 %. The average distance patients had to travel was 94 miles (Range 12 - 164 miles) with a travel time of 1 hour and 52 minutes on average (Range 20 minutes - 2.5 hours) to reach the transplant center. Conclusion(s): We report comparable outcomes from our new rural transplant program despite several barriers to delivery of quality care to our population.

A rare case of isolated large vessel pulmonary vasculitis

Isolated large vessel pulmonary vasculitis can present as isolated pulmonary artery stenosis with an absence of typical systemic vasculitis manifestations which can make diagnosis and treatment a challenge. A 16-year-old female athlete with no medical history presented with a 2-month history of exertional dyspnea. She denied cough, palpitations, fevers, chills, weight loss, arthritis, or rashes. Her vitals and physical exam were benign. Electrocardiogram showed sinus tachycardia. Chest x-ray was unremarkable. Computer tomography angiography (CTA) of the chest showed diffuse soft tissue thickening in the bilateral perihilar regions and along the bilateral pulmonary arteries causing moderate to severe narrowing of the right lobar segment pulmonary artery without parenchymal abnormalities (Figure A). A magnetic resonance angiography (MRA) showed no other areas of vascular involvement. A whole-body positron-emission tomography (PET) showed an isolated fluorodeoxyglucose uptake in the bilateral perihilar regions (Figure B). An infectious workup including bacterial, acid-fast bacilli, fungal, viral (including severe acute respiratory syndrome coronavirus 2) was negative. Complete blood count, complete metabolic profile, autoimmune serologies including anti-neutrophil cytoplasmic antibody, antinuclear antibody, angiotensin-converting enzyme levels were within normal limits. Erythrocyte sedimentation rate and C-Reactive Protein were elevated. A right and left cardiac catheterization showed an isolated distal bilateral pulmonary artery stenosis without aortic or aortic branch involvement and no evidence of pulmonary hypertension. She was diagnosed with isolated large vessel pulmonary artery vasculitis. The patient was treated with pulsed steroids followed by a taper of prednisone with transition to methotrexate subcutaneous as a steroid-sparing agent. At 2-month follow up, she was well, asymptomatic, and tolerating her medications. Isolated large vessel pulmonary artery vasculitis is rare with an unknown prevalence. It can present with only pulmonary symptoms with an absence of typical systemic vasculitis manifestations, which can represent a primary idiopathic disorder. A workup for possible systemic large vessel involvement is warranted to exclude secondary conditions such as infectious diseases, connective tissue diseases, hypersensitivity disorders and malignancies. Secondary systemic large vessel vasculitis includes Takayasu arteritis, giant cell arteritis and Bechet's disease which need to be excluded. In addition to CTA, MRA and PET are useful tools for diagnosis and eventually monitor the disease. Isolated large vessel pulmonary artery vasculitis responds to immunosuppressive therapy halting disease progression and may improve pulmonary hemodynamics. Prognosis is generally favorable, but it needs to be monitored due to the risk of subsequently developing systemic vasculitis with systemic manifestations and pulmonary hypertension with right ventricular dysfunction.

The impact of Covid-19 on E-business practices and consumer buying behavior in a developing country

Online trade has shown a sharp increase since the outbreak of pandemic Coronavirus. The COVID-19 has affected almost all financial and business activities around the world, even in Pakistan. It has changed the way consumers used to shop before the pandemic outbreak. Many companies until recently have developed and created their online stores and making up the most of their sales using internet channel. Consumer have no other choice but shop from home. In this research study, we discuss the impact of COVID-19 on e-business practices and consumer behavior in Pakistan. The theory of acceptance model has been applied where consumer behavior, e-business, and COVID-19, and posted as a key construct of the proposed research model. Structural Equation Modelling approach has been used to examine the interrelationship of variables of research. We applied two-step recommended Structural Equation Modelling approach, first, validate the constructs by using Confirmatory Factor Analysis, and then conducted Structural Equation Modelling path analysis and report the results, which indicated that in the present scenario COVID-19 has significantly impacted both e-businesses and consumer buying behavior in the context of Pakistan. This research briefly highlights the e-commerce trends and discusses the rapidly growing scope for online businesses and makes several future research suggestions, especially in the context of cultural and other barriers such as digital payment adoption in developing economies. This study limitation is the study sample and context-specific to Pakistan.