Browsing by Author "Shrestha, Reena"
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Publication Peripartum Hysterectomy among Patients Admitted to the Department of Obstetrics and Gynaecology in a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2023) Lama, Sushma; Todi, Sushila; Shrestha, Reena; Acharya, SwikrityAbstract Introduction: Emergency peripartum hysterectomy is a life-saving procedure performed as an emergency procedure to control torrential bleeding and it is associated with significant maternal morbidity and mortality. There are only a few studies regarding this topic so this study guides us to monitor the trend and start appropriate policies to reduce unnecessary caesarean deliveries. The aim of this study was to find out the prevalence of peripartum hysterectomy among patients admitted to the Department of Obstetrics and Gynaecology in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology of the tertiary care centre. Data from 1 January 2015 to 31 December 2022 were collected between 25 January 2023 and 28 February 2023 from the hospital records. Ethical approval was obtained from the Institutional Review Committee of the same institute (Reference number: 2301241700). Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 54,045 deliveries, peripartum hysterectomy was seen in 40 (0.074%) (0.05-0.10, 95% Confidence Interval). The major indication of emergency peripartum hysterectomy was abnormal placentation (placenta accreta spectrum) which was 25 (62.50%) followed by uterine atony in 13 (32.50%) of patients and uterine rupture in 2 (5%). Conclusions: The prevalence of peripartum hysterectomy was lower than in other studies done in similar settings. The indication for Emergency peripartum hysterectomy has changed in recent years from uterine atonicity to the morbidly adherent placenta which is due to a rise in the caesarean section rate.Publication Primary Immune Response Provides Protective Efficacy against SARS-CoV-2 Reinfection(Nepal Medical Association, 2021) Shrestha, Rupendra; Shrestha, Reena; Khadka, Ram Bahadur; Gyawali, RabinAbstract: While there is absolutely no evidence to ensure recovered patients are either likely or unlikely to get reinfected. But studies in non-human primates indicate that reinfection of recovered patients is highly unlikely. It is also clear that primary immune responses or induced immunity to severe acute respiratory syndrome coronavirus 2 remain in circulation for several months and at least temporarily confer immunity to protect from reinfection. In addition, negative virus culture analysis of re-positive suggests that positive reverse transcriptase-polymerase chain reactions in recovered patients are more likely to be false-positive, or detection of genetic remnants of virus discharged from lesions of lungs or better sampling at the time of repeat analysis. However, emerging severe acute respiratory syndrome coronavirus 2 variants are likely to be causing the infections observed in some of the recovered patients.Publication Resistant Uropathogens in Gulmi Hospital: High Time to Take Action(Institute of Medicine, 2022) Shrestha, Reena; Pachya, Uttam; Thapa, Tulsi R; Pachya, Ambika ThapaABSTRACT Introduction: Recent study in Nepal showed 29.5% culture positive cases of Urinary Tract Infections (UTIs). Extensive consumption of broad-spectrum antibiotics leading to increased AMR rates amongst uropathogens. This study has been carried out to determine the proportion and types of uropathogens causing infections and their antibiotics susceptibility pattern based on WHO classification of antibiotics- access, watch and reserve ('AWaRe') categories. Methods: Record review of the urine isolates with antibiotic susceptibility testing reported from Laboratory of Gulmi Hospital from April 2019 to April 2021. Ethics approval was obtained from Nepal Health Research Council (NHRC). Calculation of frequencies and proportions and cross-tabulation was done. Results: Bacterial yield was found in more than one-third of the total 315 samples. Majorities (84.48%) of them were gram negative bacteria. More than three-fourth of the urine isolates were of female. Urinary isolates showed variable resistance to the 'access' and 'watch' group of antibiotics. There was high resistance to the conveniently prescribed antibiotics like cefixime, ciprofloxacin, ofloxacin, for UTIs. Among tested urine isolates, 75.7% were sensitive to Nitrofurantoin. Conclusion: The yield of urine culture was 36.83% in our study with higher proportions in female. The resistance was high for conveniently prescribed antibiotics. Sensitive antibiotics like Nitrofurantoin were incorporated in the empirical therapy for UTI in this hospital after the study. It is an awakening call to implement measures to strengthen antimicrobial surveillance with inclusion of the peripheral hospitals to the reporting by capacitating them for quality reporting of the antibiograms. Keywords: Antimicrobial resistance, AWaRe category, peripheral level hospital, urinary tract infections, urine culture