The current worldwide outbreak of COVID-19 has changed the modus operandi of all segments of society. While some pandemic-related stressors affect nearly everyone, many especially affect women. Purpose: To review what is known about the pandemic's effect on women's mental health, what makes them more predisposed to vulnerabilities and adverse impacts, and strategies for preventing and treating these mental health consequences in the female population during specific stages across the lifespan. Methods: The authors performed a narrative review in combination with their observations from clinical experience in the field of women's mental health and reproductive psychiatry. Articles on women's mental health and COVID-19 up to May 30, 2020, were searched using the electronic PubMed and PsychInfo databases, as well as publications by major health entities (e.g., World Health Organization, Centers for Disease Control and Prevention, the United Nations) and press releases from prime communication outlets (e.g., National Public Radio). Results and conclusions: Women who are pregnant, postpartum, miscarrying, or experiencing intimate partner violence are at especially high risk for developing mental health problems during the pandemic. Proactive outreach to these groups of women and enhancement of social supports could lead to prevention, early detection, and prompt treatment. Social support is a key protective factor. Similarly, parenting may be substantially more stressful during a pandemic. Gender disparities may be accentuated, particularly for employed women or single parents, as women are disproportionately responsible for the bulk of domestic tasks, including childcare and eldercare.

Background “ESKAPE” is an acronym for a group of life-threatening nosocomial pathogens, viz, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp. Global efforts on controlling multidrug-resistant (MDR) organisms have been hampered by their ability to escape antibacterial drugs. This study was undertaken to determine the prevalence of ESKAPE pathogens with prime focus on biofilm production and antibiotic resistance. Methods A total of 8756 clinical samples were processed for the isolation and identification of ESKAPE pathogens following standard microbiological procedures. These isolates were subjected to antimicrobial sensitivity test as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Test for MDR, extended-spectrum β-lactamase (ESBL), metallo-β-lactamase (MBL), methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) was done by the disk diffusion and E-test methods. In the case of VRE molecular detection was done for vanA and vanB genes. All the isolates were processed for biofilm detection by the tube adherence method. Results The percentage distribution of Enterococcus faecium was 5.5%, S. aureus 33.4%, K. pneumoniae 33.0%, A. baumannii 8.6%, P. aeruginosa 18.6%, and Enterobacter aerogenes 0.9%. MRSA was 57.6%, and vancomycin resistance among Enterococcus faecium was 20%. ESBL- and MBL-producing K. pneumoniae were 16.1%, and 8.1%, A. baumannii 10.3% each and P. aeruginosa 10.7% and 8.3%, respectively. A total of 42.3% of isolates were biofilm producers. Linezolid was the drug of choice for VRE. Ampicillin-sulbactam was most useful against A. baumannii apart from polymyxins, whereas piperacillin-tazobactam was effective against other Gram-negative bacteria. VanA gene was detected in all the VRE isolates. Conclusion This study estimates the burden of the ESKAPE organisms and their antimicrobial resistance pattern in a hospital setting. A high percentage of drug resistance and biofilm production was noted; hence antimicrobial resistance surveillance targeting ESKAPE pathogens should be incorporated in the infection control policy in Nepal.

Background: “ESKAPE” is an acronym for group of organisms as Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter calcoaceticus baumannii complex, Pseudomonas aeruginosa and Enterobacter spp. They are associated in causing life threatening infections. Global efforts on controlling multidrug resistant (MDR) organisms have been hampered by their rapid emergence, inadequate tests for rapid detection and their ability to escape the antibacterial drugs. The objective of this study was to determine the prevalence of ESKAPE pathogens with prime focus on biofilm production and antibiotic resistance. Methods: A total of 8756 clinical specimens were processed for the isolation and identification of ESKAPE pathogens following standard microbiological protocol. These isolates were subjected to antibiotic sensitivity test as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Detection of resistance phenotypes, viz., extended-spectrum-beta-lactamase (ESBL), metallo-beta-lactamase (MBL), Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant enterococci (VRE) was done by disk diffusion method and E- test method as applicable. The VRE isolates were subjected for detection of Van A and Van B genes. All the isolates were processed for biofilm detection by tube adherence method. Results: The percentage distribution of Staphylococcus aureus was 33.5%, followed by Klebsiella pneumoniae 33.0%, Pseudomonas aeruginosa 18.3%, Acinetobacter calcoaceticus baumannii complex 8.7%, Enterococcus faecium 5.6% and Enterobacter aerogenes 0.9%. MRSA was 57.6% and Vancomycin resistance among Enterococcus faecium was 20%. ESBL and MBL producing Klebsiella pneumoniae were 16.1%, and 8.1%, Acb complex 10.3% each and Pseudomonas aeruginosa 10.7% and 8.3% respectively. A total of 42.3% of isolates were biofilm producers. Linezolid was drug of choice for VRE isolates. Piperacillin- tazobactam was found to be effective against Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterobacter aerogenes; Ampicillin-sulbactam was the most effective drug against Acb complex excluding polymyxins. Van A gene was detected in all the VRE isolates. Conclusion: This study estimates the burden of the ESKAPE organisms and their antibiotic resistance pattern in a Nepalese hospital. The increasing percentages of drug resistance among these biofilm-producing pathogens pose great threat in medical setting. Surveillance targeting ESKAPE pathogens should be incorporated in infection control policy in Nepal.

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Objectives: The main objective of this study was to determine prevalence of methicillin resistance Staphylococcus aureus among dumpsite workers. Methods: Total 60 nasal swab samples were collected. Conventional microbiological methods were used to isolate and identify S. aureus. Antibiotic susceptibility test was performed by Kriby Bauer disc diffusion method. MRSA was confirmed by using Cefoxitin disc. The organism showing resistance against three or more class were considered as MDRSA. Results: The prevalence rate of S. aureus and MRSA was found to be 46.67% (28/60) and 6.67% (4/60) in total population. The nasal carriage rate of S. aureus was found to be higher in age group 28-37 (70.06%, 12/17), gender male (47.5%, 19/40), district Kathmandu (70%, 14/20) and dumpsite workers (50%, 15/30). The isolated S. aureus were resistant to Penicillin (35.7%), Erythromycin (35.7%), Cefoxitin (14.3%) and Oxacillin (10.7%). S. aureus was susceptible (100%) to Tetracycline, Gentamycin, Ciprofloxacin, Co-trimoxazole, Chloramphenicol, and Vancomycin. Multidrug resistant S. aureus was not found in community of Kathmandu Valley. Conclusion: The study shows prevalence of MRSA strains of S. aureus in Kathmandu Valley. The occurrence of MRSA indicates development of Community acquired-antibiotic resistant bacteria.

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Historically women have been excluded from positions of power and subjected to abuse of various kinds. Both religious and scientific reasons have been used to confine women to inferior roles in society. In many societies, a female newborn is viewed as a liability, and all through the reproductive phases of life women may experience these as defining and incapacitating them. Menstruation may limit activities and be considered shameful. Fertility may be linked to reproductive injustice, and access to abortion may be nonexistent or under massive attack, and sexual access to unwilling women is seen as an entitlement in many situations. Postpartum depression poses particular social challenges. In the family, women are still subject to oppression. It is also within the family that women are most at risk of psychological and physical abuse. Women entering professional careers may encounter considerable resistance, varying from mistrust to outright harassment. Women’s rights, though recognized in a few places, are under attack in others, and fundamentalist expressions of religion may restrict women’s roles and rights. The #MeToo movement did not resolve women’s challenges, and it is doubtful if abused women are better off than they were before #MeToo. This chapter provides a list of clinical and social applications to incorporate the impact of social realities into the practice of medicine including psychiatry. Social psychiatrists have an important role to examine all that affects a woman’s mental health in order to prevent misunderstandings and subsequent mismanagement.